BEFORE THE MEDICAL BOARD OF CALIFORNIA ...4patientsafety.org/documents/Kurian, Leonard Sunil...

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

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LEONARD SUNIL KURIAN, M.D.)

Physician's and Surgeon's Certificate No. G 70489

Respondent

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Case No. 800-2014-008107

DECISION

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 June 9, 2017.

IT IS SO ORDERED: May 11, 2017.

MEDICAL BOARD OF CALIFORNIA

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XAVIER BECERRA Attorney General of California E. A. JONES III Supervising Deputy Attorney General BENETH A. BROWNE Deputy Attorney General State Bar No. 202679

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

Attorneys for Complainant


DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA


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

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

Respondent.

Case No. 800-2014-008107

OAH No. 2016080204

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

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 Board

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

23 this matter by Xavier Becerra, Attorney General of the State of California, by Beneth A. Browne,

24 Deputy Attorney General.

25 2. Respondent Leonard Sunil Kurian, M.D. (Respondent) is represented in this

26 proceeding by attorney Dennis R. Thelen, Esq., whose address is: P.O. Box 12092

27 Bakersfield, CA 93389-2092.

28 3. On or about December 17, 1990, the Board issued Physician's and Surgeon's

STIPULATED SETTLE\1ENT (800-2014-008107)

Certificate No. G70489 to Respondent. The Physician's and Surgeon's Certificate was in full

2 force and effect at all times relevant to the charges brought in Accusation No. 800-2014-008107,

3 and will expire on April 30, 2016, unless renewed.

4 JURISDICTION

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4. Accusation No. 800-2014-008107 was filed before the Board and is currently pending

against Respondent. The Accusation and all other statutorily required documents were properly

served on Respondent on April 13, 2016. Respondent timely filed his Notice of Defense

contesting the Accusation.

5. A copy of Accusation No. 800-2014-008107 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. 800-2014-008107. 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 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.

CULP ABILITY

9. Respondent admits the truth of each and every charge and allegation in Accusation

26 No. 800-2014-008107.

27 10. Respondent agrees that his Physician's and Surgeon's Certificate is subject to

28 discipline and he agrees to be bound by the Board's imposition of discipline as set forth in the

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STIPULATED SETTLEMENT (800-2014-008107)

Disciplinary Order below.

2 CIRCUMSTANCES IN MITIGATION

3 11. Respondent has been compliant with the terms of his current probation. He is

4 admitting responsibility at an early stage in the proceedings.

5 CONTINGENCY

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

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

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

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

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

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

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

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

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

15 considered this matter.

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

17 copies of this Stipulated Settlement and Disciplinary Order, including PDF and facsimile

18 signatures thereto, shall have the same force and effect as the originals.

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

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

21 Disciplinary Order:

22 DISCIPLINARY ORDER

23 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. G70489 issued

24 to Respondent shall be and is hereby subject to one additional year of probation pursuant to

25 California Business and Professions Code section 2227, subdivision (a). The one additional year

26 shall be added to his current seven-year probation being served according to the Decision entered

27 in Jn the Matter of the First Amended Accusation Against Leonard Sunil Kurian, MD., Case No.

28 05-2011-214708, as contained in Exhibit B.

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1. PROBAIION COMPLIANCE. The Decision in In the Maller of the First Amended

2 Accusation Against Leonard Sunil Kurian, M.D., Case No. 05-2011-214708, as contained in

3 Exhibit B, shall remain in full force and effect, with the addition of one year of probation as

4 ordered herein.

5 ACCEPTANCE

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

7 discussed it with my attorney, Dennis R. Thelen, Esq. I understand the stipulation and the effect

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

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

JO Decision and Order of the Medical Board of California.

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12 DATED:

13 LEONA~ KURIAN, M.D. Respondent

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15 I have read and fully discussed with Respondent LEONARD SUNIL KURIAN, M.D. the

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

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Disciplinary Order. I approve its form~-

DATED: "];"2}.. .. -17 ~ ....... - ....

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DENNIS R. THELEN, ESQ. Attorney for Respondent

4 STIPULATED SETTLEMENT (800-2014-008I07)

ENDORSEMENT

2 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

3 submitted for consideration by the Medical Board of California.

4 Dated: 2./Z'J./• 'T

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62296328

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Respectfully submitted,

XAVIER BECERRA Attorney General of California E. A. JONES III Supervising Deputy Attorney General

BENETH A. BROWNE Deputy Attorney General Attorneys for Complainant


Exhibit A

Accusation No. 800-2014-008107

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


Attorneys for Complainant

BEFORE THE

FILED ST ATE OF CALIFORNIA

MED~ALBOARDOFCALIFORN~

SACRAMEN\°~~' 20.Ya._ ev:?l.J .:c ~ NALYST

MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA


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

Case No. 800-2014-008107

ACCUSATION

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

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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.

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

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

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

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

26 JURISDICTION

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

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

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

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

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

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

4 Hearing Panel in exercising their disciplinary authority."

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

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

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

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

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6. Section 2234 of the Code, states:

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

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

limited to, the following:

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

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

"(b) Gross negligence.

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

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

the applicable standard of care shall constitute repeated negligent acts.

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

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

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

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

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

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

standard of care.

"( d) Incompetence.

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

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

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

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

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

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

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

7 the proposed registration program described in Section 2052.5.

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

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

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

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

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

13 unprofessional conduct."

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FIRST CAUSE FOR DISCIPLINE

(Gross Negligence)

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

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

patient. The circumstances are as follows:

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

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

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

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

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

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

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

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

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

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(J FON ARO SlJNIL KlJRIAN. M.0.) ACCUSATION NO. 800-2014-008107

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

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

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

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

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

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

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

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

9 fibroids.

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

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

12 assisted (laparoscopic) uterine myomectomy to preserve J.V.'s fertility and chromopertubation.3

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

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

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

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

17 training for the procedure only about six months previously.

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

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

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

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

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

23 fertility evaluation.

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

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

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

3 Chromopertubation involves instilling dye through the fallopian tubes to assess tubal patency, relevant to assessing 1. V. 's fertility.

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

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

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

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

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

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

6 have been proven to grow where they land.

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

8 the surgical procedure would include robotic assisted uterine myomectomy and

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

10 previous appointments referenced above.4

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

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

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

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

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

16 chromopertubation.

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

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

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

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

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

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

23 removed prior to beginning the laparoscopy.

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

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

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rr .FON ARO SIJNTT, KlJRJAN. M.0.) ACCUSATION NO. 800-2014-008107

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

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

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

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

5 on the day of discharge with appropriate notes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

6 surgery on her as follows:

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

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

9 was a risk that the surgery would be prolonged.

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

11 organs because of scarring and adhesions from previous surgeries.

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

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

14 and weigh her options.

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

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

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

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

evidence of a physical exam.

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

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

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

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

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

uterine size.

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

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

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

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

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

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

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

6 on all consents.

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

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

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

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

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

12 catheter was removed prior to beginning the laparoscopy.

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

14 instrumentation from the vagina.

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

16 prepare appropriate notes regarding her status.

17 (m) Respondent failed, in ot1icc notes after J.V.'s surgery, to document

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

19 up on positive results.

20 SECOND CAUSE FOR DISCIPLINE

21 (Repeated Negligent Acts)

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

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

24 patient. The circumstances are as follows:

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

26 here as if fully set forth.

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

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

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1 as follows:

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

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

4 was a risk that the surgery would be prolonged.

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

6 organs because of scarring and adhesions from previous surgeries.

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

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

9 and weigh her options.

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

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

12 medical records, as follows:

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

14 evidence of a physical exam.

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

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

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

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

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

20 uterine size.

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

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

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

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

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

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

27 on all consents.

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

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

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

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

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

5 catheter was removed prior to beginning the laparoscopy.

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

7 instrumentation from the vagina.

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

9 prepare appropriate notes regarding her status.

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

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

12 up on positive results.

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

14 Rumi catheter cup in the patient's vagina.

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

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

17 fever over 100 degrees.

18 THIRD CAUSE FOR DISCIPLINE

19 (Failure to Maintain Accurate and Adequate Medical Records)

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

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

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

23 follows:

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

25 DISCIPLINARY CONSIDERATIONS

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

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

28 Matter of the Accusation Against Leonard Sum"! Kurian, M.D. before the Medical Board of

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

18 PRAYER

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

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

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

22 issued to Leonard Sunil Kurian, M.D.;

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

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

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

26 costs of probation monitoring; and

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

2

3 DATED: April 13, 2016

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61919701

Executiv Director Medical Board of California State of California Complainant

12 (1 r<nl\TADn CTTl\ITT lCTTRTAl\J Mn\ ArrrT<.:::ATTnN Nn RnfL'?flLLnnRHl7

Exhibit B

Decision - Case No. 05-2011-214708


DEPARTMENT OF CONSU'.\'1ER AFFAIRS STATE OF CALIFORNIA

In the Matter of the First Amended Accusation Against:

Leonard Sunil Kurian, M.D.


Respondent

) ) ) ) ) ) ) ) ) )

~~~~~~~~~~~~~~- )

DECISION

Case No. 05-2011-214708

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 Mav 8, 2015.

IT IS SO ORDERED: April 9, 2015.

'.\'IEDICAL BOARD OF CALIFORNIA

7

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\) j

I 0 1l

K.\\1.\1.,\ I>. I L\IUOS

t\ttorncv (icneral nt'l'alifornia L. i\ . .lt)Nt:S Ill Supervising I )1.:puty Allorncy ( icncral BL'.:Ll II J\. BHO\\'NI

Deputy Allomcy tlcnl..'ra! Statc Bar No. 202h79

California Dcpartmcnt of Justice JOO So. Spring Street. Suite 1702 Los An~cks. CA 9001.1 TckplH;llL': ( 21.1) 8tJ7-7816 F..11.:simi!c: (2 I J) 897-1)J95

.-I llomeys/or ( '01111J/ai11a111

Bl'.:FORE TllE MEDICAL BOARI> OF CALIFORNIA

DEPAl~TMENT OF CONSllMER AFFAIRS STATE OF C\LIFOR!'\IA

I I 1-l 1-1 t-h-1..·-i\-·1-m-l c-·r-· 1-i 1-. t_h_c_I _· ir-·s-l -A-n-11:--1-1t_k_d_1_\\.:-.c-.t-is-at-i1_ll_l ..., C :t:-.1..' No. 05-::!0 I 1-2 ! .+ 708

:\gains!: 12

I ' ·' I .J

15

Ill

!.l-:ON.1\RD SllNll. KURl\N. M.D. I _\JI \\'est t\ vcnud. Stc. I 02 I .;irn.:astcr. { ',\ 9J53•l

i>iwsid:111's :111J Sun!,con's ( 'crtitk:1tc Nt; ( i 70.189 -

( ):\ 11 No. 2013 I I 07X I

STIPULATED SETTLEMENT ANI> DISCIPLINARY OIU>lm

17 '\.-~~~~~~~~~~~~~~~~--J

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I ~I I

IT IS I IUffln' STIPllLATl:U AND Mil{IJI) by a11d hctwL'cn thc parties to the abovc-

l'ARTI LS

1'i111b,:rly Kin:h1111:ycr ("Co111plaina11i") is the 1:xe1.:utiV1..' Din.:l:lnr oJ"tlH: i\,kdical

l3oard o!"C;llili1rnia. She brought this action sole!) in hL'r n!fo:ial capacity and is rcprL'sentcd in

thi" lll:lllt"r hy 1-.:mnala D. I larris. '\twn11.:y licneral ol'thc Statc of California. by lkncth :\.

lhownc. lk•pul) Allorn1.') ( kncral.

I I < >N:\RD Sl INIL Kl l[{lt\N. i\l.D. ("Rcspnndent"i is rcprL·sct11cd in this prrn.:ecding

S llf'l 'L\ I !.I> Sl·:tTl.1-\ ll:~T{05-20 I I·:? 1-1708 l

3. On mahout !kn·mh-:r 17. llJ1JO. lhl.' Mcdil.'al Board of California issw.::tl Physi<..:ian's

2 and Surgcon's Ccrtilicatc No. (i 70-t89 to Respondent. Thc Physician's and Surgeon's Ccrtilkatt:

3 \\as in l'ull forcc anJ cflcd :it all timcs relevant to the 1.:hargcs brought in First 1\mt:ndcd

-t Accusation No. 05-2011-21·1708 and will cxpin.: on April J0. 20J(i, unlcss rcncwL·c.I.

5

() .). First A mt'.ndt:d .i\t'.cusat ion No. 05-20 I I -21.nox "as Ii 11..'.J b-:Con: tlw i'vkdical Board

7 ol' Ltlifornia (Buard). lkpartmcm ol'Con:-.umer Albirs. and is l.'lllTently pcnding :igainsl

8 Rcspnndl.'nt. The 1-irst :\mended :\n:usation and all other statutorily required dm:umcnts wcrc

\) prnp1:rly si.·rvl.'d on R-:spond;.:nt on 1\pril X. 201-L Rcspondcnl had pn..·\iously timely lilc<l his

!O Notic-: nl' Dc.:fonse contesting the charges.

l I 5. ;\ copy or hr:->! AmcnJcd 1\ctusat ion Nu. 05-20 I I -:2 1-1708 is attached as exhibit A

12 and im:orporatcd herein hy rcli:n.:ncc.

l)

! -t i r

I 'i I

ii, Rcspondcnt has card'ully rcad, fully <liscuss1:d \\ilh 1:mmseL and understands the

charges and alil'galinns in l·ir:-.t A1rn:ndcd i\crnsation No. O:'i-~Ol l-21-1708. Respondc11t has also

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carcl'ully read. fully dis1:uss1..·d \\ith counsd. and 11ndcrsta11Js th1: cl'lccts nl'thi;-; Stipulatc.:d

7. Rcspo11Jc11t i:i t'ull~ ~l\\a1"1: nfhis kg.al right-; in this rnat11:r. including lhc right to a I

l () ht:aring 011 thc clwrgcs and allegations in lht: l·ir:-.t /\mended Accusation; thc right 111 he

20 rt:prL'Scnh.~d by Cll1111s1.•I al his 0\\11 expense: 1hc right to c1111front and cross-cx.iminc the \Vitncsscs

21 :1gai11st him: the right to pres-:nl c\·iJ-:n..:c and to ll:stif) 1m his !l\\11 behalf: the right to the

,.., tsSU:llll'.l.' of suhpocnas to compel !he :ltl\.'.IHlancc of\\ itllt.'SSl.'S and the produl:I i11n of dOCllllll.'nlS;

.., ~ -'·' till'. right tu ret:onsidcralion ;111d rnmt n.:view of an adverse lk<:ision: and all other rights m:cordcd

2-1 hy thl.' Calil'ornia ;\dmi11i:-.tra!i\e Pro1:t:dur1: 1\d and othl.'r applit:ablc laws.

2:'i 8. l{cspondc111 rnltmtmily. !..rnmi11gly. and intdlig.1.'tlll~ \\aivcs and gives up cad1 and

=() I.'\ ery riglH set l(irth above.

27 { 'l 11.PAIHI .ITY

~8 9 Respondent u11derstan<ls and agr1:es that the charges and allegations in First Amended

SI !l'l if ·\fl I) SITrl .E\11. \T ((l~·'.20 I 1-21-170S)

/\1.:rnsation No. O:'i-20 I 1-2 I -i708. if' proven al a hcarinJ:.!. u111st itulc cause for imposing Jisciplinc

2 upon his Physician's and Surgco11's ( ·crlilicah:.

3 ! 0. R-:spondcrll admits Ill tlJL• truth of the Third Cauw for Disciplim: in th1: First Amended

-1 !\ccusal inn. For the purpos1: or n:solving the 1-'irsl :'\1111:nded ;\1.:cusation without the expense and

5 lllKCrlHillt) or rurthcr proC\.'l:tlings. Respondent .igrecs that. al a hearing. Complainant could

() l'stablish a fot:tu:il basis as 10 other allegations in the First .'\1111.:ndt:d Acc.:usation and that those

7 charges constitute cause for disl'iplinl'. Ri.:spondcnt hen:hy gi\ cs up his right lo contest that cuusc

8 for discipline exists based 011 those charges.

9 I l. Respondent agn:cs that his Ph;si,·ian's and Surgeon's ( \·rtilieah: is subject to

10 disl'iplin,· and he agn:es to b"· hl1t111d h; the l~oard's prohati1111ar; terms as SL'\ forth in the

11 Disciplinar) Order bdm\.

I~'. ~:<>t:-:Uti<WN.LY

I _l 12. This slipulatirn1 shall be subject to approval b) !hi.' i\ledical Board olTalifornia.

14 Rt•spondent u11ders1ands and agn.:es that l.'OU!lscl for Complainant and lhL' staff or Lile ivledical

15 nnnrd of California may ro1111mrnicate directly \\ith the Board rcganlini; this stipulation and

16 st:tth.:ml.'111. \\ith1111t 11otil.'.I.' to or pankipation b) Rt:spnndrnt or his counsel. ny signing the

17 stipulation. Respondelll understands and agrt·cs that he may not withdr:ll\ his agreement or seek

18 to rcstind the stipulation prior to the time th.: no.ml consitkrs anJ acts upon it. If' the Board foils

19 to :1dopl this stipulation ;1s its lkl.'ision and ( lnkr. !ht: Stipulated Selllemt:nt and Disciplinary

20 ( )nkr slwl I bt: or no force or effect. l.:XCCJl! for this paragraph. it -.hall be inmlmissible ill any legal

:.. I action bctwrrn !he part ks. <md !he Board shall 1101 hi.: disqualilkd from rurther action by having

,,., eonsidl'n:d this matter.

2.\ I:;, The part ics 1111dcrstand and agree that Portable I Jornmcnt Format ( PDI·) and facsimile

2..J cop·i~·..; ol"this Slipul:t!ed Sclll.:rnent and Disciplinary Order, including Portable Doctunent Format

.:;5 (PDF) and fi1l·similc signatures thcrcto. shall haw the saml· fore.: and cl"li:d as thc originals .

.2(1 14. 111 consideration ol"thl' forcgoing admissions and stipulations. the partit.:s agree that

27 thl' B11:trd may.\\ itlwut fl1rthcr nut ice or liirmal pron.:1.:dinµ. issu"· and en\er the follm\ ing

28 Disi.:iplin:iry Ord.:r:

S 111'1 :r .\IE!> SI· ITl.F\11::'\T (0;\-:?011-21-1708)

DISCll>LINAR\' ORDER

2 IT IS l IERl:llY ORDERED that Physkian's and Surg1:on's Ccrtilicalc No. G 70489 issud

> lo Rcspontknt I H>NARD SI !Nil. Kl IRl/\N. i\l.D. 1R..:sprn1tk11t) is rcvokcJ. I !owcvcr. the

.j rcvm:ation is staycJ and Respondent is p!m:cd on prnhation for sc\1.'n (7! yt:ars on tht: following

:; terms and conditions.

I. EDUCATION COlJHSI:. Within 60 cakndar days ortht: t:lfoctivc date of this

7 lk1:ision. and 011 an annual basis thcrea!icr. Respondent shall submit to the Board or its Jcsigncc

x li:ir its prior approval cducatiomd program(s) nr 1:m1rsc(s) \\·hich shall not be less than 40 hours

!) f)l.T year. l(ir ca1.:h year of probation. The edm:ational program(s) or coursc(s) shall be uimed m

Io corn:ct ing an> :m~as or (.klici..:nt pracl i1.:c or kmm kdgL' and sh;il I he l ·a11.•gor) I certi lku. The

11 educatitrnai program{s} or coursc(s) shall he at R1.·srH11Hkn1·s l''Pens1.· and shall be in addition to

12 the Cnminuing f\kdical LJucatinn (l'MI~) r1.·qui11:mc11ts liir r1.·11..:\\al n!' lit:ensurc. Following the

1 _; cnmpkli(ln lli'cud1 course. the Board nr its d,:sign..:e ma:- administer al1 L'\amination lo test

1-1 Rcspondl.'.ll!. s ktHl\\• ledge or the l'OlffSC. R..:spnndenl shall prm id1.· proor or allcndancc for 65

15 hours nf CMi: of\\hich 40 hours were in s:1tis!;1dio11 ol'this c1111di1io11.

l {J MFDICAL RECORD KITPIN< i COi !HSI .. Within <>0 Gtknd:.ir days of the effective

17 dalL' nf this Decision. Respondent shal I enroll in a course in medical r..:cord keeping equivalent lo

18 lhL' Ml.'.dical Record Keeping Coursl.! olkrcd by the Physician 1\sses-;111e111 and Clinical Education

l <) l'nigrani. l Jnivcrsity ol'California, San Di..:go School o!' McdicinL· (Program). approved in

::'.O ;alvann· by the Board or its dcsigncc. Respnndent shall pnl\ ide till' program \\ ith any information

21 , :ind doctmh:nts thai the Program may dct:m pcl1illL'llL l\.:sp1mtk111 shall panicipale in anJ

'Yl Slll.'.CCssfu 11 y Clllll plctc Lill' i.:lassrornn ~·0111po11e11t ll r the 1.:1 lttrse not lakr I han si .\ ( 6) months :ificr

!~espomklll's initial cnrollrn..:111. Rt:spondent shall sun·essfull> cu111pkll· any nthcrl.'.omponcnt or the coursl' \\ i11!i11 Olli.'. (I) y..:ar or ..:11n1li1111.·nt. Thi.' llll'dkal n:cnnl k..:..:ping course shall be at

lfrspnndl'nt's c.'\pensc and shall be in adJition to !he ( '011tinui11g i\IeJical Cuw.:ation (CME)

requil\'llll'llls ror renewal or liccnsun:.

:\ rnedic;ll r.:cord keeping course taken a!kr the acts that gavL' rise 10 the dwrgcs in the

1\ccusation. but prior to the elkctive dat..: of th..: Decision may. in the sole discrdion ol'thc Board

-I

SI 11'1 'I.\ r l:f) s1: ITl.E.\IE7'T ({)5-201 l-21·170X)

or its dcsigncc. be acccrt~~d Inwards tlH: fullill1111..·111 of this n1nditi1111 iftlie niursc would have

been approved by !hi.~ l~oan.I or its tksigrn:c had the course hccn lakcn :dicr the effective dale of'

Respoll(h.;111 shall suhrnit a certilication or sm:cL'ssful comph:tion to the 13oan:.l or its

dcsigncL' not later than l .5 calendar days alh:r slH.:CL~ssfull) compkling the course. or not later than

15 call'nd:ir da:. salter the i.:ffcctivc dak or the Decision. whichl.'ver is later.

). PROITSSIONALISM PROGRAM (FTI llCS COl !RSF). Within 60 cakn<lar days of

the cffcctivc dale of this Decision. llcspondL·ni shall enroll in a proli:ssion:ilism program. that

meets tht: requircnH:nts of Title I (1. California ('ode pf Rcgul;ilions {( '( 'R J sett inn I :;58.

Respondent shall participatl' in and slll'Cl'ssfully complcti: that program. Ri:srondi:nt shall

prt)\'idi.: any i11f11rn1ation and dm:umellls that thL· program may tb.:111 pcrti111.:11t. Rcspomlcnt shall

successfully cnrnpktc the classrnom component of the program not lati:r than six (6) rthmlhs allt:r

Rcspn11dc11t's initial cnrol!111ent. and !hi: !011gillldi11al t:OlllfJ\lllelll or the progr<Hll not later than the

time spi:cificd hy thi: program. but no later than 0111.· (I) year alkr ut11.·11ding the classroom

component. The professionalism progrmn shall hem Rcspomknt"-. L'.\pcnsL' and shall be in

additiun to thl' Cunlinuing ivkdit:al hl11rn1iun ({ 'i\·11·:) requi1-..:mcn1s li1r renewal nf lkcnsun.'.

;\ prolcssion:ilism program taken after the acls that gave rise 10 the charges in thi:

Accusation. hut prior to the effi:ctivi.: d:1le of the lkcision may. in lhe Sllll' discretion ol'thc noard

t•r ils designec. bc :1cci:ptl'<l tm\<1rds the li1!lillmenl of this cu11diti1111 if tile program would have

bcl!n apprn' 1.:d by the Board or its dcsig11ec had lhc prn!,!r:im hcl'n tak\.'ll alkr lhl' clkcti\'c dale of

this lkdsion.

Respondcnl shall '>Uhm it a certilit::11ion or successful comp kt inn tu lhl' Board or its

designci: not later than 15 calendar days a lier sucL'essrul!y mm pkt ing thi: program or not l<ltl!r

than 15 caknd:ir days alter the cffccli\i: date 11l'thc Di.:cisi1111. \\liichc\cr is latt.:r.

-I. ~ ·1.1 \J IC.,\ I. TRt\ IN IN< i PRrn ilt·\ ~ !. Within W t·akndar da: s of the 1.:ITcctivc date

ufthis lkt·isitin. Rl..'sp11ndcrll shall enroll in :1 dinical trn\ni11~ lll' educational program equivalent

Lo the Ph) sician Assessment and ( 'linical hlw.:ation Program t I' 1\\. I·.) nl'!i.:n:d at the University of'

California - San Diego School of Medicine ("Program"). Resp1111dent shall sw.:cessfully complete

SI ll'l'L,\ II:!> SFTI LI ~II:'-: I' \05-2011-:!t-170l0

lhL· Program not lati:r than six (<J) 11w11ths alter Rl.'sp(lndcnl·s initial cnrollmi:nl unless the Board

-, or !ls di:signcl.' agrl.'cs in writing to an L'.xll'nsion of that 1i111c.

3 The Program shall consist of a ( 'ompri:hcnsivi: t\sscss1rn.:nt prngrm11 crnnpris1.:<l ol' a l\\o-

..i day asscssmi:nt or Respondent's physii.:al and nK'llli!I health: basic clinical and communication

5 skills common tn all dinit'ians: and medical kmmkdg1.:. skill a11Jjudgm1.:n1p1.:r1aining10

(> Respomknt's area or practice in which Respondent \\as alkgL'd tn he delicient. and at minimum.

7 a ,10 hour program or clinical education in the arc;i or prai:l ici: in which Respondent was alleged

8 to be delkknt and \Vhich takes into aci:ount data obtained frnm thl' as~i:-.s111L'11l. Decisi11n(s). First

9 .1\mi:nded 1\ccusa1in11. and any othi.:r information that till' Board ur i1s tk-.igncl· di:ems rdevanl.

Io l{cspondent shall pay all i.:xpcnses associated \vith th .. · clinical training program.

I I l~ascd on Rcspnndi.:nt's performance and ti.:st rL'stilts in the ;bs .. ·ssmcnl and clinit.:al

I::; i.:ducation. the Prngram "i 11 advise the Bnard or its dL'~i~nce n r its rcn1111111enJa1 ionls) for the

I> scopi.: ;111d knglh ol' any additional i.:dth.::itional nr clinical training. tri.:atml..'nt for any mcdical

1-t cPndition. ln:a1n11.:11t l(n· any psycholoJ:!ical condition. or anything cbi.: ;1i'li:cting Rcsponden1·s

I :'i pr;11..:1icc ol' lllL'dici1w. Respondent shalt comply with Prngram fl'C<HlllllL'Jllla!inns.

I(> ,\1 the completion or an~ aJditional cdurn1io11al m clinie:ll trnining. l{l'.spnndent shall

17 submit to and pass an cxrnnination. Dcl\.Tmination as lo whL'tllL'r lkspontknt s11ccessl'ully

18 complctc<l thi.: examination or sun:essfully cnmpktcd the program is ~olL'ly within the progrmn·s

19 jurisdiction.

20 I I. Respondent fails to i.:nrnll. participate in. or successl'ull> comph:te the clinical training

21 progr;1m within th1: di.:signatetl time period. Respo11JL'11t shall receive a nntilication from the

n 13oard or its tlesi!,.!llCL' to ct.:ase the pr;icliCL' of nwdieine within thrci.: ( :l) calendar days a lier being

2.'~ so nutified. The RL'sptmliL'nt shall not resume the pr:n.:tin.: o( medicine until L'nnillmcnt or

2-l participation in the outstanding por1io11s ol'thc dinical training program havi.: been completed. Ir

25 tile Respondent did 1101 suCcL'ssJ'ully complete thi.: clinical training progrrnn. the RcspondL'll! shall

](i nut ri.:sumi.: thc pr:1ctici.: or medicine until a linal <kcision has been renderi.:d n1111le accusation

27 and/or a pi.:tition to rc\oke prub:11io11. ThL' c1.:ssatiu11 ofpr;1cticc shall 11111:1pply10 the ri.:duclion of

28 thL' probationary timL' pL'rind.

Slll'l'l.\!TDSI ITI l·~IE'.\:T(05-2011-21-170SJ

! I Within 30 days after Rcspo11dcn1 has SllL't:cssl"ully complcled the clinical training prngrum.

Rt:spondcnt shall purticipatc in a prnlcssional cnharn.:ement program equivaknt to the one olfored

' .' 11\ the 1>1nsicia11 /\sscssmcnl and Clinical Ldm:ation Pro!!ram at the Universitv ol'l'alifornia. San • # - .,;

I) iego School or Medicine. which shall in dude quarter I y chart rcvic\v. scrn i-annual practice

assessment. and scm i-a1rnual n:v iew or proli:ssional growth and c<lucat ion. Hcspondcnt shall

participate in the professional c11hancc111cnl program at Respnmknt's expense during the entire

7 term or probation. or until the Board or its designec determines that further participation is no

8 longer necessary.

5. NOTIFIC/\TION. Within seven (7) days of the ertcctive Jate or this Decision. the

1 o Respomkm shall provide a true rnpy of this Decision and Accusation to the Chief ol' Staff or the

11 Chief hecutiv..: Onicl'r at c\·cry hospital when; privileges or membership arc extended 10

12 Rcspondcnt. at any other facility \\h1.TL' Hesp11nden1 engages in the prat:tice of medicine,

I:; induding all physicirn1 and locurn tc11e11s registries or other similar agencies, and to the Chier

l ·I Lxecutive Oniccr at every insuranc..: carricr which extends malpractice insurance coverage lo

I ."i Respondent. Respondrnt shall suhmit proof or compliance to the Board or its dcsignec within 15

I (1 cakndar days.

17 This condition shall apply to any dwngc(sl in hospitals. other facilities or insllrancc carrier.

6. Sl!P!·.RVISION OI· l'l IYSlt 'l;\\l ASSIST/\NTS. During probation, Respondent is

I lJ prohibit1:J from supervising physician assistants.

20 7. OBEY t\ U. L;\ \VS. Respomknl shall obey all federal. stale and local la\\'s. all rules

21 governing the practice ol'medicinl.! in ( ·alifornia :md remain in full compliance with any court

'l'l ordered criminal probation, payments. and ulher orders.

23 ' 8. !,HJARTERl.Y DECl.ARATIONS. Respondent shall suhmil quarterly declarations

24 u11der penally or perjury Oil forms providcd by the !Soard, Slating \Vhethcr there has been

25 cumpliam:e \Vith al! thc conditions or probation.

2<> Rcspon<lcnl shall submit quarterly declarations nnt later than 10 calendar days after the end

27 ol thc prcccdin~ quarter.

28 /: i

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:-,Tll'ULATED SEITl.1'.l\!E'IT (05-2011-21-17(18)

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Compliancc with Probation l111it

Resrnndenl shall crnnply \\ilh the Board's probation unit and all ll.:rms and conditions of'

this Decision.

:\ddress Cham.?.cs

Respondent shall. at all times. kccp the Board informc<l of Respondent's business and

residcncc addresses. cm ail address ( i r available). and telephone m1mber. Changes of such

aJdrcs-;cs shall he i111111cdiatcly rnmnn111i1:ated in writing to the 11oard or its tksigm:c. LrH.h:r no

cirrn111s1:111ccs shall a pns1 ulfo:e box scrvL' <ts an address ofrceord. cxcl.:'pl as alltmcd by Business

and ProlCssions ('ode SL'ction 2021 ( b).

!'!:ice of Practice

Respondent shall not engage in the practice or medicine in Respondent's or patient· s pluct:

of residence. unkss the patient residt:s in <1 skilled nursing foci lily or other similar licensed

lilcilitv.

Resrondent shall maintain a current and rene\\cd California physician's and surgeon's

licenst•.

l<espomknt slwll imrnediatdy inl\1rm the Board nr its dcsignee. in writing. oftravd to any

ar\.';1s outside the jurisdictio11 ot' < ·aliforni;i \\hich lasts. or is contemplated lo last. more lhan thirly

{30) cakmlar days.

In the c\'ent lfrspondcnt should leave the State of California to reside or lo practice

1(-:sponJcnt shall notil) the Board or its designec in \Hiting 30 calendar days prior to the dates or

dt:parturt: and n:turn.

25 IU. IN'IJ~RVILW \\ ITI I 1111·: BOARD OR ITS D!·:SICINEI·:. Respondent shall be

avai la bk in person upon request for inter\iC\\ s t:ither UI Respomknt' s place or business or al the

27 prubati1n1 unit onicc. \\ilh or \\ilhuut prior notice throughout the term of probation.

28 ,' / I I 11

STll1 t:LATED SETrLE!\lENT (05-20 I 1-21-170X)

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I l. NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or

its dcsigm·e in writing within 15 calcnd;ir Jays or any periods or nlln-pnu..:tice lasting more than

30 c:1kndar days and within 15 calendar days i1r Respondent's return to practice. Non-practice is

ddined as any pcrioJ of time Rcsp,1ndcnt is not pra\.:tici11g.1111:Jici111.: in California as defined in

Husinl~Ss and l'rokssions Code sc<.:tions 2051 and 2052 for at kast -10 hours in a \.:alcndar month

in direct p<llient care. dinil.:al activity or teaching. or other activity as approved hy the Board. All

time spcm in an intensive training program which has hL'en approved by the Board or its designee

shall nnt he w11sid1..:red non-prm.:ticc. Practidng medicine in another state of' the United States or

h:tleral jurisdiction \Vhile on prohation with the medical licensing authority nfthat slate or

jurisdicl ion shal I not be considered non-practice. 1\ Board-ord1.:red suspension or practice shall

not he considered as a period of non-practice.

In !he cvL'nt Respondent's period or non-prnctiL'c whik on prohation exceeds 18 calendar

months. Re:.pondenl shall successli.tlly complete a clinil:al trnining program that meets the criteria

ufConditinn 18 orthi.: curr1.:n1 wrsion of the Board's ··Manual or Modi.:! Disciplinary Orders anti

Disciplinary Guidi.:lincs·· prior to resuming th1.: practiC'c ot"medicine.

R1.:spo11,ko1 ·s period of non-practice \\ hik on prohat ion sh al I not exceed 1wo (2) years.

PL'riods of non-practice \\ill not ;1pply 10 th1..• n:ductio11 of the prohationm·) term.

l\:riods or non-prm:tice \\ i II relieve Resptimlent of the respunsibili1y to comply with the

probationary ti.!rms anti conditions with th1.: cxc1..•ption or lhis condition anti the following terms

and conditions of probation: Obey 1\111.aws; and (icncrul Probation Requirements.

1 ·.i ~0\!ll.:LJi.11.QN Ol'.E!_{_Ol~~~Jl<l1~. R1.!spo11Jcnl shall 1.:omply '"ith nil linancial

.,., ohligutions (e.g .. restitution. probation costs) not later than 120 <:al..:ndar days prior lo the

:; C<Hnpktion of probation. llpon successful crnnph.:tion ofprobutinn. RcspnndL'nt"s certificate shall

2:" I>. \1101.:\TION OF PROBATION. Failur..: to !'ully co111ply \\ ith any tL'rm or condition

2() of probation is a violution or probation. If Respondent violates probation in any respect. lhl!

27 13onrd. alter giving Respon<knt notice and the opportunity to be hc•trd. may n!vok1.: probation and

28 carry out the tlisC'iplinary order that was stayed. Ir an !\C'cusation. or P1.:tition to Revoke Probation.

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or an Intcnm Suspension Or<lcr is iih:<l againsi Respom.lcnl <luri:1g probation, the Board shall h:ivc

2 continuing jurisdiction until tht: matter is lina!, and the period of probation shall be extended until

3 the matter is tinal.

4 14. UC:El::J.SJ: SURRENDER. Following the cffoctivc date of this Decision, if

5 Respondent ceases pra<:ticing due to retirement or :1caith reasons or is otherwise unable to satisfy

6 the tcnns and conditions of probation, Respondent may requ.:st to si:rremlcr his or her liwn:;e.

7 The Hoard reserves the right to evaluate Respondent's request and to exercise its discretion in

ii dctennining whether or not to grant the request, or to t:tkc any o!hcr action deemed appropriate

9 and rcasonabk under the cireumstJ.Occs. Cpon fonnal acceptance of the surrender, Respondcnc

l O shall within 15 1:akndar days deliver Respondent's walk! and wall certificate to fac Board or its

I ! dcsigm:e and Respondent shall 1w longer practice mcdicim:. Rc$pomlcnt will no longer be subjc1:l

12 to the terms anti cL;nditions of probation. lf Hcspondcnt re-applies for a medical license, the

13 apµlication shall be lrcmcJ as a pccition for reinstatement of a revoked certificate.

14 15. PROBATIO!"\ MO:-\ITOHl:"G COSTS. llcspondcni shall pay the costs associated

15 with probation monitoring each and every year of probation, as design;itcd by the Board. which

J 6 rr.ay be adjusted on an mmua! basis. Such costs shall be payable to the Medical Board of

17 California and delivered to the Bmml or its J~signcc no latc;r than J:muary 31 of each calendar

J 8 year.

20 J have carefully ri:ad the above Stipulated Scttlcmcm and Disciplinary Order and have fully

21 di;;cusscd it wJth my attorney, Henry Lewin, Esq. l uni.krst:md the ~ripu~a!ion and the effect it

22 will havl.! on my Physiciau's and Surgeon's C.:rtilicatc. l ..:mer into this Stipulated Settlement and

23 Disciplinary Onlcr voluntarily. knowingly, and imclligc!llly, and agree to be bound by the

24 Decision and Order of the Mc,lical Bo:ird of California.

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26 DATED: __;/_!/!_~---27 Respondent

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____ , ______ 1_0 ------STlPCl.A TED SETfLEMct>.T (OS·201 l-21470S)

I have r..:atl and fully discussed with Rcspontlcnl LEONARD SlJNll. KURIAN. ~1.D. the

terms and conditions and other matters co111ai11cd in the above Stipulall.!d Scllkmcnt and

Disciplinary Order. I approve its form and content.

DA Tl ll: _ _!>_if-01--11 _("'

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8 LNDORSFMENT

9 The fo1-.:gl1ing Stip11lated Sdtkmcnt and Disdplinary Ordl.!r is hcrchy respectfully

l O submincd l{>r con"ideration by the l\lcdical !loan! ol'California.

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DateJ: \{l/15

L:\~O l .\607869 C. I :183878.1.k>.:

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l{cspe1.:trully submiltcd.

KA\!.\!..\ D. I f,.\RIUS

Attorney Gl!neral ol'C'aliforniu Lt\. JONES Ill Supervising Deputy Attorney General

Bl.NUii A. BIWW!\'I. Deputy /\Horney Cieneral . I ft orm~r.,)iw ( ·0111ploi mm!

s IWUL:\Tl·:n SI'. ITL!o.\ll:NT !05-~011-::?

Exhibit A

Fir:-! Amended Accusation No. 05-201 l-21..i708

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KA!v1Al.A D. HARRIS Attorney General of California E. A. JO>lES lll Supervising Deputy Attorney Genera! BENETH A. BROWNE Deputy Attorney General State Bar No. 202679


FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA

8A°J!M7(3;ro~~ 20...\!i. 8V•4 '.\C=':LiALYST

7 • Attorneys for Complainant

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BEFORE THE MEDICAL BOARD OF CALIFORr\IA

DEPARTMEN'f OF COi"\St:MER AFFAIRS STATE OF CALIFORNIA

In the Matter of the First Amended Accusation Case No. 05-2011-214708 Against:

LEONARD SUNIL KURIAN, M.D. 1331 West Avenue J, Suite 102 FlRST AMENDED ACCUSATION Lancaster, California 93534


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Respondent.

PARTIES

Kimberly Kirchmeycr (Complainant) brings this First Amended Accusation solely in

20 I her official capacity as the Executive Director of the Medical Board of California, Department of

21 Consumer Affairs.

22 2. On or about December 17, 1990, the Medical Roard of California issued Physician's

23 and Surgeon's Certificate Number G 70489 to Leonard Sunil Kurian, M.D. (Respondent). The

24 Physicim1's and Surgeon's Certificate was in full force and effect ·,,t all times relevant to the

25 charges herein and will expire April 30, 2014, unless renewed.

26 .lURISDICTION

27 3. This First Amended Accusation is brought before the Yledical Board of California

28 (Board), Department of Consumer Affairs, under the authority of the following laws. All section

I!-· 1 : ! First Amendt:d Accu~ation; Calle No. 05-2011-214708

references are to the Business and Professions Code (Code) unless otherwise indicated.

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

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

4 the California Board of Podiatric Medicine, and administnitive law judges of the Medical Quality

5 Hearing Panel in exercising their disciplinary authority."

6 5. Section 2227 of the Code provides that a licensee \Vbo is found guilty under the

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

8 one year, placed on probation and required to pay the costs of probation monitoring, or such other 1

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

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6. Section 2234 of the Code, states:

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

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

limited tu, the following:

"(a) Violating or atter:1pting to violate, directly or indirectly, assisting in or abetting the

violation ot: or conspiring to violate any provision of this chapter.

"(b) Gross negligence.

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

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

the applicable standard of care shall constitute repeated negligent acts.

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

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

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

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

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

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

standard of care.

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

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First Amended Accusation; Case No. 05-201 l-214708

"(d) Incompetence.

2 "(c) The commission of any act involving dishonesty or corruption which is subs~tially

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

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

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

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

7 apply to this subdivision. 'Ibis subdivision shall become operative upon the implementation of the

8 proposed registration program described in Section 2052.5.

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

IO participate in an interview scheduled by the mutual agreement of the certificate holder and the

11 board. This subdivision shall only apply to a certificate holder who is the subject of an

12 investigation by the board."

13 7. Section 2266 of the Code states:

14 "The fajJure of a physician and surgeon to maintain adequntc and accurate records relating

15 lo the provision of services to their patients constitutes unprofessional conduct."

16 FIRST CAt;Si.: FOR DISCIPLINE

17 (Gross Negligence)

18 8. Respondent is subject to disciplinary action under section 2234, subdivision (b), in

19 that he was grossly negligent in the care and treatment of three patients. The circumstances arc as

20 follows:

21 Patient C.S.

22 9. On or around April 18, 2007, C.S., a 2l'l-year-old married female, presented to

23 Respondent, a gynecologist and obstetrician in Lancaster, for her first prenatal visit. C.S. was

24 Gravida 2, Para O; she had had two pregnancies but no live births. C.S. 's last menstrual period

25 wm~ on February 28, 2007, her menses were irregular, and she had a history of infertility. C.S.'s

26 past medical history was subsequently noted as negative.

27 l 0. Respondent had previously treated C.S. Respondent had documented a diagnosis of

28 polycystic ovary syndrome (PCOS) in C.S. in 2000, presenting as androgen excess, hlrsuitism,

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First Amended Accusation; Case No. 05-2011-214708

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anovulation, weight gain and infertility. Respondent treated C.S. with Mctformin and

recommended fertility treatment with Ciomid when she was ready to conceive. On November

30, 2006, Respondent had referred C.S. to a reproductive endocrinologist (REI). Lab work on

C.S. dated January 31, 2007, reflected elevated testosterone and DHEAS,2 low progesterone, and

C.S. being heterozygous for the :vtTHFR3 mutation. Anti-phospholipid antibody results were

not obtained because, Respondent has testified, she had no risk factors for thrombosis.

11. On or about April 26, 2007, C.S. presented at the Antelope Valley Hospital

Emergency Room complaining of pelvic pain. The emergency room records document C.S.'s

medications as including 40 mg CQ Lovenox, baby ASA, Folic Acid, and Progesterone. An

intrauterine pregnancy showing 2 gestational sacs with fetal poles was identified. A past history

of coagulopathy resulting in a "hypercoaguable" state was listed. The physical exam was

negative. An ultrasound confirmed a twin gestation at 7 weeks 4 days with f1uid in the

gestational sues. lbe final diagnosis was threatened abortion with a ruptured ovarian cyst.

14 12. On or about April 30, 2007, C.S. was referred to a perinatology (a mati:.rnal and fetal

15 medicine (~lfF:vt) specialist).

16 13. On May 22, 2007, C.S. received an ultrasound with the perinatologist. It revealed

17 "no obvious problems in either fetus." The plan was to aw-ait biochemistry results. He

18 documented that although it was an in vitro fertili;r.ation pregnancy (lVF), C.S. had no history of

19 pregnancy losses or DVT. However, he noted, there was a family history of coagulopatl1ics. The

20 pcrinatologist recommended continuing Aspirin alone without Metformin or Lovcnox, but noted

21 that complete blood work was not available for review. He noted that C.S. wus at increased risk

22 for gestational diabetes, given her history of PCOS, twins and maternal obesity.

23 14. On or about :vtay 22, 2007, C.S. also received genetic counseling where risk factors

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----- ... -------2 DI IEAS stands for Dchydrocpiandrostcronc Sulfate, a hormone that comes from the

adrenal gland.

l MTI !FR is official symbol for the gene "methylcnetetrahydrofolate reductase (NAD(P)H)." This gene provides instructions for making an enzyme called

' mcthylenetetrahydrofolatc reductase. This enzyme plays a role in processing amino acids, the 27 building blocks of proteins. Variations in this gene may be related to occlusive vascular disease,

neural tube defects, dementia, colon cancer, and acute leukemia." 28

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were reviewed. C.S. reported that her sister had Lupus, Anti-phospholipid syndrome, positive

2 Anti-cardiolipins, a history of fetal demise, MTHFR mutation, and a child with Autism. On that

3 basis, the perinatologist recommended that C.S. undergo further testing. The risks of

4 Progesterone, Lovenox, and ASA achninistration during pregnancy were reviewed.

5 15. Respondent's ACOG antepartum records4 dated May 31, 2007,5 for CS indicated she

6 was a G2 PO (had two prcg.1ancics but no live births). CS's last menstrual period was on

7 February 28, 2007, her menses were irregular, and she had a history of infertility. CS's past

8 medical history was entered as negative. CS was allergic to Sulfa.

9 16. C.S.'s family history was noted as positive for breast cancer and heart disease.

10 Respondent made no reference in the ACOO records, or any other medical records, of C.S.'s

I l family history of coagulapathy. Genetic screening was checked off as all negative - including no

12 blood disorders, no recurrent pregnancy Joss, no current medications and no over-the-counter

13 drugs or supplements. Respondent made no reference in the ACOG records, or any other medical

14 records, of C.S. 's current medications, progesterone, A~-pirin (ASA) or Lovenox and he did not

15 evaluate their use. Respondent made no reference to C.S. 's fertility problems, or that she had

16 achieved the current pregnancy through in vitro fertilization (JV F), in the ACOO records, or any

17 other medical records, of C.S .. Likewise, Respondent made no reforcncc in the ACOO records,

1.8 or any other medical records, of C.S., to any consultation with tl1e Reproductive Endrocinologist

19 seen by C.S. The circumstances of the fVF were not considered.

20 17. On or about May 31, 2007, C.S.'s physical examination was remarkable for a 14-16

21 week size uterus and "narrow pelvis." Two cold sores were noted. C.S. was given an EDC,

22 expected date of delivery, of December 5, 2007.

23 1 18. On or around June of2007, at 16 weeks gestation, a~ indicated by Respondent's

24 medical records for C.S., she called Respondent's office and was anxious in light of her sister's

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4 ACOO stands for The American College of Obstetricians and Gynecologists; ACOG has standard forms many practitioners use.

5 The Initial Physical Exam documented in the ACOG antcpartum records is dated May 31, 2007. Some other items in the ACOG antepartum records were presumably entered subsequently as they occurred.

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First AmcndeJ Accusation; Case No. 05-2011-214708.

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history of incompetent cervix resulting in a miscarriage at 25 weeks.

19. On or about August 2, 2007, a follow-up ultrasound was performed for the

pcrinatologist. ft revealed a normal twin pregnancy at 22 weeks. C.S.'s cervical length was

nom1al. C.S. was advised to reduce activity by 50%.

20. On or about August 13, 2007, C.S. was admittcd·to Antelope Valley Hospital in

premature labor. Her cervical length was shortened with funneling. C.S. was treated with

magnesium sulfate and bed rest. Labor was successfully stopped. C.S. remained in the hospital

on bed rest. Respondent treated C.S. during her hospital stay.

21. On or about August 21, 2007, sequential suppression boots (thromboguards) were

ordered for C.S.

22. On or about September 25, 2007, C.S. was discharged from the Antelope Valley

Hospital to Matria Home Health Care on Procardia. Upon discharge, an ultrasound identified a

23 week twin gestation with no fluid around twin A. C.S. was documented as having reported

leakage over the past few days. After having been discharged, C.S. was readmitted lo the

Antelope Valley Hospital with preterm premature mpture of membrane (PPR OM) and treated

with "rescue" steroids, IV antibiotics, and "not aggressive" tocolysis. C.S. complained of sharp

pain in her left groin area unrelated to uterine contractions. Respondent's partner was notified.

C.S.'s pain resolved in a few hours. C.S. was observed on bcdrcst for the remainder of her

pregnancy W1der Respondent's care. During her hospital stay, C.S. was noted to have edema and

C.S. complained of left inguinal pain.

23, On or about November 9, 2007, at 36 weeks gestation, Respondent performed ~n

elective c-section on C.S. without complications. C.S. gave birth to healthy baby girl and a

healthy baby boy. The twin babies did well.

24. On or about J'\ovcmber 12, 2007, C.S. was discharged from the hospital. C.S.'s

hemoglobin was 8.6, out of range. C.S. was taking Repliva, an iron supplement and

I Iydrocodonc, a narcotic pain-reliever.

25. On or about November 20, 2007, C.S. had a regular follow up appointment with

Respondent to review any complaints she had and check her incision, consistent with his custom

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First Amended Accusation; Case No. 05-2011~214708

and practice. Respondent documented no complaints and noted the incision was healing well.

2 Aside from referencing the incision, no physical exam or discussion with Respondent was

3 described. Family members of C.S. reported that, at the time, C.S. had a slight fever, an irritating

4 cough, was complaining of painful swelling in her legs and ankles and she urinated frequently,

5 two to three times per day. Lactation was difficult, us she produced little milk. She stated she felt

6 cold all of the time. C.S. was concerned she was having post-partum depression.

7 26. On or about December 4, 2007, C.S. had her final appointment with Respondent.

8 Respondent documented that she complained of depression, weakness and a cough. Respondent

9 documented that C.S. 's lungs were clear to auscultation. Respondent documented prescribing

1 O C.S. a cough suppressant, an antidepressant and ordered lab worl:. Respondent ordered a CBC

11 and thyroid studies. Re.-;pondcnt knew that C.S.'s family planned to move to Idaho and would he

12 driving there soon. Respondent gave C.S. no directives and made no recommendations to C.S.

13 about the driving trip to move to Idaho or any subsequent treatm1:nt. Respondent had no concerns

14 about her driving aside from the usual situation when people arc driving any distance when thl'Y

15 1 are pregnant or in the post-partun1 period, notwithstanding the risks for patient C.S. developing

16 thrombosis.

17 27. On or about December 6, 2007, C.S. and her family began their drive to Idaho. On or

18 about December 7, 2007, at 4:30 p.m., C.S. and her f<unily arrived at the home of relatives in

19 Idaho. C.S. visited with immediate and extended family. T ,ess than two hours later, C.S. lined a

20 bag, climbed the stairs of her family's home, collapsed and lost consciousness. Relatives called

21 911 and summoned an ambulance. An ambulance arrived but emergency medical personnel were

22 unable to revive C.S. They drove her lO a Boise hospital where she wa<> officially pronounced

23 dead.

24 28. Respondent was grossly negligent in his care and treatment of patient C.S., taken

25 singularly or collectively, when he:

26 (1) initiated obstetric care of C.S. without first obtaining a complete: (a) history· of

27 her then-current pregnancy; (b) list of her then-current medications; and ( c) family

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(2) failed to recognize patient C.S. 's risk of thrombosis; and

2 (3) failed to anti-coagulate C.S. in the weeks following her c-section.

3 Patient 11.M.

4 29. On or about early October, 2010, H.M., a 37-year-old patient, presented to

Respondent with a chief complaint of chronic right pelvic pain with an acute exacerbation of the

pain more recently. She provided Respondent an ultrasound, the report for which identified a 6

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cm complex right ovarian cyst.6 Due to the chronic pelvic pain associated with her identified I right ovarian cyst and her profmmd fear of cancer, H.M. requested Respondent to perform a right ,

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oophorcctomy.7 H.M. 's history included right lower quadrant pain for years, since she was

seventeen to eighteen years old. Her history was strictly of right- sided pain. H.M. 's past

medical history was significa.'1t for a connective tissue disorder,8 Hashimotos disease,9 herpes,

and interstitial cystitis. 10 She described an extensive surgical history, significant for a

hysterectomy, 11 right ovarian cystcctomy,: 2 ;md a laparoscopy for adhcsiolysis. 13

14 30, Respondent pcrfonncd a pelvic exam and identified tenderness and fullness of the

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6 An ovarian cyst is a sac filled with fluid that forms on or inside of an ovary.

7 Oopborcctomy is the surgical removal of one or both ovaries.

8 Connective tissues are groups of fibers and cells that "connect" the framework of the body and literally hold it together. Their functions include cushioning, protecting, supporting, insulating and strengthening the body's tissues and organs. Examples of connective tissue are tendons, ligaments, cartilage, blood, bone, and the dennis of the skin. Because connective tissues exist in so many structures of the body, disorders of these tissues may involve o. variety of symptoms, including pain and dysfunction in different areas of the body.

9 Also called Hushimoto's thyroiditis, IIashimoto's disease is an autoimmune disease, a disorder in which the irnmtmc system turns against the body's own tissues.

10 Interstitial cystitis is a chronic inflammation of the lining of the bladder causing it to scar, stiffen and expand differently, creating chronic pain, discomfort, a sense of urgency and increased frequency of urination.

11 A hysterectomy is surgery to remove a woman's uterus or womb.

12 An ovarian cystectomy is surgical removal of an ovariar1 cyst from an ovary. 26 I 27

I 13 Adhesiolysis is the process of cutting adhesions between two abdominal structures -this is done laparoscopically to minimize complications. H.S. had lysis of pelvic adhesions (24,

28 30).

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First Amended Accusation; CHSc N'o. 05-2011-214708

right adnexa. His physical exam of H.M. pinpointed the pain with manipulation of the right

2 ovary. Ovarian tumor markers were negative, but Respondent agreed that he would perform

3 laparoscopic robotic surgery on H.M. and he assured H .. M. that he would remove her right ovary

4 in order to help her chronic pain. Respondent appeared to consider the ultrasound report to

5 provide a definitive diagnosis, but a defiPJtive diagnosis of pelvic pain requires laparoscopy

6 where direct visualization and possibly biopsies will diagnose pathology.

7 31. Surgery was scheduled for October 25, 2010. 14 Respondent obtained H.M.'s

8 operative consent to perform a laparuscopic right salpingo-oophorectomy. 15 Due to H.M. 's fear

9 of cancer, the consent also documented a possible laparotomy 16 with left oophorectomy and

10 omcntcctomy17 and pelvic lymphadenectomy, plus rapid frozen section. Additional procedures

11 beyond the right salpingo-oophorectomy would only be perfonned, however, if findings during

12 surgery were suspicious for malignancy and a frozen section was performed; only in that case

13 would a laparotomy, along with a complete oncologic dissection, be performe<l, including

14 removal ofH.M.'s lefc ovary.

15 32. Respondent failed to provide H.M. infonned consent; he failed 10 impart to her in

16 laymen's terms without ambiguity, what proccdurc(s) would be performed and under what

17 circumstances and the risks, benefits and alternative l.reatments available. Respondent's

18 documentation of informed consent failed to clearly explain the possible laparotomy. His

19 documentation was unclear as to whether an oncologist would be consulted or on standby. The

20 documentation also Jacked a description of Respondent's discussion of the procedure with H.M.

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14 In light of her previous pelvic surgeries and the anticipated adhesions - a urologist was consulted for urctcral stcnts in expectation of a diflicult adhesiolysis.

15 Salpingo-oophorectomy is the removal of the fallopian tube (salpingectomy) and ovary (oophorectomy).

16 Laparotomy is surgery performed on the abdomen using the traditional full-size incision, rather than a minimally invasive approach. The equivalent procedure using the minimally invasive laparoscopic technique is called laparoscopy.

17 Omentectomy: Surgery to remove part or all of the omentum, an large apron of fatty 27 ' . tissue containing veins, arteries, lymphatics. 'Ibe omcntum attaches to and nourishes the stomach

28 and the entire colon.

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F[;gt Amended A~cusation; Case ;..lo. 05-20! l-2 l 470Rj

1 33. On or about October 24, 2010, H.M. received an admission history and physical. lt

2 documented that the right adnexa was full and tender. The admission history and physical stated

3 that the chief complaint was severe right pelvic pain. It detailed a complex 6 cm septated right

4 ovary. 18 All pre-operative findings pointed to right adnexa pathology. H.M. had a lengthy

5 history of right sided pelvic pain. She previously undefW'ent a right ovarian cystectomy which

6 commonly causes adhesions to the organ. On exam, her pain localized to the right ovary. An

7 ultrasound defined a complex right ovarian cyst. 19

8 34. On or about October 25, 2010, during the laparascopic procedure, Respondent failed

9 to follow-up on the information obtained in the pre-operative work-up of H.M., to evaluate the

10 presumed diagnosis and to remove the pathology identified as the most likely source of the pelvic

11 pain. Although all pre-op findings pointed to right adnexa pathology, the entire operative report

12 I failed to mention the right ovary. Intraopcratively, Respondent failed to explore H.~.'s right

131 ovary.

14 35. Instead, Respondent surgically removed H.M.'s left ovary. The prc-opcrntive

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diagnosis had been erroneously entered on the operative report. The actual prt~-operative

diagnosis was complex right ovarian cyst, but the operative report mistakenly indicated a

complex left ovarian cyst. The operative report referenced the left ovary as multi-cystic and

noted bilateral abdominal adhesions. Respondent later admitted that the cyst appeared benign

and, in fact, pathology confirmed a simple cyst hemorrhagic follicle, a corpus albicantia,20 along

with the fallopian tube and adhesions. The benign pathology would not explain the H.M.'s

symptoms of severe right pelvic pain.

111 A scptated ovarian cyst is composed of both solid and liquid matter and has a wall in it (septum means wall).

19 A complex ovarian cyst is a type of cyst that has both solid and liquid components. Found in the ovary and encased in a thin wall, it can appear to be exactly like a bac;ic cy:.'1:, but it has a higher potential to become life threatening and should be treated quickly once detected.

20 Corpus albicans (corpora albicantia) are white fibrous tissue that replaces the regressing corpus luteum in the human ovary in the latter half of pregnancy, or soon after ovulation when pregnancy docs not supervene. The corpus luteum is a progesterone-secreting ye11ow glandular mass in the ovary formed from the wall of an ovarian follicle that has matured and discharged its ovum.

10

First Amended Accusation; Case No. 05-2011-214708 i

36. Likewise, bilateral abdominal adhesions21 were found, but they would not explain

2 H.M.'s symptoms of severe right pelvic pain. >lo adhesions were found on H.M.'s pelvis.

3 Laparoscopy is performed in order to diagnose and treat pelvic pathology, so during a

4 laparoscopy for pelvic pain, the entire pelvis must be completely evaluated and the findings

5 documented. Here, because H.M. 's chief complaint was chronic right lower quadrant pain, the

6 laparoscopic examination should have concentrated on identifying an explanation for that pain.

7 37. ln the operative report, Respondent incorrectly documented both a preoperative

8 diagnosis and a post-operative diagnosis of complex left ovarian cyst. Respondent failed to

9 document any examination of the right ovary or pelvis to explain the pre-operative findings.

l O Respondent failed to describe his thought process leading him to surgically remove H.M. 's left

J J ovary and not her right ovary. Additionally, Respondent failed to integra.tc findings from the

12 history and physical exam on I l.M. over time to formuJate a plausible differential diagnosis and

13 plan of treatment. The surgical procedure that Respondent performed did not conform to the pre-

14 operative findings. Because there were no pelvic adhesions that might cause referred pain, to

15 correlate the findings at surgery with the history and physical, the right ovary should have been

16 thoroughly evaluated and the findings documented.

17 38. Although the pre-operative ultrasound had reported a 6 cm septated right ovarian cyst

18 \\'ith possible hemorrhagic component, photos from the !aparoscopy showed a right tube and

19 ovary adherent to the pelvic sidewall. This 'complex' of structures can appear on an uJtrasound as

20 reported- a c.omplcx cystic right ovary. Respondent demonstrated an inability to integrate basic

21 knowledge of ovarian physiology into the plan of treatment of H.M.

22 39. When H.M. had undergone a hysterectomy, the procedures included dissection of her

23 broad ligament and mesosalpinx along with transection of the her ovarian ligament. The

24 unavoidable tTauma to the tissue in these locations undoubtedly resulted in some degree of

25 adhesion formation. A retained ovary is invariably left fixed in closer proximity to the ovary

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21 Abdominal adhesions are bands of fibrous scar tissue that form on organs in the abdomen, causing the organs to stick to one another or to t..he wall of the abdomen.

11 - --- -- _,, ___ J First Amended Accusation; Case No. 05·2011-214708 f

fossa22 or LP. ligarncnt.23 Sometimes the ovary becomes transfixed to the vaginal cuff or sidewall

2 following removal of the uterus.

3 40. With ovarian cystectomy, the trawna to the ovarian capsule will result in the

4 formation of adhesions. This scar tissue may encapsulate the entire ovary and fix it to adjacent

5 structures in the body's attempt to repair damage. The ovary remains dymm1ic and continues to

6 cyclically respond to pituitary hormone stimulation with maturation of ovarian follicles. This

7 normal physiologic process cyclically results in the formation of ovarian cysts. Rapid growth of

8 cysts can result in hemorrhage into the ovary or beneath the adhesions. The expansion of follicles

9 creates tension on the adjacent peritoneum, which is extremely sensitive to pain. Therefore, these

10 patients will experience acute, chronic, or cyclic pelvic pain as a result of these adhesions.

11 Although Respondent acknowledged the phenomenon of an ovary becoming adherent to the

12 sidewall after a hysterectomy, he mistakenly described the condition as rarely painful.

J 3 41. Post-operatively, IL~. continued to experience right pelvic pain. On November 9,

14 2010, ll.M. presented for a repeat pelvic ultrasound. Consistent with the information Respondent

15 last conveyed to her, she reported that on October 25, 2010, she had undergone a right

16 oophorectomy. She learned, however, that she was missing her left ovary and that her right ovary

17 had not been removed. 1t was present a.'1d contained a 3 c.m. complex right ovarian cyst. Had

18 she been fully informed before the surgery, H.M. would not have agreed to it. H.M. eventually

19 sought the care of a.'1other gynecologist who performed the right oophorectomy and consequently,

20 ll.M. has subsequently required continued estrogen replacement H1empy.

21 42. On or about October 25, 2010, Respondent was grossly negligent in his care and

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treatment of patient ll.M., taken singularly or collectively, when he:

------------22 An ovarian fossa is a depression in the parietal peritoneum of the pelvis in which the

ovary is situated.

23 The suspensory ligament of the ovary, also infundibulopelvic ligament (commonly abbreviated IP ligament or simply IP), is a fold of peritoneum that extends out from the ovary to the wall of the pelvis. The peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra~abdominal organs. It is composed of a layer of mcsothelium supported by a thin layer of COMective tissue. The peritoneum both supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves.

12


( 1) Failed to provide her informed consent;

2 (2) Failed to integrate findings from a detailed history and physical exam to

J formulate a plausible diff\.'tential diagnosis and plan of trt~atment;

4 (3) Failed to thoroughly examine and document examining her right ovary during

5 surgery;

6 (4) Surgically removed her left ovary and not her right ovary.

7 Patient C.M.

8 43. On or about Sunday, August 7, 2011, C.M., who was a 34-year-old OB-GY~ patient

9 of Respondent, presented by ambulance to the Antelope Valley Hospital Emergency Room. She

1 o c.omplained of sharp constant right lower quadrant pain. C. M. was at 38 weeks gestation. 24 An

t t immediate ultrasound was obtained to rule out placenta abruption. Prophylactic ampicillin was

12 administered IV for her positive GBS status. Another physician, covering for Respondent,

13 delivered a healthy baby girl weighing 7 pounds, one ounce, having an 8/9 APGAR score afkr a

14 rapid and uneventful labor. During C.\1.'s labor and delivery hospital stay;nursing notes

15 described right sided pain, continuing abdominal distention, and changes in vital signs.

16 44. On or around Monday, August 8, 2011, Respondent re-assumed the cure of the C.M.

17 following her w1eventful vaginal delivery by another physician. C.M. complained of right flank

18 and buck pain. '£be exam was reported as negative and C.M.'s back pain was attributed to

19 chronic muscle strnin. Pathology reported a nomrnl placenta. C.M.'s white blood cell count was

20 4.1.

21 45. On or about August 9, 2011, C.M. complained of back pain of 3 days duration that

22 had decreased. She had a temperature of l 00. l degrees, respiration at 1J8, and a pulse of 120.

23 C.M. 's right-sided abdominal pain, present on admission, persisted but had decreased to a 4/10.

24 Respondent V\-"aS notified by nursing of a change in C.M. 's vital signs when C.M.'s pulse

25 increased to 124 beats per minute, her respirntions were at 118 and her temperature was l 00.1

26 degrees. C.M. required further ob:;crvation. Evaluation for infection was warranted. Further

27

28 24 C.M. was gravida 3, para 2. She had tv.-·o older children.

13 -------------


, studies, including a complete blood count (CBC) and urinalysis, were indicated.

2 46. Cpon reswning care of C.M. post-partum, Respondent failed to adequateJy evaluate

3 C.M.'s status. He described being unaware ofC.:\1.'s evaluated temperature, change in vital

4 signs, and continuous right-sided pain. Respondent discharged C.M. home to her newborn.

5 Respondent later admitted that he never read the nurses notes docwnenting the C.M. 's three-day

6 history of pain and change in vital signs. Doing so would not be part of his custom and practice.

7 47. Two days later, on or about Thursday, August 11, 2011, at 6:20 a.m., C.M. was

8 brought back to the Antelope Valley Hospital Emergency Room. She complained again of sharp

9 right lower quadrant pain. The Emergency Department evaluated C.M. and identified an "acute

10 abdomen" requiring hospital admission. In addition to her right-sided abdominal pain, C.M.

11 complained of nausea and vomiting and gave a three-day history of diarrhea. Her fever had risen

12 ' to 102 degrees. An ultrasound \Vas ordered. Initial labs identified a stable hemoglobin, a

13 depressed white blood cell count (WBC), and abnormal clcclroiytcs. Additionally, C.M. was

14 both hypotensive, with a blood pressure at 90/58, and tachycardic,25 with her heart racing at 148

15 beats per minute.

16 48. Respondent assumed care of C.M. via a text message at 8:49 a.m. which stated a

17 patient was admitted via the E.R., "SVD 2 days? \\1th abd pain." Respondent texted, "What do

18 they think is the diagnosis?" and received a response, "Unclear. CT suggested hemopcritoneum,

19 26 hut not obvious. Perhaps cndomyometritis, 27 but no fover" and ":..1omal H/H, VVS," "VSS."28

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25 Tachycardic: relating to rapid heart rate.

26 Hemoperitoneum (sometimes also hematoperitoneum): the presence of blood in the peritoneal cavity. The blood accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. It is generally classified as a surgical emergency; in most cases, urgent laparotomy is needed to identify and control the source of the bleeding.

27 Endomyometritis: sepsis involving the tissues of the uterus. Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad tenn covering the presence of many types of microscopic disease-causing organisms. The presence of sepsis is indicated by blood tests showing particularly high or low white blood cell coWlts. The causative agent is determined by blood culture. ln some cases the doctor may order imaging studies to rule out pneumonia, or to determine whether the sepsis has developed from a ruptured appendix or other leakage from the digestive tract into the abdomen.

28 Normal vital signs.

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49. The CT was actually an ultrasound which demonstrated material in the uterus and

diffuse fluid in the abdomen. In fact, the patient was febrile, hypotensive and tachycardic with

immunosuppression.29 She complained of nausea, diarrhea, and abdominal pain for days.

Crinalysis showed stable hemoglobin, a low WBC, abnormal cl~ctrolytes.

50. Nursing staff called Respondent four times during the day and requested him to come

evaluate his patient. Respondent was nonresponsive. Respondent also failed to respond to

C.M.'s family members' three documented caJJs to his office requesting him to evaluate C.M. at

the hospital. Instead, Respondent remained in his office during the day. At or about 7 p.m. on

August 11, 2011, Respondent saw his patient C.M. A pelvic ultrasound that had been performed

demonstrated material in C.M.'s endometrial cavity (clots in her uterus) and a large fluid

collection in her abdomen.

51. Ten hours after Respondent assurryed care of the patient, he saw the patient. Despite

the objective information rcfe.rcnced above, Respondent continued with the cndomctritis30 and

hemopcritoncum diagnosis. C.M. had a normal, uncomplicated vaginal delivery and had two

previous children, making most etiologies of blood in the abdomen slim. Further, C.M.'s normal

post-partum hemoglobin level had remained stable. Although C.M. was not bleeding,

Re.'lpondent would carry the diagnosis of endometritis and hcmoperitoncum from C.M. 's second

admission to the hospital, through her surgery and finally to her "record of death."

52. The interpretation on the ultrasound report, which Respondent read (without viewing

the films), and took as fact, was endomctritis and hemopcritoncum. On exam, Respondent found

that her abdomen was distended and tender, with rebound. There is no evidence that Respondent

made himself aware ofC.M.'s depressed WBC31 or abnonnal electrolytes. Coupled with his

29 Immunosuppression: an abnormul condition of the immune system characterized by markedly inhibited ability to rel>'J)Ond to antigenic stimuli.

30 Endometritis: inflammation of the lining of the uterus (endometrium).

31 \.VBC: \Vhite blood cell; or leukocytes, arc the cells of the immune system that are involved in defending the body against both infectious disease and foreign materials. There arc two major categories of white blood cell disorders: proliferative and leukopenias. In the proliforative disorders there is an increase in the number of white blood cells. This increase is commonly reactive (cg., due to infection) but may also be cancerous. In leukopenias there is a

(continued ... )

15 ------··--~·-·-·-····-·--


History and Physical, C.M.'s depressed WBC and abnormal electrolytes indicated sepsis.

2 Although she was in the midst of a gynecologic emergency, Respondent failed to ever perform a

3 pelvic exam on C.M.

4 53. Respondent ordered a CT scan. Results were reported at 9:38 p.m. as hcmatoma in

5 the endometrial cavity, diffuse intra-peritoneal free fluid, distended bowel and intraperitoncal

6 (inside the abdominal cavity) air bubbles. Respondent received the results by telephone. C.M.'s

7 vital signs remained unstable. Despite demonstrated diffuse free fluid and air bubbles in C.M.'s

8 abdomen, however, Respondent did not consider it a surgical emergency. Respondent failed to

9 seek any surgical consult and instead scheduled to perform a D&C32 and laparoscopy himself

1 O without surgical assistance the next day, a Friday, when he normally performed surgeries.

11 54. The CT scan identified diffuse fluid in the abdomen plus air bubbles. This indicates a

J 2 ruptured viscus. 33 There is no evidence that the finding was considered. In that the patient was

13 septic with stable hemoglobins, the differential diagnosis should have explored infectious

14 etiologies including cndomctritis and appendicitis. C.M.'s hemoglobin at 11 was normal and

15 remained stable. Iler white blood-cell count was 3.1 with bands and her bicarb was low. Nurse's

16 notes describe a significantly distended abdomen, firm and tender.

J 7 55. Although a perforation of a viscus was identified, Respondent ordered a soft diet for

18 C.M. until she was made NPO (oral foods and fluids were withheld) atler midnight in preparation

19 for the surgery. No labwork was ordered to be taken until the next morning.

20 56. Respondent failed to reinterpret the radiologist's differential diagnosis to conform to

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decrease in the number of white bloo<l cells. Both proliferative disease and leukopenias are quantitative disorders of white blood cells. Qualitative disorders of white blood cells are another category. These arc disorders in which the number of white blood cells is normal but the cells do not function normally.

32 Dilation ru1d curettage (D&C): a brief surgical procedure in which the cervix is dilated and a sp<..-cial instrument is used to scrape the uterine lining. It is done to: (1) Remove tissue in the uterus during or after a miscarriage or abortion or to remove small pieces of placenta after childbirth. This helps prevent infection or heavy bleeding. (2) Diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat gmwths such as fibroids, polyps, or endometriosis, honnonal imbalances, or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.

33 Viscus: an internal organ

16


known objective findings of C.M. Instt;:ad, Respondent simply took the differential diagnosis

2 provided by radiology as fact; he continued with a diagnosis of endomctritis and

J hemoperitoneum. Respondent failed to evaluate C.M. 's stable hemoglobin of 11 and evidence of

4 sepsis. Respondent never fonned a pelvic examination. Respondent never proposed a plausible

5 differential diagnosis.

6 57. Follov.ing an uncomplicated vaginal delivery withm;t prolonged rupture of

7 membranes, endometritis is characterized by pelvic pain accompanied by foul vaginal discharge

8 and/or heavy bleeding. Work-up requires a pelvic exam. Endometrial sampling is for cytology

9 and cultures, for proper diagnosis and treatment. Removal of retained secundines34 is often the

1 O only treatment required. In this case diagnosis of endometritis was made in the absence of cla<;sic

11 symptomatology. It was never evaluated via pelvic exam or cervical cultures. A D&C was

12 scheduled to be after a 24 hour delay. Pathology was negative for an infectious process or

13 retained tissue.

14 58. The next day, on August 12, 2011, at 10:00 a.m., patient C.M. was taken for the

15 scheduled D&C and laparoscopy. Aware that C.M. 's belly was filled with fluid, Respondent had

16 nonetheless opted to do a laparoscopy ·without any surgical consultation, and without a surgeon

17 readily available. A general surgeon should be present or available during any surgical

18 intervention involving an acute abdomen with sepsis and/or a perforated viscus. Respondent had

19 placed the differential diagnosis provided by radiology as the diagnosis on the surgical note,

20 notwithstanding other objective data not supporting that conclusion. Respondent failed to obtain

21 informed consent for an open procedure.

22 59. Although the pathology had been negative, Respondent perfonned a D&C to obtain

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products of conception. Respondent tried to perform a diagnostic laparoscopy, but it was

precluded by adhesions and purulent fluid. Respondent finally sought surgical consultation. The

unplanned consultation resulted in a one hour intra-operative delay; when a surgeon was called to

the O.R., one was not available for an hour. As a result, C.M. remained under anesthesia for four

34 Secundines: afterbirth; the placenta and fetal membranes expelled from the uterus after childbirth.

17

First Amended Accusation; Case :"'o. 05-2011-214708

hours total.

2 60. A general surgeon arrived. confirmed that C.M.'s appendix had burst and completed

3 an appendectomy. Subsequently, Respondent failed to perform a post-operative evaluation of 4 C.M. and failed to have h<."! sent to an acute care unit. Instead, following the Japarotomy for a

5 ruptured appendix with diffuse purulent fluid, Respondent wrote a post-operative order sending

6 her to medical surgical nursing unit where C.Yl.. would receive routine post-op care. Critical care

7 consultations for this septic patient with hemodynarnic instability who had ju.st undergone four

8 hours of anesthesia and surgery, were only requested several hours later. C.M. 's monitoring

9 results were not checked. An on-call physician assumed care of C.M. at 5:00 p.m. without

Io receiving any communication from Respondent. The on-call physician. covering for Respondent,

11 transferred C.YI. to the intensive care unit at about l 0: 15 p.m. that night and wrote a chart note to

12 Respondent reconunending that C.M.'s incision be reopened in light of the known infectious

13 process.

14 61. The following duy, on or about August 13, 2011, because of acute renal failure, a

15 renal specialist was consulted. A pulmonologist consultation was sought. An infectious disease

16 consult was elicited and farther antibiotic recommendations were given at 7:20 a.m. At the same

17 lime, C.M. went into cardiopulmonary arrest and was pronounced dead at 8:00 a.m.

18 62. On or about August 7 through August 13, 2011, Respondent was grossly negligent in

19 his care and treatment of patient C.M., taken singularly or collectively, when he:

20 (1) failed to recognize C.M.'s acute abdomen and waited twelve hours to intervene;

21 (2) failed to obtain a surgical consult upon admission; and

22 (3) failed to have a generaJ surgeon available at surgery;

23 (4) failed to properly integrate objective data when fonnulating a plan of treatment

24 for C.M.;

25 (5) failed to provide a prompt evaluation, diagnostic studies, interventions and

26 follow-up of C.M.;

27 (6) maintained an unsubstantiated differential diagnosis in spite of contradictory

28 evidence and the patient1s clinical course; and

18 ------------··· ··---·-- -·· --------· ------ w•••·-•·-----

First Amended Accusation; Case No. 05-2011-214 708

1 (7) failed to adequately cvalua~e this patient, taken singularly or collectively, on

2 four occasions, including: (a) Prior to discharge post-partum; (b) promptly upon her

3 readmission; (c) prior to formulating a treatment plan; i:md (d) following a lengthy major

4 surgery.

5 SECO~D CAUSE FOR DISCIPLll\'E

6 (Repeated ~egligcnt Acts)

7 63. Respondent is subject to disciplinary action Wlder section 2234, subdivision (c), of

8 the Code in that he was repeatedly negligent in the care and treatment of four patients. The

9 circumstances are as follows:

I 0 Patient C.S. I

11 i 64. The facts and circumstances as alleged in paragraphs 9 through 27 are incorporated


13 65. Respondent was repeatedly negligent in his care and treatment of C.S. when he:

14 ( 1) initiated obstetric care of C.S. without first obtaining, taken singularly or

t 5 collectively, a complete: (a) history of her thcn-ctU'rent pregnancy; (b) list of her thcn-

16 current medications; and (c) family history;

t 7 (2) failed to recognize the risk of thrombosis in patient C.S.;

18 (3) failed to anti-coagulate C.S. for weeks following a c-section;

19 ( 4) taken singularly and collectively, failed to document: (a) the circumstances of

20 the C.S.'s 1VF; (b) the medications prescribed; (c) the initial ultra.sound exams; (d) the

21 IVF as it a.fleeted the calculation of the EDC; ( e) medications taken or complications

22 before and during C.S. 's pregnancy; (t) antepartum treatment plans; (g) perinatology

23 consults; (h) evidence of considering recommendations of consultants; and (i) C.S.'s

24 family history of coagulopathy;

25 (5) taken singularly and collectively, failed to make proper use ofC.S.'s

26 reproductive endocrinologist and perinatologist, by failing to: (a) communicate with them;

27 (b) note their findings; and (c) duly consider their recommendations.

28 / / /

19


Patient H.M.

2 66. The facts and circumstances alleged in paragraphs 29 through 41 arc incorporated


4 67. On or about October 25, 2010, Respondent was repeatedly negligent in his care and

5 treatment of patient H.M. when he:

6 (1) Failed to provide her informed consent;

7 (2) Failed to integrate findings from a detailed history and physical exam to

8 fonnulate a plausibie differential diagnosis and plan of treatment.

9 (3) Failed to thoroughly examine and document examining her right ovary during

10 surgery;

l I ( 4) Surgically removed her left ovary and not her right ovary;

12 (5) Used a pelvic ultrasound for evaluation of her pelvic pain;

13 (6) Lacked ability to and thereby fa.iled to integrate basic knowledge ofovarian

14 physiology into the plru1 of treatment of H.M.;

15 (7) Failed to completely and accurately document subjective and objective findings,

16 assessment of the patient's condition and treatment phm.

17 Patient C.M.

18 68. The facts and circumstances alleged in pamgraphs 43 to 61 are incorporated here as if

19 fully set forth.

20 69. On or about August 8 through August 13, 2011, Respondent was repeatedly negligent

21 in his care and treatment of patient C.M. when he:

22 (1) failed to recognize C.M.'s acute abdomen and waited twelve hours to intervene;

23 (2) foHed to obtain a surgical consult upon admission; and

24 (3) failed to have a general surgeon available at surgery;

25 (4) failed to properly integrate objective data when formulating a plrm of treatment

26 for C.M.;

27 (5) failed to provide a prompt evaluation, diagnostic studies, interventions and

28 follow-up of C.M.;

20 ·-----·------·- ..

First Amended Accusation; Case No. 05-2011-21'170&

(6) maintained an unsubstantiated differential diagnosis in spite of contradictory

2 evidence and the patient's clinical course; and

3 (7) failed to adequately evaluate this patient, taken singularly or collectively, on

4 four occa'>ions, including: (a) Prior to discharge post-partum; (b) promptly upon her

5 readmission; (c) prior to formulating a treatment plan; and (d) following a lengthy major

6 surgery.

7 (8) failed to respond to multiple telephone requests to come to see his patient, who

8 had required emergent admission to the hospital;

9 (9) discharged C.M. from the hospital on August 9, 2011, without ensuring that she

1 o was stable, resolving her complaints, ensuring her vital signs were stable and ensuring that

11 her prognostic indicators were improving; and

12 (9) failed to properly diagnose and treat the presumed endomctritis of C.M.

13 Patient K.Q.

14 70. On or about September 10, 2008, patient K.Q. presented to Respondent for an annual

15 examination. She reported heavy menstrual periods and surgical options were reviewed.

16 Hemoglobin was tested at 13.5. At an appointment on or abou.t September 23, 2008, patient K.Q.

J 7 saw Respondent and complained of heavy irregular menses, with clotting, and cramping. Oral

18 contraceptives had not helped and her husband had had a vasectomy. She also complained that

19 her labia was too large and caused her discomfort. On exam the labia minora were noted to be

20 "elongated (and) hypertrophied." She was given the surgical options of hyslcroscopy, and/or.

21 endomctrial ablation, along \\rith labiapla<1ty. She chose endometrial ablation and labiaplasty.

22 71. On or about October 9, 2008, an ultrasound was reported as nonnal, except for

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thickening of the endometrium. An endometrial biopsy was performed in the office demonstrating

benign pathology.

72. On or about October 24, 2008, at the Antelope Valley Surgery Center, Respondent I 26 performed a diagnostic hystcroscopy, cndomctrial ablation with novasurc and a vaginal 1

1

labiaplasty on patient K.Q. 27

73. Respondent could not adequately d::il or demonstrate a thorough knowledge of the I First Amended Accusation; Case No. 05-201 l-2147ost

28

lahiaplasty procedure. He was not familiar \\ith multiple proven techniques. Likewise, he was

2 not familiar with possible complications wit11 labiaplasty, including common complications with

3 the procedure.

4 74. Respondent performed novasure endomctrial ablation and labiaplasty together and

5 without prophylactic antibiotics despite the risk of contamination, creating a risk of infection at

6 the lubiaplasty suture line. A Iabiaplasty suture line must be kept clean and dry. However, an

7 endometrial ablation involves cauterizing the lining of the uterus creating an open wound that

8 drains for four to eight weeks post-op requiring the patient to wear an absorbant perinea! pad

9 continuously. The drainage from an endometrial ablation would result in a continuous flow of

10 bacteria from the vagina to the suture line, the use of perinea! pads would cause the area to remain

11 moist, allowing bacteria from the rectum to seed the area, and it would serve as a constant irritant

12 to the wound. Prophylactic antibiotics would be indicated.

13 75. The operative report regarding the labiaplasty states:

14 "The labia was extended and marked with a marking pen bilaterally and the excess labial

15 tissue was transected with Metzcnbaum scissors. The labia on each side were reapproximated in

16 two layers the deep layer with 3-0 Vicryl suture in a running stitch and the superficial layer with

17 4-0 Monocryl suture in a subcuticular stitch. Good hemostasis nt t!-ic end of the case." The

18 documentation is inadequate. [t fails to include details of surgical techniques employed, the type

19 of incision, and the location and placement of incisions and sutures.

20 76. Prior to surgery, regarding the labiaplasty, Respondent failed to document that he

21 completely described all surgical procedures to be performed, the more commonly encountered

22 complications and alternative treatments available. The written consent was limited to

23 describing endometrial ablation and a potential blood transfusion. Optional techniques, with

24 their specific risks and benefits, were not reviewed with the patient. Chronic pain was not

25 discussed. Complete disclosure must include changes in vulvar ruage and/or vasculature resulting

26 from the placement of incisions or suture. The labia have significant vasculruization, frequently

27 resulting in hcmatoma, making dehiscencc a significant risk. Respondent subsequently stated the

28 most common complications were only infection and asymmetry.

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77. On or about October 24, 2008, Respondent was repeatedly negligent in his care and

treatment of patient K.Q. when he:

(1) Performed a labiaplasty on patient K.Q. without having the necessary training

a..'1d knowledge to do so;

(2) Combined surgical procedures on K.Q. by performing both an endomctrial

ablation and a labiaplasty;

(3) Failed to adequately document the surgical procedures performed in the

labiaplasty; and

(4) Failed to obtain adequate informed consent from K.Q. regarding the surgeries.

THIRD CAUSE FOR DISCIPLINE

(Medical Record-Keeping)

78. Respondent is subject to disciplinary action under section 2266 in that he failed to

maintain adequate and accurate records relating to the provision of services to two patients,

thereby committing unprofessional conduct. The circumstances are as follows:

79. Paragraphs 9 through 27 referencing patient C.S. arc incorporated herein as if fully

set forth.

80. Paragraphs 70 through 76 referencing patient K.Q. are incorporated herein as if fully

set forth.

FOURTH CAUSE FOR DISCIPLINE

(J ncompetence)

81. Respondent is subj~t to disciplinary action 1.mder section 2234, subdivision (d), of

the Code in that he was incompetent in the care and treatment of three patients. The

circumstances are as follows:

82. The fact'> and circumstances alleged in paragraphs 29 through 42 above arc

incorporated here as if fully set forth.

83. On or abou~ October 25, 2010, in his care and treatment of patient H.M., Respondent

demonstrated a lack of knowledge regarding ovarian cysts, the pathogenesis of pelvic adhesions

following gynecologic surgery, the etiologies of pelvic pain, abdominal ultrasounds, the

23

First Amcnckt! /\ccusa!ion; Case No. 05-2011-2 l 4i08

pathophysiology underlying abdominal ultrasounds, the integration of basic knowledge of ovarian

2 physiology into a plan of treatment, the removal of ovaries adherent to the pelvic sidewall, and

3 the diagnostic work-up and treatment plan of pelvic pain.

4 84. The facts and circumstances alleged in paragraphs 43 through 62 above are

5 incorporated here as if fully set forth.

6 85. On or about August 7 though August 13, 2011, in his care and treatment of patient

7 C.M., Respondent demonstrated a lack of knowledge about: the diagnosis of appendicitis in

8 pregnancy; the diagnosis and treatment of the acute abdomen; the diagnosis of sepsis; the

9 interpretation of CT findings of free air in the abdomen; the disease process of sepsis and

10 appendicitis post- partwn; and the disease process of endometritis.

11 86. The facts and circumsta.'1ces alleged in paragraphs 70 through 77 above are

12 incorporated here as if fully set forth.

13 87. On or about October 24, 2008, in his care and treatment of patient K.Q., Respondent

14 demonstrated a lack of knowledge about the labiaplasty surgical procedure.

15 JllSCIPLINARY CONSIDERATIONS

16 88. To determine the degree of discipline, if any, to be imposed on Respondent,

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

18 Matter of the Accusation Against Leonard Sunil Kurian, Y1.D. before the Medical Board of

19 California, in Case Number 05-2003-145058, Respondent was issued a public letter of reprimand

20 and required to complete a clinical training program, record keeping course and ethics course

21 based on allegations of unprofessional conduct in the care and treatment of a patient. That

22 decision is now final and is inc-0rporated by reference as if fully set forth.

23 PRAYER

24 WI IEREFORE, Complainant requests that a hearing be held on the matters herein alleged,

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

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

27 issued to Leonard Sunil Kurian, M.D.;

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

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First Amended Accusation; Case No. 05-201 l-2l470S,

physician assistants, pursuant to section 3527 of the Code;

2 3. Ordering Respondent, if placed on probation, to pay the 'Yfcdical Board of California

3 the costs of probation monitoring; and

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

6 DA TED: April 8, 2014

7 Executive Director Medical Board of California

8 Department of Consumer Affairs State of California

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Complainant

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