BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against: ) ) ) )

MADHURE BASAPPA MANJUNATH, M.D. ) )

Physician's and Surgeon's ) Certificate No. A 29758 )

) Respondent )

DECISION

Case No. 11-2013-234905

The attached Stipulated Settlement and Disciplinary Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00 p.m. on May 27, 2016.

IT IS SO ORDERED: April 28, 2016.

MEDICAL BOARD OF CALIFORNIA

;f/.;; . -~ t;.. ' ~ OWard Krauss, M.D., Chair

Panel B

KAMALA D. HARRIS Attorney General of California

2 .JUDITH T. ALVARADO Supervising Deputy Attorney General

3 CLAUDIA RAMIREZ Deputy Attorney General

4 State Bar No. 205340 California Department of Justice

5 300 South Spring Street, Suite 1702 Los Angeles, California 90013

6 Telephone: (213) 897-5678 Facsimile: (213) 897-9395

7 Attorneys for Complainant

8 BEFORETHE MEDICAL BOARD OF CALIFORNIA

9 DEPARTMENT OF CONSUMER AFFAIRS

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STATE OF CALIFORNIA

[n the Matter of the Accusation Against: Case No. 11-2013-234905

MADHURE BASAPPA MANJUNATH, M.D. OAH No. 2015051084 23 79 Pepperdale Drive Roland Heights, CA 91748 STIPULATED SETTLEMENT AND

DISCIPLINARY ORDER

Physician's and Surgeon's Certificate No. A 29758,

Respondent.

18 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above-

19 entitled proceedings that the following matters are true:

20 PARTIES

21 1. Kimberly Kirchmeyer ("Complainant") is the Executive Director of the Medical

22 Board of California. She brought this action solely in her official capacity and is represented in

23 this matter by Kamala D. Harris, Attorney General of the State of California, by Claudia Ramirez,

24 Deputy Attorney General.

25 2. Respondent Madhure Basappa Manjunath, M.D. ("Respondent") is represented in this

26 proceeding by attorney Michael A. Firestone, whose address is: Marvin Firestone, MD, JD, &

27 Associates, 1700 South El Camino Real, Suite 204, San Mateo, California, 94402.

28 3. On or about November 19, 197 5, the Medical Board of California issued Physician's

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Stipulated Settlement ( 11-20 13-234905)

and Surgeon's Certificate No. A 29758 to Respondent. That Certificate was in full force and

2 effect at all times relevant to the charges brought in Accusation No. 11-2013-234905 and will

3 expire on October 31,2017, unless renewed.

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JURISDICTION

4. Accusation No. 11-2013-234905 was filed before the Medical Board of California

("Board"), Department of Consumer Affairs, and is currently pending against Respondent. The

Accusation and all other statutorily required documents were properly served on Respondent on

September 17, 2014. Respondent timely filed his Notice of Defense contesting the Accusation.

5. A copy of Accusation No. 11-2013-234905 is attached as exhibit A and incorporated

herein by reference.

ADVISEMENT AND WAIVERS

6. Respondent has carefully read, fully discussed with counsel, and understands the

charges and allegations in Accusation No. 11-2013-234905. Respondent has also carefully read,

fully discussed with counsel, and understands the effects of this Stipulated Settlement and

Disciplinary Order.

7. Respondent is fully aware of his legal rights in this matter, including the right to a

hearing on the charges and allegations in the Accusation; the right to be represented by counsel at

his own expense; the right to confront and cross-examine the witnesses against him; the right to

present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel

the attendance of witnesses and the production of documents; the right to reconsideration and

court review of an adverse decision; and all other rights accorded by the California

Administrative Procedure Act and other applicable laws.

8. Respondent voluntarily, knowingly, and intelligently waives and gives up each and

every right set forth above.

CULPABILITY

9. Respondent does not contest that, at an administrative hearing, Complainant could

establish a prima facie case with respect to the charges and allegations contained in Accusation

No. 11-2013-234905 and that he has thereby subjected his license to disciplinary action.

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Stipulated Settlement ( 11-20 13-234905)

10. Respondent agrees that if he ever petitions for early termination or modification of

2 probation, or if the Board ever petitions for revocation of probation, all of the charges and

3 allegations contained in Accusation No. 11-2013-234905 shall be deemed true, correct, and fully

4 admitted by Respondent for purposes of that proceeding or any other licensing proceeding

5 involving Respondent in the State of California.

6 11. Respondent agrees that his Physician's and Surgeon's Certificate is subject to

7 discipline and he agrees to be bound by the Board's probationary terms as set forth in the

8 Disciplinary Order below.

9 CONTINGENCY

10 12. This stipulation shall be subject to approval by the Medical Board of California.

11 Respondent understands and agrees that counsel for Complainant and the staff of the Medical

12 Board of California may communicate directly with the Board regarding this stipulation and

13 settlement, without notice to or participation by Respondent or his counsel. By signing the

14 stipulation, Respondent understands and agrees that he may not withdraw his agreement or seek

15 to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails

16 to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary

17 Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal

18 action between the parties, and the Board shall not be disqualified from further action by having

19 considered this matter.

20 13. The parties understand and agree that Portable Document Format (PDF) and facsimile

21 copies of this Stipulated Settlement and Disciplinary Order, including Portable Document Format

22 (PDF) and facsimile signatures thereto, shall have the same force and effect as the originals.

23 14. In consideration of the foregoing admissions and stipulations, the parties agree that

24 the Board may, without further notice or formal proceeding, issue and enter the following

25 Disciplinary Order:

26 DISCIPLINARY ORDER

27 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. A 29758 issued

28 to Respondent Madhure Basappa Manjunath, M.D. is revoked. However, the revocation is stayed

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Stipulated Settlement (1 I -20 I 3-234905)

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and Respondent is placed on probation for thirty-five (35) months on the following terms and

conditions.

1. CLINICAL TRAINING PROGRAM. Within 60 calendar days of the effective date

of this Decision, Respondent shall enroll in a clinical training or educational program equivalent

to the Physician Assessment and Clinical Education Program (PACE) offered at the University of

California - San Diego School of Medicine ("Program"). Respondent shall successfully complete

the Program not later than six (6) months after Respondent's initial enrollment unless the Board

or its designee agrees in writing to an extension of that time.

The Program shall consist of a Comprehensive Assessment program comprised of a two­

day assessment of Respondent's physical and mental health; basic clinical and communication

skills common to all clinicians; and medical knowledge, skill and judgment pertaining to

Respondent's area of practice in which Respondent was alleged to be deficient, and at minimum,

a 40 hour program of clinical education in the area of practice in which Respondent was alleged

to be deficient and which takes into account data obtained from the assessment, Decision(s),

Accusation(s), and any other information that the Board or its designee deems relevant.

Respondent shall pay all expenses associated with the clinical training program.

Based on Respondent's performance and test results in the assessment and clinical

education, the Program will advise the Board or its designee of its recommendation(s) for the

scope and length of any additional educational or clinical training, treatment for any medical

condition, treatment for any psychological condition, or anything else affecting Respondent's

practice of medicine. Respondent shall comply with Program recommendations.

At the completion of any additional educational or clinical training, Respondent shall

submit to and pass an examination. Determination as to whether Respondent successfully

completed the examination or successfully completed the program is solely within the program's

jurisdiction.

If Respondent fails to enroll, participate in, or successfully complete the clinical training

program within the designated time period, Respondent shall receive a notification from the

Board or its designee to cease the practice of medicine within three (3) calendar days after being

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Stipulated Settlement (11-20 13-234905)

1 so notified. The Respondent shall not resume the practice of medicine until enrollment or

2 participation in the outstanding portions of the clinical training program have been completed. If

3 the Respondent did not successfully complete the clinical training program, the Respondent shall

4 not resume the practice of medicine until a final decision has been rendered on the accusation

5 and/or a petition to revoke probation. The cessation of practice shall not apply to the reduction of

6 the probationary time period.

7 2. MONITORING- PRACTICE. Within 30 calendar days ofthe effective date of this

8 Decision, Respondent shall submit to the Board or its designee for prior approval as a practice

9 monitor, the name and qualifications of one or more licensed physicians and surgeons whose

10 licenses are valid and in good standing, and who are preferably American Board of Medical

11 Specialties (ABMS) certified. A monitor shall have no prior or current business or personal

12 relationship with Respondent, or other relationship that could reasonably be expected to

13 compromise the ability of the monitor to render fair and unbiased reports to the Board, including

14 but not limited to any form of bartering, shall be in Respondent's field of practice, and must agree

15 to serve as Respondent's monitor. Respondent shall pay all monitoring costs.

16 The Board or its designee shall provide the approved monitor with copies of the Decision(s)

17 and Accusation(s), and a proposed monitoring plan. Within 15 calendar days of receipt of the

18 Decision(s), Accusation(s), and proposed monitoring plan, the monitor shall submit a signed

19 statement that the monitor has read the Decision(s) and Accusation(s), fully understands the role

20 of a monitor, and agrees or disagrees with the proposed monitoring plan. If the monitor disagrees

21 with the proposed monitoring plan, the monitor shall submit a revised monitoring plan with the

22 signed statement for approval by the Board or its designee.

23 Within 60 calendar days of the effective date of this Decision, and continuing throughout

24 probation, Respondent's practice shall be monitored by the approved monitor. Respondent shall

25 make all records available for immediate inspection and copying on the premises by the monitor

26 at all times during business hours and shall retain the records for the entire term of probation.

27 If Respondent fails to obtain approval of a monitor within 60 calendar days of the effective

28 date of this Decision, Respondent shall receive a notification from the Board or its designee to

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Stipulated Settlement ( 11-20 13-234905)

cease the practice of medicine within three (3) calendar days after being so notified. Respondent

2 shall cease the practice of medicine until a monitor is approved to provide monitoring

3 responsibility.

4 The monitor(s) shall submit a quarterly written report to the Board or its designee which

5 includes an evaluation of Respondent's performance, indicating whether Respondent's practices

6 are within the standards of practice of medicine, and whether Respondent is practicing medicine

7 safely. It shall be the sole responsibility of Respondent to ensure that the monitor submits the

8 quarterly written reports to the Board or its designee within 10 calendar days after the end of the

9 preceding quarter.

10 If the monitor resigns or is no longer available, Respondent shall, within 5 calendar days of

11 such resignation or unavailability, submit to the Board or its designee, for prior approval, the

12 name and qualifications of a replacement monitor who will be assuming that responsibility within

13 15 calendar days. If Respondent fails to obtain approval of a replacement monitor within 60

14 calendar days of the resignation or unavailability of the monitor, Respondent shall receive a

15 notification from the Board or its designee to cease the practice of medicine within three (3)

16 calendar days after being so notified Respondent shall cease the practice of medicine until a

17 replacement monitor is approved and assumes monitoring responsibility.

18 In lieu of a monitor, Respondent may participate in a professional enhancement program

19 equivalent to the one offered by the Physician Assessment and Clinical Education Program at the

20 University of California, San Diego School of Medicine, that includes, at minimum, quarterly

21 chart review, semi-annual practice assessment, and semi-annual review of professional growth

22 and education. Respondent shall participate in the professional enhancement program at

23 Respondent's expense during the term of probation.

24 " .). NOTIFICATION. Within seven (7) days ofthe effective date ofthis Decision, the

25 Respondent shall provide a true copy of this Decision and Accusation to the Chief of Staff or the

26 Chief Executive Officer at every hospital where privileges or membership are extended to

27 Respondent, at any other facility where Respondent engages in the practice of medicine,

28 including all physician and locum tenens registries or other similar agencies, and to the Chief

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Stipulated Settlement (11-20 13-234905)

Executive Officer at every insurance carrier which extends malpractice insurance coverage to

2 Respondent. Respondent shall submit proof of compliance to the Board or its designee within 15

3 calendar days.

4 This condition shall apply to any change(s) in hospitals, other facilities or insurance carrier.

5 4. SUPERVISION OF PHYSICIAN ASSISTANTS. During probation, Respondent is

6 ]prohibited from supervising physician assistants, unless Respondent successfully completes a

7 clinical training or educational program equivalent to the Physician Assessment and Clinical

8 Education Program (PACE) offered at the University of California - San Diego School of

9 Medicine and he supervises the physician assistants only in a hospital setting.

10 5. OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules

11 governing the practice of medicine in California and remain in full compliance with any court

12 ordered criminal probation, payments, and other orders.

13 6. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations

14 under penalty of perjury on forms provided by the Board, stating whether there has been

15 compliance with all the conditions of probation.

16 Respondent shall submit quarterly declarations not later than 10 calendar days after the end

1 7 of the preceding quarter.

18 7. GENERAL PROBATION REQUIREMENTS.

19 Compliance with Probation Unit

20 Respondent shall comply with the Board's probation unit and all terms and conditions of

21 this Decision.

22 Address Changes

23 Respondent shall, at all times, keep the Board informed of Respondent's business and

24 residence addresses, email address (if available), and telephone number. Changes of such

25 addresses shall be immediately communicated in writing to the Board or its designee. Under no

26 circumstances shall a post office box serve as an address of record, except as allowed by Business

27 and Professions Code section 2021 (b).

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Stipulated Settlement (11-20 13-234905)

1 Place of Practice

2 Respondent shall not engage in the practice of medicine in Respondent's or patient's place

3 of residence, unless the patient resides in a skilled nursing facility or other similar licensed

4 facility.

5 License Renewal

6 Respondent shall maintain a current and renewed California physician's and surgeon's

7 license.

8 Travel or Residence Outside California

9 Respondent shall immediately inform the Board or its designee, in writing, oftravel to any

10 areas outside the jurisdiction of California which lasts, or is contemplated to last, more than thirty

11 {30) calendar days.

12 In the event Respondent should leave the State of California to reside or to practice

13 Respondent shall notify the Board or its designee in writing 30 calendar days prior to the dates of

14 departure and return.

15 8. INTERVIEW WITH THE BOARD OR ITS DESIGNEE. Respondent shall be

16 available in person upon request for interviews either at Respondent's place of business or at the

17 probation unit office, with or without prior notice throughout the term of probation.

18 9. NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or

19 its designee in writing within 15 calendar days of any periods of non-practice lasting more than

20 30 calendar days and within 15 calendar days of Respondent's return to practice. Non-practice is

21 defined as any period of time Respondent is not practicing medicine in California as defined in

22 Business and Professions Code sections 2051 and 2052 for at least 40 hours in a calendar month

23 in direct patient care, clinical activity or teaching, or other activity as approved by the Board. All

24 time spent in an intensive training program which has been approved by the Board or its designee

25 shall not be considered non-practice. Practicing medicine in another state of the United States or

26 Federal jurisdiction while on probation with the medical licensing authority of that state or

27 jurisdiction shall not be considered non-practice. A Board-ordered suspension of practice shall

28 not be considered as a period of non-practice.

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Stipulated Settlement ( 11-20 13-234905)

In the event Respondent's period of non-practice while on probation exceeds 18 calendar

2 months, Respondent shall successfully complete a clinical training program that meets the criteria

3 of Condition 18 ofthe current version ofthe Board's "Manual ofModel Disciplinary Orders and

4 Disciplinary Guidelines" prior to resuming the practice of medicine.

5 Respondent's period of non-practice while on probation shall not exceed two (2) years.

6 Periods of non-practice will not apply to the reduction of the probationary term.

7 Periods of non-practice will relieve Respondent of the responsibility to comply with the

8 probationary terms and conditions with the exception of this condition and the following terms

9 and conditions of probation: Obey All Laws; and General Probation Requirements.

1 0 10. COMPLETION OF PROBATION. Respondent shall comply with all financial

11 obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the

12 completion of probation. Upon successful completion of probation, Respondent's certificate shall

13 be fully restored.

14 11. VIOLATION OF PROBATION. Failure to fully comply with any term or condition

15 of probation is a violation of probation. If Respondent violates probation in any respect, the

16 Board, after giving Respondent notice and the opportunity to be heard, may revoke probation and

17 carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke

18 Probation, or an Interim Suspension Order is filed against Respondent during probation, the

19 Board shall have continuing jurisdiction until the matter is final, and the period of probation shall

20 be extended until the matter is final.

21 12. LICENSE SURRENDER. Following the effective date ofthis Decision, if

22 Respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy

23 the terms and conditions of probation, Respondent may request to surrender his or her license.

24 The Board reserves the right to evaluate Respondent's request and to exercise its discretion in

25 determining whether or not to grant the request, or to take any other action deemed appropriate

26 and reasonable under the circumstances. Upon formal acceptance of the surrender, Respondent

27 .shall within 15 calendar days deliver Respondent's wallet and wall certificate to the Board or its

28 designee and Respondent shall no longer practice medicine. Respondent will no longer be subject

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Stipulated Settlement (11-20 13-234905)

1 to the terms and conditions of probation. If Respondent re-applies for a medical license, the

2 application shall be treated as a petition for reinstatement of a revoked certificate.

3 13. PROBATION MONITORING COSTS. Respondent shall pay the costs associated

4 with probation monitoring each and every year of probation, as designated by the Board, which

5 may be adjusted on an annual basis. Such costs shall be payable to the Medical Board of

6 California and delivered to the Board or its designee no later than January 31 of each calendar

7 year.

8 ACCEPTANCE

9 I have carefully read the above Stipulated Settlement and Disciplinary Order and have fully

10 discussed it with my attorney, Michael A. Firestone. I understand the stipulation and the effect it

11 will have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Settlement and

12 Disciplinary Order voluntarily, knowingly, and intelligently, and agree to be bound by the

13 Decision and Order of the Medical Board of California.

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DATED:

19 I have read and fully discussed with Respondent Madhure Basappa Manjunath, M.D. the

20 terms and conditions and other matters contained in the above Stipulated Settlement and

21 Disciplinary Order. I approve its form and content.

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DATED: ·7_ I ~I I h I I Michael A. Firestone, Esq.

Attorney for Respondent

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Stipulated Settlement ( 11-20 13-234905)

ENDORSEMENT

2 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

3 submitted for consideration by the Medical Board of California.

4 Dated: ~ J ~j2o I (p 5

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61722834.doc

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Respectfully submitted,

KAMALA D. HARRIS Attorney General of California JUDITH T. ALVARADO Supervising Deputy Attorney General

ClM~~ ~~vUZ:s· CLAUDIA RAMIREZ Deputy Attorney General Attorneys for Complainant

Stipulated Settlement (11-2013-234905)

Exhibit A

Accusation No. 11-2013-234905

FILED

1 KAMALA D. HARRIS

STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA

SA~RAMENTO ~~ \l20~ BY:~._:..£)~::N LYST

Attorney General of California 2 JUDITHT. ALVARADO

Supervising Deputy Attorney General 3 CLAUDIA RAMIREZ

Deputy Attorney General 4 State Bar No. 205340

California Department of Justice 5 300 South Spring Street, Suite 1702

Los Angeles, California 90013 6 Telephone: (213) 897-5678

Facsimile: (213) 897-9395 7 Attorneys for Complainant

BEFORE THE 8

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MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation Against: Case No. 11-2013-234905

MADHURE BASAPPA MANJUNATH, M.D. 2379 S. Pepperdale Drive Rowland Heights, California 91748 A C C US AT I 0 N

Physician's and Surgeon's Certificate No. A 29758,

Respondent.

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, Department of Consumer

22 Affairs ("Board").

23 2. On or about November 19, 1975, the Board issued Physician's and Surgeon's

24 Certificate Number A 29758 to Madhure Basappa Manjunath, M.D. ("Respondent"). That

25 certificate was in full force and effect at all times relevant to the charges brought herein and will

26 expire on October 31,2015, unless renewed.

27 JURISDICTION

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

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Accusation

1 laws. All section references are to the Business and Professions Code ("Code") unless otherwise

2 indicated.

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

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

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

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

5. Section 2234, subdivisions (b) and (d) of the Code state: "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:

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"(b) Gross negligence.

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"(d) Incompetence."

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

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

unprofessional conduct."

7.

FIRST CAUSE FOR DISCIPLINE

(Gross Negligence)

Respondent is subject to disciplinary action under section 2234, subdivision (b) of the

20 Code in that he was grossly negligent in the care and treatment of Patient M.G., Patient A.M.,

21 Patient C.D., and Patient J.B.1 The circumstances are as follows:

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8. On or about August 22, 2013, Respondent worked at Willow Urgent Care in Signal

Hill, California on a temporary basis.

Patient M.G.

9. On or about August 22, 2013, Patient M.G., a twenty-two-year old female, went to

'Nillow Urgent Care complaining of pain in her right eye. Respondent examined her.

1 The initials of the patients' names are used to protect their right of privacy.

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Accusation

1 Respondent documented that the chief complaint details were "irritation R eye." He documented

2 that the history of present illness was "R eye irritated possibly from contacts." He documented

3 that the physical exam indicated Patient M.G. was alert and in no acute distress. He documented

4 that the physical exam of the eye revealed "R eye irritated, bruised from her contacts. Extensive

5 erythema & profuse tears this side."

6 10. Respondent diagnosed Patient M.G. with Conjunctivitis? He prescribed Cortisporin

7 Otic Suspension (ear drops). 3 He instructed her to return the next day for a recheck. Patient M.G.

8 was dissatisfied with the care that she received from Respondent and requested a re-evaluation by

9 another physician. She was evaluated by Joan Rosenburg, M.D., the same day. Dr. Rosenberg

10 diagnosed her with a corneal abrasion and prescribed Vigamox4 and Vicodin.5 She also arranged

11 for Patient M.G. to be seen at Eye Physicians of Long Beach.

12 11. The next day, Patient M.G. was seen at Eye Physicians of Long Beach. Eli Chang,

13 M.D., an ophthalmologist, diagnosed her with Corneal ulcer6 and lritis.7 Patient M.G. was treated

14 with continued use of the Vigamox antibiotic. She was also prescribed Pred Forte8 and Cyclogyl.9

15 Dr. Chang saw Patient M.G. on or about August 30, 2013 and her conditions had resolved.

16 12. Whenever a patient presents for evaluation of a painful red eye, the standard of care

17 requires a physician to obtain an adequate history and perform the necessary physical examination

18 elements to determine if an ocular emergency exists, determine the cause of the patient's

19 symptoms, and treat it appropriately.

20 13. Respondent was grossly negligent in the care and treatment of Patient M.G. as

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follows:

2 Conjunctivitis is also known as pink eye. 3 Cortisporin Otic Suspension is a topical antibiotic used for external ear infections and

not indicated for any use in or around the eye. 4 Vigamox is an antibiotic eye drop. 5 Vicodin is an opiate pain medication. 6 The cornea is the transparent front part of the eye that covers the pupil, the iris, and the

anterior chamber. A Corneal Ulcer is a painful disruption of the surface layer of the cornea. It can be caused by inflammation and/or infection.

7 Iritis is a painful inflammation of the structures directly underneath the cornea. 8 Pred Forte is a topical steroid to reduce inflammation. 9 Cyclogyl is an anti-cholinergic eye drop which blocks nerve impulses to the front of the

eye, relaxes eye muscles, dilates the pupil, and eases the pain associated with Iritis.

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Accusation

1 A. Respondent did not take or document an adequate history of present illness. A

2 physician evaluating a red, painful eye should document if the patient perceives any change in

3 vision, if light causes eye pain, and how the patient got hurt. Although Respondent documented

4 that the symptoms were "from contact lenses," he did not clarify the history any further.

5 B. Respondent did not conduct or document an adequate physical exam of the eye. First,

6 Respondent did not measure or document Patient M.G.'s visual acuity. 10 A measure of a patient's

7 visual acuity (using a standard Snellen letter chart) is a fundamental and critical part of any eye

8 evaluation. This often differentiates ocular emergencies from less urgent conditions.

9 1. Second, Respondent did not evaluate or document if photophobia 11 was present.

10 Inflammation of the eye, such as Iritis, often manifests with photophobia. The presence of

11 photophobia is a concerning finding for a condition that would need an ophthalmologist's

12 consultation.

13 11. Third, Respondent documented "R eye irritated, bruised from her contacts." This

14 description is not standard language for an eye exam and does not clearly describe any physical

15 findings. He also documented "Extensive erythema12 and profuse tears this side." This language

16 is not sufficient by itself.

17 111. Fourth, Respondent failed to perform or document a fluorescein dye test. 13 A

18 physician evaluating a red, painful eye is expected to perform a fluorescein dye test to evaluate the

19 integrity of the corneal surface. Many corneal conditions which require an ophthalmologist's

20 expertise are invisible without this stain.

21 IV. Last, Respondent did not touch Patient M.G.'s eye and did not perform a thorough

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search for a foreign body. Manipulating the eyelids to search for possible foreign bodies is

required for a complete eye examination. The treatment and follow up for a corneal ulcer, eye

10 Visual acuity refers to a patient's ability to see. It refers to acuteness or clearness of VISIOn.

11 Photophobia refers to increased pain when light is directed into the eyes. 12 Erythema is redness of the skin or mucous membranes. It occurs with any skin injury,

infection, or inflammation. 13 Fluorescein dye allows corneal abrasions/scratches and ulcers to glow brightly when the

eye is examined under blue light. Both standard slit lamps and hand-held ophthalmoscopes provide the blue light.

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Accusation

1 damage from a foreign body, and simple conjunctivitis differ significantly.

2 C. Respondent failed to diagnose Patient M.G. with a corneal abnormality.

3 14. In sum, Respondent was grossly negligent in the care and treatment of Patient M.G. in

4 that he failed to complete the basics of an appropriate ocular examination, missed the diagnosis of

5 a corneal defect, failed to document a complete history of Patient M.G.'s right eye disease, and

6 failed to document the basics of an appropriate ocular examination.

7 Patient A.M.

8 15. On or about August 22, 2013, Patient A.M., a twelve-year old male, was injured while

9 ice skating at a day camp. His mother took him to Willow Urgent Care for a cut near the left eye.

10 Respondent examined him. Patient A.M.'s electronic medical record shows that his chief

11 complaint was "injury, dizzy/faint, pain/strain." Respondent documented that the chief complaint

12 details were "Slip & Fall 2 hrs ago." He documented that the history of present illness was that

13 Patient A.M. "was ice skating 2 hrs. ago, slipped and fell." Thus, Patient A.M. presented with

14 signs and symptoms of a head injury and facial laceration.

15 16. Respondent documented that the physical exam showed Patient A.M. was alert and in

16 no acute distress. He documented that the physical exam of the eye was normal. Respondent did

17 not describe the physical appearance of Patient A.M.'s injury. His impression was "laceration L

18 upper lid." Respondent did not document any treatment.

19 17. On a handwritten progress note, Respondent wrote "1 em superficial laceration (up-

20 arrow) L lid." Respondent's orders were that the wound was to be cleaned and dressed.

21 18. Patient A.M.'s mother was dissatisfied with the care that her son received from

22 Respondent and requested a re-evaluation by another physician.

23 19. Whenever a patient presents after head trauma, the standard of care requires that a

24 physician assess if there was significant damage to the central nervous system, which includes a

25 thorough history of the injury as well as a neurological examination.

26 20. Patient A.M.'s chief complaint was "injury, dizzy/faint, pain/strain," but the history of

27 present illness contains only the brief comment that Patient A.M. "was ice skating 2 hrs ago,

28 slipped and fell." Whenever there is head trauma, a physician must document how the fall

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Accusation

1 occurred and the presence or absence of loss of consciousness. The physician must also

2 document any symptoms of neurological injury, such as vomiting, dizziness, or confusion.

3 Respondent did not evaluate or document this information.

4 21. In addition, the terms "dizzy/faint" required further clarification. Respondent did not

5 evaluate or document any information concerning this chief complaint.

6 22. At the time Patient A.M. was seen by Respondent, National Institute for Health and

7 Care Excellence ("NICE") clinical guideline 56 was a standard clinical guideline used worldwide

8 for the evaluation of head trauma. The NICE guidelines define a dangerous mechanism of injury

9 (how the injury occurred) as a fall from a height from 5 stairs or greater providing some loss of

10 consciousness or memory loss was experienced. The guidelines would have recommended urgent

11 brain imaging with CT scanning had Patient A.M. met those criteria. Respondent did not gather

12 or document enough information to ensure Patient A.M. was safe to be discharged home.

13 23. Whenever a patient has a laceration injury, a physician should describe the laceration

14 in the medical record. The documentation should describe the location of the wound, if any

15 deeper tissues are damaged, and if the wound appears contaminated. Respondent did not

16 document any information about Patient A.M.'s wound in the physical examination.

17 24. In sum, Respondent was grossly negligent in the care and treatment of Patient A.M. in

18 that he failed to adequately evaluate Patient A.M.'s injuries.

19 Patient C.D.

20 25. On or about August 22, 2013, Patient C.D., a forty-one-year old male went to Willow

21 Urgent Care complaining of an "infected bite." Respondent examined him. The physical exam

22 revealed Patient C.D. was in significant pain. Respondent's diagnosis was "abscess14 R calf,

23 cellulitis." 15 Respondent treated Patient C.D. with Rocephin16 and Toradol. 17 He instructed

24 Patient C.D. to return the next day for re-evaluation.

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skin.

14 An abscess is an infection including pus trapped in a pocket under the surface of the

15 Cellulitis is a bacterial infection involving the skin. 16 Rocephin is an injected antibiotic. 17 Toradol is pain medication.

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Accusation

1 26. Patient C.D. returned the next day to Willow Urgent Care and the abscess was

2 confirmed as pus. A different physician, Michael Roberts, D.O., completed an incision and

3 drainage. Dr. Roberts prescribed a course of oral antibiotics. Patient C.D. returned for follow up

4 visits until the condition was largely resolved.

5 27. Whenever a patient presents with symptoms and signs consistent with an abscess, the

6 standard of care requires a physician to perform an incision and drainage procedure.

7 28. Patient C.D. presented with symptoms consistent with a possible right calf abscess.

8 Respondent did not put gloves on or touch Patient C.D.'s leg as part of the examination.

9 Respondent examined him from a distance while Respondent leaned up against the exam room

10 wall. Palpating the involved area is a critical aspect of evaluating skin infections. Pus below the

11 skin (fluctuance) feels different from normal skin or skin that is merely inflamed (cellulitis).

12 29. Respondent did not indicate if fluctuance was present or not. But even if fluctuance

13 was not present, with the degree of pain that Patient C.D. reported, most physicians would lance

14 the possible abscess to allow a drainage path for the infected material.

15 30. Respondent also did not document the size of the redness. It is important for

16 physicians providing follow-up care to know that information.

17 31. Respondent treated the "abscess R calf cellulitis" with injected antibiotic and pain

18 medication. By themselves, antibiotics are not an effective treatment for abscesses, regardless of

19 their route of administration (oral, intramuscular, or intravenous). They can be used in addition to

20 incision and drainage, but not as a stand-alone therapy.

21 32. In sum, Respondent was grossly negligent in the care and treatment of Patient C.D. in

22 that he failed to provide incision and drainage to treat the abscess.

23 Patient J.B.

24 33. On or about August 22, 2013, Patient J.B., a sixteen-year-old male, went to Willow

25 Urgent Care complaining of chest pain. Respondent examined him. Respondent documented that

26 the chief complaint details were "chest pain 4 hours." He documented that the history of present

27 illness was "[p ]atient is an athlete has chest pain since 4 hours, patient feels nervous. [P]ain is

28 noted in the back of the chest, feels a bit of pressure and it does not radiate. States never had

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Accusation

1 similar pain." Respondent recorded as part of the physical exam that Patient J.B. had "no acute

2 distress, alert." Respondent did not examine the chest wall, although the cardiac and lung exam

3 were normal. Respondent's diagnosis was left ventricular hypertrophy. He did not develop a

4 treatment plan for Patient J.B.

5 34. Respondent discussed the case with Dr. Rosenberg and stated he thought Patient J .B.

6 did not need an electrocardiogram test18 ("EKG") due to his age. Dr. Rosenberg disagreed.

7 Respondent asked Dr. Rosenberg to interpret the EKG. Dr. Rosenberg ordered the EKG and took

8 over the care of the patient. Although Dr. Rosenberg took over the care of Patient J .B.,

9 Respondent did chart (document the patient's history and care) on the patient.

10 35. Whenever a patient presents with chest pain, the standard of care requires a physician

11 to obtain a sufficient history, physical exam, and diagnostic data to ensure no life-threatening

12 condition exists, to diagnose any pathology, and to treat the chest pain appropriately. The history

13 and physical exam documentation must accurately reflect the condition of the patient. If further

14 diagnostic studies such as an EKG and chest x-rays are indicated, they should be done promptly

15 and interpreted correctly.

16 36. The history documented by Respondent is incomplete. He did not determine if

17 trauma was involved. He did not determine if pain changed with the movement of the chest wall

18 during breathing to help determine if the pain was likely from muscles or other structures of the

19 chest wall. Chest wall pain is a common and benign cause of chest pain in this age group.

20 37. Life-threatening chest pain often worsens with exercise and may present with a

21 feeling of breathlessness. Respondent did not ask Patient J.B. if an increased activity level

22 worsened the pain. He did not document if Patient J .B. had shortness of breath.

23 38. Respondent failed to examine the chest wall. A chest x-ray was also indicated to

24 evaluate for other causes of chest pain such as collapsed lung, and may show a congenitally,

25 misshapen heart.

26 39. Dr. Rosenberg documented that Patient J.B. was in so much discomfort that he was

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18 An electrocardiogram test is a study that examines electrical conduction through the heart muscle.

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Accusation

1 ''unable to lift himself off the table due to pain." Her assessment approximately one hour later

2 suggested that Patient J .B. was in significant discomfort when he tried to move. Thus,

3 Respondent's documented physical exam does not accurately reflect Patient J.B.'s condition. Dr.

4 Rosenberg noted some swelling under a clavicle (collar bone) which might have had diagnostic

5 significance.

6 40. Patient J.B. received the EKG. The EKG computer interpreted Patient J.B.'s tracing

7 as left ventricular hypertrophy. However, thin, muscular, young individuals will often have EKGs

8 that are interpreted by the computer as left ventricular hypertrophy, but are actually normal.

9 41. Most EKG machines contain analysis software that provides preliminary diagnoses

10 that are printed at the top of the EKG printout. The computer-generated diagnosis must be

11 interpreted within a given clinical scenario. Thus, the diagnosis printed by the EKG is frequently

12 misleading or incorrect. Physicians always provide the final EKG interpretation. Left ventricular

13 hypertrophy vs. normal is one of the more common clinical scenarios where the EKG machine

14 provides an incorrect interpretation.

15 42. Respondent copied the EKG machine's reading of left ventricular hypertrophy

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without addressing either a false reading by the machine or a continued investigation for such

abnormality. He diagnosed Patient J.B. only with left ventricular hypertrophy, which is a

condition that by itself does not cause chest pains. A physician who believes left ventricular

hypertrophy is present in a young patient should next order a chest x-ray and possibly and

echocardiograrn19 to assess for heart size abnormalities. Respondent did not order either a chest

x-ray or an echocardiogram.

43. In sum, Respondent was grossly negligent in the care and treatment of Patient J.B. in

that he failed to fully evaluate Patient J.B.

44. Respondent's acts and/or omissions as set forth in paragraphs 8 through 43, inclusive

above, whether proven individually, jointly, or in any combination therefore, constitute gross

negligence pursuant to Code section 2234, subdivision (b). Therefore, cause for discipline exists.

19 An echocardiogram is an ultrasound of the heart.

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Accusation

1 SECOND CAUSE FOR DISCIPLINE

2 (Incompetence)

3 45. Respondent is subject to disciplinary action under section 2234, subdivision (d) of the

4 Code for incompetence in the care and treatment of Patient M.G. and Patient J.B. The

5 circumstances are as follows:

6 Patient M.G.

7 46. Paragraphs 8 through 14 are incorporated by reference andre-alleged as if fully set

8 forth herein.

9 47. Respondent was incompetent in the care and treatment of Patient M.G. for not

10 tmderstanding the indication for the fluorescein dye test.

11 Patient J .B.

12 48. Paragraphs 33 through 43 are incorporated by reference andre-alleged as if fully set

13 forth herein.

14 49. Respondent was incompetent in the care and treatment of Patient J.B. in that he was

15 unable to properly interpret the EKG.

16 50. Respondent's acts and/or omissions as set forth in paragraphs 46 through 49,

17 inclusive above, whether proven individually, jointly, or in any combination thereof, constitute

18 incompetence in violation of Code section 2234, subdivision (d). Therefore, cause for discipline

19 exists.

20 THIRD CAUSE FOR DISCIPLINE

21 (Inadequate and Inaccurate Medical Record Keeping)

22 51. Respondent is subject to disciplinary action under section 2266 of the Code in that he

23 failed to maintain adequate and accurate medical records. The circumstances are as follows:

24 52. Paragraphs 8 through 43 are incorporated by reference andre-alleged as if fully set

25 forth herein.

26 53. Respondent's acts and/or omissions as set forth in paragraph 52, inclusive above,

27 whether proven individually, jointly, or in any combination thereof, constitute inadequate and

28 inaccurate medical record keeping in violation of Code section 2266. Therefore, cause for

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Accusation

1 discipline exists.

2 DISCIPLINE CONSIDERATIONS

3 54. To determine the degree of discipline, if any, to be imposed on Respondent's

4 physician's and surgeon's certificate, Complainant alleges that on or about September 28, 1983,

5 an Accusation was filed against Respondent. On or about October 10, 1984, Respondent admitted

6 making false medical claims. The claims falsely represented that he had treated patients for

7 illnesses which in fact they did not have and for which they were not treated. Respondent further

8 admitted that he prescribed dangerous drugs without a prior good faith examination or medical

9 indication. Respondent further admitted that, on or about October 13, 1982, he was convicted,

10 following a guilty plea of violating Penal Code sections 487.1 (grand theft) and 72 (presenting

11 false medical claims) and Insurance Code section 556 (presenting false insurance claims) in the

12 case of People v. Madhure Manjunath, M.D. (Municipal Court of Los Angeles, State of

13 California, Case No. 372377).

14 55. Respondent stipulated that cause for disciplinary action was established under

15 sections 2234, subdivision (e) (dishonesty related to qualifications, functions, or duties); 2242,

16 subdivision (a) (furnishing dangerous drugs without examination); 2236, subdivision (a)

17 (conviction of offense related to qualifications, functions, or duties); and 490 (discipline for

18 substantially related crimes) of the Code. As a result, his certificate was revoked; however, the

19 revocation was stayed and he was placed on probation for five years subject to the following

20 terms and conditions: (1) twenty-five hours per year of courses related to general practice and the

21 proper prescribing of controlled substances (in addition to the Continuing Medical Education

22 requirements for relicensure). At the completion of each course, the Board or its designee could

23 administer an examination to test Respondent's knowledge of the course; (2) maintain a record of

24 all schedule III and IV controlled substances prescribed, dispensed, or administered by

25 Respondent; (3) sixteen hours per month (eleven months per year) of community service in the

26 form of free medical services; and ( 4) standard terms and conditions of probation.

27 56. The Board adopted the stipulation as its decision on April 22, 1985 and the decision

28 became effective on May 22, 1985. That decision is now final and is incorporated by reference as

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Accusation

1 if fully set forth.

2 PRAYER

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

4 and that following the hearing, the Board issue a decision:

5 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 29758

6 issued to Respondent;

7 2. Revoking, suspending, or denying approval of Respondent's authority to supervise

8 physician assistants pursuant to section 3527 of the Code;

9 3. Ordering Respondent, if placed on probation, to pay the Board the costs of probation

10 monitoring; and

11 4. Taking such other and further action as the Board deems necessary and proper.

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14 DATED: September 17, 2014

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KIMBERLY Km.CH EYER' 1; / Executive Director U Medical Board of California Department of Consumer Affairs State of California Complainant

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