BENETH A. BROWNE SACR~MEN~~J- Deputy Attorney General ...4patientsafety.org/documents/Kurian, Leonard Sunil 2016-04-13.pdf · Los Angeles, CA 90013 Telephone: (213) 897-7816 Facsimile:

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KAMALA D. HARRIS Attorney General of California E. A. JONES III Supervising Deputy Attorney General BENETH A. BROWNE Deputy Attorney General State Bar No. 202679

California Department of Justice 300 So. Spring Street, Suite 1702 Los Angeles, CA 90013 Telephone: (213) 897-7816 Facsimile: (213) 897-9395

Attorneys for Complainant

BEFORE THE

FILED STATE OF CALIFORNIA

MED~ALBOARDOFCAUFORN~

SACR~MEN~~J- 2D.fu._ BY.~ .. ~ ~ NALYST

MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation Against:

LEONARD SUNIL KURIAN, M.D. 1331 West Avenue J, Ste. 102 Lancaster, CA 93534

Physician's and Surgeon's Certificate No. G70489,

Respondent.

Case No. 800-2014-008107

ACCUSATION

18 Complainant alleges:

19 PARTIES

20 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official

21 capacity as the Executive Director of the Medical Board of California.

22 2. On or about December 17, 1990, the Medical Board issued Physician's and Surgeon's

23 Certificate Number G70489 to Leonard Sunil Kurian, M.D. (Respondent). The Physician's and

24 Surgeon's Certificate was in full force and effect at all times relevant to the charges brought

25 herein and will expire on April 30, 2016, unless renewed.

26 .JURISDICTION

27 3. This Accusation is brought before the Board, under the authority of the following

28 laws. All section references are to the Business and Professions Code unless otherwise indicated.

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(LEONARD SUNIL KURIAN, M.D.) ACCUSATION NO. 800-2014-008107

1 4. Section 2229 of the Code states, in subdivision (a):

2 "Protection of the public shall be the highest priority for the Division of Medical Quality, 1

3 the California Board of Podiatric Medicine, and administrative law judges of the Medical Quality

4 Hearing Panel in exercising their disciplinary authority."

5 5. Section 2227 of the Code provides that a licensee who is found guilty under the

6 Medical Practice Act may have his or her license revoked, suspended for a period not to exceed

7 one year, placed on probation and required to pay the costs of probation monitoring, or such other

8 action taken in relation to discipline as the Board deems proper.

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6. Section 2234 of the Code, states:

"The board shall take action against any licensee who is charged with unprofessional

conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not

limited to, the following:

"(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the

violation of, or conspiring to violate any provision of this chapter.

"(b) Gross negligence.

"(c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or

omissions. An initial negligent act or omission followed by a separate and distinct departure from

the applicable standard of care shall constitute repeated negligent acts.

"(1) An initial negligent diagnosis followed by an act or omission medically

appropriate for that negligent diagnosis of the patient shall constitute a single negligent act.

"(2) When the standard of care requires a change in the diagnosis, act, or omission

that constitutes the negligent act described in paragraph (1 ), including, but not limited to, a

reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the

applicable standard of care, each departure constitutes a separate and distinct breach of the

standard of care.

"(d) Incompetence.

1 Pursuant to Business and Professions Code section 2002, the "Division of Medical Quality" or "Division" shall be deemed to refer to the Medical Board of California.

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1 "(e) The commission of any act involving dishonesty or corruption that is substantially

2 related to the qualifications, functions, or duties of a physician and surgeon.

3 "(f) Any action or conduct which would have warranted the denial of a certificate.

4 "(g) The practice of medicine from this state into another state or country without meeting

5 the legal requirements of that state or country for the practice of medicine. Section 2314 shall not

6 apply to this subdivision. This subdivision shall become operative upon the implementation of

7 the proposed registration program described in Section 2052.5.

8 "(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and

9 participate in an interview by the board. This subdivision shall only apply to a certificate holder

10 who is the subject of an investigation by the board."

11 7. Section 2266 of the Code states: "The failure of a physician and surgeon to maintain

12 adequate and accurate records relating to the provision of services to their patients constitutes

13 unprofessional conduct."

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FIRST CAUSE FOR DISCIPLINE

(Gross Negligence)

8. Respondent Leonard Sunil Kurian, M.D. is subject to disciplinary action under

section 2234, subdivision (b), in that he was grossly negligent in the care and treatment of a

patient. The circumstances are as follows:

9. On or about September 9, 2010, Patient J.V.2 had an appointment at Respondent's

office. She complained of heavy, irregular, painful menstrual periods of eight to ten days. An

ultrasound exam from the prior day showed large multiple uterine fibroids. The largest one was

on the posterior right side measuring 5.8 em. Another posterior fibroid measured 3.6 em and an

anterior lower uterine segment fibroid measured 3 em. Medical history was noted to include

thyroid dysfunction and anemia. Her obstetric history was noted to include: 4 gravida (total past

pregnancies); 2 full term pregnancies; 1 spontaneous abortion; 1 ectopic pregnancy, 2 para

(pregnancies producing one or more viable offspring), no c-sections and no hysterectomy. She

2 Patients are referred to by initials in this accusation to protect their privacy.

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1 was not pregnant. Prior surgeries were noted to include breast biopsy of the right breast with a

2 lumpectomy being benign, tubal ligation, tubal reanastomosis and an ectopic pregnancy in the

3 right tube. Notes indicated that J.V. stated she was tired of the heavy painful periods and would

4 like to have a myomectomy since she wanted to preserve her fertility. Respondent noted

5 discussing a robot assisted uterine myomectomy. Respondent's notes failed to include: a detailed

6 medical history; surgical methodology that had been used for the tubal ligation or ectopic

7 pregnancy; description of a physical examination of J.V.'s abdomen including the location of any

8 scars from J.V.'s previous surgeries; quantitation of J.V.'s uterine size; or description ofpalpable

9 fibroids.

10 10. On or about November 11, 2010, Respondent conducted a preoperative consultation

11 with J.V. Respondent documented obtaining informed consent from J.V. for a robotically

12 assisted (laparoscopic) uterine myomectomy to preserve .T.V.'s fertility and chromopertubation?

13 J.V. signed consent forms that she understood and accepted the risks of robot assisted uterine

14 myomectomy and chromopertubation. J.V. was not advised and did not therefore provide

15 informed consent with regard to the risk of a prolonged surgery due to Respondent's having only

16 performed one or two of the same procedures using the same method before and having received

17 training for the procedure only about six months previously.

18 11. There is no documentation that J.V. was provided information about alternative

19 therapies. An open laparotomy would have taken approximately 90 minutes to 2 hours.

20 Alternative therapies should have included laparotomy, uterine arterial embolization or Lupron

21 therapy without surgery, bilateral salpingectomies, endometrial ablation and even hysterectomy.

22 There is also no documentation that Respondent discussed whether .T.V. should receive a thorough

23 fertility evaluation.

24 12. There is no documentation of a physical exam except the patient's pulse, weight and

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blood pressure. Respondent's notes again failed to include: a detailed medical history; surgical

methodology that had been used for the tubal ligation or ectopic pregnancy; description of a

3 Chromopertubation involves instilling dye through the fallopian tubes to assess tubal patency, relevant to assessing J.V.'s fertility.

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1 physical examination of J.V. 's abdomen including the location of any scars from J.V.'s previous

2 surgeries; quantitation of J.V. 's uterine size; or description of palpable fibroids. Additionally,

3 Respondent failed to describe a plan to remove the fibroids from the abdomen, rather than using

4 the morcellator to grind up and extract the tissue, a technique that increases risks of injury to

5 bowel or other organs and risks seeding the abdominal cavity with myomatous tissue cells which

6 have been proven to grow where they land.

7 13. On November 20, 2010, Respondent issued pre-operative orders. They indicated that

8 the surgical procedure would include robotic assisted uterine myomectomy and

9 chromopertubation. Respondent's notes lacked the same documentation that was lacking in

10 previous appointments referenced above.4

11 14. On November 22, 2010, the patient was admitted for the surgery. Respondent

12 performed a history and physical examination of J.V. at the hospital. Again, Respondent's notes

13 lacked the same documentation that was lacking in previous appointments on September 9,

14 November 11 and November 20, 2010, referenced above. Patient J.V. signed additional consent

15 forms that she understood and accepted the risks of robot assisted uterine myomectomy and

16 chromopertubation.

17 15. The surgery lasted approximately seven hours. Although chromotubation had been

18 listed as a procedure on all consents, the operative report lacks any reference to it. Additionally,

19 although the surgery was performed to "preserve fertility," the operative report does not mention

20 or report pelvic adhesions, the condition of J.V. 's fallopian tubes, or the integrity of her

21 endometrial cavity after the myomectomies. The operative report does not document an

22 instrument count. The operative report does, erroneously, state that the Rumi catheter was

23 removed prior to beginning the laparoscopy.

24 16. On or about November 24, 2010, post op day two, J.V. reported her pain level to be

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4 In previous appointments on September 9 and 11, 2010, Respondent's notes failed to include: a detailed medical history; surgical methodology that had been used for the tubal ligation or ectopic pregnancy; description of a physical examination of J.V. 's abdomen including the location of any scars from J. V.' s previous surgeries; quantitation of J. V.' s uterine size; a description of palpable fibroids; or any appropriate plan to remove the fibroids from the abdomen.

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1 increasing during the morning. She requested pain medication. A nurse reported she had an

2 elevated temperature of 100.1 °F. Patient J.V. was not evaluated by exam or laboratory studies

3 and the etiology of her increased pain and temperature elevation were not determined. Tylenol

4 was administered to J.V. per Respondent who discharged J.V. over the phone. J.V. was not seen

5 on the day of discharge with appropriate notes.

6 17. On or about December 14, 2010, J.V. was seen by Respondent for a brief office visit.

7 She expressed no complaints. She was shown intraoperative photos. No pelvic examination was

8 performed. J.V.'s age was noted to be 40 years old when in fact she was 36 years old.

9 18. On or about January 10, 2011, J.V. was seen at Respondent's office. She presented

10 with vaginal odor of two weeks duration. A hospitalist covering Respondent's office performed a

11 pelvic examination and found a foreign object in J.V.'s vagina. A cervical cup device was

12 removed. A complete blood count was ordered. Doxycycline,5 Flagyl (metronidazole)6 and

13 clindamycin7 were given to J.V. and she was advised to return in 24 hours.

14 19. On or about January 11, 2011, J.V. had a follow up visit, and reported feeling better

15 but stating that she was very ill the prior night with fever, nausea and vomiting after taking her

16 second dose of antibiotics. The hospitalist covering Respondent's office advised her that she

17 could discontinue clindamycin but emphasized the importance of completing Flagyl and

18 doxycycline therapy. J .V. was informed that her complete blood count results were normal. She

19 was advised to return in two days to evaluate symptomology and review cultures. She provided a

20 urine sample for analysis. Subsequently, J.V. did not return to Respondent's office.

21 20. On or about January 13, 2011, J.V.'s urine culture was reported to be positive for

22 Escherichia coli (E. coli) which was sensitive to tetracycline. There is no documentation as to

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5 Doxycycline is an antibiotic that is used in the treatment of several types of infections caused by bacteria and protozoa.

6 Metronidazole is also an antibiotic and antiprotozoal medication. It is marketed under the brand name Flagyl among others.

7 Clindamycin is an antibiotic used to treat certain serious bacterial infections. It is marketed under the brand name Cleocin.

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1 whether there was follow-up regarding the positive results. Notes show that Bactrim8 was

2 prescribed although the patient was on doxycycline, but there is no documentation of whether

3 J.V. was even informed of the results or provided the prescription or medication.

4 21. Respondent was grossly negligent in his care and treatment of Patient J.V., taken

5 individually or collectively, when he failed to obtain her informed consent prior to performing

6 surgery on her as follows:

7 (a) Respondent failed to adequately educate Patient J.V. or document educating

8 her that due to his inexperience and the high learning curve of laparoscopic surgery, there

9 was a risk that the surgery would be prolonged.

10 (b) Respondent failed to advise Patient J.V. of the risk to her intra-abdominal

11 organs because of scarring and adhesions from previous surgeries.

12 (c) Respondent failed to advise Patient J.V. about numerous possible

13 alternative surgical and nonsurgical therapies available so that she could fully assess risk

14 and weigh her options.

15 22. Respondent was grossly negligent in his care and treatment of Patient J.V., taken

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singularly or collectively, when he repeatedly failed to document necessary information in Patient

J.V.'s medical records, as follows:

(a) Respondent failed, in office notes, to include a detailed medical history or

evidence of a physical exam.

(b) Respondent failed, in office notes, to document the surgical methodology

that had been used for treating J. V.' s prior ectopic or tubal reversal.

(c) Respondent failed, in documenting the physical examination of JV's

abdomen, to describe the location of the scars from JV's previous surgeries.

(d) Respondent failed, in office notes, to describe palpable fibroids or quantitate

uterine size.

(e) Respondent failed, in the informed consent, to fully explain the robotic

8 Bactrim is the brand name of a product that contains sulfamethoxazole and trimethoprim, antibiotics that treat different types of infection caused by bacteria.

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1 procedure beyond simply stating that the robot facilitates minimally invasive surgery.

2 (f) Respondent failed, in pre-operative notes and the operative report, to

3 document an appropriate plan to remove the fibroids from J.V. 's abdomen.

4 (g) Respondent failed, in the operative report or any post-operative notes, to

5 mention chromopertubation or to document its results although it was listed as a procedure

6 on all consents.

7 (h) Respondent failed, in the operative report, to document pelvic adhesions,

8 the condition of the fallopian tubes or the integrity of the endometrial cavity after the

9 myomectomy although the procedure was performed to preserve J.V.'s fertility.

10 (i) Respondent failed, in the operative report, to document an instrument count.

11 (j) Respondent erroneously documented in the operative report that the Rumi

12 catheter was removed prior to beginning the laparoscopy.

13 (k) Respondent failed, in the operative report, to document the removal of

14 instrumentation from the vagina.

15 (1) Respondent failed, post-operatively on the day of discharge, to see J.V. and

16 prepare appropriate notes regarding her status.

17 ( m) Respondent failed, in office notes after J. V.' s surgery, to document

18 notifying J.V. of any results of lab work performed in his office or appropriately following

19 up on positive results.

20 SECOND CAUSE FOR DISCIPLINE

21 (Repeated Negligent Acts)

22 23. Respondent Leonard Sunil Kurian, M.D. is subject to disciplinary action under

23 section 2234, subdivision (c), in that he was repeatedly negligent in the care and treatment of a

24 patient. The circumstances are as follows:

25 24. The facts and circumstances as alleged in paragraphs 9 through 20 are incorporated

26 here as if fully set forth.

27 25. Respondent was negligent in his care and treatment of Patient J .V., taken individually

28 or collectively, when he failed to obtain her informed consent prior to performing surgery on her

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1 as follows:

2 (a) Respondent failed to adequately educate Patient J.V. or document educating

3 her that due to his inexperience and the high learning curve of laparoscopic surgery, there

4 was a risk that the surgery would be prolonged.

5 (b) Respondent failed to advise Patient J.V. of the risk to her intra-abdominal

6 organs because of scarring and adhesions from previous surgeries.

7 (c) Respondent failed to advise Patient J.V. about numerous possible

8 alternative surgical and nonsurgical therapies available so that she could fully assess risk

9 and weigh her options.

10 26. Respondent was negligent in his care and treatment of Patient J.V., taken singularly

11 or collectively, when he repeatedly failed to document necessary information in Patient J.V.'s

12 medical records, as follows:

13 (a) Respondent failed, in office notes, to include a detailed medical history or

14 evidence of a physical exam.

15 (b) Respondent failed, in office notes, to document the surgical methodology

16 that had been used for treating J.V.'s prior ectopic or tubal reversal.

17 (c) Respondent failed, in documenting the physical examination of JV's

18 abdomen, to describe the location of the scars from JV's previous surgeries.

19 (d) Respondent failed, in office notes, to describe palpable fibroids or quantitate

20 uterine size.

21 (e) Respondent failed, in the informed consent, to fully explain the robotic

22 procedure beyond simply stating that the robot facilitates minimally invasive surgery.

23 (f) Respondent failed, in pre-operative notes and the operative report, to

24 document an appropriate plan to remove the fibroids from J.V.'s abdomen.

25 (g) Respondent failed, in the operative report or any post -operative notes, to

26 mention chromopertubation or to document its results although it was listed as a procedure

27 on all consents.

28 (h) Respondent failed, in the operative report, to document pelvic adhesions,

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1 the condition of the fallopian tubes or the integrity of the endometrial cavity after the

2 myomectomy although the procedure was performed to preserve J.V.'s fertility.

3 (i) Respondent failed, in the operative report, to document an instrument count.

4 G) Respondent erroneously documented in the operative report that the Rumi

5 catheter was removed prior to beginning the laparoscopy.

6 (k) Respondent failed, in the operative report, to document the removal of

7 instrumentation from the vagina.

8 (1) Respondent failed, post-operatively on the day of discharge, to see J.V. and

9 prepare appropriate notes regarding her status.

10 (m) Respondent failed, in office notes after J.V.'s surgery, to document

11 notifying J.V. of any results of lab work performed in his office or appropriately following

12 up on positive results.

13 27. Postoperatively, Respondent left a foreign object inside of the patient, specifically, a

14 Rumi catheter cup in the patient's vagina.

15 28. Respondent prematurely discharged the patient from the hospital, failing to evaluate

16 her and evaluate the etiology and for possible infection given that she experienced pain and a

17 fever over 100 degrees.

18 THIRD CAUSE FOR DISCIPLINE

19 (Failure to Maintain Accurate and Adequate Medical Records)

20 29. Respondent Leonard Sunil Kurian, M.D. is subject to disciplinary action under

21 section 2266 in that he failed to maintain adequate and accurate records relating to the provision

22 of services to Patient J.V., thereby committing unprofessional conduct. The circumstances are as

23 follows:

24 30. Paragraphs 9 through 20 are incorporated herein as if fully set forth.

25 DISCIPLINARY CONSIDERATIONS

26 31. To determine the degree of discipline, if any, to be imposed on Respondent,

27 Complainant alleges that on or about March 2, 2006, in a prior disciplinary action entitled In the

28 Matter of the Accusation Against Leonard Sunil Kurian, M.D. before the Medical Board of

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California, in Case Number 05-2003-145058, Respondent was issued a Public Reprimand and

was required to successfully complete a clinical training program, record keeping course and

ethics course based on allegations of unprofessional conduct in the care and treatment of a

patient. That decision is now final and is incorporated by reference as if fully set forth herein.

32. To further determine the degree of discipline, if any, to be imposed on Respondent

Leonard Sunil Kurian, M.D., Complainant alleges that on or about May 8, 2015, in a prior

disciplinary action entitled In the Matter of the First Amended Accusation Against Leonard Sunil

Kurian, M.D. before the Medical Board of California, in Case Number 05-2011-214708,

Respondent's license was revoked, the revocation was stayed, and he was placed on probation for

seven years and was required, again, to successfully complete a clinical training program, record

keeping course and ethics course. Additionally, after successfully completing a clinical training

program, Respondent's probation requires that he participate in a Professional Enhancement

Program including quarterly review of Respondent's charts; semi-annual assessment of

Respondent's practice; and semi -annual review of Respondent's professional growth and

education. The discipline was based on allegations of unprofessional conduct relating to his care

and treatment of a patient in 2007 who died, a patient in 2010 and a patient in 2011 who died.

That decision is now final and is incorporated by reference as if fully set forth herein.

PRAYER

WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,

and that following the hearing, the Medical Board of California issue a decision:

1. Revoking or suspending Physician's and Surgeon's Certificate Number G 70489,

issued to Leonard Sunil Kurian, M.D.;

2. Revoking, suspending or denying approval of Leonard Sunil Kurian, M.D.'s authority

to supervise physician assistants, pursuant to section 3527 of the Code;

3. Ordering Leonard Sunil Kurian, M.D., if placed on probation, to pay the Board the

costs of probation monitoring; and

Ill

Ill

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4. Taking such other and further action a deemed necessary and proper.

3 DATED: April 13, 2016

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LA2015602118 61919701

Executiv Director Medical Board of California State of California Complainant

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Documents

BENETH A. BROWNE SACR~MEN~~J- Deputy Attorney General ...4patientsafety.org/documents/Kurian, Leonard Sunil 2016-04-13.pdf · Los Angeles, CA 90013 Telephone: (213) 897-7816 Facsimile: