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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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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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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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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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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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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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