before the medical board of california department of ...4patientsafety.org/documents/lehman, kent...

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation ) Against: )

) )

KENT WALTER LEHMAN, M.D.)

Physician's and Surgeon's Certificate No. G 38595

Respondent

) ) ) ) )

Case No. 09-2012-225474

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 5:00p.m. on November 18, 2016.

IT IS SO ORDERED: October 20, 2016.

MEDICAL BOARD OF CALIFORNIA

KAMALA D. HARRIS Attorney General of California

2 E. A. JONES III Supervising Deputy Attorney General

3 RANDALL R. MURPHY Deputy Attorney General

4 State BarNo. 165851 California Department of Justice

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

6 Telephone: (213) 897-2493 Facsimile: (213) 897-9395

7 Attorneys for Complainant

8 BEFORETHE MEDICAL BOARD OF CALIFORNIA

9 DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

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11 In the Matter of the Accusation Against:

12 KENT LEHMAN, M.D. 999 North Tustin Ave, #222

13 Santa Ana, CA 92705

14 Physician's and Surgeon's Certificate No. G 38595,

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Respondent.

Case No. 09-2012-225474

OAH No. 2016010891

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

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

23 this matter by Kamala D. Harris, Attorney General of the State of California, by Randall R.

24 Murphy, Deputy Attorney General.

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2. Respondent KENT LEHMAN, M.D. ("Respondent") is represented in this proceeding

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by attorney William Behrndt, whose address is:

William Behrndt, Esq. 2913 El Camino Real, #219 Tustin, CA 92782

STIPULATED SETTLEMENT (09-2012-225474)

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3. On or about December 21, 1978, the Medical Board of California issued Physician's

and Surgeon's Certificate No. G 38595 to Kent Lehman, M.D. (Respondent). The Physician's and

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

Accusation No. 09-2012-225474, and will expire on December 31, 2016, unless renewed.

JURISDICTION

4. Accusation No. 09-2012-225474 was filed before the Medical Board of California

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

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

December 11,2015. Respondent timely fl.led his Notice ofDefense contesting the Accusation.

5. A copy of Accusation No. 09-2012-225474 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. 09-2012-225474. 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 ofhis 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.

CULPABILITY

9. Respondent understands and agrees that the charges and allegations in Accusation

No. 09-2012-225474, if proven at a hearing, constitute cause for imposing discipline upon his

Physician's and Surgeon's Certificate.

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1 10. For the purpose of resolving the Accusation without the expense and uncertainty of

2 further proceedings, Respondent agrees that, at a hearing, Complainant could establish a factual

3 basis for the charges in the Accusation, and that Respondent hereby gives up his right to contest

4 those charges.

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

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

7 Disciplinary Order below.

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

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

10 allegations contained in Accusation No. 09-2012-225474 shall be deemed true, correct and fully

11 admitted by respondent for purposes of that proceeding or any other licensing proceeding

12 involving respondent in the State of California.

13 CONTINGENCY

14 13. This stipulation shall be subject to approval by the Medical Board ofCalifornia.

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

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

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

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

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

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

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

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

23 considered this matter.

24 14. The parties understand and agree that Portable Document Format (PDF) and facsimile

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

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

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1 15. In consideration of the foregoing admissions and stipulations, the parties agree that

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

3 Disciplinary Order:

4 DISCIPLINARY ORDER

5 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. G 38595 issued

6 to Respondent Kent Lehman, M.D. is revoked. However, the revocation is stayed and

7 Respondent is placed on probation for eight (8) years on the following terms and conditions.

8 1. CONTROLLED SUBSTANCES- PARTIAL RESTRICTION. Respondent shall not

9 order, prescribe, dispense, administer, furnish, or possess any controlled substances as defined by

10 the California Uniform Controlled Substances Act, except for the Schedule III drugs of

11 Phendimetrizine and Testosterone, the Schedule IV drugs of Phentermine and Nuvigil/Provigil

12 and Schedule V drugs. At the end of the fourth year of probation, Respondent may request that

13 the restrictions listed in this paragraph be lifted. The Board or its designee, after reviewing all

14 aspects of Respondent conduct on probation and exercising its discretion, may grant

15 Respondent's request.

16 Respondent shall not issue an oral or written recommendation or approval to a patient or a

17 patient's primary caregiver for the possession or cultivation of marijuana for the personal medical

18 purposes of the patient within the meaning of Health and Safety Code section 11362.5. If

19 Respondent fonns the medical opinion, after an appropriate prior examination and medical

20 indication, that a patient's medical condition may benefit from the use of marijuana, Respondent

21 shall so infonn the patient and shall refer the patient to another physician who, following an

22 appropriate prior examination and medical indication, may independently issue a medically

23 appropriate recommendation or approval for the possession or cultivation of marijuana for the

24 personal medical purposes of the patient within the meaning of Health and Safety Code section

25 11362.5. In addition, Respondent shall inform the patient or the patient's primary caregiver that

26 Respondent is prohibited from issuing a recommendation or approval for the possession or

27 cultivation of marijuana for the personal medical purposes of the patient and that the patient or

28 the patient's primary caregiver may not rely on Respondent's statements to legally possess or

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1 cultivate marijuana for the personal medical purposes of the patient. Respondent shall fully

2 document in the patient's chart that the patient or the patient's primary caregiver was so

3 informed. Nothing in this condition prohibits Respondent from providing the patient or the

4 patient's primary caregiver information about the possible medical benefits resulting from the use

5 of marijuana.

6 Respondent shall immediately surrender Respondent's current DEA pennit to the Drug

7 Enforcement Administration for cancellation and reapply for a new DEA permit limited to those

8 Schedules authorized by this order. Within 15 calendar days after the effective date of this

9 Decision, Respondent shall submit proof that Respondent has surrendered Respondent's DEA

10 pennit to the Drug Enforcement Administration for cancellation andre-issuance. Within 15

11 calendar days after the effective date of issuance of a new DEA pennit, Respondent shall submit a

12 true copy of the permit to the Board or its designee.

13 2. CONTROLLED SUBSTANCES- MAINTAIN RECORDS AND ACCESS TO

14 RECORDS AND INVENTORIES. Respondent shall maintain a record of all controlled

15 substances ordered, prescribed, dispensed, administered, or possessed by Respondent, and any

16 recommendation or approval which enables a patient or patient's primary caregiver to possess or

17 cultivate marijuana for the personal medical purposes of the patient within the meaning of Health

18 and Safety Code section 11362.5, during probation, showing all the following: 1) the name and

19 address of patient; 2) the date; 3) the character and quantity of controlled substances involved;

20 and 4) the indications and diagnosis for which the controlled substances were furnished.

21 Respondent shall keep these records in a separate file or ledger, in chronological order. All

22 records and any inventories of controlled substances shall be available for immediate inspection

23 and copying on the premises by the Board or its designee at all times during business hours and

24 shall be retained for the entire tenn of probation.

25 3. EDUCATION COURSE. Within 60 calendar days of the effective date of this

26 Decision, and on an annual basis thereafter, Respondent shall submit to the Board or its designee

27 for its prior approval educational program(s) or course(s) which shall not be less than 40 hours

28 per year, for each year of probation. The educational program( s) or course( s) shall be aimed at

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correcting any areas of deficient practice or knowledge and shall be Category I certified. The

educational program(s) or course(s) shall be at Respondent's expense and shall be in addition to

the Continuing Medical Education (CME) requirements for renewal of licensure. Following the

completion of each course, the Board or its designee may administer an examination to test

Respondent's knowledge of the course. Respondent shall provide proof of attendance for 65

hours of CME of which 40 hours were in satisfaction of this condition.

4. PRESCRIBING PRACTICES COURSE. Within 60 calendar days of the effective

date of this Decision, Respondent shall enroll in a course in prescribing practices equivalent to the

Prescribing Practices Course at the Physician Assessment and Clinical Education Program,

University of California, San Diego School of Medicine (Program), approved in advance by the

Board or its designee. Respondent shall provide the program with any information and documents

that the Program may deem pertinent. Respondent shall participate in and successfully complete

the classroom component of the course not later than six (6) months after Respondent's initial

enrollment. Respondent shall successfully complete any other component of the course within

one (1) year of enrollment. The prescribing practices course shall be at Respondent's expense

and shall be in 'addition to the Continuing Medical Education (CME) requirements for renewal of

licensure.

A prescribing practices course taken after the acts that gave rise to the charges in the

Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

or its designee, be accepted towards the fulfillment of this condition if the course would have

been approved by the Board or its designee had the course been taken after the effective date of

this Decision.

Respondent shall submit a certification of successful completion to the Board or its

designee not later than 15 calendar days after successfully completing the course, or not later than

15 calendar days after the effective date of the Decision, whichever is later.

5. MEDICAL RECORD KEEPING COURSE. Within 60 calendar days of the effective

date of this Decision, Respondent shall enroll in a course in medical record keeping equivalent to

the Medical Record Keeping Course offered by the Physician Assessment and Clinical Education

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1 Program, University of California, San Diego School of Medicine (Program), approved in

2 advance by the Board or its designee. Respondent shall provide the program with any information

3 and documents that the Program may deem pertinent. Respondent shall participate in and

4 successfully complete the classroom component of the course not later than six (6) months after

5 Respondent's initial enrollment. Respondent shall successfully complete any other component of

6 the course within one (1) year of enrollment. The medical record keeping course shall be at

7 Respondent's expense and shall be in addition to the Continuing Medical Education (CME)

8 requirements for renewal oflicensure.

9 A medical record keeping course taken after the acts that gave rise to the charges in the

10 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

11 or its designee, be accepted towards the fulfillment of this condition if the course would have

12 been approved by the Board or its designee had the course been taken after the effective date of

13 this Decision.

14 Respondent shall submit a certification of successful completion to the Board or its

15 designee not later than 15 calendar days after successfully completing the course, or not later than

16 15 calendar days after the effective date of the Decision, whichever is later.

17 6. PROFESSIONALISM PROGRAM (ETHICS COURSE). Within 60 calendar days of

18 the effective date of this Decision, Respondent shall enroll in a professionalism program, that

19 meets the requirements ofTitle 16, California Code ofRegulations ("CCR") section 1358.

20 Respondent shall participate in and successfully complete that program. Respondent shall

21 provide any inforn1ation and documents that the program may deem pertinent. Respondent shall

22 successfully complete the classroom component of the program not later than six (6) months after

23 Respondent's initial enrollment, and the longitudinal component of the program not later than the

24 time specified by the program, but no later than one (1) year after attending the classroom

25 component. The professionalism program shall be at Respondent's expense and shall be in

26 addition to the Continuing Medical Education (CME) requirements for renewal of licensure.

27 A professionalism program taken after the acts that gave rise to the charges in the

28 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

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1 or its designee, be accepted towards the fulfillment of this condition if the program would have

2 been approved by the Board or its designee had the program been taken after the effective date of

3 this Decision.

4 Respondent shall submit a certification of successful completion to the Board or its

5 designee not later than 15 calendar days after successfully completing the program or not later

6 than 15 calendar days after the effective date of the Decision, whichever is later.

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

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

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

10 California- San Diego School of Medicine ("Program") (such as the CPEP Program, at the

11 Center for Personalized Education for Physicians, located in Denver, Colorado). Respondent

12 shall successfully complete the Program not later than six (6) months after Respondent's initial

13 enrollment unless the Board or its designee agrees in writing to an extension of that time.

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

15 day assessment ofRespondent's physical and mental health; basic clinical and communication

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

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

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

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

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

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

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

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

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

25 condition, treatm.ent for any psychological condition, or anything else affecting Respondent's

26 practice of medicine. Respondent shall comply with Program recommendations.

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

28 submit to and pass an examination. Detennination as to whether Respondent successfully

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

2 jurisdiction.

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

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

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

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

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

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

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

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

11 the probationary time period.

12 Within 60 days after Respondent has successfully completed the clinical training program,

13 Respondent shall participate in a professional enhancement program equivalent to the one offered

14 by the Physician Assessment and Clinical Education Program at the University of California, San

15 Diego School of Medicine, which shall include quarterly chart review, semi-annual practice

16 assessment, and semi-annual review of professional growth and education. Respondent shall

17 participate in the professional enhancement program at Respondent's expense during the tenn of

18 probation, or until the Board or its designee determines that further participation is no longer

19 necessary.

20 8. MONITORING- PRACTICE. Within 30 calendar days of the effective date of this

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1 5 shall cease the practice of medicine until a monitor is approved to provide monitoring

16 responsibility.

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

18 includes an evaluation of Respondent's perfonnance, indicating whether Respondent's practices

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

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

21 qumierly written reports to the Board or its designee within 10 calendar days after the end of the

22 preceding quarter.

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

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

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

26 15 calendar days. If Respondent fails to obtain approval of a replacement monitor within 60

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

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

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

2 replacement monitor is approved and assumes monitoring responsibility.

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

4 ("PEP") equivalent to the one offered by the Physician Assessment and Clinical Education

5 Program at the University of California, San Diego School of Medicine, that includes, at

6 minimum, quarterly chart review, semi-annual practice assessment, and semi-annual review of

7 professional growth and education. Respondent's participation in a PEP would be at

8 Respondent's own expense during the tenn of probation if he chooses that option.

9 9. NOTIFICATION. Within seven (7) days of the effective date of this Decision, the

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

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

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

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

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

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

16 calendar days.

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

18 10. SUPERVISION OF PHYSICIAN ASSISTANTS. During probation, Respondent is

19 prohibited from supervising physician assistants.

20 11. OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules

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

22 ordered criminal probation, payments, and other orders.

23 12. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations

24 under penalty of perjury on fonns provided by the Board, stating whether there has been

25 compliance with all the conditions of probation.

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

27 of the preceding quarter.

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13. GENERAL PROBATION REQUIREMENTS.

2 Compliance with Probation Unit

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

4 this Decision.

5 Address Changes

6 Respondent shall, at all times, keep the Board infonned of Respondent's business and

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

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

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

10 and Professions Code section 2021 (b).

11 Place of Practice

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

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

14 facility.

15 License Renewal

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

17 license.

18 Travel or Residence Outside California

19 Respondent shall immediately inform the Board or its designee, in writing, of travel to any

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

21 (30) calendar days.

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

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

24 departure and return.

25 14. INTERVIEW WITH THE BOARD OR ITS DESIGNEE. Respondent shall be

26 available in person upon request for interviews either at Respondent's place ofbusiness or at the

27 probation unit office, with or without prior notice throughout the tenn of probation.

28 15. NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or

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

2 30 calendar days and within 15 calendar days of Respondent's return to practice. Non-practice is

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

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

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

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

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

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

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

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

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

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

13 of Condition 18 of the current version of the Board's "Manual of Model Disciplinary Orders and

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

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

16 Periods of non-practice will not apply to the reduction of the probationary tenn.

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

18 probationary tenns and conditions with the exception of this condition and the following terms

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

20 16. COMPLETION OF PROBATION. Respondent shall comply with all financial

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

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

23 be fully restored.

24 17. VIOLATION OF PROBATION. Failure to fully comply with any term or condition

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

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

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

28 or an Interim Suspension Order is filed against Respondent during probation, the Board shall have

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continuing jurisdiction until the matter is final, and the period of probation shall be extended until

2 the matter is final.

3 18. LICENSE SURRENDER. FollO\ving the effective date of this Decision, if

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

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

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

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

8 and reasonable under the circumstances. Upon formal acceptance of the sunender, Respondent

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

l 0 designee and Respondent shall no longer practice medicine. Respondent \Vill no longer be subject

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

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

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

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

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

16 California and delivered to the Board or its designee no later than 1 anuary 31 of each calendar

17 year.

18 ACCEPTANCE

19 r have carefully read the above Stipulated Settlement and Disciplinary Order and have fully

20 discussed it with my attomey, \Villiam Behrnclt. 1 understand the stipulation and the effect it will

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

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

23 Decision and Order of the Medical Board of Califomia.

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Kent Lehman, M.D. Respondent

I have read and fully discussed with Respondent KENT LEHMAN, M.D. the tenns and

2 conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order.

3 I approve its form and content.

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DATED: :_;_jJ v //6 William Beh;ndt l~,. Attorneyfor Respondent

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7 ENDORSEMEN'I:

8 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

9 submitted for consideration by the Medical Board of California.

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Dated:

LA20; 5601239 61975399.doc

Respectfully submitted,

KAMALA D. HARRlS Attorney General of California E. A. JONES Ill Supervising Deputy Attomey General

RANDALL R. MURPHY Deputy Attorney General Attorneysfor Complainant

I have read and fully discussed with Respondent KENT LEHMAN, M.D. the terms and



4 DATED: William Behrndt

5 Attorneyfor Respondent

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7 ENDORSEMENT


9 submitted for consideration by the Medical Board of California.

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Dated (r' /1) j /1/

LA2015601239 61975399.doc

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Respectfully submitted,

KAMALA D. HARRIS Attorney General of California E. A. JONES Ill Supervising Deputy Attorney General

/~/ /l ,/ '/ I,//

,// It--/; / / / /

RANDALL R. MURPHY Deputy Attorney GeneraY Attorneys for Complainant


Exhibit A

Accusation No. 13-2012-225474

KAMALA D. HARRIS Attorney General of California

2 ROBERT MCKIM BELL Supervising Deputy Attorney General

3 RANDALL R. MURPHY Deputy Attorney General

4 State Bar No. 165851 California Department of Justice

5 300 South Spring Street, Suite 1702 Los Angeles, California 900 13

6 Telephone: (213) 897-2493 Facsimile: (213) 897-9395


FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA SACj;!:Et';J/!j!f/ll)xr II 20 IS BY , L/. ANALYST

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BEFORE THE 8

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MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

11 In the Matter of the Accusation Against: Case No. 09-2012-225474

12 KENT LEHMAN, M.D.

999 North Tustin Avenue, #222 Santa Ana, California 92705

ACCUSATION

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Physician's and Surgeon's Certificate G 38595,

Respondent.

18 Complainant alleges:

19 PARTIES

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

21 capacity as the Executive Director of the Medical Board of California, Department of Consumer

22 Affairs (Board).

23 2. On or about December 21, 1978, the Medical Board issued Physician's and Surgeon's

24 Certificate Number G 38595 to Kent Lehman, M.D. ("Respondent"). That license was in full

25 force and effect at all times relevant to the charges brought herein and will expire on December

26 31, 2016, unless renewed.

27 3. In a disciplinary action entitled In the Matter of the Accusation Against Kent

28 Lehman, lvf.D., Case No 04-1990-001604, the Board issued a decision, effective September 12,

(KENT LEHMAN, M.D.) ACCUSATION NO. 09-2012-225474

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1992, in which Respondent's Physician's and Surgeon's Cetiificate was revoked. However, the

revocation was stayed and Respondent's license was placed on probation for a period often years

with certain terms and conditions. A copy of that decision is attached as Exhibit A and is

incorporated by reference.

4. In a second disciplinary action entitled In the Matter of the Accusation and Petition

to Revoke Probation Against Kent Lehman, MD., Case No D 1-1990-001604, the Board issued a

decision, effective May 6, 2004, in which Respondent's Physician's and Surgeon's Certificate was

revoked. However, the revocation was stayed and Respondent's license was placed on probation

for a period of five years with certain terms and conditions. A copy of that decision is attached as

Exhibit B and is incorporated by reference.

JURISDICTION

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

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

indicated.

6. The Medical Practice Act ("Act") is codified at sections 2000-2521 of the Business

and Professions Code.

7. Pursuant to Code section 2001.1, the Board's highest priority is public protection.

8. Section 2004 of the Code states:

"The board shall have the responsibility for the following:

"(a) The enforcement of the disciplinary and criminal provisions ofthe Medical

Practice Act.

"(b) The administration and hearing of disciplinary actions.

"(c) Carrying out disciplinary actions appropriate to findings made by a panel or an

administrative law judge.

"(d) Suspending, revoking, or otherwise limiting certificates after the conclusion of

disciplinary actions.

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"(e) Reviewing the quality of medical practice carried out by physician and surgeon

2 certificate holders under the jurisdiction of the board.

3 " "

4 9. Code section 2227, subdivision (a), provides as follows:

5 "(a) A licensee whose matter has been heard by an administrative law judge ofthe Medical Quality Hearing Panel as designated in Section 11371 ofthe

6 Government Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in

7 accordance with the provisions of this chapter:

8 "(I) Have his or her license revoked upon order of the board.

9 "(2) Have his or her right to practice suspended for a period not to exceed

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one year upon order of the board.

"(3) Be placed on probation and be required to pay the costs of probation monitoring upon order of the board.

"(4) Be publicly reprimanded by the board. The public reprimand may include a requirement that the licensee complete relevant educational courses approved by the board.

"(5) Have any other action taken in relation to discipline as part of an order of probation, as the board or an administrative law judge may deem proper.

"(b) Any matter heard pursuant to subdivision (a), except for warning letters, medical review or advisory conferences, professional competency examinations, continuing education activities, and cost reimbursement associated therewith that are agreed to with the board and successfully completed by the licensee, or other matters made confidential or privileged by existing law, is deemed public, and shall be made available to the public by the board pursuant to Section 803.1."

10. 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.

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

2 acts or omissions. An initial negligent act or omission followed by a separate and distinct

3 departure from the applicable standard of care shall constitute repeated negligent acts.

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

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

6 negligent act.

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

8 omission that constitutes the negligent act described in paragraph (1 ), including, but

9 not limited to, a reevaluation of the diagnosis or a change in treatment, and the

10 licensee's conduct departs from the applicable standard of care, each departure

11 constitutes a separate and distinct breach of the standard of care.

12 "(d) Incompetence.

13 "(e) The commission of any act involving dishonesty or corruption which is

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

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

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

17 meeting the legal requirements of that state or country for the practice of medicine. Section

18 2314 shall not apply to this subdivision. This subdivision shall become operative upon the

19 implementation of the proposed registration program described in Section 2052.5.

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

21 attend and participate in an interview by the board. This subdivision shall only apply to a

22 certificate holder who is the subject of an investigation by the board."

23 11. Section 2238 of the Code states: "A violation of any federal statute or federal

24 regulation or any of the statutes or regulations ofthis state regulating dangerous drugs or

25 controlled substances constitutes unprofessional conduct."

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12. Section 2242 ofthe Code states:

2 "(a) Prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022

3 without an appropriate prior examination and a medical indication, constitutes unprofessional

4 conduct.

5 "(b) No licensee shall be found to have committed unprofessional conduct within the

6 meaning of this section if, at the time the drugs were prescribed, dispensed, or furnished, any of

7 the following applies:

8 "(1) The licensee was a designated physician and surgeon or podiatrist serving in the

9 absence of the patient's physician and surgeon or podiatrist, as the case may be, and if the drugs

10 were prescribed, dispensed, or furnished only as necessary to maintain the patient until the return

11 of his or her practitioner, but in any case no longer than 72 hours.

12 "(2) The licensee transmitted the order for the drugs to a registered nurse or to a licensed

13 vocational nurse in an inpatient facility, and ifboth of the following conditions exist:

14 "(A) The practitioner had consulted with the registered nurse or licensed vocational

15 nurse who had reviewed the patient's records.

16 "(B) The practitioner was designated as the practitioner to serve in the absence of the

17 patient's physician and surgeon or podiatrist, as the case may be.

18 "(3) The licensee was a designated practitioner serving in the absence of the patient's

19 physician and surgeon or podiatrist, as the case may be, and was in possession of or had utilized

20 the patient's records and ordered the renewal of a medically indicated prescription for an amount

21 not exceeding the original prescription in strength or amount or for more than one refill.

22 "(4) The licensee was acting in accordance with Section 120582 of the Health and Safety

23 Code."

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

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

26 unprofessional conduct."

27 14. Health & Safety Code section 11154 states:

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"(a) Except in the regular practice of his or her profession, no person shall knowingly

2 prescribe, administer, dispense, or furnish a controlled substance to or for any person or animal

3 which is not under his or her treatment for a pathology or condition other than addiction to a

4 controlled substance, except as provided in this division."

5 15. Health & Safety Code section 11173 states in relevant part:

6 "(a) No person shall obtain or attempt to obtain controlled substances, or procure or

7 attempt to procure the administration of or prescription for controlled substances, (1) by fraud,

8 deceit, misrepresentation, or subterfuge; or (2) by the concealment of a material fact.

9 (b) No person shall make a false statement in any prescription, order, report, or

10 record, required by this division."

11 FACTS

12 PATIENT L.A.

13 16. Respondent began treating L.A. on June 25, 2010, for chronic pain related to

14 rheumatoid arthritis. He continued to treat L.A. until at least February 7, 2014.

15 17. Respondent's initial progress note dated June 25, 2010, indicates that L.A. had

16 previously received treatment for pain from another physician, whom Respondent identified. He

17 indicated the prior physician had terminated L.A. from his practice because L.A. tested positive

18 for "meth." (The documentation suggests it was methadone as opposed to methamphetamine.)

19 There are no other details about L.A.'s prior pain management.

20 18. Respondent's June 25, 2010 note is brief, provides little detail regarding L.A.'s

21 presenting pain symptoms and includes almost no evidence of any physical examination.

22 Respondent's diagnosis was that L.A. suffered from kyphoscoliosis and also had severe

23 rheumatoid hands. There is no documentation concerning L.A.'s substance abuse history apart

24 from a medical history form included in the records that does not have a name or date but appears

25 to be L.A.'s form, because it indicates a prior history of rheumatoid arthritis. On the form, L.A.

26 indicates that he did not have an alcohol or drug problem. There is no indication in the chart that

27 Respondent checked a urine drug screen or a CURES report prior to prescribing opioids to L.A.

28 The diagnoses are listed as mihritis, back pain, scoliosis and fatigue-malaise. There is no

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treatment plan apart from a prescription for OxyContin 80 mg #901

and hydrocodone/

2 acetaminophen I 0/325, #120. Respondent appears to have assumed responsibility for prescribing

3 medications L.A. was previously receiving from another physician. Specifically, OxyContin 240

4 mg and hydrocodone 40 mg daily (although quantities are not indicated). There is no record of

5 informed consent by L.A. for the high dose opioid therapy.

6 19. On August 12, 2010, Respondent requested a consultation from a physical medicine

7 and rehabilitation specialist for help with managing L.A.'s right knee. The records do not

8 indicate the results of this consultation.

9 20. Respondent's records do not indicate that a history or physical examination

10 commensurate with the circumstances of L.A.'s initial visit was ever done and no records exist

11 showing that it was subsequently performed, to the extent warranted by LA's presenting

12 complaint.

13 21. Respondent does not appear to have actually assessed the nature and extent of L.A.'s

14 complaints of pain or the impact of the pain upon L.A.'s functioning. Respondent did not inquire

15 about previous pain treatment and any history of substance abuse.

16 22. Respondent's records show that he did not establish a legitimate medical indication

17 for the use of a controlled substance for L.A. Respondent's records do not reflect development of

18 a treatment plan with specific treatment objectives.

19 23. Respondent's records show that he did not discuss with L.A. common potential risks

20 and benefits relative to the use of the prescribed controlled substance in order to allow L.A. to

21 give an informed consent.

22 24. Respondent's records show that he did not see L.A. periodically in order to monitor

23 the controlled substances therapy. Thus, Respondent was unable to assess L.A.'s progress toward

24 treatment objectives, assess L.A.'s adherence to the controlled substances treatment regimen, and

25 assess whether L.A. was having any adverse effects from the controlled substances. Thus,

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1 All prescription notations follow the form of drug prescribed (OxyContin), dosage (80 mg), and number of tablets prescribed (#90).

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Respondent was unable to determine whether treatment of L.A.'s pain with controlled substances

2 should be continued or modified.

3 25. Respondent's notes are generally written on a monthly basis. The records contain

4 little information concerning whether L.A. was benefiting from this high dose opioid therapy.

5 When Respondent rated L.A.'s pain, it was generally severe with one exception in a note dated

6 June 22, 2012, indicating, "Finally patient getting good pain relief on 5x/d OxyContin otherwise

7 pain 1 0/10 neck/back." A subsequent note dated August 16, 2012, indicates L.A. stated that he

8 was getting excellent pain relief from the current regimen.

9 26. Respondent's records show that he failed to ask L.A. about any side effects common

10 with the substances being prescribed, such as constipation and falls. The records show that L.A.

11 had difficulty walking and required use of a walker, suggesting that he was at an increased risk

12 for falling independent of the opioid therapy. Respondent's note of January 6, 2012, indicates

13 that L.A. had occasional falls, was weak and "unstable," but there is no indication that

14 Respondent considered altering the medication treatment plan (although no plan is actually

15 contained in the records) as a result of this observation. Due to the paucity of information in the

16 medical records, it is unclear whether L.A. had any cognitive side effects from the drugs. It is

17 also unclear whether L.A. was advised not to drive, if he was driving and whether the medications

18 potentially impacted his driving safety, which when coupled with his noted physical conditions

19 requiring use of a walker could present a public safety hazard.

20 27. Respondent's records indicate that he was treating L.A. for hypogonadism with

21 testosterone supplementation, which might have reflected an unnoted side effect of the long-term

22 opioid therapy.

23 28. Although there is little or no reference to any physical examination after the initial

24 very limited physical examination reflected in the June 25, 20 I 0 note, it does appear that

25 Respondent made a minimal effort to monitor L.A.'s adherence to treatment with the opioids.

26 Respondent's September 28, 2012 note indicates that he "collected urine to monitor narcotic

27 levels." However, no urine drug screen results are in the medical records corresponding with this

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(KENT LEHMAN, M.D.) ACCUSA TTON NO. 09-2012-225474

29. Respondent's records contain a treatment agreement signed by L.A. on January 11,

2 2013. There is also a consent for clu·onic opioid therapy, although the date on the form is

3 covered. There are several CURES reports in the front of the file that Respondent obtained on

4 August 29,2013 (with minor notations in Respondent's handwriting), September 16,2013, and

5 January20,2014.

6 30. Respondent wrote an extensive progress note on April 15, 2013, detailing L.A.'s pain

7 and noting that L.A. was scheduled for an ankle fusion with the orthopedist. However, the

8 physical examination was very limited and the diagnoses were very general consisting of arthritis,

9 neck pain, back pain, and foot pain. Respondent indicated that L.A. had tried gabapentin,

10 presumably in an effort to treat the pain, but it "didn't work," and Cymbalta was too expensive.

11 Respondent refilled L.A.'s prescription for OxyContin 80 mg #120.

12 31. Respondent's November 4, 2013 notes reflect the results of a drug screen showing

13 that L.A. tested positive for amphetamine, marijuana, "met," and benzodiazepine. However,

14 Respondent did not indicate how these findings impacted his treatment of L.A., although the

15 notes indicate that the results were unexpected, including the positive result for marijuana and the

16 positive result for a benzodiazepine. What is meant by the term "met" is unclear from the

17 records.

18 32. Respondent's records do contain notes from the orthopedist who performed an ankle

19 fusion on L.A. in 2013. These notes corroborate the notes showing that L.A. suffered from severe

20 rheumatoid arthritis and had a history of bilateral hip and knee joint replacement surgeries.

21 33. Tlu·ee CURES reports were obtained during the investigation of Respondent. The

22 reports reflect data from August 13, 2009 through August 13, 2012, December 19, 2011 through

23 December 19,2012 and December 5, 2012 through December 15,2013.

24 34. The CURES reports show that L.A. filled 40 prescriptions from Respondent for

25 OxyContin 80 mg from June 25,2010 through December 15,2013. L.A. averaged 376 mg of

26 oxycodone daily during this period.

27 35. The CURES repotis show that L.A. filled 31 prescriptions from Respondent for

28 hydrocodone/acetaminophen during the time covered by the three CURES reports. He averaged

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67 mg ofhydrocodone daily during this period. This constitutes high-dose oral opioid therapy,

2 which warrants closer monitoring than low-dose therapy by virtue of the increased risk for

3 adverse effects, which can include overdose and death.

4 PATIENT D.A.

5 36. Respondent's records contain a number of progress notes from March 15, 2004

6 through July 18, 2012. The records include laboratory test results, imaging study results,

7 including a report from a lumbar spine x-ray dated August 25, 2010, showing 50-60%

8 compression fractures at Ll and L4. There is a chest x-ray from August 25, 2010, and an

9 electrocardiogram from August 24, 2010. There is a consultation dated September 2, 2010, from

10 a specialist in physical medicine and rehabilitation, Dr. S., although page one is missing. Dr. S.

11 diagnosed D.A. with lumbar disc degeneration, osteoarthritis, and an acute lumbar compression

12 fracture. Dr. S. also recommended specific treatments, however, the notes do not reflect that such

13 treatments ever took place.

14 37. Respondent's records contain a history and a physical examination pertaining to

15 D.A.' s hospital admission on January 10, 2011, for placement of a cardiac pacemaker, which

16 notes were signed by a Dr. G.

17 38. Respondent last wrote D.A. a prescription for a controlled substance (hydrocodone)

18 on August 24, 2010. Respondent's progress notes describe D.A. as having "arthritis pains"

19 impacting his back and knees. Respondent noted that D.A. voiced a complaint of anxiety, or

20 "nervousness," that at times impacted his sleep. Respondent also diagnosed D.A. with gout and

21 prescribed anti-inflammatory medication, including N aprosyn.

22 39. Respondent's notes arc handwritten and provide limited information concerning the

23 nature and extent of D.A.' s complaints, such as back pain, anxiety, and insomnia. For example,

24 the November 11, 2009 progress note indicates that D.A. had back pain and stiffness with

25 intensity 6/10 without medication as well as ankle swelling, arthritis, hypertension, and anxiety,

26 but nothing further. Fmihermore, there is a note for D.A. dated September 21 without a year,

27 showing a diagnosis of dementia.

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40. On August 24, 2010, Respondent noted that D.A. had fallen twice and injured his

2 back but did not remember falling. Respondent described D.A. 's heart rate as irregular at that

3 visit. Respondent also diagnosed syncope, arrhythmia, anemia, benign prostatic hypertrophy, and

4 back pain, ordering laboratory testing, a chest x-ray and a lumbar spine x-ray. Respondent

5 prescribed hydrocodone/APAP 10/325 #120. No indication of Respondent's response if any to

6 the range of issues is reflected in the notes except the prescription.

7 41. On November 28, 2011 Respondent diagnosed D.A. with Alzheimer's disease and

8 prescribed Namenda as a cognitive enhancer. However, the notes do not indicate whether D.A.

9 was benefiting from use of the pain and antianxiety medications. Neither do the notes indicate

10 whether D.A. was having any adverse effects from the pain and anti-anxiety medications.

11 42. Three CURES reports were obtained during the investigation of Respondent. The

12 reports reflect data from August 13, 2009, through August 13, 2012, December 19, 2011, through

13 December 19,2012, and December 5, 2012, through December 15, 2013.

14 43. The CURES reports show that D.A. filled seven prescriptions from Respondent for

15 diazepam 10 mg #30, four prescriptions for alprazolam 2 mg #30, two prescriptions for zolpidem

16 10 mg #30, and eight prescriptions for hydrocodone/acetaminophen #60 in either the 7.5 mg or 10

17 mg formulations from August 13, 2009 through August 13, 2012.

18 PATIENT C. A.

19 44. Respondent's initial visit with C.A. took place in May 2004 (although the date is not

20 clear in the records) when she presented for treatment of obesity with a request to begin diet pills.

21 At the initial visit C.A. weighed 254 pounds on her 66-inch frame. Respondent documented a

22 brief history and a problem focused examination.

23 45. Respondent's records show that he began treating C.A. with phentermine and

24 continued to treat her until at least March 20, 2012. During that time Respondent provided C.A.

25 with numerous prescriptions for hydrocodone and alprazolam with some additional prescriptions

26 for carisoprodol and zolpidem, in addition to the anorexic drug phentermine. A handwritten note

27 on the front of the chmi indicates that C.A. died on August 17, 2012, without further explanation.

28 It is unclear if the note was written by Respondent.

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1 46. Respondent's records include a note dated October 19 that appears to be from 2009

2 (based upon its location within the chart) indicating that C.A. had "right knee pain-no cartilage

3 right knee, worse when driving car or cold." There is no further description of the pain nor is

4 there any indication of previous pain treatment.

5 4 7. Respondent's records contain no documentation of a substance use history apart from

6 a form entitled "Patient's Check List for Medical History" in a different section of the file, but that

7 form does not have a patient's name and is undated. There is no record of a physical examination

8 ofC.A's knee.

9 48. Respondent indicated "knee pain/arthritis" and prescribed C.A. 60 tablets ofVicodin.

10 However, there is no indication of discussion of treatment options other than the opioid analgesic.

11 49. Respondent continued to prescribe C.A. hydrocodone over the next two and one-half

12 years.

13 50. Respondent's documentation in support of his continuing prescription of

14 hydrocodone to C.A. is incomplete. On January 6, 2010, he noted C. A.'s chief complaint to be

15 "continued back pain-stiffness." However, there was no physical examination noted in the

16 records. Eight months later, on August 16, 2010, there is a more detailed note describing C.A. as

17 having "arthritis pains" in her neck "with radiculopathy into both hands." Respondent noted C.A.

18 was taking Lyrica. They indicate a reduced cervical range of motion and brisk reflexes at the

19 elbows. Respondent's diagnosis was neck pain and arthritis. He prescribed Norco 10/325 #60

20 and Soma 350 mg #60 each with one refill.

21 51. On September 17, 2010, Respondent issued C.A. a prescription for alprazolam

22 (Xanax) 2 mg #45. There is no indication in the progress note as to why he prescribed her this

23 drug.

24 52. Respondent's October 7, 2010 note indicates that C.A. had "continued neck pains"

25 and an x-ray showed degenerative changes in her cervical spine. Interestingly, the x-ray report is,

26 dated February 5, 2009, and was ordered by another physician. Furthermore, there was no

27 physical examination apmi from her weight and a diagnosis of neck pain. Notwithstanding the

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lack of an examination and the singular diagnosis, Respondent prescribed Xanax 2 mg #60,

2 Norco 10/325 #90, Soma 350 mg #120, and Neurontin 300 mg #90.

3 53. Respondent's notes ofNovember 4, 2010, state that C.A. was having "really bad back

4 pains also knees really bad." He described her posture as kyphotic and diagnosed back pain and

5 arthritis. Respondent prescribed her Xanax 2 mg quantity #60, Vicodin ES #120, and Soma #120.

6 54. On December 24,2010, Respondent noted that C.A. had "dropped Xanax," but that

7 statement is unexplained in the notes. However, on January 28, 2011, Respondent notes that C.A.

8 had "lost-misplaced Xanax." He further noted "anxiety" as a diagnosis with nothing further. He

9 then prescribed Xanax 2 mg #60 with instruction to take one tablet twice daily as needed. He also

10 prescribed Prozac 20 mg #60 with instruction to take one daily as needed. However, Prozac is

11 not prescribed on an as needed basis.

12 55. There is very little data contained in the medical records indicating how C.A.' s

13 symptoms of pain and anxiety were responding to treatment with these drugs. In addition, there

14 is very little information concerning how she was actually using the medications and whether she

15 was using them as directed or having any adverse effects from the drugs.

16 56. Respondent's medical records dated April22, 2011 indicate that C.A. had not taken

17 her Vicodin (hydrocodone/acetaminophen) because it kept her awake. Nonetheless, Respondent

18 prescribed her more hydrocodone/acetaminophen on that visit. The apparent adverse effect of the

19 drug should have prompted an investigation by Respondent into the symptom and consideration

20 of switching the medication.

21 57. Respondent's notes provide very little information concerning whether C.A. was

22 having difficulty controlling her use ofthe medication. A note on April29, 2011, indicates

23 Respondent talked with C.A. about "too many Xanax," although there is no further explanation of

24 this statement and he continued prescribing her Xanax. His Xanax prescriptions for C.A.

25 subsequent to that visit ranged .from 10 tablets to 60 tablets per prescription.

26 58. A neurological consultation dated June 1, 2011, was ordered because C.A. reported

27 having progressive weakness in all four limbs with abnormal reflexes. Notes from the neurologist

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indicate an eventual diagnosis with multiple sclerosis and cervical myelopathy due to cervical

2 spine stenosis.

3 59. On July 11, 2011, Respondent noted that C.A. had been diagnosed with multiple

4 sclerosis. He continued prescribing her Norco, Xanax, Ambien, and Prozac. There is no mention

5 of any symptoms in Respondent's notes and there is no physical examination reflected in the

6 note. Neither is there a treatment plan relative to the prescription of controlled substances.

7 60. On October 17, 2011, Respondent noted he had spoken with C.A. and her speech was

8 "very slurred." His notes indicate that she "wanted more Xanax," but that he told C.A. that it

9 sounded like she had taken too much Xanax, which was dangerous. According to the medical

10 records, Respondent advised C.A. that "[i]n order to get more meds, she would need some

11 responsible [sic] to monitor her meds." C.A. appears to have agreed to the monitor and said she

12 would come in supposedly to set up a monitoring plan. However, the records contain no

13 documentation indicating how or if this monitoring was ever effected.

14 61. There are no CURES reports in the medical records but a listing in the back of the

15 chart from Well Point pharmacy dated October 16, 2009, indicated that C.A. had received

16 prescriptions for Vicodin and Soma from other physicians during the summer of2009. This was

1 7 during the time Respondent began prescribing C.A. hydrocodone. The medical records do not

18 indicate any discussion as to whether C.A. was tolerating the controlled substances or having

19 significant adverse effects from them. The sole instance, referenced above was when C.A. had

20 slurred speech, suggesting she may have been misusing her medication.

21 62. In terms of diagnostic testing, there are a number of laboratory repmis found in the

22 chart. There are copies of brain and cervical MRI scans dated June 3, 2011, ordered by another

23 physician to evaluate C.A. for possible multiple sclerosis. There is no evidence that Respondent

24 ever ordered or checked a urine drug screen.

25 63. Three CURES repmis were obtained during the investigation of Respondent. The

26 repmis reflect data from August 13, 2009 through August 13, 2012, December 19,2011 through


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64. The CURES reports show that C.A. filled 27 prescriptions from Respondent for

2 hydrocodone/acetaminophen from October 20, 2009 tlu·ough March 20, 2012. The quantity of

3 tablets per prescription ranged from 30 to 180, and he prescribed her an average of 45 mg of

4 hydrocodone daily during that time.

5 65. The CURES reports show that C.A. :filled 35 prescriptions for alprazolam from

6 Respondent from September 17, 2010 through August 10, 2012. The quantity of tablets per

7 prescription ranged from 10 to 60, with an average of 5.4 mg of alprazolam prescribed daily

8 during that time.

9 PAT lENT K.A.

10 66. Respondent began treating K.A. on September 9, 2009 and continued to treat her up

11 until at least August 9, 2013. Respondent's notes indicate that he was treating her for back pain

12 and anxiety and in the initial visit the notes indicate that K.A. presented with a request for

13 prescriptions.

14 67. At the initial September 9, 2009 visit, Respondent described K.A. as having anxiety

15 and stress and also reported that she had fallen and hurt her tailbone area. Respondent did not

16 delineate the nature and extent of her pain in the progress note. Included in the medical

17 records is a Brief Pain Inventory form that better describes the location and severity of the

18 pain, but it is not dated, so it is unclear whether K.A. completed this form at the time of the

19 initial visit. The records also contain an anxiety symptom questionnaire but again without a

20 date. There is no reference to K.A. 's prior treatment. There are no old records within the file

21 to understand her prior treatment.

22 68. There is no delineation of K.A. 's substance use history apart from a medical

23 history form dated September 9, 2009, upon which K.A. denied having an alcohol or drug

24 problem. However, K.A. also denied having any mental problem or history of nervous

25 breakdowns, which seems inconsistent with the progress note from this same date stating she

26 suffered from anxiety and stress.

27 69. Respondent's physical examination ofK.A. was limited. The only

28 musculoskeletal reference indicates reduced range of motion in her back in forward flexion

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and no indication that K.A. 'slower back or sacral region was palpated. Furthermore, there is

2 no documentation of neurological testing of K.A. 's lower limbs and no diagnostic testing to

3 determine whether K.A. had a fracture to account for pain in the sacrococcygeal region2

4 despite her complaints of back pain. There is no urine drug screen connected with the initial

5 visit.

6 70. There is no CURES report in Respondent's medical records. There is no

7 indication of a treatment plan or discussion of treatment options other than documentation

8 that Respondent prescribed her Xanax 2 mg #30, Vicodin ES #60, and what appears to be a B

9 vitamin "cocktail."

10 71. There is no informed consent from K.A. documented with the initial visit. The

11 file contains a consent for chronic opioid therapy and a treatment agreement for the use of

12 controlled substances in the treatment of chronic pain, which were signed on February 14,

13 20 12, over two years after the initial visit.

14 72. Respondent treated K.A. for several years and saw her on a regular basis, but his

15 progress notes contain little information concerning her symptoms and examination findings.

16 A representative entry for March 18, 2010, indicates that K.A. "threw back out," yet the

17 physical examination indicates only that K.A. was well developed and well nourished.

18 However, Respondent prescribed her more Vicodin, Xanax, and Prozac on that visit.


20 reports reflect data from August 13,2009 through August 13,2012, December 19,2011 through

21 December 19, 2012 and December 5, 2012 through December 15,2013.

22 74. The CURES reports indicate that K.A. filled 36 prescriptions from Respondent for

23

24

25

26

27

28

hydrocodone/acetaminophen 7.5 mg from September 9, 2009 through April23, 2013, for an

average of2.5 tablets daily during the period. The CURES reports indicate that K.A. filled 43

prescriptions from Respondent for alprazolam 2 mg from September 9, 2009 through July 2,

2013, averaging 1.6 tablets daily during that period.

2 There is a report of a lumbar x-ray that Respondent ordered, but this was not done until May 31, 2013 ( 4 years after the initial visit) and was normal with only mild degenerative spurs ..

16


75. Respondent's notes dated March 24, 2011 indicate that Respondent discussed

2 K.A. 's back pain, stating that "Medication allows her to continue work and normal activities

3 of daily living." However, the physical examination was again limited, although he mentions

4 that K.A. had "some tender areas" in her back, but no diagnosis is included with that observation.

5 He also questioned whether she had arthritis, but apart from refilling her prescriptions there is no

6 clear treatment plan reflected in the records.

7 76. On June 28, 2011 Respondent noted that K.A. returned "early" for refill of her

8 medication, which he attributed to her having increased back pain due to an increased workload

9 and he noted that she was taking three pain pills daily. On that visit he actually performed a

10 physical examination and noted tenderness in the lumbosacral region and over the coccyx. As a

11 result, he prescribed her more Vicodin #90 and suggested use of a doughnut cushion for sitting

12 and nonsteroidal anti-inflammatory medication.

13 77. On August 22, 2011, Respondent noted that the medication helped reduce K.A.'s pain

14 intensity and provided some quantification of the pain intensity. However, there is no physical

15 examination record apart from listing her weight.

16 78. On October 18,2011, Respondent had a follow-up and noted K.A.'s pain intensity

17 was 10/10. However, again there was no physical examination apart from noting that she

18 appeared "distressed" and walked in a "guarded" fashion and a recorded weight. He refilled her

19 Vicodin and Xanax, recommended nonsteroidal anti-inflammatory drugs and a topical pain patch.

20 The progress notes do not indicate how K.A. would utilize her medications. Furthermore, there is

21 no indication Respondent asked K.A. whether she had trouble controlling her use of the

22 medications and no indication that he checked a CURES report.

23 79. Respondent's note dated August 9, 2013, indicates that K.A. was seeing a

24 chiropractor for treatment of her pain. Respondent performed a limited physical examination

25 including assessing her cervical range of motion and palpating for tenderness in her back. He

26 prescribed Xanax 1 mg #30, ibuprofen 600 mg #60, and Robaxin 500 mg #30. However, despite

27 his many prescriptions of Xanax for K.A. for the treatment of anxiety and his note that she might

28

17


--------------- ------------------

have a bipolar disorder, there is no indication that he ever considered referring her for a mental

2 health consultation with either a psychologist or psychiatrist.

3 PATIENT R.A.

4 80. R.A. died on March 31, 2011, at age 43 of an accidental overdose reported as an

5 acute polydrug intoxication due to the combined effects of methadone, morphine, codeine,

6 carisoprodol, meprobamate, sertraline, and alprazolam. The coroner's report indicates he had

7 a prior drug history.

8 81. The Drug Worksheet in the coroner's report indicates that there were prescriptions

9 to R.A. from Respondent for Tylenol with codeine (seven prescriptions) and carisoprodol

10 (five prescriptions).

11 82. On June 14, 2011, Respondent reported seeing R.A. regularly for back pain,

12 including a visit on February 1, 20 11, when he prescribed R.A. hydrocodone and Tylenol

13 with codeine.

14 83. Three CURES reports were obtained during the investigation ofRespondent. The


16 December 19, 2012 and December 5, 2012 through December 15,2013.

17 84. The CURES reports indicate Respondent gave four prescriptions to R.A. for

18 Tylenol with codeine 300/60 mg #90 on December 14, 2010 and December 17, 2010. In

19 addition, Respondent gave four prescriptions to R.A. for Tylenol with codeine 300/60 mg

20 #180 on January 7, 2011 and February 1, 2011.

21 85. Respondent had no medical records for R.A. despite a history of providing him

22 prescriptions as evidenced by the CURES reports.

23 PATIENT M.A.

24 86. Respondent treated M.A. for back pain with an initial note in the file dated

25 February 18 with no year indicated, making it unclear when treatment began. In addition,

26 M.A.'s patient information form, usually completed on the initial visit, is undated.

27 Respondent continued to treat M.A. until at least May 24, 2012.

28

18


87. Respondent failed to provide a year on the first two notes in M.A.'s medical records,

2 with the second note date only March 23. However, the first note of February 18 indicates a

3 chief complaint of "back pain" and states that M.A. hurt his back while at work. There is

4 neither further discussion as to how M.A. was injured nor any documentation of the nature

5 and extent of the pain beyond characterizing it as back pain.

6 88. Respondent's records from the initial visit fail to include any past medical history,

7 social history or substance abuse history. There is no CURES report or urine drug screen

8 connected with the initial visit. The physical examination at the initial visit is limited and

9 from a musculoskeletal standpoint consists only of documented tenderness in the lumbosacral

10 region and a positive "straight leg," although it is unclear whether M.A. had unilateral or

11 bilateral abnormal straight leg raise testing. There is no neurological examination, such as

12 lower limb strength, reflex, or sensory testing documented in the records. The records

13 contain no recommendation for diagnostic testing.

14 89. Respondent's diagnosis at the initial visit is simply "back pain," and the "treatment

15 plan" consists of prescriptions for Vicodin ES #60 and Valium I 0 mg #20. Treatment

16 objectives are unclear, and there is no evidence of informed consent.

17 90. At the March 23 visit, noted above with no year indicated, Respondent noted that

18 M.A. had back pain with an intensity 8110. There is no physical examination documented,

19 apart from a weight. The diagnosis is back pain/arthritis. Respondent prescribed M.A.

20 Vicodin, Valium, and Xanax.

21 91. Respondent's notes indicate that M.A.'s next visit was on April 28 (again no year is

22 noted). No history or examination is reflected in the notes. However, the note does not

23 indicate if Respondent actually saw M.A. on that date.

24 92. Respondent saw M.A. again on June 30 (again no year is noted) and documented

25 "continued low back pain" with tenderness in the lumbosacral region. He ordered an x-ray of

26 the lumbar spine, though there is no evidence that this x-ray was ever done. He prescribed

27 M.A. Xanax, Vicodin, and Soma, and also gave M.A. an injection ofToradol. Respondent's

28 treatment objectives are not stated in the notes and are unclear.

19


93. Respondent's next note is dated August 24, 2009, with M.A.'s chief complaint listed

2 as the need for a prescription refill. The medical records indicate that M.A. had continued

3 low back pain that was worse due to physical lifting and bending at work. There was no

4 physical examination reflected in the notes except for blood pressure, weight, and a notation

5 that M.A. was well dressed and well-nourished. Respondent's diagnosis was now "back

6 pain/myalgia/anxiety." He prescribed the patient Vicodin, Xanax, and Soma.

7 94. Respondent's progress reports generally provide little or no information about the

8 nature and extent of the M.A.'s pain with little or no physical examination. There does not

9 appear to be any inquiry concerning whether M.A. was tolerating the medications and taking

10 them as directed.

11 95. Respondent's November 23, 2009 notes again recommended a lumbar x-ray, but

12 again there is no evidence in the file that this was ever done. However, there is a report in the

13 file of a lumbar MRJ from February 26, 2010, which showed normal alignment of the spine

14 with mild degenerative changes at L4-L5 and L3-L4 and a small disc protrusion causing

15 narrowing of the right neuroforamina at L3-L4. It is unclear who ordered the study, because

16 Respondent does not mention the MRI order or otherwise refer to it in his progress notes until

17 May 14,2010, suggesting that he did not order the study.

18 96. Respondent's records contain no coherent treatment plan other than the

19 prescription of controlled substances. There is no indication he considered nonpharmacologic

20 interventions, such as a home exercise program or physical therapy. Neither is there adequate

21 attention to whether M.A. was adhering to treatment with controlled substances that were

22 being prescribed nor is there any evidence of a urine drug screen test.

23 97. Respondent's notes from March 26, 2010, indicate that M.A. was "trying to cut

24 back on 'narcotic' pain meds." There is a notation on May 14, 2010, that M.A. "was taking

25 too many Vicodin-hurts stomach." However, there is never any indication of any inquiry into

26 M.A.'s substance abuse history.

27 98. On August 9, 2010, Respondent saw M.A. to refill his prescriptions for

28 oxycodone, Vicodin, Xanax, and Soma. There was no clear treatment plan for prescription of

20


these controlled substances. Respondent indicated that M.A. had suffered a work injury and

2 had been seen at Kaiser, but there is no further discussion of that event, the nature of the

3 injury, the Kaiser diagnosis or any other facts as to that injury.

4 99. Respondent completed some disability forms for M.A. on August 10, 2010, in

5 which he described M.A. as having severe low back pain due to herniated disk and

6 radiculopathy.

7 100. On November 18, 2010, Respondent noted that M.A. had been "flagged by DEA,"

8 but indicated "patient states that it's not him." However, there is no further discussion ofthis

9 issue in the notes and the files do not indicate a CURES report was run or any other follow up

1 o was performed. There is no physical examination at that visit apart from describing him as

11 well dressed and well nourished. Respondent proceeded to prescribe him more oxycodone 30

12 mg #120 and Norco 10/325 #90, which were intended to be a 30 day supply of medication.

13 Respondent then instructed M.A. "to seek new pain management group," which infers that he

14 no longer planned to prescribe M.A. controlled substances.

15 101. Despite the above-referenced indication that Respondent had instructed M.A. to seek

16 another pain management group, in a visit on June 1, 2011, where M.A. presented apparently

17 for a request for a prescription, Respondent prescribed M.A. 120 Soma tablets without

18 performing an examination or a history.




22 103. The CURES report from August 13, 2009 through August 13, 2012 indicates that

23 Respondent prescribed M.A. controlled substances, including multiple prescriptions for

24 hydrocodone, oxycodone, alprazolam, and zolpidem plus a single prescription for diazepam

25 during this time.

26 104. The CURES reports show that M.A. filled 13 prescriptions from Respondent for

27 hydrocodone/acetaminophen from August 24, 2009 through February 4, 2011. The quantity

28

21


oftablets per prescription ranged from 60 to 150, and he prescribed M.A. an average of32

2 mg ofhydrocodone daily during that time.

3 105. The CURES reports show that M.A. filled eight prescriptions from Respondent

4 for oxycodone 30 mg from April22, 2010 through November 18, 2010. The quantity of

5 tablets per prescription ranged fiom 20 to 120, with an average prescription of 102 mg of

6 oxycodone daily during that time.

7 106. The CURES reports show that M.A. filled 11 prescriptions from Respondent for

8 alprazolam 2 mg #30 from August 24, 2009 through July 8, 2010. He prescribed M.A. an

9 average of 2 mg of alprazolam daily during that time.

10 107. The CURES reports show that M.A. filled eight prescriptions from Respondent for

11 zolpidem either in the 10 mg or 12.5 mg formulations from August 24, 2009 through

12 February 19, 2010. Respondent prescribed M.A. an average of 19 mg ofzolpidem daily

13 during that time.

14 108. The CURES data shows that Respondent prescribed M.A. a one-month supply of

15 alprazolam 2 mg (30 tablets) on August 24, 2009, September 1, 2009, and again on

16 September 14, 2009.

17 109. The last medical records included in M.A.'s chart include a CURES report from

18 October 27,2009 through October 27,2010 that was faxed to Respondent from a "Mike."

19 The CURES report does not appear to have been generated at Respondent's request. That

20 report shows that M.A. was obtaining controlled substances from multiple providers during

21 this period.

22 PATIENT V.B.

23 110. Respondent initially treated V.B. for injuries stemming from an automobile accident.

24 In V .B.'s medical records there is a Patient Information Sheet and a medical history checklist

25 both dated October 22, 2007. However, the first progress note is dated almost a year later on

26 October 20, 2008, and recounts her history of having been involved in an auto accident and

27 suffering a concussion, cervical strain, and lumbar strain.

28

22


Ill. At the October 20, 2008 visit, Respondent performed an appropriate prior

2 examination before prescribing her Vicodin ES #20 and carisoprodol #20. The records include

3 subsequent visit notes dated November I 0, 2008, December 11, 2008, January 9, 2009, January

4 28, 2009, February 13, 2009, March 6, 2009 and April 7, 2009.

5 112. V.B.'s medical records were not together in records recovered from Respondent, but

6 rather were located in two separate areas within the files. This itself makes it difficult to

7 understand how Respondent could properly track V.B. 's progress. Respondent's handwritten

8 notes start on the entry for January 2, 2008, and notes that he gave V.B. a hormone injection. A

9 later note (date uncertain) describes V.B. as having a prior history of a "traumatic incident" and

10 previous treatment with antidepressant medicines. Respondent described V.B. as having anxiety

11 and depression and prescribed Xanax and Prozac.

12 113. Respondent's note dated January 9 and found in the second set of records in the files

13 does not include a discernible year. However, it is likely 2009 because the first set of records

14 found includes a visit on January 9, 2009. That note indicates that V.B. had "migraines" without

15 further elaboration. Respondent prescribed her Fioricet with codeine and Prozac. There was no

16 evident physical examination performed on that visit. Respondent's handwritten notes in the

17 second section of the file are brief and none contain information about a physical examination,

18 except that weight is often recorded but no blood pressure or other relevant information.

19 114. Respondent's note dated April 7 without a discernible year (likely 2009 because of

20 another visit on April 7, 2009 in the separated file) indicates that V.B. complained of pain in the

21 region of her right sacroiliac joint and extending down her leg with an intensity of9110. A

22 physical examination noted only that V.B. was tender over the right sacroiliac joint.

23 Respondent's diagnosis was sciatica, though there was no documentation of a neurological

24 examination with lower limb strength, reflexes, or straight leg raise testing to reach that diagnosis.

25 Respondent gave her an injection ofToradol and prescribed hydrocodone/acetaminophen 10/325 .

26 #60.

27 115. A note dated May 8 without a year indicates V.B. had "continued headaches ...

28 migraines." Respondent prescribed Fioricet, Prozac and Xanax.

23


116. Respondent's note dated September 9, 2011, enters a diagnoses of migraine and

2 fibromyalgia. Again, there is no history or physical examination other than her weight.

3 117. Respondent's note dated November 21,2012, indicates that V.B. was "no longer

4 taking Xanax-Soma," but there is no explanation as to why V.B. had stopped those medications.

5 Respondent described V.B. as having "continued migraines/fibromyalgia" and prescribed her

6 more Fioricet and Vicodin.

7 118. Respondent's note dated March 29, 2013, indicates only that V.B had returned for a

8 refill and had continuing neck pain with "daily migraines" and depression. Her pain intensity was

9 7110, and Respondent described her as worse following an auto accident that occurred two weeks

10 prior to the visit. Although there is an entry in the objective section of the note it is illegible.

11 119. Respondent's note dated April 26, 2013 indicates that V .B. had migraines since an

12 auto accident in 1986. In addition to prescribing her Vicodin, Fioricet, and Prozac, Respondent

13 also prescribed her 10 tablets of amitriptyline 10 mg and gave her samples of Lyrica as well.

14 120. Respondent's note dated May 26, 2013, indicates that V.B. had continued migraines

15 with complaints of insomnia and also bilateral hip pain and left-sided knee pain. Respondent also

16 noted that she took over-the-counter preparations but he did not delineate what over the counter

17 preparations she had taken, which is necessary to determine if there was any potential for adverse

18 drug-drug interactions with the medications Respondent himself prescribed her.

19 121. Respondent's note dated June 21, 2013, includes a "post-it note" attached to the page

20 indicating "phase off pain Rx," with nothing further. Considering the later prescriptions provided

21 to V.B., it is difficult to determine what is meant by the post-it note and if it refers to V.B. at all.

22 122. Respondent's note dated August 6, 2013, indicates that V.B. had a left hip x-ray at his

23 request, and the study was normal. In a follow up on August 16, 2013, Respondent reviewed the

24 x-ray results with V.B. and ordered laboratory testing to include a complete blood count,

25 chemistry panel, and sedimentation rate. He prescribed her more Fioricet and Vicodin.

26 123. Respondent's note dated September 19,2013, reiterated V.B.'s various pains and

27 associated pain intensities. However, the physical examination consisted only of her weight and

28 neck range of motion in lateral rotation. Interestingly, Respondent also indicated the results of

24

(KENT LEHMAN, M.D.) ACCUSATiON NO. 09-2012-225474

1 V.B.'s urine drug screen (the order for which is not in the records) in which she tested positive for

2 barbiturate, benzodiazepine, THC, opioid, and something else that is illegible. It is unclear if or

3 how he integrated this urine drug screen result into her treatment plan.

4 124. Respondent's last note dated February 19, 2014, describes V.B. as having "really bad

5 migraines" that she believed were secondary to an old neck injury. The physical examination

6 consisted only of describing her as a white female in moderate distress. This note reads as though

7 Respondent had no recollection of this patient. He prescribed her more Fioricet, Vicodin,

8 ibuprofen, and BuSpar.

9 125. V.B's chart contains a medical history checklist dated October 22, 2007, on which

10 V .B. indicated she had a history of some type of mental problem, although it is unclear as to the

11 nature of the problem. Respondent later notes V.B as having depression and anxiety. V.B.

12 endorsed severe headache as a symptom and also endorsed night sweats, ankle swelling, and loss

13 of appetite. V .B. denied having an alcohol or drug problem. There is no other indication in the

14 file concerning whether or not V.B. had a substance abuse problem despite Respondent

15 prescribing her several controlled substances over an extended period of time and indications that

16 V.B. was misusing her Fioricet.

17 126. V .B had a history of migraine as shown by the charts. She also had anxiety and

18 depression, which increased her risk for misuse of the controlled substances Respondent

19 prescribed her. There is no documentation in the medical records indicating that Respondent ever

20 talked with V.B. about how she was taking the medications.

21 127. Three CURES reports were obtained duringthe investigation of Respondent. The



24 128. V.B's CURES reports suggests she had difficulty controlling her use ofFioricet.

25 129. During the periods reflected in the CURES reports, V.B. first filled a prescription

26 from Respondent for a controlled substance, Fioricet with codeine, on August 24, 2009. V.B.

27 filled a total of 66 prescriptions for Fioricet with codeine during the time from August 24, 2009

28

25


1 through December 2, 2013. The quantity for each ofthese prescriptions varied between 30 and

2 100 capsules, but was generally either 60 or 90 capsules per prescription.

3 130. During the first year that Respondent prescribed her Fioricet, he prescribed her an

4 average of7.2 capsules daily, which is a very high dose. V.B. frequently filled prescriptions for

5 Fioricet and sometimes filled them just days apart. For example, V.B. filled a prescription for 60

6 tablets on December 4, 2009, only to fill another prescription for 60 tablets on December 7, 2009.

7 The CURES report also shows that during this first year V.B was filling the prescriptions at two

8 different pharmacies, often indicative of a desire not to raise suspicion about the quantity of

9 medication she was receiving.

10 131. Fioricet is an analgesic that combines in a single tablet a low dose of an opioid (30

11 mg of codeine), a barbiturate (50 mg ofbutalbital), acetaminophen, and caffeine. It is used for

12 the acute treatment of headache with the recommendation not to exceed a total daily dose of six

13 capsules. It is not intended to be taken daily or even frequently in one month because of its habit-

14 forming potential and its potential to make a person's headache condition worse.

15 132. The CURES reports indicate that V.B. filled 27 prescriptions from Respondent for

16 hydrocodone/acetaminophen 7.5 during the time covered by the three CURES reports. V.B.

17 averaged 1.6 tablets daily during this period. The CURES reports indicate that V.B. filled 18

18 prescriptions for alprazolam 2 mg from Respondent during the time frame covered by the three

19 CURES reports. She averaged 0.4 tablets daily during this period.

20 133. The CURES reports indicate that V.B. filled four prescriptions for carisoprodol from

21 Respondent during the time frame covered by the three CURES reports. She filled these

22 prescriptions between June 4, 2012 and November 29, 2012.

23 134. V.B's file contains an opioid therapy consent form that is signed and dated April26,

24 2013, several years after she began receiving prescriptions for controlled substances from

25 Respondent. There is also a controlled substances treatment agreement that is signed but not

26 dated. A Brief Pain Inventory was completed by V.B on April 26, 2013 and a Pain Anxiety

27 Symptom Scale was completed, which is not dated.

28

26


135. No record exists of Respondent checking a CURES report in order to monitor V.B.'s

2 adherence to treatment instructions despite the length of time he prescribed her controlled

3 substances.

4 136. Respondent's notes dated September 19,2013, indicate that V.B.'s urine drug screen

5 tested positive for barbiturate, benzodiazepine, THC, opioid, and something else that is illegible

6 in the records. It is unclear how he integrated this urine drug screen result into her treatment plan,

7 if at all.

8 137. V.B's progress notes have little or no history and little or no physical examination.

9 They do list the medications he prescribed for her, but there is no indication as to how she was

10 tolerating the medications and generally no information as to whether they were helpful in

11 treating her symptoms.

12 138. Respondent's treatment objectives are unclear in the medical record. Despite V.B.'s

13 continuing complaint of severe headache, there is no evidence Respondent considered referring

14 her for consultation to a headache specialist, such as a neurologist. His physical examination

15 documentation is inadequate and should contain more details regarding her neurological

16 functions, since the differential diagnosis for chronic headache includes conditions other than

17 m1grame.

18 139. There is no indication that Respondent monitored V.B. for potential adverse effects

19 from the analgesics, such as liver damage, until he recommended laboratory testing in his note

20 dated August 16, 2013. However, there are no laboratory testing results in the file. Such testing

21 should be done on a periodic basis when routinely prescribing analgesics that contain

22 acetaminophen.

23 PAT lENT S.B.

24 140. Respondent began treating S.B. in 2006 (although the date is uncertain due to

25 deficiencies in the medical records) for weight loss and continued to treat her for other problems

26 including chronic pain and anxiety at least through October 17, 2013. Respondent treated S.B.

27 for chronic pain and anxiety and wrote S.B. multiple prescriptions for controlled substances,

28 including hydrocodone, alprazolam and carisoprodol.

27


141. The initial note in S.B. 's chart is very brief, indicating a chief complaint of "diet pill"

2 and indicating "father: ETOH." There is a notation that "phen before worked." There is a brief

3 physical examination followed by notation that he prescribed her phentermine 37.5 mg #30,

4 Xanax 2 mg #20, Prozac 20 mg #30, and Am bien 10 mg #20. There is no indication in the chart

5 why all of these controlled substances were prescribed for a chief complaint of"diet pill."

6 142. Respondent's next note is dated "April 17", but again there is no year indicated.

7 Respondent indicates that S.B. complained of low back pain with intensity 7/10 without

8 medication. There is no further description of the symptom in the progress note, though a

9 medical history checklist completed by S.B. on May 7, 2007 (a significant amount of time after

10 the initial visit which, based on the overall records, occurred in early summer of 2006) indicated

11 symptoms of tingling, numbness, limited motions, and disturbance in walking without specifying

12 the body part to which the symptoms referred. Neither discussion of prior pain treatment nor any

13 indication of questions concerning any history of substance abuse (other than the medical history

14 checklist where she denied a history of alcohol, drug and/or mental problems) is contained in the

15 note. The note also indicates "anxiety insomnia" without further explanation.

16 143. The "April 17" note contains no indication that Respondent performed any physical

17 examination pertaining to S.B's back pain apart from noting her weight of240 pounds. No

18 musculoskeletal or neurological examination to evaluate her spinal condition is shown. There is

19 no diagnosis or treatment plan other than the prescription of medications, including Vicodin ES

20 #60, Xanax 2 mg #30, Am bien 10 mg #30, and Prozac 20 mg #60. However, there is no

21 indication of informed consent relative to these drugs and there is no treatment objective listed in

22 the note.


24 reports cover the time from August 13, 2009 through August 13, 2012, December 19, 2011

25 through December 19, 2012 and December 5, 2012 through December 15, 2013.

26 145. The CURES reports indicate that Respondent provided 49 prescriptions to S.B. for

27 hydrocodone/acetaminophen from November 16,2009 through November 15,2013. The

28

28


quantity of tablets per prescription ranged from 60 to 240, and he prescribed the patient 5,580

2 tablets during that time.

3 I46. The CURES reports indicate that Respondent provided 25 prescriptions to S.B. for

4 alprazolam from August 4, 2009 through June I7, 2013. The quantity of tablets per prescription

5 ranged from I5 to 45, and Respondent prescribed S.B. 1,475 tablets during that time, for an

6 average dose of2.4 mg daily.

7 147. The CURES data shows that Respondent provided 22 prescriptions to S.B. for

8 carisoprodol from January 25, 20I2 through November I5, 20I3. The quantity oftablets per

9 prescription ranged from 30 to 90, and he prescribed S.B. 1,590 tablets during that time, for an

I 0 average of 2. 7 tablets daily.

II I48. Respondent saw S.B. on multiple occasions throughout the course of his treatment of

12 her. However, his notes provide little information about the nature and extent of S.B. 's

I3 symptoms, only her complaints of low back pain and anxiety. Respondent's note of October I5,

I4 2009, indicates that S.B's low back pain was worse in the mornings. His note of February 18,

I5 20 I 0, suggests exercise exacerbated her low back pain. His note of August 20, 20 I 0 notes that

16 S.B.'s pain intensity was "8/10 at times without medicine," but there is no indication concerning

I7 the impact medication had upon her pain or her ability to function. Respondent's notes prior to

18 2011 are devoid of any examination pertinent to the evaluation of S.B. 'slow back pain apart from

I9 two entries. The first, on October 15,2009, indicates that S.B.'s back was "tender, tense, stiff' in

20 the lumbosacral region. The second, which appears to be on March 18, 2007 (legibility makes the

21 date uncertain), indicates that S.B.'s lower back was "tender." Thus, for 5 years, through the end

22 of20IO, S.B.'s medical records fail to adequately describe the nature of her symptoms and the

23 details of any physical examination findings, indicating that no physical examinations had

24 occurred.

25 149. Respondent's note dated January 13, 2011, is entitled "interim note-pain

26 management." In this entry, Respondent goes into greater detail about S.B. 's history and

27 indicates that he did not actually stati treating her back pain until2009. This is striking because

28 earlier notes in the medical record appear to date back as far as 2006 and at least 2007.

29


150. Respondent's note dated January 13,2011, delineates minimal treatment objectives

2 relative to S.B's low back pain and her use of pain medicine. Respondent discusses information

3 germane to informed consent and precautions typical of a pain treatment agreement with S.B. He

4 said it appeared the pain medications were "allowing her to live with a tolerable level of pain" and

5 "to function at a reasonable level at work and at home." There is a minimal physical examination

6 indicated on this note with weight, blood pressure, and a reference that S.B's back was "tight"

7 with a questionable reduction in range of motion. Respondent recommended that S.B. have a

8 lumbar x-ray. A copy of a lumbar x-ray report dated March 8, 2011 is in the file. The x-ray

9 showed that S.B. had mild degenerative changes at the L5-S 1 disc.

10 151. Respondent's note dated March 11, 2011 indicates that he assessed her lumbar

11 bending, because S.B. was "unable to bend/fingers to knees." There is no indication as to how

12 Respondent assessed her lumbar bending.

13 152. Respondent's note dated April28, 2011 indicates that S.B. had a negative "straight

14 leg." However, there was no evaluation of her lower limb strength or reflexes reflected in the

15 notes, or any other indication as to how Respondent arrived at that conclusion.

16 153. Respondent's notedated August 3, 2011, indicates that S.B. was "taking more meds

17 for relief." There was no indication as to whether she was having difficulty controlling her use of

18 the dmgs, or if the fact that she was "taking more meds for relief'' was considered a positive or

19 negative treatment point, or any other conclusion.

20 154. Respondent's note dated August 29, 2011, indicates that S.B. was "very anxious," and

21 describing job-related stress. Her pain was 10/10. Her anxiety was 10110. It is not indicated

22 what plan of treatment Respondent developed for these complaints other than the continued

23 prescription of controlled substances.

24 155. Respondent's note dated September 30, 2011, indicates that S.B. was "still visibly

25 anxious" and fidgety. Respondent continued to prescribe her Xanax, Vicodin, Ultram, and Soma.

26 There is no indication that he ever considered referring her for mental health care, even though he

27 noted in his March 18, 2010 entry (18 months prior) that she had "bipolar" disorder.

28

30


156. Respondent's note dated February 23,2012, indicates that he was unable to determine

2 whether or not S.B. was bipolar and that he felt it would be wrong to diagnose her with that

3 condition "without an expeti evaluation." He added, "[i]t seems that it is sufficient to treat

4 empirically." S.B.'s medical records contain a consent for chronic opioid therapy, which S.B.

5 signed and dated on August 23, 2012, approximately 6 years after Respondent first began

6 prescribing her medications covered by that consent. There is also a treatment agreement for the

7 use of controlled substances in the treatment of chronic pain, which S.B. signed and dated on

8 February 23, 2012, approximately 6 years after respondent first began prescribing her

9 medications covered by that consent.

10 157. Respondent continued to prescribe S.B. Vicodin, Xanax, Soma, and Ultram

11 throughout 2012 without consideration of alternative approaches to treating her symptoms. There

12 is no indication of a referral for physiotherapy or consultation with a pain specialist or

13 orthopedist. There are ambiguous suggestions in the progress notes that S.B. was taking more

14 medication than directed. Respondent made a comment in his January 13, 2013 note suggesting

15 that was a problem, writing, "also aware of concerns over Xanax and Soma and narcotics ... will

16 reduce slowly?"

17 158. Respondent's note dated April 11, 2013, indicates that he talked with S.B. about

18 reducing her medications, and that she agreed to a gradual reduction. For the first time

19 Respondent recorded the results of S.B. 's urine drug screen in which she tested positive for

20 opiate, cannabis, and benzodiazepine.

21 159. Respondent's note dated June 23,2013, finally indicates consideration of an MRI,

22 pain consultation, and laboratory studies to evaluate for possible arthritis. Laboratory results

23 from August 13,2013, show S:B. to be within normal limits, including comprehensive metabolic

24 panel, complete blood count, and sedimentation rate.

25 160. Respondent's note dated October 17, 2013, is the last note in the chart (and was after

26 the investigation into Respondent's practices had been initiated), and contains components ofthe

27 neurological examination, including sensory and reflex testing in S.B. 's limbs. The notes indicate

28 that Respondent considered S.B. a candidate for permanent disability. There is also a notation

31


indicating "forms filled," though it is unclear what forms are referenced. A Brief Pain Inventory

2 and an anxiety symptom scale are in the chart with the notes for October 17, 2013, but neither of

3 which are dated, making it possible that these are the forms referenced although he could also

4 have been referring to disability forms.

5 161. The only evidence in the chart that Respondent was monitoring whether S.B. was

6 receiving prescriptions from other physicians occurs in the latter portion of 2013.

7 Three CURES reports dated August 20, 2013, August 29, 2013 and October 17, 2013 are

8 contained in the records. Thus, no inquiry regarding S.B.'s receipt of prescriptions for controlled

9 substances from other physicians occurred until Respondent had been prescribing her controlled

] 0 substances for over 7 years.

11 162. The August 29, 2013 CURES report has the names of two other providers who had

12 written the patient prescriptions for controlled substances during 2013 circled.

13 PATIENT T.B.

14 163. Respondent began treating T.B. for back pain on November 30,2007, and continued

15 treating him through at least February 5, 2013. Respondent also treated T.B. for inguinal pain

16 related to hernia.

17 164. Respondent's initial evaluation ofT.B. was on November 30, 2007. The file contains

18 a brief note indicating a chief complaint of back pain and a medical history indicating that T.B.

19 had "minimal back pain" prior to injuring his back three days prior to the visit, for which he had

20 been to a chiropractor. There is no further delineation of the nature and extent of the pain and

21 neither is there any other discussion of prior treatment efforts. There is no review ofT .B.'s

22 substance abuse history except the medical history questionnaire completed on November 30,

23 2007, upon which he indicated he had no history of an alcohol or drug problem.

24 165. Respondent's notes indicate a limited general physical examination was performed

25 but the only reference to T.B.'s back is a notation of tenderness in the lumbosacral paravertebral

26 region. There is no range of motion, strength, or reflex testing documented.

27 166. The November 30, 2007 diagnosis was back pain. However, there is no indication

28 whether T.B. had any symptoms of nerve root irritation, such as sciatica. A treatment plan is

32


reflected in the notes consisting of prescriptions ofVicodin ES #40 and Robaxin 750 mg #40 with

2 a recommendation to continue treatment with the chiropractor.

3 167. Respondent first prescribed the patient Xanax on November 8, 201 0. There is no

4 documentation in the medical records to support the prescription ofXanax. Neither is there any

5 indication that T.B. su1Tered from an anxiety disorder.

6 168. Respondent's notes dated September 25,2011, indicate that T.B. had right shoulder

7 pain. However, there is no further elaboration concerning the nature and extent of the pain and

8 there is no indication of any examination of the right shoulder in the notes. Respondent continued

9 prescribing T.B. hydrocodone and Xanax as an ongoing matter.

10 169. On February 5, 2013, Respondent saw T.B. to refill his prescriptions for hydrocodone

11 and Xanax. There is a "post-it note" on the progress note that states 11 get off pain meds. 11 There is

12 no date on the post-it note and no indication of when it was placed in the file. The progress note

13 itself has no treatment plan other than the continued prescription of drugs.

14 170. Three CURES reports were obtained as part of the investigation of Respondent. They

15 cover the time periods from August 13, 2009 through August 13, 20 12, December 19, 2011

16 through December 19,2012 and December 5, 2012 through December 15,2013.

17 171. The CURES reports indicate that T .B. filled 19 prescriptions from Respondent for

18 hydrocodone/acetaminophen from November 9, 2010 through February 20, 2013. The quantity

19 of tablets per prescription ranged from 60 to 150. Respondent prescribed T.B. an average of29

20 mg ofhydrocodone daily during that time.

21 172. The CURES reports indicate that T.B. filled 19 prescriptions from respondent for

22 alprazolam from November 9, 2010 through February 20, 2013. The quantity oftablets per

23 prescription was either 30 or 40. Respondent prescribed the patient an average of 1.9 mg of

24 alprazolam daily during that time.

25 173. Respondent saw T .B. approximately once a month. However, the progress notes

26 contain minimal history and very little evidence of any physical examination. Other than the

27 notes from the initial visit on November 30, 2007, there is one additional detailed assessment of

28 T.B.' s pain in the entire chart and that consists only of a Brief Pain Inventory questionnaire T.B.

33

(KENT LEHMAN, M.D.) ACCUSATION NO. 09-20 I 2-225474

completed on February 5, 2012. There is also an anxiety symptom questionnaire in the file, but

2 that has no date.

3 174. Respondent's notes have no history or examination information apart from noting that

4 T.B. was presenting for a prescription refill. There is neither reference nor indication concerning

5 the use of the medication to treat T.B.'s "hernia pain" or back pain.

6 175. Respondent's notes for the 6 years of T.B.'s treatment contain no indication

7 evidencing any assessment of T.B. 's adherence to treatment requirements with controlled

8 substances. T.B. 's file contains no CURES reports or urine drug screens. Neither is there any

9 indication that Respondent ever discussed the medication with T.B., and how T.B. was taking the

10 prescribed controlled substances to ensure that T.B. did not have a drug problem.

11 176. T.B. 's file contains a signed, undated treatment agreement for the use of controlled

12 substances in the treatment of chronic pain. There is also a consent for chronic opioid therapy

13 signed and dated February 24, 2012, approximately 6 years after Respondent first began

14 prescribing such controlled substances to T.B.

15 177. Respondent's notes contain no documentation that T.B. was ever asked ifhe had

16 experienced any adverse effects from the prescribed drugs.

17 178. Respondent's notes dated July 20, 2009, indicate that he had referred T.B. to a

18 general surgeon. However, there is neither a surgical consultation in the file nor any record of

19 any follow up concerning that referral or why the referral was made.

20 179. Respondent's notes are deficient in that they contain little or no history and little or

21 no physical examination findings for T.B. T.B.'s pain complaints are not adequately described in

22 the medical record. The rationale for Respondent's prescription ofXanax is nowhere found in the

23 medical records despite that prescription being refilled regularly for several years. Overall,

24 Respondent's treatment objectives for T.B. are unclear, unstated and unknown.

25 PATIENT V.C.

26 180. Respondent first saw V.C. on August 20,2010. Her chief complaint is noted as "Rx

27 request, pain lower back (center)" which appears to reference a request for a prescription for back

28 pain. Respondent's notes indicate she had "residual back pain," and had pain of9/10 intensity

34


------ ----------

without medication. The note suggests that V.C. was not taking any medications at the time she

2 presented to Respondent. However, there is no further discussion ofthe nature and extent ofthe

3 pain, whether there was any extension of the pain into her lower limbs, or whether there was any

4 associated weakness or sensory disturbance.

5 181. Respondent's notes contain no past medical history except from what can be gleaned

6 from a checklist that V.C. completed on the date of the initial visit. V.C. denied any history of

7 alcohol, drug, or mental problems on that checklist. Respondent's note does not contain any

8 discussion of her prior pain treatment efforts. However, an orthopedic consultation report dated

9 May 27, 2010, is contained in the medical records. That orthopedic consultation report references

10 a consultation with an orthopedist due to an automobile accident on April 24, 2010. The report

11 indicates that orthopedist performed a comprehensive evaluation and diagnosed her with cervical

12 sprain, lumbar sprain, blunt abdominal trauma, headache and dizziness due to concussion, and

13 "rule out anxiety." The orthopedist recommended chiropractic treatment and neurological

14 consultation and prescribed her Norco 10/325 #60 and Prilosec 20 mg #60.

15 182. Respondent's notes document a limited, general physical examination. The only

16 mention Respondent made of any musculoskeletal or neurological finding was that her neck had

17 reduced range of motion, although V.C. presented with a chronic, severe musculoskeletal

18 complaint and Respondent had access to the orthopedic report.

19 183. Respondent's notes contain no indication that he considered diagnostic testing to

20 evaluate V.C. 's complaints of severe pain despite four months having passed since her injury in

21 the automobile accident. Respondent's diagnoses was simply "auto accident, cervical strain, and

22 lumbosacral strain," with no indication of how he came to those conclusions.

23 184. Respondent's "treatment plan" was the prescription ofNorco 10/325 #90, Xanax 2

24 mg #20, and Soma 350 mg with no quantity noted. There is nothing in the medical records to

25 indicate V.C. gave informed consent until February 21, 2012, when she signed a consent for

26 chronic opioid therapy. There is nothing in the medical records to indicate consideration of any

27 alternative treatments apart from controlled substances.

28

35


185. Three CURES rep01is were obtained during the investigation of Respondent. These

2 CURES reports are from August 13,2009 through August 13, 2012, December 19,2011 through


4 186. The CURES reports indicate that Respondent provided V.C. with 42 prescriptions for

5 hydrocodone/acetaminophen from August 20,2010 through November 15,2013. The quantity of

6 tablets per prescription ranged from 30 to 240. Respondent prescribed V.C. 5,990 tablets of

7 hydrocodone/acetaminophen during that time.

8 187. The CURES reports indicate that Respondent provided V.C. with 25 prescriptions for

9 alprazolam from August 20,2010 through April29, 2013. The quantity of tablets per

10 prescription ranged from 10 to 30. Respondent prescribed V.C. 530 tablets during that time

11 frame.

12 188. The records indicate that Respondent historically saw V.C. every 1-2 months,

13 prescribing hydrocodone and alprazolam on a consistent basis. In addition, on August 4, 2011,

14 Respondent prescribed V.C. zolpidem 10 mg #30. On April13, 2012, Respondent prescribed

15 V.C. Soma 350 mg #60. However, these prescriptions for zolpidem and Soma were isolated and

16 not recurring prescriptions. The hydrocodone and alprazolam were recurring prescriptions.

17 189. Respondent's notes do not describe the nature and extent ofV.C.'s pain symptoms at

18 any point in time. The notes do not provide examination data.

19 190. Respondent provided multiple prescriptions for alprazolam during his first year of

20 treating V.C., but no reference to anxiety is mentioned in the notes until August 4, 2011, when the

21 single word "anxiety" is entered without any fmiher delineation of the nature and extent ofV.C.'s

22 anxiety.

23 191. There is no documentation explaining why Respondent prescribed V.C. alprazolam,

24 although following the single entry on August 4, 2011, it is possible the prescription could have

25 been for the symptom of anxiety. However, because the notes are deficient it is impossible to

26 determine the diagnosis resulting in the prescription.

27 192. The single word reference to "anxiety" in the August 4, 2011 note is the only

28 reference to anxiety in the entirety ofthe progress notes until Respondent notes on March 11,

36


2013, that V.C. was more anxious after having been involved in an automobile accident on March

2 11, 2013.

3 193. Respondent notes that on May 23,2013, V.C.'s anxiety was "much better." A "Pain

4 Anxiety Symptom Scale" is located in the medical records, but it was not dated, so it is unclear

5 when V.C. completed that form.

6 194. Respondent began prescribing V.C. Prozac on November 21, 2012, for reasons that

7 are unclear, Respondent indicating only that V.C. did not feel good on Xanax and could not get to

8 sleep at night.

9 195. Respondent's notes dated August 21, 2012, indicate that V.C. had a history of seven

10 prior automobile accidents. Those notes also indicate that V.C. was unable to reduce to 150 per

11 month, although it is not stated which prescription was being referenced by that note. However,

12 he prescribed V.C. 180 tablets ofNorco that day.

13 196. Respondent's notes dated October 13,2012, indicate that V.C. had been in yet

14 another automobile accident and that he had increased her use of one of the medications

15 (presumably Norco due to the quantity referenced) to seven tablets daily. However, the records

16 do not indicate any concern over the number of automobile accidents that V.C. represented

17 having been in despite the high level of controlled substances being prescri_bed.

18 197. Respondent's notes make multiple references to V.C.'s applications for disability,

19 which he based on her difficulty concentrating due to taking medication. However, despite that

20 reference there is no apparent attention concerning whether V.C. had any adverse effects from the

21 drugs, such as cognitive impairment, especially in light of the frequent automobile accidents.

22 This is particularly troubling because Benzodiazepines, such as alprazolam, have been shown to

23 adversely impact a person's ability to drive safely.

24 198. Respondent's notes dated March 11, 2013 indicate that V.C. was involved in yet

25 another automobile accident (this is the eighth reported automobile accident for V.C.).

26 Respondent provided a few sentences of history in that March 11, 20 13 note, but no examination

27 is recorded other than noting "WM." What is meant by "WM" is unknown. Respondent's plan

28

37


was to "continue current n1edication" and to order an x-ray of her neck. A report of a cervical x-

2 ray dated March 25,2013 is in the file. The x-ray was normal.

3 199. V.C.'s medical records also contain reports showing normal x-rays ofher neck and

4 low back dated September 1, 2011, a normal renal ultrasound dated November 8, 2013, and

5 laboratory testing dated September 23, 2013, comprising all of the diagnostic testing over the

6 course of three years of treatment.

7 200. Respondent's pattern of prescribing indicates that V.C. may have had trouble

8 controlling her use of the drugs. Respondent said in his May 23,2013 note that he had "to slowly

9 reduce her pain meds by 30" per month, although there is no evidence that this reduction

10 occurred. Respondent's note dated May 23,2013, states that he advised her to follow up with

11 physical therapy, making this the first reference to consideration of physical therapy in his

12 progress notes. There is no evidence Respondent ever ordered a urine drug screen for V.C.

13 201. Although Respondent appears to have ordered two CURES reports, the first dated

14 August 29, 2013, and the second November 20, 2014, there is no indication of why these reports

15 were ordered or what action, if any, was taken as a result of these CURES reports.

16 202. Respondent's notes indicate that he did not consider referring V.C. for consultation

17 with a psychologist or psychiatrist despite her "anxiety" and his numerous prescriptions to her for

18 alprazolam.

19 203. Respondent's records contain no informed consent regarding V.C.'s long-term use of

20 opioid therapy until February 21,2012, when V.C. signed a consent for chronic opioid therapy

21 and a treatment agreement for controlled substances.

22 204. Respondent's progress notes have little or no history and little or no physical

23 examination findings. V.C.'s pain complaints are not adequately described in the medical record

24 and Respondent's treatment objectives are unclear.

25 PATIENT B.C.

26 205. Respondent first examined B.C. on June 17, 2009. The initial note indicates the B.C.

27 presented complaining of pain in his right hand and shoulder due to sports injuries and surgeries.

28

38


However, Respondent did not further delineate the nature and extent of the patient's pain

2 symptoms.

3 206. Respondent's records include records from an orthopedist who treated B.C. prior to

4 Respondent. Those records indicate that B.C. had two surgeries on his right hand and a right

5 shoulder surgery in the six years prior to presenting to Respondent.

6 207. Respondent noted that B.C. "was on Norco for pain relief also was taking marijuana,"

7 but Respondent did not elaborate as to how B.C. was using these drugs. There is no delineation

8 ofpast medical history except the medical history checklist completed by B.C. on the day of the

9 initial visit, which checklist also included the standard question as to a history of alcohol, drug, or

10 mental problems that B.C. denied having. Respondent did not check a CURES report or request a

11 urine drug screen.

12 208. Respondent's notes indicate a physical examination revealing that B.C. had a full

13 range of motion in his "back" with a "normal curve." The examination of the right upper limb is

14 limited. The examination also indicates that B.C. had an "equal full grip" and what appears to be

15 a slight resting tremor in the right hand with "full dexterity." Respondent's notes also reference

16 "arm 11 o'clock," but it is unclear what is meant by this notation. Respondent's diagnosis was

17 right shoulder pain with impingement syndrome and brachial nerve "impin."

18 209. Respondent prescribed B.C. Norco 10/325 #60 and Ultram 50 mg #40. There is no

19 evident treatment plan reflected in the notes apart from the prescription of these opioids. There is

20 no documentation of informed consent relative to the medicines except for a consent for chronic

21 opioid therapy, which B.C. did not sign until January 30,2012.

22 210. Three CURES reports were obtained during the investigation of Respondent. These

23 CURES reports are from August 13,2009 through August 13,2012, December 19,2011 tlu·ough


25 211. The CURES reports indicate that Respondent provided B.C. with 63 prescriptions for

26 hydrocodone/acetaminophen from September 15, 2009 through November 24,2013. The

27 quantity of tablets per prescription ranged from 20 to 180. Respondent prescribed B.C. 6,850

28

39


tablets during that time, which equates to an average dose of approximately 62 mg of

2 hydrocodone daily.


4 alprazolam from January 30, 2012 through August 30, 2013. The quantity oftablets per

5 prescription ranged from 10 to 30. Respondent prescribed the patient 517 tablets during that time,

6 which equates to an average dose of about 1.9 mg daily.


8 carisoprodol from January 30, 2012 through November 11, 2013. The quantity oftablets per

9 prescription ranged from 20 to 120. Respondent prescribed the patient 2,240 tablets during that

10 time, which equates to an average dose of 4. 7 tablets daily (although the actual dosage per day is

11 difficult to discern from the records).

12 214. Respondent saw B.C. on a regular basis to refill the prescriptions for hydrocodone,

13 tramadol, and carisoprodol with the later addition of a1prazolam. Respondent's progress notes

14 usually indicate a chief complaint of "Rx refill" with little or no history or physical examination.

15 Respondent occasionally recorded a pain intensity level, as he did in his September 24, 2010 note

16 where he indicated "pain 8/10 esp when working-lifting."

17 215. B.C.'s medical records include two "Brief Pain Inventory questionnaires" relative to

18 his pain intensity and the impact of pain upon his functioning. These two questionnaires were

19 completed on two occasions, November 21, 2012 and March 17, 2014.

20 216. Respondent's n~tes indicate that on July 28, 2010, B.C. reported "back pain, knee

21 pains." However, there is no physical examination, nor treatment goals indicated. On that visit

22 Respondent refilled prescriptions for hydrocodone, tramadol, and carisoprodol.

23 217. Respondent saw B.C. again on August 23,2010, September 24,2010, November 12,

24 2010 and December 14, 2010 to refill the medications with no indication of any physical

25 examination. No vital signs are recorded even though there are blank spaces for the patient's

26 weight and blood pressure on each note. There is no evidence that Respondent performed any

27 examination or other testing on B.C. whatsoever.

28

40


218. Respondent's note dated February 7, 2011, offers some physical examination relative

2 to B.C.'s back, indicating a reduced back range of motion and "paravertebral muscles 'tight."

3 219. Respondent's note dated April 21, 2011 indicates that B.C. had "continued shoulder

4 and low back pain," which B.C. apparently attributed to "swinging hammer all day."

5 Respondent's notes indicate that he considered whether the B.C. had arthritis, but there is no

6 indication of any referral for diagnostic evaluation for the now chronic complaint of low back

7 pain.

8 220. On May 12, 2011, Respondent noted that B.C. had been stopped by the police who

9 took his medications, so Respondent simply prescribed him more Norco and Soma.

10 221. Respondent saw B.C. on June 8, 2011, July 14,2011, July 26, 2011, August 4, 2011,

11 August 29, 2011 and September 21, 2011, apparently solely for medication refills. The notes

12 from those visits are devoid of any history or examination findings apart from a few measures of

13 the patient's weight. The same is true for multiple visit notes in 2012, as set forth in the medical

14 records.

15 222. Respondent began prescribing B.C. Xanax on November 30,2012. However, there is

16 no indication in the records as to why he prescribed B.C. Xanax, but this became a recurring

17 prescription for small quantities of the drug. Respondent's progress notes do not indicate that

18 B.C. complained of anxiety or made other complaints for which Xanax might be prescribed.

19 There is a Pain Anxiety Symptom Scale form in the chart, but this is not dated.

20 223. Respondent's notes dated July 11, 2012, indicate that B.C. had continued left

21 shoulder pain and was to have left shoulder surgery the following week. The physical

22 examination consisted only of B.C.'s weight and a description of him as "WD WN WM," which

23 appears to mean that B.C. was "well dressed, well nourished, white male."

24 224. A note indicating that B.C. underwent shoulder arthroscopy at Kaiser on July 18,

25 2012, is in the file. There is no indication in the records that Respondent coordinated his

26 prescription of analgesic medications with the surgeon who performed the surgery in order to

27 prevent B.C. from getting drugs from both doctors.

28

41


225. In 2013, B.C. saw Respondent for multiple visits for prescriptions with no history or

2 physical examination findings recorded in the notes. The May 2, 2013 progress note indicates

3 only that B.C. had right hand pain intensity 7110. Respondent issued him prescriptions for

4 hydrocodone, carisoprodol, alprazolam, and ibuprofen.

5 226. Respondent's note dated May 26, 2013, provides a slight history and a physical

6 examination result indicating B.C.'s left arm "raises to 2 o'clock only," and his right hand was

7 swollen. There does not appear to be a reason for that swelling

8 227. Respondent's note dated November 11, 2013 indicates that B.C. had left shoulder

9 surgery on October 23, 2013, and would be starting physical therapy. However, in a previous

10 note Respondent had stated that B.C. underwent left shoulder arthroscopy at Kaiser on July 18,

11 2012. There is no indication in the records as to whether or not both surgeries, one, or none

12 actually took place. There are no records from any surgeon or any indication that Respondent had

13 communicated with a surgeon concerning B.C. However, the note referencing July 18, 2012

14 surgery refers to that surgery in the past tense so it is reasonable to suggest that Respondent must

15 have actually seen evidence of that surgery at the time he entered the information in his progress

16 notes. However, the same is also true for the November 11, 2013 note.

17 228. Respondent's notes indicate that he made no effort to monitor whether B.C. was

18 using the prescribed medications as directed until June of2013. The first urine drug screen in the

19 file is dated June 24, 2013, and indicates that B.C. tested positive for opiate and benzodiazepine,

20 which is to be expected based on the prescription history, but he also tested positive for THC. A

21 second urine drug screen documented in the March 17,2014 progress note shows the same

22 results. No mention of marijuana use is reflected in the progress notes after the notation in the

23 initial visit note on June 17, 2009.

24 229. B.C.'s records include a signed treatment agreement for controlled substances, but

25 there is no date on this form.

26 230. Respondent's records contain one CURES report Respondent accessed on B.C. dated

27 August 29, 2013. There is no indication that Respondent took any action or otherwise made note

28 of that report.

42


231. Respondent's note dated December 23, 2013, indicates that B.C. was "struggling" to

2 decrease his use to 120 per month, apparently referring to his use of hydrocodone, as that is the

3 only controlled substance that B.C. was taking in a quantity able to be reduced to that number.

4 Respondent's documentation reflects no evidence that he assessed B.C. for possible adverse

5 effects from the controlled substances that he prescribed him over the course of five years. Only

6 one laboratory test result is in B.C.'s medical records and that was ordered by B.C.'s primary care

7 physician at Kaiser, with results from August and October 2013. Respondent never ordered any

8 such laboratory testing.

9 232. Norco is a combination ofhydrocodone and acetaminophen. Daily dosing of

10 acetaminophen raises concerns about potential liver toxicity, which is determined by laboratory

11 testing.

12 PATIENT N.D.

13 233. Respondent's initial visit with N.D. was on February 8, 2007, and continued at least

14 until February 4, 2014.

15 234. Respondent's note dated February 8, 2007, indicates that N.D. presented with

16 complaints of chronic back pain and anxiety. There is no further description of her symptoms in

17 the notes and neither is there a description of any prior treatment for pain or anxiety. The

18 physical examination is limited, and the only detail noted with respect to her musculoskeletal and

19 neurological examinations is back tenderness in the lumbosacral region. There is no mental status

20 examination. Diagnoses are simply anxiety and back pain. There are no diagnostic test results

21 noted. There is no evident treatment plan apart from prescription for medications, including

22 Xanax 2 mg #30, Prozac 20 mg #30, Vicodin ES #30, and possibly Wellbutrin, although the

23 record is unclear on that medication. There is no documentation indicating informed consent

24 relative to the medications was given.

25 235. Past medical history can only be gleaned from the "patient's checklist for medical

26 history" dated February 8, 2007. That checklist does not indicate any issues with muscles, joints,

27 or nerves, and N.D. denied any history of alcohol, drug, or mental problems. There is no

28 substance abuse history documented apart from what can be gleaned from this questionnaire.

43


236. Respondent's progress notes show that N.D. was generally seen on a monthly basis.

2 However, Respondent's notes are generally devoid of history and physical examination findings

3 apart from occasional brief references. There are occasional references to the diagnosis of

4 migraine but without any history to support the diagnosis. In the June 20, 2008 note, the

5 diagnoses of tibromyalgia and arthritis appear with no supporting documentation.

6 237. Respondent's notes from August 14, 2009, indicate a prescription for Ambien

7 (zolpidem), but the notes make no reference to N.D. having a sleep problem until December 9,

8 2009, when Respondent noted "[patient] depressed-sleep problems" without elaboration.

9 238. Respondent's notes list a diagnosis of back pain without other diagnoses, yet at every

10 visit he refills prescriptions for hydrocodone, alprazolam, zolpidem, and fluoxetine.

11 239. On August 27, 2010, Respondent began prescribing N.D. two different strengths of

12 hydrocodone, but there is no explanation as to why this is necessary and prescribing a patient two

13 different strengths ofthis drug is an uncommon practice.

14 240. The notes contain limited clinical information indicating that Respondent made an

15 effort to refine the nonspecific diagnoses of anxiety and back pain. There is a report of a lumbar

16 x-ray in the file, but that was not done until June·17, 2013, six years after Respondent began

17 prescribing to N.D. That x-ray showed only mild degenerative changes. The only laboratory

18 testing results in the file are dated December 22, 2012, and those were normal and included tests

19 looking for an underlying mihritic condition, like rheumatoid arthritis.

20 241. Respondent's notes provide little data to determine whether N.D. benefited from

21 taking the medications in terms of her pain, mood, and sleep. There is a pain assessment scale,

22 the "Brief Pain Inventory," which presumably N.D. completed, but that is found on only one

23 occasion on April29, 2013. N.D.'s medical records contain an anxiety symptom scale (usually

24 completed by the patient), but it is undated. The lack of clinical data makes it difficult to

25 determine the rationale for continuing or altering treatment with the prescribed drugs.

26 242. Respondent's notes contain limited data to indicate that he was attentive to whether

27 N.D. was taking the medications as directed or misusing them. There are notes from an

28

44


emergency room visit on September 17, 2010, concerning N.D.'s having had a new onset seizure,

2 which suggests she may have been misusing her medications.

3 24 3. N.D.'s medical records contain three CURES reports Respondent apparently accessed

4 on August 29,2013, September 27, 2013 and January 21,2014. These CURES reports indicate

5 that N.D. obtained prescriptions for alprazolam and hydrocodone on multiple occasions during

6 2013 from other physicians. Respondent's notes on September 27, 2013, indicate that he "again

7 spoke to patient" about not seeing another physician. However, there is no indication that

8 Resp~ndent altered his treatment ofN.D. as a result.

9 244. The medical records contain the results of a single urine drug screen included in

10 Respondent's July 3, 2013 progress note. N.D. tested positive for amphetamine, opiate, THC,

11 benzodiazepine, PCP, and "met." No indication of any change in Respondent's treatment ofN.D.

12 as a result of these test results is contained in the file.

13 245. The notes contain no indication of an informed consent discussion until January 31,

14 2012, when N.D. signed a consent for chronic opioid therapy and also signed a treatment

15 agreement for controlled substances.

16 246. Respondent's notes contain no indication that he considered referring N.D. for

17 consultation with a psychiatrist, psychologist, or pain specialist. There is no indication he

18 considered referring her for physical therapy or some other nonmedicinal approach to managing

19 her symptoms, despite her long-standing symptoms and requirement for multiple medications.




23 248. The CURES reports indicate that Respondent provided N.D. with 92 prescriptions for

24 hydrocodone/acetaminophen from August 14, 2009 through November 1, 2013. The quantity of

25 tablets per prescription ranged from 30 to 180. Respondent prescribed the patient 9,470 tablets

26 during that time.

27 249. The CURES data for the 92 prescriptions for hydrocodone/acetaminophen from

28 August 14, 2009 through November 1, 2013 is peculiar because it indicates numerous instances

45


where N.D. filled two separate prescriptions for hydrocodone from Respondent on the same day

2 for different strengths of the drug; one for the 7.5 mg formulation and the other for the 10 mg

3 formulation. These prescriptions have different prescription numbers eliminating the possibility

4 of clerical error. Furthermore, in addition to the CURES data, the medical records contain copies

5 of prescriptions dated August 29, 2013 and June 17, 2013, dates on which Respondent prescribed

6 N.D. two different strengths of the same drug.


8 alprazolam from August 14, 2009 through November 1, 2013. The quantity of tablets per

9 prescription ranged from five to 40. Respondent prescribed N.D. an average of2 mg of



12 zolpidem from August 14,2009 through January 4, 2012. The quantity of tablets per prescription

13 was either 30 or 40. Respondent prescribed N.D. an average of 8 mg of zolpidem daily during

14 that time.

15 252. Respondent also prescribed N.D. oxycodone/acetaminophen 10/325 #60 on April 29,

16 2013. There were no other prescriptions for oxycodone during the times covered by the CURES

17 reports.

18 PATIENT M.F.

19 25 3. Respondent first saw M.F. on November I, 20 11. Respondent's initial note indicates

20 that M.F. had suffered a severe injury to his right foot in a January 2011 motorcycle accident, had

21 undergone multiple surgeries, and had severe pain with intensity 8-10/10. Respondent indicated

22 that M.F. "was going to Kaiser and VA." He noted that M.F. stated that Norco made him sick.

23 There is no further delineation of the pain symptom or prior treatment efforts, and there is no

24 indication Respondent obtained prior treatment records.

25 254. Respondent prescribed controlled substances for the treatment ofM.F.'s chronic pain

26 condition until M.F. died of an accidental overdose on February 19,2013. The coroner's report

27 indicates the overdose was due to the combined effects of fentanyl, mi1iazapine, alprazolam, and

28 nordiazepam.

46


255. Respondent did not record a substance abuse history apart from M.F. 's medical

2 history checklist, which docs not have a name or date but appears to be M.F.'s, because it

3 mentions a January 2011 motorcycle accident. On this checklist, the patient denied alcohol, drug,

4 and mental problems. There is no indication that Respondent reviewed a CURES report or

5 obtained a urine drug screen in connection with the first visit.

6 256. Respondent's physical examination is notable for its completeness including the

7 report ofM.F. walking with a limp and having a markedly disfigured right ankle and foot with

8 scarring and reduced range of motion at the ankle. Respondent diagnosed right-sided foot ankle

9 pain with history of a compound fracture at the ankle/foot. He prescribed the patient

I 0 hydrocodonc/acctaminophcn 10/325 #60 with instructions to take one tablet twice daily as needed

11 for pain. There is an informed consent for chronic opioid therapy the patient signed and dated on

12 January 16, 2012. There is also a treatment agreement for long-term controlled substances

13 therapy for chronic pain M.F. signed and dated on January 16, 2012.

14 257. Respondent continued to see M.F. on a monthly basis after the initial visit until his

15 final visit with the patient on January 28,2013. As noted above, M.F. died from an accidental

16 overdose on February 19,2013.

17 258. A CURES report for M.F. shows Respondent provided M.F. with 10 prescriptions for

18 controlled substances from December 8, 2012 through January 28, 2013, including three

19 prescriptions for oxycodone/acetaminophen 10/325 #60, two prescriptions for transdermal

20 fentany150 mg #15, three prescriptions for alprazo1am 2 mg #20-30, and two prescriptions for

21 hydrocodone/acetaminophen 10/325 #30. As noted above, the coroner's report indicates M.F.

22 died from the combined effects of fentanyl, mirtazapine, alprazolam, and nordiazepam.

23 259. Respondent prescribed M.F., Norco 10/325 #30 on December 12,2011. The notes

24 from that date do not indicate why Respondent prescribed this drug to M.F. This is particularly

25 interesting because on M.F. 's first visit with Respondent he stated that Norco made him sick.

26 260. Respondent's note dated January 4, 2012 is entitled "Interim Treatment Plan."

27 Respondent provides further details about M.F. 's trauma and subsequent limb salvage surgeries.

28 He also provided more detail about the pain and reiterated M.P.'s statement that Norco "makes

47


him sick." Respondent indicated that M.F. had tried physical therapy and had been encouraged to

2 walk. He provided more description of the physical findings at the foot and ankle. He said the

3 patient had "achieved reasonable pain relief with a combination of Percocet and Norco, which

4 had "allowed him to increase his standing/walking." He cautioned the patient about potential

5 risks associated with the medication and the importance of safeguarding the medication. He

6 asked the patient to sign a pain treatment agreement, which was subsequently signed on January

7 16, 2012.

8 261. Respondent's note, dated March 28, 2012, indicated that M.F. requested Duragesic,

9 which he had apparently used previously. Respondent prescribed him transdermal fentanyl 125

10 mg, quantity unstated, in addition to Percocet, dosage unstated, #60 and Norco, dosage unstated,

11 #30.

12 262. Respondent's note of April2, 2012 indicated that M.F. did not feel the 25 mg dose of

13 transdermal fentanyl was adequate, because his pain was 10/10 with walking. Respondent

14 increased the dose of transdermal fentanyl to 50 mg.

15 263. Respondent's note of April 26, 2012, indicated that M.F. felt "'much better' on the

16 fentanyl patches," with improvement in his sleep. Respondent noted that M.F. was still walking

1 7 with a crutch and a limp.

18 264. Respondent's note of July 17, 2012, indicated that M.F. had complaints of anxiety

19 and stomach upset, with nausea and vomiting. There is no indication that Respondent queried

20 M.F. regarding his bowel function to assess whether M.F.'s nausea and vomiting might be due to

21 bowel dysfunction from the opioid drugs, in that long-term opioid therapy can cause severe

22 constipation. The notes do not contain a description of the nature and extent ofM.F.'s anxiety.

23 Respondent prescribed M.F. alprazolam 2 mg #20 on that visit.

24 265. Respondent's note of August 13, 2012, indicated that M.P.'s pain was 8/10 without

25 medicine but reduced to 2/10 with medication. Respondent's notes indicate that M.F. had a

26 "restless anxious feeling in leg;" which Xanax helped. Respondent did not describe this symptom

27 in any greater detail, but revised the diagnosis to "foot/ankle/leg pain and cramps and anxiety" at

28 some point. In addition to the Xanax, Respondent continued the prescriptions for alprazolam 2

48


mg # 20 in addition to the transdermal fentanyl, oxycodone, and hydrocodone prescriptions

2 previously given.

3 266. Respondent's notes ofNovember 27, 2012, indicate that M.F. had taken more

4 medication on some days, but it is unclear if that means that he had taken more than was

5 prescribed or had taken more because the pain was greater, but still within prescription limits. A

6 physical examination on that visit noted that M.F. "struggles markedly, walks with cane,

7 diaphoretic, pale." He refilled the prescriptions for all four controlled substances.

8

9 267. Respondent's note of December 27, 2012, indicates that M.F. was walking more and

10 had "adequate" pain reliefbut complained of increasing leg cramps and a crawling, itching,

11 tingling sensation in his foot, especially at night. Respondent noted that Xanax helped the patient

12 relax and decreased his breakthrough pain. There is no indication that Respondent considered

13 prescribing M.F. a non-opioid analgesic, since the note suggests more clearly that M.F. was

14 experiencing some neuropathic pain in the leg.

15 268. Respondent's note of January 2, 2013, indicates that M.F. had brought in a package of

16 fentanyl patches that his four-year-old nephew had run through a shredder. The notes indicate

17 that M.F. asked for replacement of the patches, but Respondent told him he could not give him a

18 replacement prescription and that he was responsible for securing his medications. He also said he

19 was considering referring him to specialty pain management. This incident is of particular

20 concern, since ifM.F. 's recitation is truthful, he allowed his four-year-old nephew access to the

21 fentanyl patches, which could easily have led to the death ofthe child if he had been exposed to

22 the drug. Yet other than declining to prescribe M.F. replacement patches, Respondent seems not

23 to consider the event important.

24 269. Respondent's note of January 28, 2013, indicates that M.F. complained of severe pain

25 with intensity 10110 at the right foot and ankle. He described him as anxious, diaphoretic, and

26 markedly distressed. In an "Annual Review'' Respondent on the same date, again summarized the

27 patient's history and performed "a brief, cursory exam" that showed the patient to be "in moderate

28 to marked distress," to appear anxious, and to have a "labored" style of walking with a cane. He

49


noted marked scarring about the right foot with no edema or cellulitis. In referring to the

2 treatment plan, he said the patient was "in agreement that we have achieved the level of pain

3 relief that allows him reasonable [activities of daily living]." He reprised the informed consent.

4 He indicated his plan to check a urine drug screen the following month. There is a more

5 quantitative assessment of the patient's pain on this date, in the form of the Brief Pain Inventory.

6 270. Respondent's next entry in M.P.'s file is a one-page, typed summary of"Additional

7 Facts" Respondent gathered for a postmortem analysis. He asked the decedent's wife if the

8 decedent had seen any other doctors. His notes state that: "She told me that she was his wife, not

9 his mother, and that he took care of his own medical problems and that she didn't get involved."

10 Respondent further reported that he called the pharmacy where M.F. filled his prescriptions from

11 Respondent and asked the pharmacy employee if she could run a CURES report on M.F. The

12 employee said she could not, as "she was not set up to do those. Respondent's notes indicate that

13 he then told the pharmacy employee that "I had tried to get set up myself since January but was

14 never able to get a hold of anyone there when I called."

15 271. Respondent's medical file for M.F. contains two CURES reports dated August 23,

16 2013 and August 22, 2013, months after the M.F.'s death. These reports indicate the patient was

17 obtaining prescriptions for controlled substances ( opioids and benzodiazepines) from multiple

18 doctors at multiple pharmacies.

19 PATIENT E.H.

20 272. Respondent first saw E.H. on September 23, 2007. The initial note indicates that E.H.

21 was first treated for weight loss. He did not consistently treat her for a pain condition until April

22 7, 2008.

23 273. Respondent's first mention of prescribing E.H. Talwin is in the progress note dated

24 April 7, 2008. The note indicates that E.H. had back pain secondary to "twist." There is no

25 physical examination other than her weight. The diagnosis is "back pain/conjunctivitis," and

26 Respondent prescribed her 60 Talwin tablets. Respondent's subsequent notes variously refer to

27 E.H. as having pain in her back, right leg, right foot, neck, left hand, and also migraine. There are

28 some references to E.H. having fallen and injured herself.

50


274. Respondent's, notes from June 8, 2010, that indicates that E.I-I. had fallen and

2 fractured her left knee, though there was no physical examination documented to support that

3 conclusion, or any physical examination at all noted for that visit. He prescribed her Talwin #60

4 with one refill. The visit notes generally indicate that he refilled her prescription for Talwin, but

5 there is scant history and essentially no physical examination findings to support long-term

6 prescription of the opioid.

7 275. Respondent's March 28, 2011 progress note indicates that he doubled the quantity of

8 the Talwin prescription from 60 to 120 tablets. There is no explanation in the notes and there is

9 no record in the notes to indicate a symptom of pain, any physical examination findings, or a

10 diagnosis of pain.

11 276. Respondent's progress note of July 22, 2011, indicates that E.I-I. was prescribed

12 Norco 10/325 #60 with one refill. There is no record of any symptom of pain. There is no

13 physical examination apart from her weight. There is no diagnosis of pain. Despite multiple

14 intervening visit notes, the next entry that even mentions the E.I-I. having pain is dated February

15 16, 2012, and indicates "'back pain, leg pain" without further explanation and without a physical

16 examination. He refilled her prescription for Talwin #90 with one refill.

17 277. E.H. visited Respondent on multiple occasions but the next entry that concerns pain is

18 dated March 29,2013, when Respondent noted that E.H. had continued back pain "but better,"

19 with intensity 7-8/10. Respondent also observed that E.I-I. still had "bottle almost full of meds."

20 There was no physical examination apart from weight. He indicated she had back pain, left knee

21 pain, and left foot pain and prescribed her Talwin #90. He recommended x-rays of her left knee

22 and right foot. There is a report for a right foot x-ray in the medical records dated September 11,

23 2013, showing that E.H. had degenerative joint disease at the first metatarsophalangeal joint.

24 Oddly there is also a right foot x-ray report in the chart dated May 1, 2006 (seven years prior) that

25 showed similar findings. No report of a left knee x-ray is contained in the medical records.

26 278. Respondent's April25, 2013 progress note indicates that Respondent talked with E.I-I.

27 about "alternatives to Talwin Nx." He indicated she had right foot pain that was constant with

28 intensity 8/10, had intermittent pain in the low back with intensity 9/10, plus left knee pain at

51


-------------.. ---~~~~~~~~~~~~~~~~~~~~~~-

times with intensity 7/10. There is no physical examination apart from weight. There is no

2 assessment, and the plan consists of prescriptions for Tal win, Motrin, Elavil, and samples of

3 Lyrica. The note suggests that either E.H. or Respondent wished to ease her off of Tal win.

4 However, it is impossible to determine the exact facts due to the sparse documentation. It is

5 unclear whether E.H. was having difficulty controlling her use of the drug (she was receiving

6 numerous prescriptions for the medication) or if another reason for reduction of the medication

7 caused the notation. There is no documentation concerning whether Respondent ever talked to

8 her about how she was managing her use of the drug.

9 279. There are two CURES reports in E.H. 's medical records that Respondent accessed,

10 but those were not accessed until August 29,2013 and January 21,2014. Respondent did not

11 adequately assess E.H. 's adherence to proper use of this opioid analgesic.

12 280. Respondent's medical records contain a consent for chronic opioid therapy signed by

13 E.H. on February 16, 2012. There is also a treatment agreement for long-term controlled

14 substances therapy for chronic pain which E.H. signed but did not date.

15 281. Respondent's notes do not contain documentation indicating that Respondent

16 monitored E.H. for potential adverse effects from her chronic use of pentazocine, such as

17 sedation, dizziness, nausea, mental changes, and dependence. There is a remarkable dearth of any

18 physical examination findings relative to E.H. 'spain symptoms in the entire file. It is impossible

19 to determine from the documentation what the treatment objectives were with respect to the

20 multiple prescriptions for Talwin.

21 282. Respondent's September 11, 2013 progress note provides additional history,

22 indicating that E.H. had increasing right foot pain and had apparently increased the amount of

23 medication she was taking. The pain is described as dull, throbbing, deep, and sometimes sharp

24 and as worse with standing and walking. Again there is no physical examination except for the

25 notation "x-ray/foot from 2006 shows [sic]." The diagnosis is merely foot pain. Respondent

26 prescribed her Talwin #75, gabapentin, ibuprofen, and Vistaril. He noted a urine drug screen

27 result in the left margin of the progress note, but the results are undecipherable.

28

52


1 283. Respondent's March 14, 2014 progress note contains little information except for

2 indicating that E. H. presented for prescription refills. There are no symptoms documented.

3 There was no physical examination. Respondent prescribed Norco 10/325 # 120 and ibuprofen

4 600 mg #30. The treatment plan is unclear.

5 284. Respondent's medical records do not contain any systematic assessment of E.H. 's

6 pain apart from one Brief Pain Inventory completed on January 18, 2013. On this questionnaire,

7 she indicated the location of her pain, delineated her pain intensity, and rated the pain's impact

8 upon her function.



11 December 19, 2012 and December 5, 2012 through December 15,2013. There is also a CURES

12 report in Respondent's file that is dated January 21,2014 and includes five additional

13 prescriptions from Respondent that are not included on the CURES reports obtained as part ofthe

14 investigation.

15 286. The CURES reports show that E.H. filled 128 prescriptions for pentazocine/naloxone

16 (trade name Talwin Nx) from Respondent from September 4, 2009 through January 13, 2014.

17 Pentazocine is a weak opioid analgesic used for the relief of moderate to severe pain. It is

18 available as an oral agent in combination with a small amount of naloxone, and the naloxone is

19 intended to reduce the risk of its being abused intravenously. Over slightly more than four years,

20 Respondent prescribed her 8,951 tablets for an average dose of 317 mg of pentazocine daily. (The

21 manufacturer recommends a total daily dose of pentazocine not exceed 600 mg.)

22 287. Respondent issued E.H. several other prescriptions for controlled substances from

23 September 4, 2009 through January 13, 2014, including a prescription for Butrans 5 mg patches

24 on May 5, 2011, prescriptions for hydrocodone on July 22, 2011 and September 30, 2013, and a

25 prescription for codeine on November 4, 2013.

26 PATIENT J.I.

27 288. Respondent first saw .T.I. on February 25, 2008, for an initial complaint of bronchitis

28 and anemia. There is no history in this note and a limited physical examination. The diagnoses

53


1 were bronchitis and anemia, and a treatment plan consisted of vitamin supplementation and a

2 testosterone injection.

3 289. Respondent's second visit with J.I. occurred on May, 14, 2008, at which time

4 Respondent started prescribing J.I. Norco 10/325 #60, for a diagnosis of sinusitis. The records do

5 not contain any description of the nature and extent of the pain nor any record of any examination

6 other than blood pressure and weight. There was no indication of informed consent or any

7 discussion of the possible risks associated with Norco. There is no indication as to whether the

8 patient had a history of substance abuse apart from what can be gleaned from J.I. 's self-

9 completed, undated medical history checklist upon which J.I. denied alcohol, drug, or mental

10 problems. However, Respondent does comment upon the substance abuse issue four years later

11 in a note dated January 23, 2012.

12 290. Respondent's January 14, 2009 note references J.I. as having continued "sinus

13 pressure/pain." Respondent prescribed him Norco 10/325 #80. There is no documentation of an

14 examination other than J.l. 's weight.

15 291. Respondent's February 12, 2009 progress note indicates that J.I. had "sinus facial

16 pains" and was seeing an otolaryngologist. Respondent prescribed J.I. 100 Norco tablets.

17 292. Respondent's April20, 2009 progress note mentions "headaches" as J.I. 's subjective

18 complaint without further description of the symptom. Respondent prescribed J .I. Vicodin ES

19 #100.

20 293. Respondent's August 11, 2009 note indicates a diagnosis of migraine for the first

21 time. There is no further history and no examination of the neurological system. Respondent

22 prescribed J.I. Norco 10/325 #120.

23 294. Respondent's January 1, 2010 progress note makes the first reference to pain

24 intensity, noting "pain is 8-1 Oil 0 without meds." Respondent noted that he spoke with .1 .I. about

25 "seeing two doctors" and indicated the patient said he would not get medicines from the other

26 doctor without notifying Respondent. Respondent's assessment was now pain in the neck, back,

27 and face (sinuses), and he prescribed J.I. Norco 10/325 #120.

28

54


295. Respondent's March 11, 2010 note indicates a diagnosis of trigeminal neuralgia, back

2 pain, and cellulitis. There is no neurological examination. There is no examination of the head

3 and neck recorded. There is no further delineation of the symptoms other than indicating the

4 patient had "severe maxillary-face pain 9/10." Respondent prescribed .T.I. Norco 10/325 #120.

5 296. Respondent saw J.I. on several interim occasions with no significant events recorded

6 in the progress notes. However, on January 3, 2011 there is a note in the medical records entitled

7 "Interim Review." In that note Respondent indicated that J.I. was "under chronic pain

8 management" and had "not sought pain meds from another physician" since he had spoken to him

9 the prior January when he learned that J.I. had been receiving narcotic prescriptions from both

1 0 Respondent and another physician. It is unclear how Respondent discovered that information. In

11 the January 3, 2011 note Respondent indicated that J.I. had achieved "adequate pain relief

12 without having to increase the amount ofNorco compared with the year before. The note

13 indicates that he cautioned J.I. about taking additional acetaminophen in over-the-counter

14 medicines, talked with J.I. about the issue of tolerance and the option of using a long-acting

15 medication and discussed the importance of safeguarding his medications to prevent diversion.

16 The note also indicates that, for apparently the first time, he warned J .I. that the prescribed

17 medications might affect his level of alertness and cause other potential side effects. Respondent

18 concluded that J.I. "had good pain relief' and had "been able to enjoy a comfortable active

19 lifestyle." There was no physical examination associated with this note other than recording the

20 patient's height, weight, and blood pressure.

21 297. Respondent's June 21, 2011 progress note indicates that J.I. complained of constant

22 pain with an intensity level of 10/10 that interfered with his concentration and drained his energy.

23 The note contains some physical findings, including tenderness to percussion below the eye,

24 though he does not indicate whether this was right-sided or left-sided. Respondent also indicated

25 that .J .I. had mild periorbital swelling. Respondent indicated that J.I. had "intractable" sinus/face

26 pain. He prescribed him Norco 10/325 #120 with one refill and promethazine and codeine cough

27 syrup, 8 ounces.

28

55


1 298. On December 20, 2011, Respondent increased the quantity ofthe Norco prescription

2 from 120 to 240 tablets. The notes indicate that J.I. 'spain intensity was 7/10 without medicine

3 but did not indicate the degree to which the medication alleviated the patient's pain.

4 299. Respondent's July 11,2012 progress note indicates that J.I. was "in satisfactory

5 comfort" and stated that the medication reduced his pain from 7-8/10 to 2-3/10. He added, "He

6 [J.I.] appears to be handling his medications responsibly. The mcds allow him to enjoy [activities

7 of daily living] and his hobby (boating, fishing, travel)." That is the extent of the information in

8 the note, with no additionally physical examination or objective readings.

9 300. Respondent's October 12,2012 progress note indicates that J.I.'s pain is no longer

10 controlled by the current prescriptions with a pain intensity of 9/10. Respondent prescribed him

11 Norco 10/325 #180 and added Percocet 10/325 #60, which is another short-acting

12 opioid/acetaminophen combination.

13 301. On January 23, 2012, Respondent wrote a report entitled "Periodic Review," in which

14 he summarized .T.I. 's history to a greater extent that had been done in the prior four years of

15 seeing .T.I. Respondent described .T.I. 's history of pain treatment prior to coming under his care.

16 Respondent also notes that .T.I. did not have a history of drug or alcohol abuse, nor did he have

17 history of any psychological problems. The note also included a limited physical examination.

18 Respondent listed a treatment plan with objectives, including the objective "to make the pain

19 tolerable so that he can enjoy a reasonable quality of life and beyond achieving normal [activities

20 of daily living] he remains quite active." Respondent mentioned informed consent and cautioned

21 .T.I. about potential risks as well as the need to secure his medications. Respondent also noted that

22 he was planning to do a urine drug screen, but results for this screen do not appear in the file until

23 July 2, 2013. The file includes a consent for chronic opioid therapy and a treatment agreement

24 for long-term controlled substances therapy for chronic pain, but .T.I. did not sign and date these

25 documents until January 23,2013 exactly one year after the periodic review.

26 302. Respondent's March 1, 2013 note indicates that Respondent began prescribing .T.I.

27 transdermal fentanyl at a dose of 50 mg with instruction to change the patch every 48 hours.

28 Respondent noted that .T.I. had tried a friend's fentanyl patch with good relief. Strikingly, there is

56


nothing in the notes indicating the Respondent advised J .I. of how dangerous it is for one patient

2 to use another person's fentanyl patch, because that could easily result in unintentional overdose

3 and death in someone who is not sufficiently tolerant to opioids. Respondent also initiated

4 treatment with the patch on a 48 hour schedule, which is not how the patch is generally dosed at

5 the outset of treatment. However, Respondent altered the schedule at the next visit on March 29,

6 2013 when he instructed the patient to change the patch every 72 hours. However, the reason for

7 altering the duration, as reflected in the notes was because J.I. stated that "his plan" would only

8 pay for use of the patch every 72 hours.

9 303. Respondent's July 2, 2013 notes include the results of the urine drug testing

10 mentioned on January 23,2013. J.I.'s urine was positive for opiate and negative for the other

11 substances tested, which was consistent with the prescription records.

12 304. Respondent's medical records for J.I. include CURES reports dated November 25,

13 2009, August 29, 2013 and September 2, 2013. The report of November 25, 2009 may have led

14 Respondent to counsel J.I. on January 20, 2010 regarding the need to get pain medications from

15 only one physician at a time.

16 305. Respondent's only entry in the several years represented in the file that quantitatively

17 assesses J.I.' s pain and activity tolerance is a Brief Pain Inventory questionnaire completed on

18 January 23, 2013. There is also one pain anxiety symptom scale in the file, but that has no date.

19 Diagnostic testing in the file in:cludes laboratory testing Respondent ordered for J.I. in November

20 2012, laboratory testing of J.l. in June 2007 that was ordered by another physician and which

21 Respondent had faxed to his office on March 4, 2008 and laboratory testing J .I. had in early 2008,

22 also ordered by another physician, which Respondent also had faxed to his office on March 5,

23 2008. It is not indicated how Respondent was made aware of these tests.

24 306. Respondent saw J.I. on a regular basis to prescribe and monitor his treatment with

25 opioid analgesic medicine, usually hydrocodone and later transdermal fentanyl, but there is an

26 inadequate description of the nature and extent of J.I. 's pain, little or no physical examinations,

27 and no noted consideration ofreferring J.I. for consultation with a specialist, such as a neurologist

28 or pain medication specialist.

57


307. Early in the course of Respondent's treatment of J.I., Respondent made reference to

2 J.J, seeing an otolaryngologist, but there is no documentation to suggest he coordinated his

3 treatment with that clinician, or what that clinician's finding were, if any. Respondent uses

4 different terms to refer to .T.I.'s pain, including facial pain, migraine, and trigeminal neuralgia, yet

5 J.I.'s diagnosis remains unclear due to lack of adequate history and no physical examinations to

6 differentiate these different disease entities, for which there are more specific treatments available

7 than just long-term opioid therapy.


9 reports reflect data from August 13, 2009 tlu·ough August 13, 2012, December 19, 2011 through


11 309. The CURES reports show that J.I. filled 54 prescriptions for hydrocodone from

12 Respondent from September 16,2009 through November 23, 2013. Over these four years,

13 Respondent prescribed J.I. 7,380 hydrocodone tablets for an average of 54 mg ofhydrocodone

14 daily. Respondent also issued J.I. a few prescriptions for promethazine with codeine cough

15 syrup, oxycodone/acetaminophen, and later during the course of treatment started him on

16 transdermal fentanyl, in addition to the hydrocodone.

17 PATIENT C.L.

18 310. Respondent first saw C.L. on June 25, 2001, for treatment of C.L. 's obesity with the

19 diet drug phentermine. There are a number of follow-up visits over the ensuing years pertaining

20 to the prescription of this diet pill. Seven of the progress notes over the following years do not

21 have a discernible date and most contain very limited information.

22 311. Respondent first prescribed C.L. an opioid analgesic on March 30, 2005, noting that

23 C.L. had back pain as indicated by an examination revealing tenderness in the lumbosacral

24 region. Respondent prescribed Vicodin ES #40.

25 312. Respondent's subsequent notes make occasional reference to C.L.'s having low back

26 pain, but Respondent did not prescribe C.L. more Vicodin until 2007. This 2007 note's exact

27 date is uncertain, but it indicates that C.L. had back and leg pain but did not include any further

28 discussion of the symptoms. There is no examination of the musculoskeletal or neurological

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1 systems. Respondent began prescribing the patient hydrocodone (e.g., Vicodin, Norco) on a more

2 consistent basis, but the only documentation of any examination findings relative to the back are

3 an occasional notation of back tenderness in the paraspinal region.

4 313. Respondent's December 5, 2008 progress note indicates that C.L. had fallen and had

5 back pain as well as right knee pain with intensity 9/10. Respondent failed to document any

6 examination of the back or the knee. Respondent prescribed C.L. hydrocodone/ APAP 10/325

7 #90 with one refill. He also recommended a right knee x-ray; however, there is no x-ray of the

8 knee in the medical records, although a report of a lumbar x-ray done on May 20, 2013 (five

9 years after the recommendation) showed minimal degenerative changes in the lumbar spine.

1 0 314. Respondent's files include laboratory test results from August 8, 200 1, August 31,

11 2006 and April 17, 2013.

12 315. Respondent's file contains a consent for chronic opioid therapy, but this was not

13 signed and dated until February 28, 2012, and a pain management agreement of the same date.

14 316. Respondent's file includes a note dated July 7, without a discernible year, that

15 indicates that C.L. had "very bad sciatica" in his left leg. There was no neurological examination

16 noted but Respondent prescribed hydrocodone/acetaminophen 10/3 25 # 90 with one refill.

17 317. Respondent's physical examination of C.L. does not address the ongoing complaints

18 of back and leg pain and is inadequate. There is no documentation concerning the range of motion

19 in the back or lower limbs or muscle, reflex, or sensory testing. Neither is there any

20 documentation of straight leg raise testing.

21 318. Respondent's file does not contain a pain treatment plan for several years apart from

22 the prescription of the opioid analgesic, even though Respondent was generally seeing C.L. on a

23 monthly basis. Respondent did prescribe C.L. ibuprofen 800 mg, but that was not until the May

24 16, 2012 visit. There is no indication Respondent considered alternative treatment options, such

25 as physical therapy or injections, until he referred the patient for consultation with a pain

26 specialist in2012. Dr. I.'s consult report is dated August 10,2012, and described the nature and

27 extent of the patient's pain and examination findings.

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319. Dr. J. made a diagnosis of lumbar radiculopathy and lumbar facet arthropathy and

2 gave specific recommendations, which are outlined in his report. The notes do not reflect those

3 recommendations being acted upon.

4 320. Respondent's November 23, 2012 notes show that he prescribed C.L.

5 hydrocodone/acetaminophen 10/325 #120 and oxycodone 30 mg #120. There is no indication in

6 the record of any reason for any prescription, but less two short-acting opioid analgesics

7 concurrently. In C.L. 's next visit on December 18, 2012, Respondent noted that C.L. indicated

8 that he still had low back pain and that oxycodone gave "much better relief;" however,

9 Respondent continued to prescribe C.L. both opioid analgesics at that visit and subsequent visits

10 on January 16,2013, February 13,2013 and March 4, 2013. Respondent increased the quantity

11 of the hydrocodone from 120 to 180 tablets at the March 4, 2013 visit while reducing the quantity

12 ofthe oxycodone from 120 to 60 tablets.

13 321. Respondent's notes indicate that on March 29, 2013, he prescribed C.L. hydrocodone

14 #240 without a prescription for oxycodone, with no explanation.

15 322. Respondent's April17, 2013 notes indicate that C.L. stated that the oxycodone was

16 "too heavy" but hydrocodone (Norco) was "too light." Respondent's response was to prescribe

17 C.L. oxycodone/acetaminophen 10/325 #60. The treatment plan for the opioid analgesics is

18 unclear.

19 323. Respondent's May 5, 2013 note indicates that C.L. was taking approximately eight

20 per day of something (presumably the oxycodone) and he also noted C.L. to say that "Percocet

21 wears off too fast." C.L. rated his pain intensity as 10/10, but it does not indicate with or without

22 medications. The notes show that Respondent did switch C.L. back from the Percocet to

23 hydrocodone/acetaminophen 10/325 #240. However, no treatment plan is delineated and no

24 physical examination of the neurological or musculoskeletal systems is recorded.

25 324. Respondent's July 26,2013 notes indicate that C.L. had continuing low back pain

26 with an intensity of9/10 without medication. Respondent's notes do not indicate how C.L.'s pain

27 intensity changed in response to the medication. Respondent also noted for what appears to be

28 the first time that C.L. had pain at his waist radiating to the left heel. He noted that another

60 (KENT LEHMAN, M.D.) ACCUSATION NO. 09-2012-225474

1 physician had ordered x-rays showing that C.L. had a disc problem at L4-L5. Respondent's notes

2 indicate that he performed an examination and C.L. had back tenderness and indicated the

3 location of that tenderness, but there was no examination of the neurological system. Respondent

4 prescribed C.L. more hydrocodone and ibuprofen.

5 325. Respondent ordered a urine drug screen for C.L. on June 27, 2013, which is the first

6 evidence of any monitoring of C.L. 's adherence to proper treatment. The results of that urine

7 drug screen show that C.L. tested positive for opiates and negative for alcohol and illicit

8 substances. However, on a subsequent urine drug screen dated September 18, 2013, Respondent

9 noted that C.L. tested positive for amphetamine, opiate, benzodiazepine, and PCP. Respondent

10 did not enter any notes showing that he discussed these findings with C.L. or that he was

11 concerned about these findings in any way.

12 326. Respondent's file contains two CURES reports for C.L. dated August 30,2013 and

13 January 21, 2014. There is no indication that Respondent reviewed or otherwise noted those

14 CURES reports, even in light of the urine drug screen results for September 18, 2013.

15 327. On December 21,2013, Respondent began prescribing C.L. a long-acting morphine

16 analgesic in addition to the oxycodone, hydrocodone and ibuprofen. No explanation is included

17 in the notes for this additional prescription.

18 328. Respondent's January 7, 2014 notes indicate that C.L. complained that the morphine

19 made him drowsy. Respondent prescribed him OxyConiin 20 mg #60, apparently to replace the

20 morphine, in addition to hydrocodone and ibuprofen.

21 329. Respondent's February 14,2014 notes indicate that C.L. complained of increased

22 back pain with an intensity of 10/10. Respondent indicated that C.L. was "taking more meds."

23 Respondent appears to have examined C.L. on this occasion and noted that C.L. was in "marked

24 distress" and unable to sit in a chair and that his back was tender. No other notation regarding

25 any neurological or musculoskeletal examination findings are included in the notes. The noted

26 symptoms suggest a significant change in C.L. 's condition, yet Respondent performed no

27 appropriate physical examination. Respondent prescribed C.L. more opioid analgesics and

28 ordered laboratory testing.

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330. Three CURES reports were obtained during the investigation of Respondent. The



4 331. The CURES reports show that C.L. filled 61 prescriptions for hydrocodone from

5 Respondent from August 19, 2009 through November 15, 20 13. Over those four years,

6 Respondent prescribed C.L. 10,3 80 hydrocodone tablets with an average dose of 60 mg of

7 hydrocodone daily.

8 332. The CURES reports show that C.L. filled 13 prescriptions for oxycodone from

9 Respondent from October 14,2011 through November 15,2013, totaling 1,400 oxycodone tablets

10 for an average dose of 69 mg daily.

11 PATIENT K.L.

12 333. Respondent first saw K.L. on June 9, 2009, although the year is not discernible on the

13 handwritten initial evaluation but can be determined by reference to a medical history checklist

14 K.L. completed on that day. The notes indicate that K.L. had undergone left hip replacement on

15 October 31, 2007, and presented to Respondent complaining of right hip pain without further

16 description of the pain in the notes. Respondent noted that K.L. would probably need to have a

17 right hip replacement and "was on OxyContin 80 mg plus oxycodone plus Norco's." There is no

18 further delineation in the records concerning K.L' s reaction to the treatment or the quantity of the

19 medications.

20 334. In the notes from the initial visit Respondent listed the name of an orthopedist and the

21 name of a pain physician who presumably were involved with K.L. 's care, but there is no

22 indication that he coordinated his treatment of K.L. with these other physicians. There is no

23 additional mention of prior treatment apart from reference to a prior left hip replacement.

24 33 5. K.L. 's past medical history can be gleaned from the "patient's checklist for medical

25 history," dated June 9, 2009, on which the patient denied any history of alcohol, drug, or mental

26 problems. There is no substance abuse history documented for K.L. The initial physical

27 examination is limited and the only thing listed in the notes is a leg length discrepancy.

28 Respondent's diagnosis is right hip pain, with no further explanation.

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336. There arc no diagnostic test results ordered for the initial visit, but there is a

2 recommendation for bilateral hip x-rays. However, there are no x-ray results in the file.

3 Respondent prescribed K.L. OxyContin 40 mg #45 with instructions to take one in the morning

4 and two in the evening, Norco 10/325 #60, and Zofran 8 mg #seven. There is no treatment plan

5 apart from the prescriptions for medications. Neither is there an informed consent related to the

6 medications prescribed in the original progress note. There is a consent for chronic opioid

7 therapy in the file which K.L. signed on March 7, 2012, almost three years after the initial visit.

8 337. Respondent's notes indicate that he next saw K.L on June 30, 2009. Respondent

9 indicated that K.L. had just had a right hip replacement and was in for a wound dressing check

1 0 and prescription refill. However, Respondent did not indicate what medications he prescribed

11 K.L. that day or any information regarding the physician who performed the hip replacement and

12 medications that physician may have prescribed.

13 338. Respondent's next note is dated "July 20" with no year indicated. Respondent

14 indicated that K.L. was taking OxyContin 60 mg three tablets daily and without medication had

15 hip pain intensity of9/10. No examination appears to have occurred with only the observations

16 noted that K.L. was in moderate distress, walked with a limp using a cane and had a weight of

17 228 pounds. Respondent prescribed OxyContin 60 mg #90, Norco 10/325 #120, and alprazolam

18 2 mg #60. There is no indication as to why Respondent prescribed K.L. alprazolam.

19 339. Respondent's notes generally provide a very limited description ofK.L. 'spain and

20 how the medicinal treatment was impacting that pain and K.L.'s functioning. Physical

21 examination findings are very infrequent and provide almost no detail.

22 340. Respondent's October 19 note (again without a year) indicates that K.L. wished to

23 "start cutting down on OxyContin." There is no indication as to why K.L. wished to do so.

24 Furthermore, there is another prescription for alprazolam with no indication as to why K.L. was

25 provided that prescription or needed alprazolam.

26 341. Respondent's January 15, 2010 note indicates that K.L. wanted an early refill ofhis

27 medication and was having surgery on Monday, but there is no indication as to what type of

28

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surgery he would be having, who was performing that surgery, what any preoperative orders were

2 or any other information regarding the surgery.

3 342. A note in the file from another physician indicates that K.L. was hospitalized from

4 January 20, 2010 through January 22, 2010 for hip replacement surgery. However, the records do

5 not indicate whether K.L. was adhering to proper treatment with the prescribed medications.

6 343. Respondent's file contains a CURES report dated September 23,2010, marked to the

7 attention of Respondent. That CURES report's prescription history is suggestive of a pattern of

8 doctor shopping, because K.L. filled prescriptions for controlled substances from multiple

9 providers at multiple pharmacies during the four-month time frame of the report.

10 344. Respondent's October 8, 2010 progress note indicates that he had reviewed a CURES

11 report but the note said nothing in addition to that notation of that review. There is no indication

12 that the report impacted Respondent's unnoted "treatment plan" for K.L.

13 345. Respondent's next note is dated November 5, 2010, wherein he indicates that he had

14 talked with K.L. about "seeing other M" [sic], without anything further documented about the

15 discussion. This note and the next seven notes are devoid of any history and physical

16 examination findings apart from an occasional listing of the patient's weight.

17 346. There is no indication of urine drug testing in the file to confirm whether K.L. was

18 taking the medications appropriately or abusing illicit substances. The file contains a form

19 entitled Long-term Controlled Substances Therapy for Chronic Pain, which is essentially a

20 treatment agreement. However, K.L. signed but did not date the form.

21 347. Respondent's July 9, 2011 note indicates that K.L. had just had right knee surgery

22 and had a swollen right calf. Respondent ordered a venous Doppler study.

23 348. Respondent's records do not indicate any clear treatment plan for the medications

24 prescribed to K.L. There is vei·y limited information in the progress notes to tell whether K.L.

25 was benefiting from the drug treatment program or having side effects. Some of Respondent's

26 notes make reference to K.L.'s pain intensity without medication, but there is no indication as to

27 the impact the medications had upon reducing his pain. The only diagnostic testing in the file is

28 laboratory testing from August 18, 2009 (shortly after the initial visit), which included a

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comprehensive metabolic panel, complete blood count, lipid panel, testosterone and prostate

2 specific antigen. There is one image of a prosthetic hip in the file, but it is unclear whether this is

3 the right hip or the left hip, it is not dated and there is no patient name on the image.




7 350. The CURES reports show that K.L. filled 18 prescriptions for OxyContin from

8 Respondent from August 18, 2009 through February 6, 2011. These were for the 80 mg

9 formulation with the exception of a single prescription for the 60 mg formulation. Respondent

10 prescribed K.L. an average of 165 mg daily of OxyContin during this time.

11 3 51. The CURES reports show that K.L. filled 24 prescriptions from Respondent for

12 oxycodone 30 mg from December 3, 2010 through November 19,2012. Respondent prescribed

13 K.L. an average of 92 mg of oxycodone daily during this time.

14 352. The CURES reports show that K.L. filled 37 prescriptions from Respondent for

15 hydrocodone/acetaminophen from August 20,2009 through November 19,2012. The quantity of

16 tablets per prescription ranged from 40 to 360. Respondent prescribed the patient 5,860 tablets

17 during that time frame for an average dose of 57 mg of hydrocodone daily.


19 alprazolam from August 20, 2009 through November 19, 2012. The quantity oftablets per

20 prescription ranged from four to 180. Respondent prescribed the patient an average of 5.3 mg of



23 carisoprodol, at 90 tablets per prescription during the time frames covered by the three CURES

24 reports. K.L. filled these prescriptions between February 1, 2012 and November 19,2012.

25 PATIENT K.M.

26 355. It is impossible to determine when Respondent first saw K.M. because Respondent

27 did not maintain a medical record for K.M. However, the coroner's report prepared following

28

65


K.M. 's death following an accidental overdose indicates that Respondent prescribed her

2 controlled substances starting on or about February 2, 2007.

3 356. According to the Drug Worksheet in the coroner's report for K.M., Respondent

4 prescribed her alprazolam #30, hydrochlorothiazide 25 mg #30 and Lunesta 3 mg #30 on

5 February 2, 2007 and butabarbital #90 and hydrocodone/acetaminophen 7.5/750 #30 on February

6 4, 2007. Respondent also prescribed her alprazolam #30 on March 2, 2007.

7 357. K.M. died at age 44 of an accidental overdose. The coroner's report indicates she

8 died of acute morphine intoxication on March 11, 2007.

9 PATIENT C.P.

10 358. Respondent first saw C.P. on June 12, 2003 and continued to treat her until December

11 30, 2009 when he gave her prescriptions for hydrocodone/acetaminophen 10/325 #120,

12 alprazolam 2 mg #30 and diazepam 10 mg #60. According to the coroner's report C.P. died one

13 week later, on January 5, 2010 of an accidental overdose due to the combined effects of

14 hydromorphone, hydrocodone, diphenhydramine, temazepam, diazepam, methadone, and

15 sertraline.

16 359. Respondent's notes indicate that C.P. initially presented to him on June 12,2003, for

17 weight control and treatment of chronic pain related to interstitial cystitis. There is a medical

18 history checklist that C.P. completed on June 12, 2003, followed in the file by a number of

19 records from other practitioners pertaining to C.P.'s evaluation and treatment prior to and

20 subsequent to Respondent's treatment of her. Respondent also ordered a number of diagnostic

21 tests during his treatment of C.P ., including multiple laboratory tests and imaging studies.

22 Reports in the file from other physicians indicate that C.P. had a history of ulcerative colitis,

23 diabetes, hypertension, obesity, interstitial cystitis, hyperlipidemia and coronary artery disease.

24 360. Respondent's progress notes suggests Respondent began prescribing the patient

25 Norco, or hydrocodone/acetaminophen, for chronic pain due to interstitial cystitis at the initial

26 evaluation on June 12, 2003.

27 361. Respondent's April13, 2004 progress notes indicate that he prescribed C.P. a

28 benzodiazepine, Valium. The notes indicate that the prescription was related to anxiety stemming

66


from being recently diagnosed with ulcerative colitis. However, the notes contain very little

2 information as to the nature and extent of C.P.'s pain or anxiety, for which complaints Respondent

3 prescribed her medication. Physical examination findings are seldom documented throughout the

4 course of Respondent's treatment of C .P.

5 362. On several different occasions Respondent's notes contain references to C.P. having

6 "back pain." However, there is no adequate physical examination of her low back and lower

7 limbs documented anywhere in the records.

8 363. Respondent's notes for January 23, 2004, indicate that C.P. was seen by Respondent

9 following an automobile accident. He documented more of a physical examination than he

10 generally did, but the only reference to her back was "tender para lumbar." His diagnoses that

11 day included lumbosacral strain, and the note indicates he recommended a lumbar x-ray. There

12 did not appear to be any x-rays in the file regarding this recommendation.

13 364. Respondent's notes reflect that the next physical examination related to her back

14 occurred on November 20, 2008. He noted her back was tender in the thoracic and lumbosacral

15 region with no other findings. There is no mention of C.P.' s spinal range of motion, lower limb

16 strength, reflexes, or sensation, such as tingling in her extremities or back.

17 365. Respondent's notes contain almost no documentation concerning C.P.'s responses to

18 treatment with controlled substances. The records do not indicate if the hydrocodone resulted in

19 pain reduction or increased her pain tolerance for daily activities. There is no indication why

20 Respondent concurrently prescribed her two benzodiazepines, Valium 10 mg and Xanax 2 mg,

21 and the records do not indicate if she was benefiting from the benzodiazepines. The records do

22 not indicate if C.P. had any adverse effects from the controlled substances, such as drowsiness,

23 cognitive impairment, and constipation.

24 366. Respondent's notes do not indicate how C.P. was controlling her use of these

25 potentially habit-forming medications. There is no indication if Respondent ever attempted to

26 determine if C.P. was having any difficulty controlling her use of the drugs or deviating from his

27 instructions when taking them. The records contain a Medication Log listing medications

28 prescribed to C.P. from October 2004 through January 2006, but nothing thereafter apart from

67 (KENT LEHMAN, M.D.) ACCUSATION NO. 09-2012-225474

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what can be determined from the progress notes. Respondent did not order a urine drug screen or

any CURES reports for C.P.

367. C.P. died of an accidental drug overdose on January 5, 2010. C.P. 's autopsy report

indicates that she died due to the combined effects of multiple drugs, including opioids and

benzodiazepines. Respondent prescribed her hydrocodone, which metabolizes into

Hydromorphone, which the autopsy found in her system. Respondent prescribed her diazepam,

which metabolizes into temazepam, which the autopsy found in her system. Respondent

prescribed her alprazolam, which the autopsy did not find in her system. Methadone was found

in her system but Respondent was not prescribing her methadone.

368. Three CURES repmis were obtained during the investigation of Respondent.

However, only the CURES report from August 13, 2009 through August 13, 2012 reflects

prescriptions for C.P.

369. The CURES report shows that C.P. tilled 5 prescriptions from Respondent for

hydrocodone/acctaminophen 10/325 # 120 from August 18, 2009 through December 30, 2010.

370. The CURES report shows that C.P. filled 5 prescriptions from Respondent for

alprazolam 2 mg #30, and five prescriptions for diazepam 10 mg four of which were for #30 and

one of which was for #60 from August 18,2009 through December 30,2010.

3 71. Respondent indicated during the investigation that he treated her for interstitial

cystitis and prescribed her numerous medications, including Norco, Xanax, Valium, Nexium, and

Reglan. He also prescribed her Zoloft at one time but said she had stopped taking that medication.

PATIENT J.S.3

372. Respondenttirst examined J.S. on September 23, 2013 and saw him again on

December 27, 2013 and January 27, 2014. These visits were recorded on video and audio.

373. Respondent's note from September 23, 2013, indicates that J.S. complained of right

shoulder pain and anxiety associated with having recently moved from Northern California to

attend a local community college. The note also references J. S. 's experiencing stress from work.

3 This is a simulated patient who saw Respondent as part of an undercover operation during the investigation of Respondent.

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The note does not contain any description of the nature of J.S. 's anxiety and if it included the

2 panic attacks or had associated depressive symptoms. Neither is there a description of if, or how

3 J.S.'s anxiety impacted his functioning, if at all. There is no indication in the progress note

4 whether J.S. had a pre-existing history of anxiety or treatment for anxiety, although there is a

5 medical history checklist, which J.S. completed and upon which he indicated he had no history of

6 mental problems. The initial note does not indicate if J.S. had a history of substance abuse,

7 although on the history checklist J.S. indicated he had no drug or alcohol problems.

8 374. Respondent's initial note does not indicate whether J.S. had a family history of any

9 psychiatric condition. There is a brief physical examination, which Respondent noted was

I 0 significant for blood pressure elevated at I50/90. The diagnosis was anxiety, shoulder pain, and

II increased blood pressure. Respondent prescribed J.S. alprazolam I mg #30 and warned J.S. to be

I2 cautious of using the drug with alcohol. The treatment plan is unclear. There is no indication that

I3 Respondent talked with J.S. about alternative treatment options for anxiety, such as a medication

I4 other than a controlled substance or counseling.

I5 375. Respondent's notes from December 27, 2013, indicate that Respondent opened the

I6 visit with J.S. by asking him if he wished a refill ofXanax. He observed the prescription had

I7 lasted J.S. "quite a while." J.S. volunteered that he had run out of the medication but used a few

I8 of his mother's while he was visiting her, but Respondent did not respond to that statement with

I9 any criticism of that approach. Respondent talked with him about his anxiety and suggested J.S.

20 take Prozac as a way to facilitate a reduction ofXanax. Respondent prescribed J.S. Xanax lmg

21 #30, Prozac 20 mg #30, and ibuprofen 600 mg #90, all with zero refills. Respondent prescribed

22 the ibuprofen for J.S. 's complaint of shoulder pain. Respondent did not perform a physical

23 examination during this visit.

24 376. Respondent's January 27, 2015 visit began with Respondent asking J.S, "More ofthe

25 same for you, the Xanax and the Prozac?" Respondent's notes indicate that J.S. was right on

26 schedule and commented that he was "on a low level" of the Xanax and could "go a day without it

27 and not freak out." Respondent asked J.S., "Does that help get you through the," and J.S.

28 interrupted, "Yeah, it sure does." That was the extent of Respondent's questions regarding

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whether J.S. 's symptoms were adequately controlled. Respondent asked J.S. if he took a whole

tablet or broke the tablet, again referring to the Xanax, and J.S. said he broke them up.

Respondent commented again that J.S. was "right on schedule." Respondent then counseled J.S.

about the potential for dependence upon Xanax without actually asking J.S. if he was having any

trouble controlling his use of the drug. Respondent did not question J.S. at all about the Prozac.

In Respondent's visit with J.S. on December 27, 2013, he suggested the Prozac would be helpful

in facilitating J.S.'s weaning offXanax, but there was no discussion as to weaning the Xanax at

the January 27, 2014 visit. Respondent did not perform a physical examination during this visit.

Documentation for this visit is limited to listing J.S. 's weight and indicating refills for Xanax and

Prozac.

377. Respondent noted that J.S. had an elevated blood pressure at the first visit, which

would be unusual for a 30-year old man, but Respondent failed to recheck his blood pressure at

the subsequent two visits. There is also nothing to indicate Respondent considered diagnostic

testing to assess why J.S. might have elevated blood pressure and anxiety, such as urine drug

screening and laboratory testing.

PATIENT J.W.4

378. Respondent first saw J.W. on December 13, 2013 and on three follow-up occasions

on December 27, 2013, January 8, 2014 and January 27, 2014. These visits were recorded on

video and audio.

379. J.W. presented to Respondent complaining ofleft ankle pain and told Respondent that

Vicodin and Percocet had been helpful to her in the past for managing flare-ups of this pain.

Respondent asked her how she had hurt her ankle. She again told him she had previously

received medications through an urgent care and had found Percocet and Vicodin helpful in

allaying the pain. Respondent took a limited history and did not ask her about any prior

substance abuse problems, though she did complete a medical history checklist (which is

undated) on which she indicated she had no history of alcohol or drug problems.

4 This is a simulated patient who saw Respondent as part of an undercover operation during the investigation of Respondent.

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380. Respondent's physical examination, as the undercover video shows, consisted of

2 asking her to stand and auscultating her heart. He did not examine her ankle by palpating the

3 ankle, testing strength and stability or any other examination. In his note from the initial visit

4 Respondent indicated her left ankle was tender but not swollen. His note also records other

5 information from a "physical exam" that are not demonstrated in the undercover video, in other

6 words, that did not actually occur.

7 381. Respondent then diagnosed her with a left ankle sprain and prescribed her Vicodin ES

8 #30 and ibuprofen 400 mg #30 each with no refills. Respondent did not talk with her about

9 possible risks of Vicodin, including drowsiness and potential for impairment of function, such as

10 driving nor did he discuss other treatment options with her.

11 382. Respondent recommended an x-ray of J.W. 's ankle and explained the rationale for the

12 x-ray. There is no indication Respondent checked or requested a urine drug screen or a CURES

13 report.

14 383. Respondent examined J.W. on the three occasions noted above. On December 27,

15 2013, J.W. reported she had not had the x-ray of her ankle, because she did not have the funds to

16 do it. J.W. told Respondent that she planned to have the x-ray done soon. The undercover

17 records show that Respondent and J.W. reviewed the manner in which J.W. was taking the

18 prescribed medications. Respondent briefly examined her ankle on this visit. Respondent agreed

19 to write J. W. a prescription for a limited quantity of medication but said he could write her no

20 more unless there was a problem on the x-ray. Respondent then talked with her about treatment

21 options, including bracing and casting. Although Respondent recommended that J.W. wean

22 herself off Vicodin, he then prescribed her Vicodin ES #20 and ibuprofen 400 mg #60 each with

23 no refills. In his notes for the December 27, 2013 visit Respondent indicated that he told J.W.

24 that he would no longer prescribe J. W. controlled substances after that visit.

25 384. Respondent next saw J.W. on January 8, 2014, when she indicated she was out of her

26 medication. Respondent replied that "I can give you anything except narcotic pain medication."

27 She asked him for prescriptions for ibuprofen, Xanax, and Soma. She volunteered that she had

28 previously taken the 1 mg and the 2 mg formulations of Xanax and found the 2 mg formulation to

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work better, but there was no discussion as to why she had taken Xanax previously. Respondent

2 did not question her regarding her previous use ofXanax. Neither did he question her concerning

3 whether she had anxiety, though in his progress note from this date he noted "anxiety" under the

4 assessment section. He prescribed her ibuprofen 400 mg #90 and Xanax 1 mg #30. He failed to

5 establish a medical indication for the prescription ofXanax.

6 385. Respondent opened the visit on January 27, 2014, by asking J.W. if she wished "the

7 usual Xanax and Motrin." Respondent then asked her how she took the medication and if she

8 needed as many Motrin tablets. J.W. then asked Respondent for Adderall, telling him that she

9 had taken her roommate's Adderall and found it helped her to focus better. Respondent

10 responded by telling her "Yes you probably do need it. .. , but I am not qualified to write for

11 Adderall." Respondent then talked with her about attention deficit disorder and risks for

12 dependence on the medication. They talked further about the potential benefits of stimulants.

13 Just before ending the visit, he commented to her, "You're so young, you probably want to try to

14 get off the Xanax, because those will become, those will create a dependence." He suggested she

15 begin skipping days without taking the medication. He wrote her prescriptions for Xanax 1 mg

16 #30 and ibuprofen 400 mg #30. There was no physical examination apart from a record of her

17 weight. In the progress note, there is nothing documented under the objective section or the

18 assessment section. There is no evident treatment plan.

19 PATIENT G.W.

20 386. Respondent's initial visit with G.W. took place on September 30, 2002, when she

21 presented with complaints of chronic headaches. He reviewed her prior treatments, which

22 included Inderal, Advil, Imitrex and Fioricet. He noted that G.W. had seen another physician

23 previously and mentioned the doctor's name.

24 387. When Respondent initially started treating G.W. on September 30, 2002, she weighed

25 100 pounds. Her weight gradually drifted downwards over the years he treated her, and by March

26 7, 2014, G. W. weighed only 77 pounds. There is no evidence in the notes for the 11 years of

27 treatment that Respondent noticed or made any effort to investigate the cause for her weight loss

28 until July 26, 2013, when he noted the weight loss and recommended laboratory testing. At the

72


ensuing visit on August 19,2013, Respondent ordered a chest x-ray. Most ofhis notes are devoid

2 of even the most basic physical examination findings, including weight.

3 388. A note in Respondent's file that appears to be dated September 25, 2006 (the date is

4 very faint), indicates Respondent spoke with G.W. about a notice he had "received from CURES

5 concerning potential over usage/dependence." (There is a CURES report in the file dated

6 September 20, 2006.) Nonetheless, Respondent prescribed her 60 Fioricet tablets that day. There

7 is no documentation in the file addressing G.W. 's possible drug dependence and its effect on a

8 treatment plan. There are no records of any urine drug testing in the file. G. W. did sign a consent

9 for chronic opioid therapy and a treatment agreement for controlled substances in the treatment of

10 pain, but these were not signed until December 10, 2012. The records show that no consultation

11 to a headache specialist was suggested, which was warranted in this case considering her history

12 and high utilization of Fioricet.

13 389. Fioricet is an analgesic that combines a low dose of an opioid (30 mg of codeine), a

14 barbiturate (50 mg ofbutalbital), acetaminophen, and caffeine. It is used for the acute treatment

15 of headache with the recommendation not to exceed a total daily dose of six capsules. It is not

16 intended to be taken daily or even most days of the month because of its habit-forming potential

17 and its potential to make a person's headache condition worse.

18 390. Respondent's noteofMarch 21, 2005, indicates that he talked with G.W. about

19 rebound headache and was "trying to gradually cut back" her medications, but he failed to take

20 adequate action in this respect over the ensuing years of treatment. This note indicates

21 Respondent's awareness of Fioricet's potential to worsen headache symptoms.

22 391. Respondent's November 13, 2008 notes indicate that G.W. claimed that her travel

23 bag had been stolen, so Respondent refilled her prescription for Fioricet #60 tablets even though

24 he had given her a prescription for that quantity of the drug just six days before on November 7,

25 2006. This behavior pattern is reflected throughout the 11 years of records when claims of lost or

26 stolen medications were asserted and a new prescription was immediately provided by

27 Respondent.

28

73


392. Respondent's April10, 2013 note (over a decade after he initiated treatment ofG.W.)

2 indicated (for no apparent reason) that G.W. had tried acupuncture and found it helpful. At that

3 visit he prescribed her Elavil, which is a drug potentially helpful in the treatment of migraine. His

4 notes indicate that he "emphasized that we would like to 1 Fioricet."

5 393. Respondent's notes for the following visit on May 5, 2013 indicate that the Elavil had

6 been of "no help," although there is no evidence that G.W. had an adequate trial of that drug. It

7 was at the August 19,2013 visit that he recommended she start Chantix. However, G.W. is a

8 cigarette smoker, which increases her risk for cancer as a potential cause for her weight loss. Her

9 loss of weight seems not to have impacted his prescribing her Fioricet. The records do not reflect

10 adequate attention to monitoring her adherence to treatment with Fioricet. The quantity of drug he

11 prescribed her suggests she was taking it daily, and the drug is not intended to be used in this

12 fashion.




16 395. The CURES reports show that G. W. filled 54 prescriptions for Fioricet from

17 Respondent from August 8, 2011 through October 7, 2013. The quantity oftablets per

18 prescription ranged from 45 to 120, and he prescribed her an average of6.7 tablets daily for a

19 total of 3,600 tablets during that time.

20 396. Respondent's overall records for G.W. show that he failed to offer her alternative

21 options for managing her migraine, including commonly used medications the benefit for which

22 has been demonstrated in randomized controlled trials.

23 397. Respondent's progress notes are deficient. They have little or no history and little or

24 no physical examination findings. G.W. 'spain complaints are not adequately described in the

25 medical record. There is no adequate physical examination and the treatment objectives are

26 unclear.

27 I I I

28 I I I

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FIRST CAUSE FOR DISCIPLINE (Unprofessional Conduct- Gross Negligence)

398. By reason ofthe matters set forth above in paragraphs 16 through 397, incorporated

herein by this reference, Respondent is subject to disciplinary action under section 2234,

subdivision (b), for gross negligence in the care and treatment of patients C.A., M.A., V.B., S.B.,

T.B., V.C., N.D., E.H., K.L., K.M. and G.W.

399. Respondent failed to provide proper oversight in order to monitor the use of

controlled substances by C.A., R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D., E.H., K.L. and

G. W ., which constitutes gross negligence and is a violation of section 2234, subdivision (b).

400. Respondent failed to maintain a medical record for R.A. and K.M. and therefore

failed to provide proper oversight in order to monitor the use of controlled substances by R.A.

and K.M., which constitutes gross negligence and is a violation of section 2234, subdivision (b).

401. Respondent failed to maintain a medical record for R.A. and K.M. to whom he was

prescribing controlled substances, which constitutes gross negligence and is a violation of section

2234, subdivision (b).

402. Respondent failed to perform any prior examination for the prescription of

controlled substances to R.A. and K.M., which constitutes gross negligence and is a violation of

section 2234, subdivision (b). SECOND CAUSE FOR DISCIPLINE

(Unprofessional conduct- Repeated Negligent Acts)

403. By reason of the matters set forth above in paragraphs 16 through 402, incorporated


subdivision (c), in that Respondent for repeated negligent acts in the care and treatment of L.A.,

D.A., C.A., K.A., R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D., M.F., E.H., J.I., C.L., K.L.,

C.P., J.S. and J.W. The circumstances are as follows:

404. Respondent did not perform an appropriate prior examination before prescribing high

dose opioid therapy to L.A., D.A., C.A., K.A., R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D.,

E.H., J.I., C.L., K.L., K.M., C.P., J.S. and J.W. Respondent's failure to properly examine any of

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the foregoing patients while prescribing numerous medications constitutes repeated negligent acts

and a violation of section 2234, subdivision (c).

405. Respondent failed to provide proper oversight in order to monitor the use of

controlled substances by L.A., D.A., K.A., V.B., S.B., T.B., V.C., B.C., N.D., M.F., E.I-I., .T.I. and

C.P., which, in conjunction with Respondent's other negligent acts, constitutes a violation of

section 2234, subdivision (c).

406. Respondent's record-keeping relative to his prescription of controlled substances to

D.A. for his complaints of pain and anxiety constitutes negligence, which, in conjunction with

Respondent's other negligent acts, constitutes a violation of section 2234, subdivision (c).

407. Respondent failed to perform an appropriate prior examination for the prescription of

hydrocodone to C.A., and T.B., which, in conjunction with Respondent's other negligent acts,

constitutes a violation of section 2234, subdivision (c).

408. Respondent's records for C.A. have little or no history and little or no physical

examination findings. C.A.'s pain complaints are not adequately described in the medical record

and the treatment objectives are unclear, which, in conjunction with Respondent's other negligent

acts, constitutes a violation of section 2234, subdivision (c).

409. Respondent failed to perform an appropriate prior examination for the prescription of

non-opioid controlled substances to V.B. and T.B., which, in conjunction with Respondent's

other negligent acts, constitutes a violation of section 2234, subdivision (c).

410. Respondent failed to order diagnostic testing for V.C., despite V.C. having persisting,

severe pain four months after an accident which, in conjunction with Respondent's other

negligent acts, constitutes a violation of section 2234, subdivision (c).

THIRD CAUSE FOR DISCIPLINE (Failure to Maintain Adequate and Accurate Records)

411. Respondent is subject to disciplinary action under section 2266 in that he failed to

maintain adequate and accurate medical records for patients L.A., D.A., C.A., K.A., R.A., M.A.,

V.B., S.B., T.B., V.C., B.C., N.D., M.F., E.H., J.I., C.L., K.M., C.P., J.S., J.W. and G.W. The

circumstances are as follows:

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412. Paragraphs 16 through 410 are incorporated herein by reference as if fully set fmih

herein.

413. The standard of care for medical record documentation is that such documentation be

interpretable by other medical providers who may be called routinely or unexpectedly to use the

information therein to further the care of the patient. This requires that the information be legible,

organized, and complete enough not to require a guess as to its content, and that any

abbreviations used are commonly recognized by other medical care providers. A record that can

only be deciphered by the author puts the patient at unnecessary risk of delay of care to track

down the author, or worse, may withhold important information if the author is not immediately

available.

414. Respondent's records relative to his prescription of controlled substances to D.A. for

his complaints of pain and anxiety fail to meet the requirements of the relevant standard of care.

415. Respondent's records relative to his prescription of controlled substances to S.B. for

her complaints of pain and anxiety fail to meet the requirements of the relevant standard of care.

416. Respondent falsified the records for the medical examination of J. W., indicating that

he examined J.W., when that did not happen as shown by a videotape of that meeting, which is a

violation of section 2266 of the Code.

417. Respondent falsified the records for the medical examination of J.W., indicating in

his notes that that J.W. suffered from anxiety when he did not ask J.W. about that issue.

418. Respondent's records are incomplete or non-existent and, thus, Respondent failed to

maintain adequate and accurate medical records for patients L.A., D.A., C.A., K.A., R.A., M.A.,

S.B., T.B., V.C., B.C., N.D., E.H., J.I., C.L., K.M., C.P., J.S., J.W. and G.W., which is a violation

of section 2266 of the Code.

FOURTH CAUSE FOR DISCIPLINE (Unprofessional Conduct - Prescribing Controlled Substances without Medical Indication)


herein by this reference, Respondent is subject to disciplinary action under section 11154 ofthe

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Health and Safety Code, in that he prescribed controlled substances without medical indication.

The circumstances are as follows:

420. Respondent never performed a complete history and physical exam over the course of

treatment for patients L.A., D.A., C.A., K.A., R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D.,

E.H., J.I., C.L., K.L., K.M., C.P., J.S., J.W. and G.W., yet continued to prescribe controlled

substances to those· patients, which prescribing practice constitutes prescribing controlled

substances without medical indication and is a violation of Health and Safety Code section 11154.

421. Respondent never ordered standard tests and follow up, nor established an

appropriate differential diagnoses over the course of treatment for patients L.A., D.A., C.A., K.A.,

R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D., E.H., J.I., C.L., K.L., K.M., C.P., J.S., J.W. and

G.W., yet continued to prescribe controlled substances to those patients, which prescribing

practice constitutes prescribing controlled substances without medical indication and is a

violation of Health and Safety Code section 11154.

FIFTH CAUSE FOR DISCIPLINE (Unprofessional Conduct- Violating Statute Regulating Controlled Substances)


herein by this reference, Respondent is subject to disciplinary action under section 2238 of the

Code, in that he violated Health and Safety Code section 11154. The circumstances are as

follows:

423. Respondent prescribed controlled substances without medical indication to L.A.,

D.A., C.A., K.A., R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D., E.H., J.I., C.L., K.L., K.M.,

C.P., J.S., J.W. and G.W., which constitutes a violation of Health and Safety Code section 11154

and, thus, section 223 8 of the Code.

SIXTH CAUSE FOR DISCIPLINE (Unprofessional Conduct - Prescribing Dangerous Drugs without

Prior Examination or Medical Indication)

424. By reason ofthe matters set forth above in paragraphs 16 through 423 incorporated


subdivision (a) of the Code, in that he prescribed dangerous drugs without an appropriate prior

78


examination and a medical indication to L.A., D.A., C.A., K.A., R.A., M.A., V.B., S.B., T.B.,

2 V.C., B.C., N.D., E.H., J.I., C.L., K.L., K.M., C.P., J.S., J.W. and G.W. The circumstances are as

3 follows:

4 425. Respondent prescribed dangerous drugs without performing an appropriate prior

5 examination to L.A., D.A., C.A., K.A., R.A., M.A., V.B., S.B., T.B., V.C., B.C., N.D., E.H., .T.I.,

6 C.L., K.L., K.M., C.P., J.S., J.W. and G.W. Respondent's failure to properly examine any ofthe

7 foregoing patients while prescribing dangerous drugs to those patients constitutes a violation of

8 section 2242, subdivision (a).

9 426. Respondent prescribed dangerous drugs to L.A., D.A., C.A., K.A., R.A., M.A., V.B.,

10 S.B., T.B., V.C., B.C., N.D., E.H., J.I., C.L., K.L., K.M., C.P., J.S., J.W. and G.W. without

11 medical indication, which actions constitute a violation of section 2242, subdivision (a).

12 PRAYER

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

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

15 1. Revoking or suspending Physician's and Surgeon's Certificate Number G 38595,

16 issued to Kent Lehman, M.D.;

17 2. Revoking, suspending or denying approval of his authority to supervise physician

18 assistants, pursuant to section 3 527 of the Code;

19 3. If placed on probation, ordering him to pay the Board the costs of probation

20 monitoring; and

21 4. Taking such other and further action as deemed necessary and proper.

22

23 DATED: December 11, 2015

24

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26

27 LA2015601239

28 61792870.docx

--- -~---~----------

Executive Di ·ector Medical Board of California Department of Consumer Affairs State of California

Complainant

79


Exhibit A Decision 9112/92 04-1990-00 1604

1 DANIEL E. LUNGREN, Attorney General of the State of California

2 MICHAEL P. SIPE Deputy Attorney General

3 Department of Justice 110 West A Street, Suite 700

4 San Diego, California 92101 Telephone: (619) 238-3391


6

7 BEFORE THE

8 MEDICAL BOARD OF CALIFORNIA

9 DIVISION OF MEDICAL QUALITY

10 DEPARTMENT OF CONSUMER AFFAIRS

11 STATE OF CALIFORNIA

12

13 In the Matter of the Accusation

14 Against: NO. D-4373 L-52298

15 KENT WALTER LEHMAN, M.D. 12828 Harbor Blvd.

16 Garden Grove, CA 92642, Physician's & Surgeon's

STIPULATION IN SETTLEMENT AND DECISION

17 License No. G038595

18 Respondent.

19

20 Kenneth Wagstaff, Executive Director of the Medical

21 Board of California, by and through his attorney,

22 Daniel E. Lungren, Attorney General of the State of California,

23 by Michael P. Sipe, Deputy Attorney General, and

24 Kent Walter Lehman, M.D. (hereinafter "respondent"), by and

25 through his attorney Ronald S. Marks, hereby stipulate as

26 follows: /

.27 I I I

1.

---- ---··--··----··--.. --- -·----·---------·-

1 1. The Medical Board of California, Division of

2 Medical Quality, Department of Consumer Affairs (hereinafter

3 uBoardu) acquired jurisdiction over respondent by reason of the

4 following:

5 A. Respondent was duly served with a copy of the

6 Accusation, Statement to Respondent, Request for Discovery, Form

7 Notice of Defense and copies of Government Code sections 11507.5,

8 11507.6, and 11507.7 as required by sections 11503 and 11505, and

9 respondent timely filed a Notice of Defense within the time

10 allowed by section 11506 of the Code.

11 B. Respondent has received and read the Accusation

12 which is presently on file as Case No. D-4373, before the Board.

13 Respondent understands the nature of the charges alleged in the

14 above-entitled Accusation and that said charges and allegations

15 would constitute cause for imposing discipline upon respondent's

16 license to practice medicine heretofore issued by the Board.

17 2. Respondent and his counsel are aware of each of

18 respondent's rights, including the right to a heqring on the

19 charges and allegations, the right to confront and cross-examine

20 witnesses who would testify against respondent, the right to

21 present evidence in his favor and call witnesses on his behalf,

22 or to testify himself, his right to contest the charges and

23 allegations, and any other rights which may be accorded to

24 respondent pursuant to the California Administrative Procedure

25 Act (Gov. Code, § 11500, et seq.), his right to reconsideration,

26 review by the Superior Court and to appeal to any other court.

27 Respondent understands that in signing this stipulation rather

2.

~~-----··-

1 than contesting the Accusation, he is enabling the Board to issue

2 the following order from this stipulation without further

3 process.

4 3. Respondent freely and voluntarily waives each and

5 every one of the rights set forth hereinabove.

6 4. The stipulations and recitals made by respondent

7 herein are for purposes of this proceeding only and any other

8 disciplinary proceedings by the Board and shall have no force and

9 effect in any other case or proceedings. Furthermore, in the

10 event this settlement is not adopted by the Board, the

11 stipulation made herein shall be inadmissible in any proceeding

12 involving the parties to it.

13 5. As a condition of settlement only, respondent does

14 not contest the charges and allegations of assisting in, or

15 attempting to, or abetting or conspiring to commit any acts of

16 dishonesty or corruption substantially related to duties of a

17 physician and surgeon (2234(a)(e)) including excessive

18 prescribing of drugs, treatment, use of diagnostic or treatment

19 procedures or facilities (725) or presenting a false or

20 fraudulent claim for payment of services to an insurance company

21 (810) as alleged in paragraphs 3 through 58 of the Accusation. A

22 copy of the Accusation is attached as Exhibit 1 and incorporated

23 herein by reference as though fully set forth.

24 6. Based upon the foregoing, it is stipulated and

25 agreed that the Board may issue the following as its decision in

26 this case.

27 Ill

3.

1 ORDER

2 IT IS HEREBY ORDERED that physician's and surgeon'

3 Certificate Number G-038595 issued to respondent is revoked.

4 However, said revocation is stayed and respondent is placed on

5 probation for 10 years on the following terms and conditions:

6 A. Respondent is suspended from the practice of

7 medicine for one year beginning the effective date of this

8 decision and shall not practice during that year except for

9 community service as set forth in paragraph B. Respondent may

10 only engage in the practice of medicine thereafter, if he

11 successfully passes the examination set forth in paragraph E.

12 B. Within 60 days from the effective date of this

13 decision, respondent shall submit to the Board for its prior

14 approval a community service program in which respondent shall

15 provide free medical services on a regular basis to a community

16 or charitable facility or agency for at least 480 hours, which

17 may be performed upon successful completion of the oral clinical

18 examination.

19 C. Within 60 days of the effective date of this


21 approval a course in Ethics, which respondent shall successfully

22 complete during the first year of probation.

23 D. Within 90 days of the effective date of this


25 approval, an intensive clinical training program. The exact

26 number of hours and the specific content of the program shall be

27 Ill

4.

1 determined by the Board or its designee. Respondent shall

2 successfully complete the training program.

3 E. Prior to resuming the practice of medicine,

4 respondent shall take and pass an oral/clinical examination in

5 general medicine with emphasis in a subject to be designated and

6 administered by the Board or its designee. If respondent fails

7 this examination, respondent must take and pass a re-examination

8 consisting of a written as well as an oral examination. The

9 waiting period between repeat examinations shall be at three

10 month intervals until success is achieved. The Board shall pay

11 the cost of the first examination and respondent shall pay the

12 cost of any repeat examinations.

13 Respondent shall not practice medicine until respondent

14 has passed the required examination and has been so notified by

15 the Board in writing. Failure to pass the required examination

16 not later than 100 days prior to the termination date of

17 probation shall constitute a violation of probation.

18 F. Respondent shall not participate in nor derive

19 compensation for medical services from any billing procedures for

20 claims relating to payment for medical services provided. Unless

21 otherwise approved by the Board, any compensation to respondent

22 for medical services shall be by salary.

23 G. Respondent shall pay a monetary penalty of

24 $5,000.00 to the Medical Board of California, a governmental

25 unit, payable within 120 days of the effective date of this

26 decision.

27 Ill

5.

1 Said sum is to be paid by check or money order and made

2 payable ·to Vernon Leeper, Enforcement Chief, Medical Board of

3 california, Division of Medical Quality, 1426 Howe Avenue, Suite

4 22, Sacramento, California 95825-3236, as reimbursement to the

5 Medical Board for costs of investigation. Said $5,000.00 shall be

6 used by Vernon Leeper solely for training and purchase of

7 equipment for the Medical Board's Enforcement Program.

8 H. Respondent shall not act as an officer, director,

9 or owner of a medical clinic or medical laboratory prior to Board

10 approval.

11 I. Respondent shall obey all federal, state, and local

12 laws, and all rules governing the practice of medicine in

13 California.

14 J. Respondent shall submit quarterly declarations

15 under penalty of perjury on forms provided by the Board, stating

16 whether there has been compliance with all the conditions of

17 probation.

18 K. Respondent shall comply with the Board's probation

19 surveillance program.

20 L. Respondent shall appear in person for interviews

21 with the Board's medical consultant upon request at various

22 intervals and with reasonable notice.

23 M. The period of probation shall not run during

24 the time respondent is residing or practicing outside the

25 jurisdiction of California. If, during probation,

26 respondent moves out of the jurisdiction of California to

27 Ill

6.

1 reside or practice elsewhere, respondent is required to

2 immediately notify the return, if any.

3 N. Upon successful completion of probation,

4 respondent's certificate will be fully restored.

5 0. If respondent violates probation in any respect,

6 the Board, after giving respondent notice and the opportunity to

7 be heard, may revoke probation and carry out the disciplinary

8 order that was stayed. If an accusation or petition to revoke

9 probation if filed against respondent during probation, the Board

10 shall have continuing jurisdiction until the matter is final, and

11 the period of probation shall be extended until the matter is

12 final.

13 I concur in the stipulation and order.

14 Dated: 7/ f) j I Cf{"L-

15 DANIEL E. LUNGREN, Attorney General

~0~= 16

17

18 MICHAEL P. SI DEPUTY ATTORNEY GENERAL


20

21

22 I concur in the stipulation and order.

23

24

25

26 RONALD S. MARKS, Esq.

27 Attorney for Respondent

7.

1

2 I have carefully read and fully understand the

3 stipulation and order set forth above. I have discussed the

4 terms and conditions set forth in the stipulation and order with

5 my attorney Ronald S. Marks, Esq. I understand that in signing

6 this stipulation I am waiving my right to a hearing on the

7 charges set forth in the Accusation No. D-4373 on file in this

8 matter. I further understand that in signing this stipulation

9 the Board shall enter the foregoing order placing certain

10 requirements, restrictions and limitations on my right to

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practice medicine in the State of California.

(\ )_"I Dated: :\\ twQ "---

(~. \gl

---:<~1 ~~~vv~~ ~\C) KENT WALTER LEHMAN, M.D. Respondent

8.

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DECISION AND ORDER OF THE BOARD

The foregoing Stipulation and Order, in Accusation No.

D-4373, is hereby adopted as the Order of the Medical Board of

California. An effective date of September 12 , 19U_, has been

assigned to this Decision and Order.

Made this 13th day of August ' 19 92 .

giead/ THERESA L. CLA SSEN, Secretary/Treasurer FOR THE MEDIC BOARD OF CALIFORNIA DIVISION OF MEDICAL QUALITY

9.

Exhibit 1

1 JOHN K. VAN DE KAMP, Attorney General of the State of California

2 BARRY LADENDORF, Deputy Attorney General

3 SAMUEL K. HAMMOND, Deputy Attorney General

4 110 West A Street, Suite 700 San Diego, California 92101

5 Telephone: (619) 237-7989


7

8

9

10

BEFORE THE MEDICAL BOARD OF CALIFORNIA DIVISION OF MEDICAL QUALITY


11

12 In the Matter of the Accusation Against:

13 KENT WALTER LEHMAN, M.D.

14 12828 Harbor Blvd. Garden Grove, CA 92642,

15 Physician's and Surgeon's

16 Certificate No. G038595,

17 Respondent.

) NO. D-4373 ) ) ) ACCUSATION ) ) ) ) ) ) ) _________________________________ )

18

19 COMES NOW Complainant Kenneth Wagstaff, who as cause

20 for disciplinary action, alleges:

21 1. Complainant is the Executive Director of the

22 Medical Board of California (hereinafter the "Board") and makes

23 and files this accusation solely in his official capacity.

24 LICENSE STATUS

25 2. On or about December 21, 1978, Physician's and

26 Surgeon's Certificate No. G038595 was issued by the Board to

27 Kent Walter Lehman M.D. (hereinafter "respondent"), and at all

28 times relevant herein, said license was, and currently is, in

1.

1 full force and effect. At all times relevant, respondent owned

2 and operated several medical offices in Southern California at

3 the same time, using the names Lehman Medical Clinics, Inc.,

4 Lehman Medical Group, Lehman Medical, Doctors of Orange and other

5 fictitious names.

6 STATUTES

7 3. This accusation is made in reference to the

8 following statutes of the California Business and Professions

9 Code (hereinafter "Code"):

10 A. Section 2227 provides that the Board may revoke,

11 suspend for a period not to exceed one year, or place on

12 probation, the license of any licensee who has been found guilty

13 under the Medical Practice Act.

14 B. Section 2234 -provides that unprofessional conduct

15 includes, but not limited to, the following:

16 "(a) Violating or attempting to violate, directly

17 or indirectly, or assisting in or abetting the

18 violation of, or conspiring to violate, any provision

19 of this chapter.

20 11 (e) The commission of any act involving

21 dishonesty or corruption which is substantially related

22 to the qualifications, functions, or duties of the

23 physician and surgeon."

24 C. Section 725 provides that repeated acts of clearly

25 excessive prescribing or administering of drugs or treatment,

26 repeated acts of clearly excessive use of diagnostic procedures,

27 or repeated acts of clearly excessive use of diagnostic or

28 treatment facilities as determined by the standard of the

2.

' 1 community of licensees is unprofessional conduct for a physician

2 and surgeon, dentist, podiatrist, psychologist, physical

3 therapist, chiropractor, or optometrist.

4 D. Section 810 provides that it shall constitute

5 unprofessional conduct and grounds for disciplinary action,

6 including suspension or revocation of a license or certificate,

7 for a health care professional to do any of the following in

8 connection with his professional activities:

9 "(a) Knowingly present or cause to be presented

10 any false or fraudulent claim for the payment of a loss

11 under a contract of insurance.

12 "(b) Knowingly prepare, make, or subscribe any

13 writing, with intent to present or use the same, or to

14 allow it to be presented or used in support of such

15 claim. 11

16 FACTS PERTAINING TO DR. CHARLES ANDREWS

17 4. On or about January 27, 1986, respondent employed

18 Charles Andrews, M.D. as one of the physicians at respondent's

19 office. Thereafter, respondent ordered, instructed, counseled,

20 encouraged or otherwise conspired with, assisted or abetted said

21 Dr. Charles Andrews to engage in excessive use of diagnostic

22 procedures and excessive use of diagnostic or treatment

23 facilities, in 11 double billing 11 of claims for services rendered,

24 and in charging for comprehensive or extended visit when only

25 minimal physical examination was performed, all for the purpose

26 of presenting false or fraudulent or inflated insurance claims as

27 more particularly alleged hereinafter.

28 \ \ \

3.

1 PATIENT ELIZABETH B.

2 A. On or about February 20, 1986, this 41-year-old

3 patient went to respondent's office with a complaint of chest

4 congestion. The patient was assigned to Dr. Charles Andrews. A

5 physical examination performed showed no abnormalities. There

6 was no historical review of cardiovascular risk factors. The

7 following diagnostic tests were ordered: EKG Tracing only, EKG

8 Interpretation & Report, Sodium, Potassium, Bun, Creatinine, Uric

9 Acid, Calcium, Phosphorus, Alkaline Phosphatase, Urinalysis,

10 Sterile Midstream Collect, CBC with Differential, Sed Rate, RPR,

11 T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index, Amylase, Bilirubin,

12 Cholesterol, Glucose, SGPT and Triglycerides. There was no

13 medical indication for these tests. Respondent's office billed

14 the patient's insurance company $644.00 for this visit.

15 On or about February 24, 1986, the patient was seen for

16 a follow-up and a laboratory review. No physical examination was

17 performed. Respondent's office billed the patient's insurance

18 company for an extended visit.

19 On or about March 10, 1986, the patient made another

20 follow-up visit. Another series of diagnostic tests were ordered

21 including Cholesterol, Triglycerides and Lipoprotein

22 Electrophoresis. There was no medical indication for these

23 tests. The patient's insurance company was billed $160.00 for

24 the tests.


26 follow-up visit. Another series of diagnostic tests were ordered

27 including a repetition of Urinalysis and Sterile Midstream

28 Collect tests. There was no medical indication for these tests.

4 .

1 The patient's insurance company was billed $129.00 for this

2 visit, which included a charge for an extended visit by the

3 patient although only minimal physical examination was performed.

4 On or about April 29, 1986, the patient made another

5 visit at which time a treadmill stress test was obtained. For

6 this test, the patient's insurance company received a bill which

7 included the following charges: $109.20 for Established Patient

8 Comprehensive Visit, $121.80 for Treadmill tracing, $140.70 for

9 Treadmill Stress Report, and $88.20 for Physician monitoring.

10 On or about May 6 1 1986, the patient made a follow-up

11 visit for review of the results of the stress test. There was no

12 physical examination of the patient. Another series of

13 diagnostic tests were ordered including the following: X-Ray

14 Chest PA & LA, CBC, Sed Rate, T-4 Ria Total, T-3 Uptake, T-7

15 Thyroid Index, Protein Electrophoresis and T-3 Ria. These tests

16 were a repetition of tests taken in the earlier visits. There

17 was no medical indication for these tests. The patient's

18 insurance company was billed $445.20 for the tests, including a

19 $71.40 charge for an extended visit by the patient.

20 On or about May 13, 1986, the patient made a follow-up

21 visit for a resolution of her chest pain after she had been sent

22 to the facility's chiropractor. Respondent's office billed the

23 patient's insurance company for an extended visit, although no

24 physical examination was performed.

25

26

PATIENT PAUL H.

B. On or about May 14, 1986, this patient went to

27 respondent's office with a complaint of sinus congestion. This

28 patient was assigned to Dr. Charles Andrews. For this visit, the

5 •

1 following diagnostic tests were ordered: X-ray Sinus Series,

2 X-ray Sinus Series P.C., Venipuncture, LDH, Glucose, Sodium,

3 Potassium, Bun, Cholesterol, Triglycerides, Total Bilirubin,

4 Alkaline Phosphatase, SGOT, Total protein, Uric Acid, CBC with

5 Differential, Sed Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7

6 Thyroid Index, Aso Titer, Monospot, Cold Agglutinins, Creatinine

7 and Nasal Culture. These tests were neither indicated by the

8 patient's history nor by any physical examination of the patient.

9 Respondent's office billed the patient's insurance company for

10 $864.00 for this visit. The bill included a charge of $142.80

11 for a comprehensive physical examination although only a partial

12 examination was performed.

13 On or about May 21, 1986, the patient returned to

14 respondent's office for a follow-up visit. For this visit, more

15 diagnostic tests were ordered including Veniculture, Alkaline

16 Phosphatate, Bilirubin and SGOT. The tests were a repetition of

17 the tests performed earlier. Respondent's office billed the

18 patient's insurance company $465.15 for this visit. This bill

19 included a $71.40 charge for an extended visit, although only

20 minimal physical examination was conducted.

21 On or about June 4 1 1986 1 the patient returned to

22 respondent's office for a follow-up visit. More diagnostic tests

23 were ordered including the following: Venipuncture, CBC with

24 Differential, Sed Rate, Alkaline Phosphatase, Bilirubin, SGOT,

25 SGPT, Ceruloplasmin and Hepatitides Profile. These tests were

26 the same tests performed on the patient on May 21, 1986.

27 Respondent's office billed the patient's insurance company

28 $537.60 which included a $71.40 charge for an extended visit.

6.

1 On or about June 18, 1986, the patient made another

2 visit to respondent's office. For this visit, a Gall Bladder

3 ultrasound was ordered. There was no medical indication for this

4 test. Respondent's office billed the patient's insurance company

5 $1,070.00 for this visit, including separate charges for the

6 following: Minimal visit with Radiologist, Gall Bladder

7 ultrasound, Gall Bladder P.C. ultrasound, Film supplies, Liver

8 Spleen scan, Liver Spleen P.C. scan, Isotope supplies and a

9 consultation with a Radiologist.

10 On or about August 1, 1986, the patient made a follow-

11 up visit. The following diagnostic tests were ordered:

12 Venipuncture, Sodium, Potassium, Bun, Creatinine, SGOT, Total

13 Bilirubin, Albumin, LDH, CBC with Differential, Sed Rate,

14 Alkaline Phosphatase, SGPT, GGTP, Quantative Immunodiffusion,

15 Hepatitis B Surface Antigen, Prothrombin Time and PTT. These

16 tests were duplicates and triplicates of tests performed earlier.


18 $424.50 for these tests.

DIANA H. 19

20 C. On or about May 7, 1986, this 33-year-old patient

21 went to respondent's office with a complaint of dizziness and

22 fatigue. Dr. Charles Andrews was assigned to this patient. For

23 this visit, the following diagnostic tests were ordered:

24 Audiometry, Venipuncture, LDH, Glucose, Sodium, Potassium, Bun,

25 Cholesterol, Triglycerides, Total Bilirubin, Alkaline

26 Phosphatase, SGOT, Total Protein, Uric Acid, Urinalysis, Sterile

27 Midstream Collect, CBC with Differential, Sed Rate, RPR, T-4 Ria

28 Total, T-3 Uptake, T-7 Thyroid Index, Aso Titer, Monospot,

7 .

1 Calcium, TSH Stimulating Hormone, Cortisone HCG-Blood and T-3

2 Ria. There was no medical indication for these tests.




6 visit. There was no physical examination, but EKG and Holter

7 monitor were ordered. The patient's insurance company was billed

8 $884.00 for these tests, including separate charges for the

9 following: Est. Patient Extended Visit, EKG Tracing only, EKG

10 Interpretation & Report, Holter Monitor 24HR record, Holter

11 Monitor Scan w/report, Battery, Tape, Electrode, Est. Patient

12 minimal Visit, Est. Patient Extended Visit, Venipuncture, Glucose

13 Tolerance Test, Glucose Fasting, Glucose Urine, Glucola 1 Bottle

14 and Insulin. This bill is an example of "double billing" of

15 laboratory tests for profit.


17 visit. There was no physical examination of the patient. The

18 following diagnostic tests were ordered: Urinalysis, Sterile

19 Midstream Collect, Urine Culture, Colony Count and Sensitivity.

20 There was no medical indication for these tests. The patient's

21 insurance company was billed $225.75 including a $71.40 charge

22 for an extended visit, although only minimal physical examination

23 was performed on the patient.

24 PATIENT MARJORIE F.

25 D. On or about October 20, 1986, this 43-year-old

26 patient went to respondent's office complaining of back pain.

27 The patient was assigned to Dr. Charles Andrews. The patient was

28 referred to the office's chiropractor whom the patient saw on

8.

1 three occasions. On or about October 27, 1986, the patient was

2 again seen by Dr. Andrews. The following diagnostic tests were

3 ordered: Venipuncture, LDH, Glucose, Sodium, Potassium, Bun,


5 Phosphatase, SGOT, Total Protein, Uric Acid, Urinalysis, Sterile

6 Midstream Collect, CBC with Differential, Sed Rate and RA Antigen

7 Elution. There was no medical indication for these tests.


9 $527.40 including $71.40 for an extended visit, although there

10 was no documentation of any physical examination.

11 On or about October 30, 1986, the patient returned for

12 a follow-up visit. The following diagnostic tests were ordered:

13 Venipuncture, CBC with Differential, Sed Rate, Sodium, Potassium,

14 Bun, Creatinine, Glucose, Albumin, Urinalysis, Sterile Midstream

15 Collect and Autoimmune Profile. These tests were the same tests

16 performed three days earlier. The patient's insurance company

17 was billed $286.95 for these tests.

18 PATIENT GARY A.

19 E. On or about February 9, 1987, this 34-year-old

20 patient went to respondent office with a complaint of

21 palpitations. The patient was assigned to Dr. Charles Andrews.

22 For this visit, the following diagnostic tests were ordered and

23 charged to the patient insurance company: EKG tracing only, EKG

24 Interpret & Report, X-ray Chest PA & LA, Venipuncture, CBC with

25 Differential, Sed Rate, Thyroid Panel, Kidney Panel, Glucose,

26 Calcium, Gamma GT, Magnesium, Urinalysis, Sterile Midstream

27 Collect. With the exception of the EKG, a CBC and the Thyroid

28 panel, these tests were ordered without any medical indication.

9 .

1 The patient's insurance company was billed $600.00 for these

2 tests.

3 On or about February 17, 1987, the patient made another

4 visit to respondent's office. On this visit, an echocardiogram

5 was ordered without any documentation of need. Respondent's

6 office billed the patient's insurance company $570.15 for this

7 test.

8 On or about April 7, 1987, the patient was referred to

9 a cardiology consultant in respondent's office. There was no

10 medical indication for this referral. Respondent's office billed

11 the patient's insurance company $227.85 for this consultation.

12 PATIENT JUDY P.

13 F. On or about January 28, 1986, this 34-year-old

14 patient went to respondent's office and requested a TB tine test.

15 This patient was assigned to Dr. Charles Andrews. The patient's

16 insurance company was billed for an intermediate visit, although

17 only minimal physical examination was performed.

18 On or about January 16, 1987, the patient made another

19 visit to respondent's office and complained of allergic symptoms.

20 The following diagnostic tests were ordered: Tetanus & D.T.,

21 Venipuncture, CBC with Differential, Sed Rate, RPR, T-4 RIA, T-3

22 Resin Uptake, T-7 Thyroid Index, Sodium, Potassium, Bun,

23 Creatinine, Triglycerides, HDL, LDL, Glucose, Calcium, Gamma GT,

24 and Mast Allergy Testing. There was no medical indication for

25 these tests. For this visit, the patient insurance company

26 received a bill for $923.85.

27 On or about January 26, 1987, the patient was seen for

28 a laboratory follow-up. For this visit, the patient's insurance

10.

1 company received a bill for an extended visit, although only

2 minimal physical examination was performed.

3 On or about December 9, 1987, the patient presented

4 with abdominal pain. Several diagnostic tests were ordered

5 including the following: Venipuncture, CBC with differential and

6 Sed Rate. These tests were repetitions of tests performed

7 earlier. For this visit, the patient's insurance company

8 received a bill for $326.85.

9 On or about December 11, 1987, the patient was seen for

10 a follow-up. Another series of diagnostic tests were ordered

11 including a repetition of the tests for Urinalysis and Sterile

12 Midstream Col. For this visit the patient's insurance company

13 received a bill for $395.95 which included a $71.40 charge for an

14 extended visit.

15

16

CHARGES AND ALLEGATIONS

5. As a result of the conduct described in paragraph 4

17 above, respondent Kent Walter Lehman, M.D. is guilty of violating

18 section 2234(e) of the Code, dishonesty, in that respondent

19 ordered, directed, counseled or encouraged Dr. Charles Andrews to

20 engage in, or otherwise conspire with, or assisted or abetted Dr.

21 Charles Andrews to engage in billing of unnecessary medical

22 diagnostic tests and medical office visits when respondent knew

23 or should have known that said tests/office visits were

24 excessive, not medically indicated and/or repetitious.

25 6. As a result of the conduct described in paragraph 4


27 section 725 of the Code, repeated acts of clearly excessive use

28 of diagnostic procedures, or repeated acts of clearly excessive

11.

1 use of diagnostic or treatment facilities, in that respondent

2 ordered, directed, counseled or encouraged Dr. Charles Andrews to

3 engage in, or otherwise conspired with, or assisted or abetted

4 Dr. Charles Andrews to engage in ordering diagnostic tests

5 without medical indication, and to engage in ordering repetitions

6 of diagnostic tests for the purpose of presenting false,

7 fraudulent or inflated insurance claims.

8 7. As a result of the conduct alleged in paragraph 4

9 above, respondent Kent Walter Lehman, M.D. is guilty of section

10 810 of the Code, insurance fraud, in that respondent ordered,

11 directed, counseled or encouraged Dr. Charles Andrews or

12 otherwise, conspired with, or assisted or abetted Dr. Charles

13 Andrews to engage in ordering diagnostic tests without medical

14 indication, and to engage in ordering repetitions of diagnostic

15 tests for the purpose of presenting false, fraudulent or inflated

16 insurance claims.



19 section 2234(a) of the code in that respondent ordered, directed,

20 counseled, or encouraged Dr. Charles Andrews or otherwise,

21 conspired with, assisted or abetted Dr. Charles Andrews in the

22 violation of sections 2234(e), 725 and 810 of the Code.

23 FACTS PERTAINING TO DR. AUGUST BIANCO

24 9. Prior to April 30, 1985, respondent employed

25 August Bianco, M.D. as one the physicians at respondent's office.

26 Thereafter, respondent ordered, instructed, counseled, encouraged

27 or otherwise conspired with, assisted or abetted said Dr. August

28 Bianco to engage in excessive use of diagnostic procedures and

12.

1 excessive use of diagnostic or treatment facilities, in "double

2 billing" of claims for services rendered, and in charging for

3 comprehensive or extended visit when only minimal physical

4 examination was performed, all for the purpose of presenting

5 false or fraudulent or inflated insurance claims as more

6 particularly alleged hereinafter.

7 PATIENT OLGA F.

8 A. On or about April 30, 1985, this patient went to

9 the respondent's office with a complaint of pain in the hip. The

10 patient was assigned Dr. August Bianco. The following diagnostic

11 tests were ordered: EKG Tracing only, EKG Interpret and Report,

12 X-ray Chest PA & LA, X-ray Lumbosacral Spine, Venipuncture, LDH,

13 Glucose, Sodium, Potassium, Bun, Cholesterol, Triglycerides,

14 Total Bilirubin, Alkaline Phosphatase, SGOT 1 Total Protein, Uric

15 Acid, Sterile Midstream Collect, Urinalysis, Sed Rate RPR, T-4

16 Ria Total, T-3 Uptake, T-7 Thyroid Index, Calcium, Creatinine and

17 Phosphorus. There was no medical indication for these tests.


19 $825.00 for these tests, including a charge of $136.00 for a

20 comprehensive visit, although only minimal physical examination

21 was performed.

22 On or about October 1, 1985, the patient returned to

23 the office for test results. There was no physical examination

24 performed. Respondent's office billed the patient's insurance

25 company for an extended visit.


27 respondent's office with a complaint of sore throat, sinus

28 congestion, and a cough. Minimal physical examination was

13.

1 performed and documented. The following diagnostic tests were

2 ordered: Venipuncture, CBC with differential, Sed Rate, Aso

3 Titer, Monospot, C-Reactive Protein, Throat Culture and

4 Sensitivity. There was no medical indication for these tests.


6 $262.50 for these tests, including a $71.40 charge for an

7 extended visit.

8 On or about June 13, 1986, the patient returned to the

9 respondent's office with a complaint of tightness in the chest.

10 A minimal physical examination was performed and documented. The

11 following diagnostic tests were ordered: X-ray Chest PA & LA,

12 X-ray Chest P.C., Venipuncture, CBC with differential, Sed Rate,

13 Aso Titer, Monospot, C-Reactive Protein, Throat Culture and

14 Sensitivity. These tests were a repetition of the tests taken

15 earlier. Respondent's office billed the patient's insurance

16 company $435.75 for these tests, including a $71.40 charge for an

17 extended visit.

18 PATIENT KEITH C.

19 B. On or about December 18, 1985, this 41-year-old

20 patient went to respondent 1 s office with a complaint of leg

21 cramps and sore throat. This patient was assigned to Dr.

22 August Bianco. No history of the patient was obtained and

23 minimal physical examination of the patient was performed. The

24 following diagnostic tests and treatments were ordered:

25 Ultrasound Treatment, P.T. Williams/Quadriceps, Instruction

26 Booklet, Hot Pack, Physical Therapy Evaluation, X-ray Knee

27 Complete, X-ray Knee P.C., X-ray Lumbosacral Spine, X-ray

28 Lumbosacral Spine P.C., Throat Culture and Sensitivity. There

14.

1 was no medical indication for these tests and treatment.


3 $553.00 including a $68.00 charge for an extended visit.

4 On or about December 19, 1985, the patient was referred

5 to a chiropractor in the office. There was no medical indication

6 for this referral. Respondent's office billed the patient's

7 insurance company $356.00 for this visit.


9 respondent's office with a complaint of diarrhea and chest pains.

10 No history of the patient was obtained and minimal physical

11 examination was performed and documented. The following

12 diagnostic tests were ordered: EKG Tracing only, EKG Interpret

13 and Report, X-ray Chest PA & LA, X-ray Lumbosacral Spine,

14 Venipuncture, LDH, Glucose, Sodium, Potassium, Bun, Cholesterol,

15 Triglycerides, Total Bilirubin, Alkaline Phosphatase, SGOT, Total

16 Protein, Uric Acid, Sterile Midstream Collect, Urinalysis, CBC

17 with Differential, Sed Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7

18 Thyroid Index, Amylase, Calcium, Creatinine, HDL and Phosphorus.

19 There was no medical indication for these tests. Respondent's

20 office billed the patient's insurance company $805.00 for these

21 tests, including a charge of $71.40 for an extended visit,

22 although only minimal physical examination was performed.

23 On or about May 30, 1986, a treadmill stress test was

24 performed. There was no medical indication for this test.


26 $416.85 for this test.

27 On or about December 1, 1986, the patient returned to

28 respondent's office complaining of foot injury as a result of

15.

1 stepping on a nail. Minimal physical examination performed and

2 documented. No previous history of tetanus immunization was

3 obtained. A tetanus injection was given with an order for a

4 repeat dosage four (4) days later. Respondent's office billed

5 the patient's insurance company for $99.00 including a $54.60

6 charge for an intermediate visit.

7 PATIENT JAIME Y.

8 c. On or about April 24, 1985, this 7-year-old patient

9 was taken to respondent's hospital with a complaint of warts.

10 The patient was assigned to Dr. August Bianco. No physical

11 examination was performed. The patient was treated for warts on

12 three subsequent visits without any documentation of response.

13 On October 10, 1985, the patient returned to respondent's office

14 complaining of the reoccurrence of the warts. There was no

15 physical examination performed of the patient. Respondent's

16 office charged the patient's insurance company $110.00 for this

17 visit, which included a $68.00 charge for an extended visit.

18 The patient made three subsequent visits between

19 November 14, 1985, and December 27, 1985, for liquid nitrogen

20 treatment for the warts. Respondent's office billed the

21 patient's insurance company for extended visits on all three

22 visits.


24 respondent's office for a: follow-up visit of the wart problem.

25 At this visit, the patient was diagnosed as suffering from

26 syncope. There was minimal physical examination performed. The

27 following diagnostic tests were ordered. Venipuncture, LDH,


16.

1 Total Bilirubin, Alkaline Phosphatase, SGOT, Total Protein, Uric

2 Acid, Sterile Midstream Collect, Urinalysis, CBC with


4 Thyroid Index, Calcium and Phosphorus. There was no medical

5 indication for these tests. Respondent's office billed the

6 patient's insurance company $582.33 for this visit, including a

7 $71.40 for an extended visit.

8 On or about June 9, 1986, the patient made another

9 follow-up visit. There was no physical examination conducted.

10 The bill sent to the patient's insurance company for this visit

11 included a $71.40 charge for an extended visit.

12 On June 13, 1986, the patient made another follow-up

13 visit. A glucose tolerance test was ordered. There was no

14 medical indication for this test. Respondent's office billed the

15 patient's insurance company $187.95 for this test including a

16 $71.40 charge for an extended visit, although only a minimal

17 physical examination was performed.

18 10. As a result of the conduct described in paragraph \

19 9 above, respondent Kent Walter Lehman, M.D. is guilty of

20 violating section 2234(e) of the Code, dishonesty, in that

21 respondent ordered, directed, counseled or encouraged Dr. August

22 Bianco to engage in, or otherwise conspired with, or assisted or

23 abetted Dr. August Bianco to engage in billing of unnecessary

24 medical diagnostics tests and medical office visits when

25 respondent knew or should have known that said tests/office

26 visits were excessive, not medically indicated and/or

27 repetitious.

28 \ \ \

17.

1 11. As a result of the conduct described in paragraph


3 violating section 725 of the Code, repeated acts of clearly

4 excessive use of diagnostic procedures, or repeated acts of

5 clearly excessive use of diagnostic or treatment facilities, in

6 that respondent ordered, directed, counseled or encouraged

7 Dr. August Bianco to engage in, or otherwise conspired with, or

8 assisted or abetted Dr. August Bianco to engage in ordering

9 diagnostic tests without medical indication, and to engage in

10 ordering repetitions of diagnostic tests for the purpose of

11 presenting false, fraudulent or inflated insurance claims.



14 section 810 of the Code, insurance fraud, in that respondent

15 ordered, directed, counseled or encouraged Dr. August Bianco

16 or otherwise, conspired with, or assisted or abetted Dr. August

17 Bianco to engage in ordering diagnostic tests without medical






23 section 2234(a) of the code in that responden·t ordered, directed,

24 counseled, or encouraged Dr. August Bianco or otherwise,

25 conspired with, assisted or abetted Dr. August Bianco in the


27 \ \ \

28 \ \ \

18.

1 FACTS PERTAINING TO DR. TOM BESLEY

2 14. Prior to June 14, 1986, respqndent employed Tom

3 Besley, M.D. as one the physicians at respondent's office.


5 or otherwise conspired with, assisted or abetted said Dr. Tom

6 Besley to engage in excessive use of diagnostic procedures and







13 PATIENT RICHARD S.

14 A. On or about October 20, 1986, this 57-year-old

15 patient went to respondent's office with a complaint of pain in

16 the right heel and headaches. This patient was assigned to

17 Dr. Richard Southwell. The following diagnostic tests were



20 Phosphatase, SGOT, Total Protein, Uric Acid, Sterile Midstream

21 Collect, Urinalysis, CBC with Differential, Sed Rate, RPR, T-4

22 Ria Total, T-3 Uptake, T-7 Thyroid Index, Ultrasound treatment

23 and physical evaluation. For these tests, respondent's office

24 billed the patient's insurance company $511.60.

25 On or about October 23, 1986, the patient made a

26 follow-up visit. Respondent's office billed the patient's

27 insurance company $122.00 physical therapy and ultrasound

28 treatment. There was no medical indication for this visit.

19.

1 On or about October 28, 1986, the patient again made a

2 visit to respondent's visit requesting a blood pressure check and

3 complaining of headaches and dizziness. There was no physical

4 examination performed or documented. The following diagnostic

5 tests were ordered: Venipuncture, Handling of specimen, Uric

6 Acid, Mast Allergy Testing, Total IGE, Urinalysis, Sterile

7 Midstream Collect, Urine Culture, Colony Count, Sensitivity,

8 X-ray Sinus Series, X-ray Sinus Series P.C. There was no medical


10 patient's insurance company $871.80 for these tests, including a

11 $71.40 charge for an extended visit.

12 On or about November 4, 1986, the patient made a

13 follow-up examination and review of the tests. Respondent's

14 office billed the patient's insurance company for an extended

15 visit.

16 PATIENT LAURIE F.

17 B. On or about July 14, 1986, this 25-year-old patient

18 went to respondent's office with complaints of injury to the

19 buttocks, dizziness and inability to urinate. The complaints

20 were the result of a fall on hard concrete. The patient was

21 assigned to Dr. Tom Besley. A physical examination was

22 performed. An extensive X-ray evaluation was ordered including

23 pelvic X-rays. There was no medical indication for the pelvic X-

24 rays.

25 On or about July 18, 1986, the patient returned to

26 respondent's office for a follow-up visit. A genital examination

27 was performed and the patient was diagnosed to have Herpes. The

28 following diagnostic tests were ordered: Gram Stain, KOH Stain

20.

' '

1 and Reading, Wet Mount Slide Reading, G.C. Culture, Chlamydiazyme

2 and Hemoccult. Respondent's office billed the patient's

3 insurance company $264.60 for this visit, including a $71.40

4 charge for an extended visit.


6 respondent's office with a complaint of the reoccurrence of

7 Herpes. The following diagnostic tests were ordered: Gram

8 Stain, KOH Stain and Reading, Wet Mount Slide Reading, G.C.

9 Culture, Chlamydiazyme, Vaginal Culture and Herpes Culture.

10 These were the same tests performed on July 18, 1986.


12 $344.40 for this visit, including a $71.40 charge for an extended

13 visit.


15 respondent's office with a complaint of vaginal discharge. The

16 following diagnostic tests were ordered: Venipuncture, LDH,


18 Total Bilirubin, Alkaline Phosphatase, SGOT, Total protein, Uric

19 Acid, CBC with Differential, Sed Rate, RPR, Chlamydiazyme, G.C.

20 Culture, Vaginal Culture, Wet Mount, Routine Stain Smear,

21 Calcium, Urinalysis, Sterile Midstream Collect, Urine Culture,

22 Sensitivity, Colony Count, Pap Smear, Disposable Speculum and KOH

23 stain & Reading. There was no medical indication for all these

24 tests. Respondent's office billed the patient's·insurance


26 extended visit.

27 On or about December 12, 1986, the patient made a

28 follow-up visit. Respondent's office billed the patient's

21.

1 insurance company for an intermediate visit, although there was

2 no physical examination of the patient.

3 PATIENT DARLA D.

4 c. On or about December 31, 1986, this 26-year-old

5 patient went to respondent's office with complaints of sore

6 throat, headache, clogged·ears and pain in ~he chest. The

7 patient was assigned to Dr. Tom Besley. A family history of the

8 patient was obtained and a brief physical examination was

9 performed. The following diagnostic tests were ordered: X-ray

10 Chest PA & LA, X-ray Chest P.C., X-ray Sinus Series, X-ray Sinus

11 Series P.C., Venipuncture, LDH, Glucose, Cholesterol,

12 Triglycerides, Total Bilirubin, Alkaline Phosphatase, SGOT,

13 Urinalysis, CBC with Differential, Sed Rate, GGT, Sterile

14 Midstream Collect, Gamma GT, Aso Titer, Monospot, Cold

15 Agglutinins, Nasal Culture, Throat Culture, Epstein-Barr Virus,

16 CMV and Prep of Specimen. There was no medical indication for

17 these tests. Respondent's office billed the patient's insurance

18 company $1,003.30 for these tests. This bill represents an

19 example of "unbundling" of chemistry panels for profit.

20 On or about December 31, 1986, the patient was referred

21 to a chiropractor at the office. There was no medical indication

22 for this referral.

23 On or about January 9, 1987, the patient made a fol1ow-

24 up visit. The following diagnostic tests were ordered: Upper

25 GI/Small Bowel, KUB 3 Views, Upper GI-Small Bowel, KUB 3 Views

26 P.C., Gallbladder U/S. There was no medical indication for these

27 tests. Respondent's office billed the patient's insurance

28 company $751.80 for these tests.

22.

1 On or about January 15, 1987, made a follow-up visit.

2 Respondent's office billed the patient's insurance company for an

3 intermediate visit, although no physical examination was

4 performed.

5 PATIENT SHANNON H.

6 D. On or about September 4, 1986, this 19-year-old

7 patient went to respondent's office with a complaint of Warts.

8 The patient was assigned to Dr. Tom Besley. A minimal

9 examination was performed. For this visit, respondent's office

10 billed the patient's insurance company $213.15, including a

11 $88.20 charge for an intermediate visit, in addition to the

12 charge for the treatment for the Warts.

13 The next day, the patient made a follow-up visit.

14 Respondent billed the patient's insurance company for an

15 intermediate visit, although no physical examination was

16 performed.


18 respondent's office with a complaint of Upper Respiratory Tract

19 infection. A minimal physical examination was performed.


21 intermediate visit.




25 respondent ordered, directed, counseled or encouraged Dr. Tom

26 Besley to engage in, or otherwise conspired with, or assisted or

27 abetted Dr. Tom Besley to engage in billing of unnecessary


23.



3 repetitious.







10 Dr. Tom Besley to engage in, or otherwise conspired with, or

11 assisted or abetted Dr. Tom Besley to engage in ordering







18 ordered, directed, counseled or encouraged Dr. Tom Besley or

19 otherwise, conspired with, or assisted or abetted Dr. Tom Besley

20 to engage in ordering diagnostic tests without medical







27 counseled, or encouraged Dr. Tom Besley or otherwise, conspired

28 \ \ \

24.

1 with, assisted or abetted Dr. Tom Besley the violation of

2 sections 2234(e), 725 and 810 of the Code.

3 FACTS PERTAINING TO DR. DANIEL BROWN

4 19. Prior to February 10, 1986, respondent employed

5 Daniel Brown, M.D. as one the physicians at respondent's office.


7 or otherwise conspired with, assisted or abetted said Dr. Daniel

8 Brown to engage in excessive use of diagnostic procedures and







15 PATIENT RANDY L.

16 A. On or about February 10, 1986, this 35-year-old

17 patient went to respondent's office with a request for a physical

18 examination and with complaints of rash in the leg, headaches and

19 genital lesions. The patient was assigned to Dr. Daniel Brown.

20 A official history was obtained. There was no physical

21 examination performed or documented. The following diagnostic

22 tests were ordered: EKG Tracing only, EKG Interpret and Report,

23 X-ray Chest PA & LA, X-ray P.C., Venipuncture, LDH, Glucose,

24 Sodium, Potassium, Bun, Cholesterol, Triglycerides, Total

25 Bilirubin, Alkaline Phosphatase, LDH, SGOT, Total Protein, Uric


27 Differential, Sed Rate, RPR, Urine Culture, Colony Count,

28 Sensitivity and Herpes Culture. There was no medical indication

25.

1 for these tests. Respondent's office billed the patient's

2 insurance company $783.00 for these tests, including a $136.00

3 charge for a comprehensive examination although no physical


5 On February 13, 1986, the patient made a follow-up

6 visit. Another series of diagnostic tests were ordered including

7 the following: Urinalysis, Sterile Midstream Collect, CBC with

8 Differential, Uric Acid, Colony Count, Urine Culture and

9 Sensitivity. These tests were a repetition of tests performed on

10 February 10, 1986. The following tests were also ordered: T-4

11 Ria Total, T-3 Uptake, T-7 Thyroid Index and SSH Stimulating

12 Hormone. There was no medical indication for these tests.



15 visit, although no physical examination was performed.

16 On or about February 24, 1986, the patient made a

17 follow-up visit for a blood pressure check. Respondent's office

18 billed the patient's insurance company for an extended visit.

19 On or about March 3, 1986, the patient again made a

20 follow-up visit for a blood pressure check. More diagnostic

21 tests were ordered including: Urinalysis, Sterile Midstream

22 Collect, CBC with Differential, Cholesterol, Creatine, HDL and

23 Triglycerides. These tests were a repetition of tests performed

24 earlier. Respondent's office billed the patient's insurance


26 extended visit, although no physical examination was performed.

27 Between about March 20, 1986 and February 24, 1987, the

28 patient made five follow-up visits for Hypertension check. There

26.

1 were no physical examinations performed or documented on each of

2 these visits. Respondent's office billed the patient's insurance

3 company for extended visits for each of these visits.

4 PATIENT KENNETH L.

5 B. On or about January 21, 1987, this 27-year-old

6 patient went to respondent's office with a palpitation complaint.

7 The patient was assigned to Dr. Daniel Brown. A brief history

8 was obtained, but a cardiovascular exam was performed which

9 indicated the presence of mid-systolic murmur and a click

10 consistent with mitral valve prolapse. Extensive diagnostic

11 tests were ordered including Sed Rate, RPR, Calcium, Magnesium

12 and Thyroid functions. There was no medical indication for these

13 tests. Respondent's office billed the patient's insurance

14 company $282.00 for these tests, including a $142.80 charge for a

15 comprehensive examination, although only minimal physical



18 follow-up visit for a review of the laboratory tests.

19 Venipuncture and CBC with differential tests were ordered. These

20 tests were a repetition of earlier tests. Respondent's office

21 billed the patient's insurance company $108.45 for the tests,

22 including a $54.60 charge for an intermediate visit, although

23 there was no physical examination performed on the patient.

24

25

PATIENT CAROLYN R.

C. On or about June 23, 1986, this 42-year-old patient

26 went to respondent's office with a complaint with a burning itchy

27 area on the back of her neck. This patient was assigned to

28 Dr. Daniel Brown. A physical examination was performed and the

27.

1 patient was treated with Dicloxacillin. On or about July 7,

2 1986, the patient returned for a follow-up visit. The following

3 diagnostic tests were ordered: Venipuncture, LDH, Glucose,


5 Bilirubin, Alkaline Phosphatase, LDH, SGOT, Total Protein, Uric


7 Differential, Sed Rate, RPR, HDL, Low Density Lipoprotein, Mast

8 Allergy Testing, Total IGE and Ana Screen. There was no medical


10 patient's insurance company $934.50 including a $71.40 charge for

11 an extended visit, although no physical examination was performed

12 on the patient.

13 D. On or about July 14, 1986, the patient made a

14 follow-up visit. More tests were ordered including Urinalysis

15 and Sterile Midstream Collect. These were a repetition of tests

16 performed earlier. Respondent's insurance billed the patient's


18 charge for an extended visit, although no physical examination of

19 the patient.

20 On or about November 11, 1986, the patient returned to

21 respondent's office with a complaint of fibrocystic breast

22 disease. No physical examination of the patient was performed.

23 More diagnostic tests were ordered including Venipuncture, KOH

24 Stain, Alkaline Phosphate, Glucose, LDH, Bilirubin, Total Protein

25 and SGOT. These tests were a repetition of tests performed on

26 earlier visit. Respondent's office billed the patient's

27 insurance company $547.35 for these tests, including $71.40 for

28 an extended visit.

28.

1 On or about December 19, 1986, the patient made another

2 follow-up visit for a review of laboratory tests. Respondent's

3 office billed the patient's insurance company for an extended

4 visit, although no physical examination was performed.

5 PATIENT SHIRLEY L.

6 E. On or about November 5, 1986, this 55-year-old

7 patient went to respondent's office with complaints of asthma

8 and postmenopausal symptomatology. A minimal physical

9 examination was performed. The following diagnostic tests were



12 Phosphatase, SGOT, Total Protein, Uric Acid, Calcium, Sterile

13 Midstream Collect, Urinalysis, Estrogen, CBC with Differential,

14 Sed Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index and

15 TSH Stimulating Hormone. There was no medical indication for



18 comprehensive visit.

19 On or about November 19, 1986, the patient returned for

20 a follow-up visit and a review of the laboratory tests. The

21 following diagnostic tests were ordered: Chlamydiazyme, G. c.

22 Culture, Vaginal Culture, Wet Mount, Pap Smear, Disposable

23 Speculum, KOH Stain & Reading. There was no medical indication



26 charge for an extended visit, although no physical examination of

27 the patient was performed.

28 \ \ \

29.


2 respondent's office with a request for a refill of asthma and

3 estrogen medications. Respondent's office billed the patient's

4 insurance company for an extended visit, although no physical

5 examination was performed on the patient.

6 PATIENT MARY L.

7 F. On or about January 27, 1986, this patient went to

8 respondent's office with complaints of Sinus and Chest

9 congestion. Minimal history of the patient was obtained. A

10 limited physical examination was performed. The following



13 Bilirubin, Alkaline Phosphatase, SGOT, Total Protein, Uric Acid,

14 LDH, CBC with Differential, Sed Rate, RPR, Cold Agglutinins and

15 Prep of Specimen. There was no medical indication for many of







22 respondent ordered, directed, counseled or encouraged Dr. Daniel

23 Brown to engage in, or otherwise conspired with, or assisted or

24 abetted Dr. Daniel Brown to engage in billing of unnecessary




28 repetitious.

30.







7 Dr. Daniel Brown to engage in, or otherwise conspired with, or

8 assisted or abetted Dr. Daniel Brown to engage in ordering







15 ordered, directed, counseled or encouraged Dr. Daniel Brown or

16 otherwise, conspired with, or assisted or abetted Dr. Daniel

17 Brown to engage in ordering diagnostic tests without medical







24 counseled, or encouraged Dr. Daniel Brown or otherwise, conspired

25 with, assisted or abetted Dr. Daniel Brown in the violation of


27 \ \ \

28 \ \ \

31.

1

2

FACTS PERTAINING TO DR. JERRY CORNERS

24. Prior to October 16, 1985, respondent employed

3 Jerry Corners M.D. as one of the physicians at respondent's

4 office. Thereafter, respondent ordered, instructed, counseled,


6 Dr. Jerry Corners to engage in excessive use of diagnostic


8 facilities, in "double billing" of claims for services rendered,





13 PATIENT JOSEPH H.

14 A. On or about October 16, 1985, this seven-year-old

15 patient with a complaint of.Asthma and Upper Respiratory Tract

16 Infection. The patient was assigned to Dr. Jerry Corners~

17 Minimal physical examination was performed. The following

18 diagnostic examination was ordered: X-ray Chest PA & LA, X-ray

19 P.C., Mast Allergy Testing, Prep of Specimen, Total IGE and

20 Indoor Inhalant Prof. Respondent's office billed the patient's

21 insurance company for a comprehensive visit.

22 On or about November 7, 1985, the patient was returned

23 to respondent's office with a complaint of Sore Throat. A

24 minimal physical examination was performed. The following




28 Sterile Midstream Collect, Urinalysis, CBC with Differential, Sed

32.

1 Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index, ASO

2 Titer, Monospot, Cold Agglutinins, Prep of Specimen, Throat

3 Culture, Sensitivity, Theophylline. With the exception of Throat

4 Culture and Theophylline level, there was no medical indication

5 for the tests performed. Respondent's office billed the

6 patient's insurance company $735.00 for these tests, including a

7 $68.00 charge for an extended visit. \

8 On or about November 14, 1985, the patient was returned

9 to respondent's office with a complaint of wheezing. Pulmonary

10 function studies were ordered without a medical indication.



13 extended visit, although no physical examination was performed on

14 the patient.



17 Infection. Minimal physical examination was performed. The

18 patient 1 s insurance company was billed for an extended visit.


20 respondent's office with a complaint of Sore Throat. The

21 following diagnostic tests were ordered: Venipuncture, CBC with

22 Differential, Sed Rate, Throat Culture, Sensitivity, Nasal

23 Culture. There was no medical indication for these tests.



26 visit.

27 On or about May 16, 1986, the patient returned for a

28 follow-up visit. A repeat Throat Culture and Sensitivity tests

33.

1 were ordered without a medical indication. Respondent's office

2 billed the patient's insurance company $143.85 for this visit,

3 including a $71.60 charge for an extended visit, although no

4 physical examination was performed on the patient.

5 PATIENT CHRISTOPHER H.

6 B. On or about November 21, 1985, this 8-year-old

7 patient was taken to respondent's office with a complaint of Sore

8 Throat and a past history of Asthma. A minimal physical




12 Phosphatase, SGOT, Total Protein, Uric Acid, Sterile Midstream

13 Collect, Urinalysis, CBC with Differential, Sed Rate, RPR, T-4

14 Ria Total, T-3 Uptake, T-7 Thyroid Index, Prep of Specimen,

15 Throat Culture, Sensitivity, Mast Allergy Testing, Total IGE and

16 Theophylline. There was no medical indication for these tests.


18 $1210.00 for these tests, including a $136.00 charge for a

19 comprehensive visit, although only a partial physical examination


21 On or about July 22, 1986, the patient was returned to

22 respondent's office with complaints fever, headache, and

23 conjunctivitis. The bill submitted to the patient's insurance

24 company for this visit, included a $142.80 charge for a

25 comprehensive visit, although the patient had already been

26 established in the office.

27 \ \ \

28 \ \ \

34.

1

2

PATIENT DIANNA H.

C. On or about November 13, 1986, t~is 31-year-old

3 patient went to respondent's office with a complaint of warts on

4 her back and right leg. This patient was assigned to Dr. Jerry

5 Corners. A minimal physical examination was;performed and the

6 warts were excised. For this treatment, a bill of $913.50 was

7 sent to the patient insurance company.


9 respondent's office for suture removal. Respondent's office

10 billed the patient's insurance company for an extended visit. On

11 or about November 21, 1986, the patient made a return visit for a

12 wound check. Respondent's office billed the patient's insurance

13 company for an extended visit, although no physical examination


15 On or about August 21, 1987, the patient returned to


17 Infection. The following diagnostic tests were ordered:

18 Venipuncture, Handling of specimen, CBC with Differential, Sed

19 Rate, ASO Titer, Monospot, Mast Allergy Testing, Total IGE, Nasal

20 Culture, Cold Agglutinins, X-ray Sinus Series and X-ray Sinus

21 Series P. There was no medical indication for these tests.



24 extended visit, although no physical examination of the patient

25 was performed.

26 PATIENT JANET M.

27 D. on or about August 20, 1986, this 26-year-old

28 patient went respondent's office with complaints of post-partum

35.

1 and Upper Respiratory Tract Infection. The patient was assigned

2 to Dr. Jerry Corners. A brief official history was obtained and

3 a minimal physical examination was performed. The following

4 diagnostic tests were ordered: X-ray Chest PA & LA, X-ray Chest

5 P. c., Venipuncture, RPR, Total Iron Binding, Sterile Midstream

6 Collect, Urinalysis, CBC with Differential, Sed Rate, ASO Titer,

7 Monospot, Cold Agglutinins, Prep of Specimen, Throat Culture,

8 Sensitivity, Urine Culture, Colony Count, B-12 Folate, Iron

9 Serum, and Reticulocyte Count. There was no medical indication



12 charge for a comprehensive visit. The bill is an example of

13 "splitting" of claims for profit.

14' On or about October 6, 1986, the patient returned to

15 respondent's office with a complaint of Sinusitis. A repeat X-

16 ray examination was ordered·. Respondent's office billed the


18 $71.40 charge for an extended visit, although no physical



21 respondent's office for evaluation of possible PMS. There was no

22 physical examination documented. Venipuncture, CBC with

23 Differential, Sed Rate, HCG-Blood Gual, RPR, Chlamydiazyme EIA,

24 Gonozyme, Vaginal Culture, Wet Mount, Gram Stain, Urinalysis,

25 Sterile Midstream Collect, Urine Culture, Sensitivity, Colony

26 Count, Pap Smear, Disposable Speculum and KOH. There was no


28 \ \ \

36.

1 the patient's insurance company $606.25 for these tests,

2 including a $71.40 charge for an extended visit.

3 PATIENT LISA P.

4 E. On or about December 15, 1986, this 10-year-old

5 patient was taken to respondent's office with complaints of

6 cough, congestion and fever. The patient was assigned to

7 Dr. Jerry Corners. A minimal physical exami~ation was performed

8 and a chest X-ray was ordered. The chest X-ray was clear

9 however, the patient was diagnosed as having pneumonia. There

10 was no medical indication noted for this diagnosis. For this

11 visit, respondent 1 s office billed the patient's insurance

12 company for a comprehensive visit.

13 On or about December 16, 1986, the patient was returned

14 for a follow-up visit. The following diagnostic tests were

15 ordered: Venipuncture, Sterile Midstream Collect, Urinalysis,

16 CBC with Differential, Sed Rate, ASO Titer, Monospot, Cold

17 Agglutinins, Prep of Specimen, Sputum Culture, C-Reactive Protein

18 and Heterophile Antibody Titer. There was no medical indication



21 charge for an extended visit, although there was no physical

22 examination of the patient.

23 On December 22, 1986 and December 30, 1986, the patient

24 was returned to respondent's office for follow-up visits.


26 extended visits on both occasions although no physical

27 examination was performed on either visit.

28 \ \ \

37.

1 PATIENT ROBERT V.

2 F. On or about October 24, 1986, this 25-year-old

3 patient went to respondent 1 s office with a complaint of sinus

4 congestion. The patient was assigned to Dr. Jerry Corners. A

5 brief history was obtained and a limited physical examination was


7 Sinus Series, X-ray Sinus Series P. C., Venipuncture, Sterile

8 Midstream Collect, CBC with Differential, Sed Rate, ASO Titer,

9 Monospo~, Cold Agglutinins, Prep of Specime~, Nasal Culture, Mast

10 Allergy Testing, and Total IGE. There was no medical indication

11 for these tests. Respondent 1 s office billed the patient


13 charge for a comprehensive visit. This bill is an example of

14 "splitting" of claims for profit.

15 On or about October 31, 1986, the patient made a

16 follow-up visit. There was no physical examination performed.

17 More allergy tests were ordered without any medical indication.

18 Respondent 1 s office billed the patient 1 s insurance company


20 extended visit.

21 PATIENT MALLIKA M.

22 G. On or about September 12, 1986, this 25-year-old

23 patient went to respondent 1 s office with a complaint of vaginal

24 discharge. The patient was assigned to Dr. ~erry Corners. A

25 brief medical history was obtained and a minimal physical


27 ordered: LDH, Glucose, Sodium, Potassium, Bun, Cholesterol,

28 Triglycerides, Total Bilirubin, Alkaline Phosphatase, SGOT, Total

38.

1 Protein, Uric Acid, Sterile Midstream Collect, Urinalysis, CBC

2 with Differential, Sed Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7

3 Thyroid Index, Gram Stain, Vaginal Culture, KOH Stain and

4 Reading, Wet Mount Slide Reading, G. c. Culture, and

5 Chlamydiazyme. There was no medical indication for these tests.



8 comprehensive visit although only a partial physical examination


10 On or about September 17, 1986, the patient made a

11 follow-up visit. No physical examination was performed.


13 extended visit.

14 On or November 14, 1986, the patient re·turned to

15 respondent's office for a pregnancy test. The following tests

16 were ordered: Venipuncture, CBC with Differential, Sed Rate, UCG

17 Urine, HCG-Blood, Chlamydiazyme, G. C. Culture, Vaginal Culture,

18 Sensitivity, Wet Mount, KOH Stain & Reading, Routine Stain Smear,

19 Urinalysis, Sterile Midstream Collect, Urine Culture and Colony

20 Count. There was no medical indication for many of these tests.



23 visit, although there was no physical examination documented.

24 On or about November 21, 1986, the patient made a

25 follow-up visit. There was no physical examination documented.

26 The serum pregnancy test was repeated. Respondent's office

27 billed the patient's insurance company $147.30 for the visit,


39.



3 violating section 2234(e) of the Code, dishq~esty, in that

4 respondent ordered, directed, counseled or encouraged Dr. Jerry

5 Corners to engage in, or otherwise conspired with, or assisted or

6 abetted Dr. Jerry Corners to engage in billing of unnecessary



9 visits were excessive, not medically indicated ·and/or

10 repetitious.






16 that respondent ordered, directed, counseled .or encouraged

17 Dr. Jerry Corners to engage in, or otherwise conspired with, or

18 assisted or abetted Dr. Jerry Corners to engage in ordering







25 ordered, directed, counseled or encouraged Dr. Jerry Corners or

26 otherwise, conspired with, or assisted or abetted Dr. Jerry

27 Corners to engage in ordering diagnostic tests without medical


40. ·----·--- --------~-- ----·-·-------- ~----·-----------~- -~-~-----

-------~------ ---------------


2 insurance claims.




6 counseled, or encouraged Dr. Jerry Corners or otherwise,

7 conspired with, assisted or abetted Dr. Jerry Corners in the

8 violation of sections 223A(e), 725 and 810 of the Code.

9 FACTS PERTAINING TO DR. DALE ELLIS

. 10 29. Prior to November 14, 1986, respondent employed

11 Dale Ellis, M.D. as one of the physicians at respondent's office.

12 Thereafter, respondent ordered, instructed, counseled,


14 Dr. Dale Ellis to engage in excessive use of diagnostic


16 facilities, in "double billing" of claims for services rendered,





21 PATIENT TIM C.

22 A. On or about January 22, 1987, this 22-year-old

23 patient went to respondent's office with complaints of sore

24 throat, ear pain, and head and body aches. The patient was

25 assigned to Dr. Dale Ellis. A brief history was obtained and a

26 limited physical examination was performed. The following

27 diagnostic tests were ordered: Venipuncture, Glucose, Sodium,

28 Potassium, Bun, Cholesterol, Triglycerides, SGPT, Total Protein,

41.

1 CBC with Differential, Sed Rate, RPR, T-4 Ria Total, T-3 Uptake,

2 T-7 Thyroid Index, Prep of Specimen and Throat Culture. There

3 was no medical indication for this extensiv~ laboratory workup.

4 Respondent's office billed the patient's ins~rance company



7 On or about January 29, 1987, the patient made a

8 follow-up visit. There was no medical indication for this visit.


10 extended visit, although no·physical examination was performed on

11 this visit.

12 PATIENT LAURA C.

13 B. On or about February 6. 1987, this 20-year-old

14 patient went to respondent's office with a complaint of

15 Bronchitis. The patient was assigned to Dr. Dale Ellis. There

16 is no documentation of a medical history or any physical

17 examination performed of the patient. The following diagnostic

18 tests were ordered: Venipuncture, Glucose, Sodium, Potassium,

19 Bun, Creatine Cholesterol, Triglycerides, Total Protein, SGOT,

20 Gamma GT, SGPT, CBC with Differential, Sed Rate, RPR, T-4 Ria

21 Total, T-3 Uptake, T-7 Thyroid Index, TSH Stimulant/Hormone,

22 Urinalysis, Sterile Midstream Collect, Prep of Specimen, Cold

23 Agglutinins, Urine Culture, Colony Count, Sensitivity and

24 Amylase. There was no medical indication for extensive tests.




28 \ \ \

42.

1 On or February 9, 1987, the patient made a follow-up

2 visit for a review of the laboratory tests. At this time, the

3 patient complained of a vaginal delivery. Another series of

4 diagnostic tests were ordered. On February 13, 1987, the patient

5 again returned for a follow-up visit. More diagnostic tests were

6 ordered including Venipuncture, Monospot, and HCG-Blood Qual.

7 There was no medical indication for these tests. On February 16,

8 1987, the patient made another follow-up visit. A Pelvic

9 Ultrasound was ordered without any medication indication.


11 $592.50 for these two visits.




15 respondent ordered, directed, counseled or encouraged Dr. Dale

16 Ellis to engage in, or otherwise conspired with, or assisted or

17 abetted Dr. Dale Ellis to engage in billing of unnecessary




21 repetitious.







28 Dr. Dale Ellis to engage in, or otherwise conspired with, or

43. -----~--

1 assisted or abetted Dr. Dale El'lis to engage in ordering







8 ordered, directed, counseled or encouraged Dr. Dale Ellis or

9 otherwise, conspired with, or assisted or abetted Dr. Dale Ellis

10 to engage in ordering diagnostic tests without medical







17 counseled, or encouraged Dr. Dale Ellis or otherwise, conspired

18 with, assisted or abetted Dr. Dale Ellis in the violation of


20 FACTS PERTAINING TO DR. SHELDON FAYNER

21 34. Prior April 10, 1985, respondent employed Sheldon

22 Fayner,M.D. as one of the physicians in respondent's office.


24 or otherwise conspired with, assisted or abetted said Dr. Sheldon

25 Fayner to engage in excessive use of diagnostic procedures and




44.




4 PATIENT MARIA Z.

5 A. On or about April 10, .1985, this 45-year-old

6 patient went to respondent's office with the complaint of

7 inability to use her right arm. A brief history of the patient

8 was obtained and nominal physical therapy was performed. The

9 following diagnostic tests were ordered: Venipuncture 1 Glucose,

10 Sodium, Potassium, Bun, Creatine Cholesterol, Triglycerides,

11 Total Bilirubin, Alkaline Phosphate, Total Protein, SGOT, Uric

12 Acid, LDH, Gamma GT, SGPT 1 CBC with Differential, Sed Rate, RPR,

13 T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index 1 Urinalysis 1 Sterile

14 Midstream Collect, RA Antigen Elution, and Ana Screen. There was

15 no medical indication for these tests. Respondent's office

16 billed. the patient's insurance company $791.00 for this visit,

17 including a $136.00 charge for comprehensive visit.

18 On or about April 12, 1985, and April 26, 1985 1 the

19 patient. made seven return visits to respondent's office for

20 physical therapy. There was no physical examination performed on

21 the patient at these visits. The patient 1 s. insurance company was

22 billed for extensive visits for most of these visits.

23 On or about June 14, 1985, the patient again went to

24 respondent's office with complaint of headaches and tiredness.

25 There was no physical examination documented. More diagnostic

26 tests were ordered without any medical indication. The patient

27 insurance company was billed a total of $263.00 for this visit.

28 \ \ \

45.

1 On or about July 10, 1985; the patient return to

2 respondent's office with a complaint of Vaginitis. There was no

3 physical examination documented. More diagnostic tests were

4 ordered including a repetition of the tests for Glucose, SGOT,

5 Potass"ium and CBC with Differential. Respondent's office billed

6 the patient's insurance company $462.00 for these tests.


8 respondent's hospital with a complaint of Bronchitis. There was

9 no physical examination documented. The following diagnostic

10 tests were ordered: IPPB, Chest X-ray, Throat Culture,

11 Sensitivity and Nasal Culture. There was no medical indication

12 for these tests. Respondent's office billed the patient 1 s



15 On or about July 18, 1985, the patient made a follow-

16 up visit. No physical examination was performed. There was a

17 repetition of IPPB tests. The patient's insurance company was

18 billed $178.00 for this visit, including a $68.00 charge for an

19 extended visit.

20 On or about July 22, 1985, the patient made a follow-

21 up visit. No physical examination was documented. The following

22 tests were ordered: Venipuncture, IPPB, Triglycerides,

23 Cholesterol, Total Protein, CBC with Differential 1 Sed Rate 1 ASO

24 Titer, Monospot, Cold Agglutinins, Prep of Specimen, Sputum

25 Culture, Iron Serum and Total Iron Bind Cap. There was no

26 medical indication for these tests. The patient's insurance

27 company was billed $501.00 for these tests, including a $68.00


46.

1 On or about August 7, 1985, the patient returned for a

2 follow-up visit. No physical examination was performed. Without

3 any documentation ·of need, the patient was referred to a

4 Chiropractor in the office. The patient's insurance company was

5 billed a total of a $759.00 for three visits to this

6 Chiropractor.

7 On or about September 25, 1985, the patient returned to

8 respondent's office with a complaint of Diarrhea. No physical

9 examination is documented. More diagnostic tests were ordered

10 including a repetition of the tests for Glucose, SGOT, Potassium,

11 CBC with Differential and Sed Rate.· The patient's insurance

12 company was billed $270.00 for these visit.

13 On September 27, 1985, the patient made a follow-up

14 visit. There was a repetition of IPPB, Throat Culture and

15 Sensitivity tests. On October 30, 1985, the patient made another

16 visit to respondent's office with a complaint of Bronchitis. No

17 physical examination was performed. The following examination

18 was ordered: Venipuncture, IPPB, Glucose, Triglycerides,

19 Cholesterol, Total Protein, SGOT, Total Bilirubin, ALbumin, LDH,

20 CBC with Differential, Sed Rate, ASO Titer, Monospot, Cold

21 Agglutinins, Prep of Specimen, Throat Culture and Sensitivity.

22 These tests were a repetition of tests performed earlier.

23 Respondent billed the patient's insurance company $518.00 for

24 these tests.

25 On January 9, 1986, the patient returned to

26 respondent's office with a complaint of Bronchitis. There was no

27 documentation of any physical examination. The following

28 diagnostic tests were ordered: EKG, IPPB, Albumin, LDH, Total

47.

1 Bilirubin, Total Protein, SGOT, CBC,with Differential, Sed Rate,

2 RPR, Sed Rate, Aso Titer, Cold Agglutinins, Prep of Specimen,

3 Throat Culture, and Sensitivity. There was no medical indication


5 insurance company $592.00 for this visit, including a $68.00


7 On or about January 22, 1986, made a follow-up visit.

8 More diagnostic tests were ordered without medical indication.

9 The patient 1 s insurance company was billed $359 for this visit.

10 On February 24, 1986, the patient made another visit to

11 respondent office. Minimal physical examination was performed.

12 More tests were ordered including repetition of the IPPB, Throat

13 Culture, Nasal Culture and sensitivity tests. The patient's

14 insurance company was billed $276 for these tests. On February

15 27, 1986, the patient made a follow-up visit. There was a

16 repetition of the IPPB tests. The patient's insurance company

17 was billed $165.00 for this visit, including a $68.00 charge for

18 an extended visit, although no physical e~amination of the

19 patient was performed.


21 follow-up visit. More diagnostic tests were ordered without any

22 medical indication. The patient's insurance company was billed

23 $151 for this visit, including a charge for an extended visit,

24 although no physical examination of the patient was performed.

25 On March 11, 1986, the patient was referred to a

26 radiologist at the office. There was no documentation of need

27 for this referral. On March 19, 1986, the patient was referred

28 to a chiropractor at the office. There was no documentation of

48.

1 need for this referral. The patient insurance company was billed

2 a total of $780 for the two visits.


4 respondent's office with a complaint of Diarrhea. There was no

5 physical examination performed. There following tests were

6 repeated: Venipuncture, sodium, Potassium, Bun, Creatine,

7 Urinalysis Sterile Midstream Collect, CBC with Differential, Sed

8 Rate, Amylase and SGOT. There was no medical indication for

9 these tests. The patient's insurance company was billed $357.00

10 for theses tests. On June 2, 1986, the patient made a follow-up

11 visit. The tests for Urinalysis, Sterile Midstream Collect,

12 Urine Culture, Colony Count, and Sensitivity were repeated.

13 Between June 9, 1986, and October 15, 1986, the patient

14 made a total of thirteen visits to respondent's office with

15 complaints of various ailments. Minimal physical examination was

16 performed on the patient during each visit. During this period,

17 the patient was referred to a chiropractor and a Radiologist

18 without any documentation of need, and several diagnostic tests

19 were ordered without any medical indication. The patient's

20 insurance company was billed $3820.60 for these visits.

21 PATIENT STEVE G.

22 B. On or about April 16, 1986, this 28-year-old

23 patient went to respondent's office complaining of stomach pains

24 and vomiting blood. This patient was assigned to Dr. Sheldon

25 Fayner. A brief medical history was obtained, but there was no

26 physical examination documented. The following diagnostic tests

27 were ordered: CBC with Differential, Sed Rate, RPR, T-4 Ria

28 Total, T-3 Uptake, T-7 Thyroid Index,.Urinalysis, Sterile

49.

1 Midstream Collect, Amylase, Glucose; Sodium, Potassium, Bun,

2 Creatine, Cholesterol, Triglycerides, Total Bilirubin, Alkaline

3 Phosphatase, Total Protein, SGOT, Uric Acid, LDH, Spirometry and

4 SGPT. There was no medical indication for these tests.

5 Respondent 1 s office billed the patient 1 s insurance company

6 $633.40 for this visit, including a $142.80 charge for


8 On or about April 23,1986, the patient made a follow-

9 up visit for review of his test results. At this time, the

10 patient complained of back pains. There was no physical

11 examination documented. The physician ordered a spinal series

12 including UGI, KUB and gall bladder. These tests were ordered

13 without any medical indication. Respondent 1 s office billed the

14 patient 1 s insurance company $1,016.00 for these tests.

15 On April 30, 1986, the patient made a follow-up visit.

16 There was no physical examination of the patient, but the

17 patient's insurance company was billed for an extended visit. On

18 May_ 5, 1986, the patient made another follow-up visit at which

19 time the patient complained of pain in the knee. No physical

20 examination was performed, but a knee X-ray was ordered. The

21 patient insurance company was billed $241.50 for this visit,



24 respondent 1 s office and complained of having a fever. No

25 physical examination was performed. The following tests were

26 ordered: Venipuncture, CBC with Differential, Sed Rate, Aso

27 Titer, Monospot, SGOT, Heterophile Antibody Titer, Throat

28 Culture, Glucose, Triglycerides, Cholesterol, Total Protein, LDH,

so.

1 Albumin, SGOT, Total Bilirubin and Blood Culture. There was no

2 medical indication for these tests.

3 On or about October 13, 1986, the patient made another

4 follow-up. No physical examination of the patient was performed.

5 The following tests were repeated: Venipuncture, CBC with

6 Differential, Sed Rate, Aso Titer, Monospot, SGOT, Total

7 Bilirubin, Albumin, LDH, and SGPT. For these two visits, the

8 patient's insurance company was billed $910.90 including charges

9 for two extended visits.

10 On October 24, 1986, the patient made another follow-

11 up visit. There was a repetition of the tests for Venipuncture,

12 CBC with Differential, Sed Rate, SGOT, Total Bilirubin, Albumin,

13 LDH, Alkaline Phosphatase and SGPT without any medical

14 indication. The patient's insurance company was billed $255.45

15 for these tests.

16 PATIENT DORIANNE G.

17 C. On or about April 29, 1986, this 35-year-old

18 patient went to respondent's office with complaints of migraine

19 headaches and weight gain. The patient was assigned to

20 Dr. Sheldon Fayner. A brief history of the patient was obtained,

21 but there was no physical examination performed of the patient.

22 The following diagnostic tests were ordered: Skull X-ray,

23 Venipuncture, CBC with Differential, Sed Rate, RPR, T-4 Ria

24 Total, T-3 Uptake, T-7 Thyroid Index, TSH Stimulating Hormone,

25 Cortisol, Urinalysis, Sterile Midstream Collect, Amylase,

26 Glucose, Sodium, Potassium, Bun, Creatine, Cholesterol,

27 Triglycerides, Total Bilirubin, Alkaline Phosphatase, Total

28 Protein, SGOT, Uric Acid, LDH, and SGPT. There was no medical

51.

1 indication for these tests. R~spondent 1 s office billed the




5 34 above 1 respondent Kent Walter Lehman, M.D. is guilty of


7 respondent ordered, directed, counseled or encouraged Dr. Sheldon

8 Fayner to engage in, or otherwise conspired with, or assisted·or

9 abetted Dr. Sheldon Fayner to engage in billing of unnecessary




13 repetitious.





18 clearly excessive use of diagnostic or treatment facilities, i'n


20 Dr. Sheldon Fa~er to engage in, or otherwise conspired with, or

21 assisted or abetted Dr. Sheldon Fayner to engage in ordering




25 37. As a result of the conduct alleged in paragraph 34 .....



28 ordered, directed, counseled or encouraged Dr. Sheldon Fayner or

52.

' 1 otherwise, conspired with, or assisted or abetted Dr. Sheldon

2 Fayner to engage in ordering diagnostic tests without medical



5 insurance claims.




9 counseled, or encouraged Dr. Sheldon Fayner or otherwise,

10 conspired with, assisted or abetted Dr. Sheldon Fayner in the


12 FACT PERTAINING TO DR BYRON HARDIN

13 39. Prior October 8, 1985, respondent employed Byron

14 Hardin, M.D. as one of the physicians in respondent's office.


16 or otherwise conspired with, assisted or abetted said Dr. Byron

17 Hardin to engage in excessive use of diagnostic procedures and

18 excessive use of diagnostic or treatment facilities, in 11 double·

19 billing 11 of claims for services rendered, and in charging for





24 PATIENT DARICE D.G.

25 A. On or about October 8, 1985, this 27-year-old

26 patient went to respondent's office with complaints of a headache

27 and sore throat. The patient was assigned to Dr. Byron Hardin.

28 There was no physical examination of the patient. The following

53.

1 diagnostic tests were ordered: Venipuncture, CBC with


3 Thyroid Index, RA Antigen Elution, Urinalysis, Sterile Midstream

4 Collect, Glucose, Sodium, Potassium, Bun, Cholesterol,


6 Protein, SGOT, Uric Acid, LDH, Throat Culture and Sensitivity.



9 visit, including a $68.00 charge for an extended visit.


11 respondent's office with a complaint of back pain. There was no

12 physical examination documented for this visit, but a series of

13 X-ray examinations were ordered. The patient's insurance company



16 PATIENT MILFORD B.

17 B. On or about January 1, 1986, this 52-year-old went

18 to respondent's office with a complaint of a headache. The

19 patient was assigned to Dr. Byron Hardin. There was no physical

20 examination performed on the patient. The following diagnostic

21 tests were ordered: EKG, Chest X-ray, Venipuncture, CBC with


23 Thyroid Index, Urinalysis, Sterile Midstream Collect, Glucose,


25 Bilirubin, Alkaline Phosphatase, Total Protein, SGOT, Uric Acid,

26 LDH, C-Reactive Protein and RA Antigen Elution. There was no


28 \ \ \

54.

1 the patient's insurance company $770.00 for this visit, including

2 a $68.00 charge for an extended visit.

3 On February 4, 1986, the patient returned to

4 respondent's office still complaining of a headache. Again no

5 physical examination of the patient was performed, but an EEG was

6 ordered. The patient's insurance company was billed $224.00 for

7 this visit, including a $68.00 charge for an extended visit.


9 respondent's office with a complaint of back pains. There was no

10 physical examination performed on the patient, but several

11 diagnostic tests were ordered, including a repetition of the

12 tests for Venipuncture, Urinalysis, CBC with Differential and

13 Sterile Midstream Collect. A Lumbersacral Spine X-ray was also

14 ordered. There was no medical indication for these tests. The

15 patient's insurance company was billed $292.95 for this visit.

16 On June 3, 1986, the patient made a follow-up visit. The patient

17 was referred to a Radiologist in the office without any

18 documentation of a medical necessity. An IVP was also ordered

19 without a medical indication. Respondent's office billed the

20 patient's insurance company $528.15 for this visit.

21 On August 25, 1986, the patient returned to

22 respondent's office with a complaint of a lump in the neck.

23 There was no physical examination documented, but the patient's

24 insurance company was billed for an extended visit. On September

25 3, 1986, the patient made a follow-up visit. There was no

26 physical examination performed 1 but the patient's insurance

27 company was billed for an extended visit.

28 \ \ \

55.

1 PATIENT TERI M.

2 c. On or May 19, 1987, this 10-year-old was taken to

3 respondent 1 s office with complaints of runny nose and a cough.

4 The patient was assigned to Dr. Byron Hardin. A brief history of

5 the patient was obtained and a minimal physical examination was

6 performed. Several diagnostic tests were ordered including

7 Sensitivity, Nasal Culture, Urinalysis and Sterile Midstream

8 Collect which were ordered without medical indication. The

9 patient 1 s insurance company was billed $408.45 for the visit,

10 including a $142.80 charge for a comprehensive visit.


12 respondent 1 s office with a complaint of upper respiratory

13 infection. There was no physical examination of the patient, but

14 throat and Nasal cultures were ordered. The patient 1 s insurance

15 company was billed for an extended visit. On November 9, 1987

16 and November 11, 1987, the patient made follow-up visits.

17 Respondent 1 s office billed the patient 1 s insurance company for

18 extended visit on both occasions although no physical examination

19 of the patient was performed.

20 PATIENT GERALD A.

21 D. On or about March 25, 1986, this 38-year-old

22 patient went to respondent's office with a complaint of infection

23 in his fourth right toe. The patient was assigned to Dr. Byron

24 Hardin. A minimal physical examination was performed. The

25 following diagnostic tests were ordered: EKG, Chest X-ray, Foot

26 X-ray, Venipuncture, CBC with Differential, Sed Rate, RPR, T-4

27 Ria Total, T-3 Uptake, T-7.Thyroid Index, Urinalysis, Sterile

28 Midstream Collect, Amylase, Glucose, Sodium, Potassium, Bun,

56.

1 Creatine, Cholesterol, Triglycerides, Total Bilirubin, Alkaline

2 Phosphatase, Total Protein, SGOT, Uric Acid, LDH, and C-reactive

3 Protein, RA Antigen Elution, Culture, Sensitivity, and Sickle

4 Cell Prep. With the exception of the Foot X-ray, the CBC and the

5 Sed Rate, there was no medical indication for these tests.


7 $900.00 for this visit, including a $136.00 charge for a

8 comprehensive examination.

9 On or about April 1, 1986, the patient made a follow-

10 up visit. The patient's insurance company was billed for an


12 was performed. On August 25, 1986, the patient returned to

13 respondent's office with a complaint of rash. A minimal physical

14 examination was performed, but the patient's insurance company

15 was billed for an extended visit.

16 PATIENT FELICIA D.

17 E. On or about August 19, 1986, this 14-month-old

18 patient was taken to respondent's office with a complaint of

19 Upper Respiratory Tract infection. The patient was assigned to

20 Dr. Byron Hardin. There was no physical examination performed on

21 the patient, but throat and nasal culture tests were ·ordered.


23 visit, including a $71.40 charge for an extended visit.

24

25

PATIENT MARK 0

F. On or about April 9, 1986, this 5-year-old patient

26 was taken to respondent's office with complaints of sore throat

27 and a cough. The patient was assigned to Dr. Byron Hardin. A

28 physical examination of the throat was performed. However, a

57. -~~~-----

------------------------------~·----

1 chest X-ray was ordered without a medical indication. The

2 patient's insurance company was billed for a comprehensive

3 examination for this visit, although only minimal physical

4 examination of the patient was performed. On May 15, 1986, the

5 patient returned to respondent's office complaining of Upper

6 Respiratory Tract infection. A brief history of the patient was

7 obtained and a minimal physical examination was performed. The

8 patient was diagnosed Bronchitis without any justification. The

9 patient's insurance company was billed for an extended visit.

10 PATIENT MARK 0., SR.

11 G. On or about March 25, 1986, this 29-year-old

12 patient went to respondent's office with a complaint of TB

13 exposure. The patient was assigned to Dr. Byron Hardin. A

14 medical history was obtained which showed the patient had a

15 history of Vertigo and a Heart murmur. There was no physical

16 examination of the patient. The following diagnostic tests were

17 ordered: EKG, Chest X-ray, Foot X-ray, Venipuncture, CBC with


19 Thyroid Index, Urinalysis, Sterile Midstream Collect, Glucose,

20 Sodium, Potassium, Bun, Creatine, Cholesterol, Triglycerides,

21 Total Bilirubin, Alkaline Phosphatase, Total Protein, SGOT, Uric

22 Acid and LDH. There was no medical indication for these tests.


24 $695.00 for this visit, including a $136.00 charge for a

25 comprehensive examination.




58.

1 respondent ordered, directed, counseled or encouraged Dr. Byron

2 Hardin to engage in, or otherwise conspired with, or assisted or

3 abetted Dr. Byron Hardin to engage in billing of unnecessary




7 repetitious.



10 violating section 725 of the Code, repeated acts of clearly . .




14 Dr. Byron Hardin to engage in, or otherwise conspired with, or

15 assisted or abetted Dr. Byron Hardin to engage in ordering



18 presenting false, fraudulent or inflated ins.urance claims.




22 ordered, directed, counseled or encouraged Dr~ Byron Hardin or

23 otherwise, conspired with, or assisted or abetted Dr. Byron

24 Hardin to engage in ordering diagnostic tests without medical




28 \ \ \

59.




4 counseled 1 or encouraged Dr. Byron Hardin or otherwise, conspired

5 with, assisted or abetted Dr. Byron Hardin in the violation of


7 FACTS PERTAINING TO DR. BERNARD HOROWITZ

8 44. Prior October 1985, respondent employed Bernard

9 Horowitz, M.D. as one of the physicians in respondent's office.


11 or otherwise conspired with, assisted or abetted said Dr. Bernard

12 Horowitz to engage in excessive use of diagnostic procedures and

13 excessive use of diagnostic or trep.tment facilities, in "double



16 examination was performed, all for t~e purpose of presenting



19 PATIENT MERCY F.

20 A. On or about January 10, 1986 1 this 29-year-o1d

21 patient went to respondent's office with a complaint of sore

22 stomach, nausea, and shortness of breath. The patient was

23 assigned to Dr. Bernard Horowitz. A history of the patient was

24 obtained. The following diagnostic tests were ordered: EKG

25 Tracing only, EKG Interpretation & Report, PFT W/Bronchodilator,

26 Venipuncture, CBC with Differential, Sed Rate, RPR, T-4 Ria

27 Total, T-3 Uptake, T-7 Thyroid Index, Urinalysis, Sterile

28 Midstream Collect, Glucose, Sodium, Potassium, Bun, Creatine,

60.


2 Phosphatase, Total Protein, SGOT, Uric Acid, LDH, TSH Stimulation

3 Hormone, Mast Allergy Testing, Prep Specimen, Total IGE, Gram

4 Stain, KOH Stain & Reading, WEt Mount, Slide, Reading, G.C.

5 Culture, Chlamydiazyme. Pap Smear and Disposable Speculum. There

6 was no medical indication for these tests. Respondent 1 s office


8 including a $136.00 charge for a comprehensive visit, although

9 only minimal physical examination of the patient was performed.

10 On or about February 5, 1986, the patient returned to

11 respondent's office with complaints of sore throat and a cold.

12 There was no documentation of any physical examination performed

13 of the patient. The following diagnostic examination was ordered:

14 X-ray Sinus Series, X-ray Sinus Series P.C., CBC with

15 Differential, Sed Rate, Aso Titer, Monospot, Ciold Agglutinins,

16 Prep of Specimen, C-Reactive Protein, Throat Culture and

17 Sensitivity. There was no medical indication for these tests.

18 The patient's insurance company was charged $495.00 for this

19 visit, including a $68.00 charge for an established visit.


21 visit to respondent's office with the complaints that she had a

22 cold, a sore throat, and was coughing blood. Again there was no

23 physical examination of the patient. The following repeat

24 diagnostic tests were ordered: X-ray Chest PA & LA, X-ray Chest

25 P.C., Series P.C., CBC with Differential, Sed Rate, Aso Titer,

26 Monospot, Cold Agglutinins, Prep of Specimen, C-Reactive Protein,

27 Throat Culture, Nasal Culture, and Sensitivity. There was no


61.

1 company was charged $514.00 for this visit, including a $68.00



4 There was no physical examination conducted of the patient, but

5 the patient 1 s insurance company was billed for an extended visit.

6 On April 3, 1986, the patient made another follow-up visit. No

7 physical examination was performed, but the patient 1 s insurance


9 On or about April 24, 1986 the patient made another

10 visit to the respondent 1 s office with a complaint of vaginal

11 itching. There was no physical examination documented. Another

12 extensive diagnostic tests were ordered including a repetition of

13 the 'following tests: Prep of Specimen, Urinalysis, Sterile

14 Midstream Collect G.C. Culture, Chlamydiazyme, KOH Stain &

15 Reading, Wet Mount Slide Reading and Sensitivity. There was no


17 company was charged $1060.50 for this visit, including a $71.40

18 charge for an established visit.


20 There was no physical examination documented, but the patient 1 s

21 insurance company was billed for an extended· visit.

22 On or about July 30, 1986, the patient made another

23 visit to respondent 1 s office with a complaint of light menstrual

24 period, swollen breasts and vaginal discharge. There was no

25 physical examination performed, but the following repeat

26 diagnostic tests were ordered: Venipuncture, Urinalysis, Sterile

27 Midstream Collect, Urine Culture, Colony Count, G.C. Culture.

28 Chlamydiazyme, KOH Stain & Reading, Hemoccult, Pap Smear,

62.

1 Disposable Speculum, Wet Mount Slide Reading and Sensitivity.


3 insurance company was charged $572.55 for this visit, including a

4 $71.40 charge for an established visit.

5 PATIENT MAREK B.

6 B. On or about November 4, 1985, this 31-year-old

7 patient went to respondent's office with a complaint of rash over

8 his body. The patient was assigned the Dr. Bernard Horowitz.


10 patient's insurance company was billed for an extended visit. On

11 May 5, 1986, the patient returned to the office again with a

12 complaint of rash. Again there was no physical examination of

13 the patient, but the patient's insurance company was billed for


15 .On or about May 6, 1986, the patient returned to

16 respondent's office for a follow-up visit. There was no

17 documentation of any physical examination, but the following

18 diagnostic tests were ordered: Venipuncture, Cholesterol, HDL,

19 Low Density Lipoprotein and Triglycerides. There was no medical

20 indication for these tests. The patient's insurance company was

21 billed $206.85 for the tests.

22 PATIENT DORIS M.H.


24 went to respondent's office for a general GYN examination. The

25 patient was assigned to Dr. Bernard Horowitz. Between the above

26 date and September 20, 1985, the patient made several visits to

27 respondent's office with various complaints, including

28 postmenopausal symptomatology and hypothyroidism. Only minimal

63.

1 physical examination was performed during all these visits. On

2 November 7, 1985, the patient made a follow-up visit. There was

3 no physical examination performed, but the following diagnostic

4 tests were ordered: T-4, T-3 Uptake, T-7 Thyroid index, TSH

5 Stimulating Hormone. There was no medical indication for these

6 tests. The patient 1 s insurance company was billed $230.00 for

7 these tests.

8 On November 11, 1985, the patient made another follow-

9 up visit. There was no physical examination conducted, but more

10 tests were ordered, including tests for Uric Acid, Calcium,

11 Phosphorus, Alkaline Phosphatase, HDL and Triglycerides. There

12 was no medical indication for these tests. The patient 1 s

13 insurance company was billed $232.00 for. these tests, including a


15 Between April 3, 1986, and April 10, 1986, the patient

16 made three follow-up visits. There was no physical examination

17 performed, but another round of tests were ordered including T-

18 4, T-3 Uptake, T-7 Thyroid index, TSH Stimulating Hormone Mast

19 Allergy testing, Prep of specimen, Total IGE, KUB X-ray and

20 Barium Enema. There was no medical indication for these tests.

21 The patient 1 s insurance company was billed $1739.35 for these

22 tests, including a $71.40 charge for an extended visit.

23 On or about April 18, 1986, the patient made another

24 follow-up visit. Again there was no documentation of a physical

25 examination performed on the patient, but the following texts

26 were ordered: urinalysis, Sterile Midstream Collect, Pap Smear,

27 Disposable Speculum, Gram Stain, KOH Stain & Reading, Wet Mount

28 Slide Reading, G.C. Culture, Chlamydiazyme and Hemoccult. There

64.

1 was no medical indication for these tests. The patient's

2 insurance company was billed $361.20 for these tests, including a


4 On or about January 26, 1987, the patient made another

5 visit to respondent's office with complaints of a cold and a

6 cough. A minimal physical examination was performed. The

7 following diagnostic tests were ordered: IPPB, IPPB & Metaprel

8 Med, Hemoccult, Dispension, Chest X-ray PA & LA, Chest X-ray

9 P.C., Venipuncture, Handling of Specimen, CBC with Differential,

10 Sed Rate, RPR, T-4 Ria, T-3 Resin Uptake, T-7 Thyroid Index,

11 Monospot, Gonozyme, Urinalysis, Sterile Midstream Collect,

12 Glucose, Sodium, Potassium, Bun, Creatine, Cholesterol,


14 Protein, SGOT, Uric Acid, LDH, TSH Stimulation Hormone, Mast

15 Allergy Testing, Prep Specimen, Total IGE, Gram Stain, KOH, Wet

16 Mount, Slide, Reading, Vaginal Culture, Nasal Culture,

17 Chlamydiazyme, Pap Smear and Disposable Speculum. There was no


19 the patient's insurance company $1076.65 for this visit,

20 including a $71.40 charge for an extended visit, although only


22 bill represents an example of "splitting" of laboratory tests for

23 profit.


25 follow-up visit complaining of a persistent cough. No physical

26 examination was performed, but another round of tests were

27 ordered including an EKG, a repetition of the IPPB test and a

28 Mammography exam. There was no medical indication for these

65.

1 tests. The bill of $460.25 sent to the patient's insurance

2 company another example of 11 splitting11 of claims for profit.

3 On or about August 31, 1987, the patient made another

4 visit to respondent's office for a follow-up and a refill for her

5 medication. There was no physical examination of the patient.

6 The following tests were ordered: Venipuncture, Handling of

7 Specimen, CBC with Differential, Sed Rate, RPR, T-4 Ria, T-3

8 Resin Uptake, T-3 Ria, T-7 Thyroid Index, Urinalysis, Sterile

9 Midstream Collect, Glucose, Sodium, Potassium, Bun, Cholesterol,


11 Protein, SGOT, Uric Acid, LDH and TSH Stimulation Hormone. There

12 was no medical indication for these tests. Respondent's office


14 including a $71.40 charge for an extended ·visit-, although·only-·


16 bill represents an example of 11 splitting" of laboratory tests for

17 profit.

18 PATIENT SUE H.

19 D. On or about May 8, 1985, this 28-year-old patient

20 returned to respondent's office for a follow-up visit. The

21 patient had been assigned to Dr. Bernard Horowitz on a previous

22 visit. Between the above date and September 17, 1985, the

23 patient made about eight follow-up visits to respondent's office

24 complaining of headaches and sinus problems among other things.

25 Minimal physical examination are documented for these visits. On

26 or about October 1, 1985, the patient made another visit to the

27 respondent's office with a complaint of pain in her right wrist~

28 A minimal physical examination was performed. The following

66.

1 diagnostic tests were ordered: Ultrasound treatment, Complete

2 wrist x-ray, Complete wrist x-ray P.C., Uric Acid, Calcium,

3 Phosphorus, Alkaline Phosphatase, CBC with Differential, Sed

4 Rate, RA Antigen Elution and ANA Screen. There were no medical


6 billed $386.00 for these tests, including a $68.00 charge for an

7 extended visit.

8 On or about October ,7, 1985, the patient made a follow-

9 up visit for a review of the laboratory tests. There was no

10 physical examination of the patient. More diagnostic tests were

11 ordered, including Ultrasound treatment, Hot pack, Mast allergy

12 testing, Prep of Specimen and Total IGE. There was no medical


14 billed $497.00 for this visit, including a $68.00 charge for an

15 extended visit.


17 respondent's office for a follow-up visit on a problem with her

18 vision. There was no physical examination, but the patient's

19 insurance company was billed for an extended visit.


21 respondent's office with a complaint of congestion in her chest.

22 Minimal physical examination was performed. A series of

23 diagnostic tests were ordered, including Chest X-ray PA & LA,

24 Chest X-ray P.C., Nasal Culture and throat culture. There was no

25 medical indication for these tests. There was also no medical

26 indication for the Ampicillin injection received by the patient.


28 visit, including a $71.40 charge for an extended visit. The next

67.

1 day, the patient made a follow-up visit. There was no

2 documentation of the status of the patient, but the patient was

3 treated with IPPB and was also given ampicillin injection. The

4 patient's insurance company was billed for an extended visit,

5 although there was no physical examination of the patient. On

6 October 9 and 10, 1986, the patient made twg follow-up visits.

7 Again there was no medical examination performed, but the patient

8 was treated with IPPB. The patient's insurance company was

9 billed for extended visits ..

10 On or about January 15, 1987, the patient returned to

11 respondent's office with a complaint of pain in the groin area.



14 The next day, the patient made a follow-up visit for physical

15 therapy. There was no physical examination of the patient, but

16 the patient's insurance company was billed for the services of a

17 physician on this visit. On January 19 and 26, 1987, the patient

18 again returned to respondent's office for physical therapy. The

19 patient's insurance company was billed for physicians' services

20 on these visits.

21 On or about February 18, 1987, the patient returned to

22 respondent's office with a complaint of lower back pain. There

23 was brief medical history and a minimal physical examination

24 performed. The following diagnostic examination was ordered:

25 Lumbosac spine X-ray, Pelvic X-ray, Culture, Excision nail and

26 Orthorentogram/Scan. The patient's insurance company was billed

27 $1026.90 for the tests and treatment for this, including a $71.40


68.


2 follow-up visit. There was no physical examination of the

3 patient, but the patient's insurance company was billed for two

4 separate extended visits.

5 PATIENT JACK R.

6 E. On·or about June 6, 1986, this 48-year-old patient

7 went to respondent's office with a complaint of chest, shoulder

8 and back pains. The patient was assigned to Dr. Bernard

9 Horowitz. There was no physical examination noted and limited

10 family history was obtained. The following diagnostic tests were

11 ordered and billed the patient's insurance company: EKG tracing

12 only, EKG Interpretation and Report, X-ray Cervical Spine, X-ray

13 Cervical Spine p. c. I X-ray Chest PA & LA, X-ray Chest p. c. I x-

14 ray Pelvic, X-ray Pelvic P.C., X-ray Lumbosacral Spine, X-ray

15 Lumbosacral Spine P.C,. Venipuncture, LDH, CBC with Differential,

16 Sed Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index, CPK,

17 Mast Allergy Testing, Prep of Specimen, Total IGE, Urinalysis,

18 Sterile Midstream Collect, Glucose, Sodium, Potassium, Bun,


20 Phosphatase, Total Protein, SGOT, Uric Acid, LDH and TSH

21 Stimulation Hormone, Orthorentogram and Orthorentogram P.C.



24 visit, including a $285.60 charge for two comprehensive visits on

25 the same day, even though no physical examirtation of the patient

26 was performed. The bill represents an example of "splitting 11 of

27 laboratory tests for profit.

28 \ \ \

69.

1 On or June 24, 1986, the patient made a follow-up

2 visit. There was no physical examination documented, but the



5 respondent's office at which time a treadmill test was performed.

6 The patient's insurance company was billed for the following:

7 Extended visit, Treadmill tracing, Treadmill stress test and

8 report, EKG 12 Lead, Physician monitoring. These charges

9 represent an example of "Double Billing."

10 PATIENT ETHEL M. J,

11 F. On or about November 7, 1986, this 35-year-old

12 patient went to respondent's office with a complaint of fever and

13 a cough. The patient was assigned to Dr. Bernard Horowitz. No

14 physical examination was conducted. The following diagnostic

15 tests were ordered: IPPB, IPPB Supplies and Metaprel Med.,

16 Ampicillin injection, Ampicillin Medication Supply, venipuncture,.

17 Handling of Specimen, CBC with Differential, Sed Rate, ASO Titer,

18 Monospot, Cold Agglutinins, Prep of Specimen, C-Reactive Protein,

19 Nasal Culture and Throat Culture. There was no medical


21 patient's insurance company $529.85 for the visit, including a

22 charge of $142.80 for a comprehensive visit, although no physical

23 examination was performed on the patient.

24 On or about 10, 1986, the patient made a follow-up

25 visit. There was no physical examination performed, but the

26 patient given an IPPB and a B-12 injection.

27 \ \ \

28 \ \ \

70.

PATIENT AARON J. 1

2 G. On or about November 7, 1986, this 12-year-old

3 patient went to respondent's office with a complaint of cough and

4 a runny nose. The patient was assigned to Dr. Bernard Horowitz.

5 There was no physical examination, but a throat. culture was

6 performed. There was no medical indication for this test. The

7 patient's insurance company was billed for this test.



10 violating section 2234(e) of the Code, dishonesty, in·that

11 respondent ordered, directed, counseled or encouraged Dr. Bernard

12 Horowitz to engage in, or otherwise conspired with, or assisted

13 or abetted Dr. Bernard Horowitz to engage in billing of

14 unnecessary medical diagnostics tests and medical office visits

15 when respondent knew or should have known that said tests/office


17 repetitious.




21 excessive use of diagnostic·procedures, or repeated acts of



24 Dr. Bernard Horowitz to engage in, or otherwise conspired with,

25 or assisted or abetted Dr. Bernard Horowitz to engage in ordering

26 diagnostic tests with~ut medical indication, and to engage in



71.




4 ordered, directed, counseled or encouraged Dr. Bernard Horowitz

5 . or otherwise, conspired with, or assisted or abetted Dr. Bernard

6 Horowitz to engage in ordering diagnostic tests without medical


8 tests for the purpose of presenting 'false, fraudulent or inflated

9 insurance claims.




13 counseled, or encouraged Dr. Bernard Horowitz or otherwise,

14 conspired with, assisted or abetted Dr. Bernard Horowitz in the


16 FACTS PERTAINING TO DR. M. LAWRENCE RUBINOFF

17 49. Prior January, 1985, respondent employed

18 M. Laurence Rubinoff, M.D. as one of the physicians in

19 respondent 1 s office. Thereafter, respondent ordered, instructed,

20 counseled, encouraged or otherwise conspired with, assisted or

21 abetted said Dr. M. Lawrence Rubinoff to engage in excessive use

22 of diagnostic procedures and excessive use of diagnostic or

23 treatment facilities, in 11 double billing 11 of claims for services

24 rendered, and in charging for comprehensive or extended visit

25 when only minimal physical examination was performed, all for the

26 purpose of presenting false or fraudulent or inflated insurance

27 claims as more particularly alleged hereinafter.

28 \ \ \

72.

PATIENT PEGGY H. 1

2 A. On or about January 7, 1986, this 27-year-old patient

3 went to respondent's office with a complaint of cough and sore

4 throat. The patient was assigned to Dr. M. Lawrence Rubinoff. A

5 history of the patient was obtained, but no physical examination

6 was performed. The following diagnostic tests were obtained: X-

7 ray Chest PA & LA, X-ray Chest P.C., X-ray Sinus Series, X-ray

8 Sinus Series P.C., Venipuncture, LDH, CBC with Differential, Sed

9 Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index,

10 Urinalysis, Sterile Midstream Collect, Glucose, Sodium,

11 Potassium, Bun, Cholesterol, Triglycerides, Total Bilirubin,

12 Alkaline Phosphatase, Total Protein, SGOT, Uric Acid, LDH, Throat

13 Culture and Sensitivity. There was no medical indication for

14 these tests. Respondent 1 s office billed the patient's insurance

15 company $846.00 for this visit, including a $136.00 charge for an

16 extended visit, although there was no physical examination of the

17 patient.

18 PATIENT CAROL L.

19 B. On or about February 28, 1986, this 45-year-old

20 patient went to respondent's office with a complaint of anemia.

21 The patient was assigned to Dr. M. Lawrence Rubinoff. A history

22 of the patient was obtained, but no physical examination was

23 performed or documented. The following diagnostic tests were

24 obtained: EKG Tracing only, EKG Interpretation and report, X'ray


26 Series P.C., Venipuncture, LDH, CBC with Differential, Sed Rate,

27 RPR, T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index, Urinalysis,


73.

----------- ------------·-----


2 Phosphatase, Total Protein, SGOT, Uric Acid, LDH, Iron Serum and

3 Total Iron Binding capacity. There was no medical indication for


5 company $774.00 for this visit, including a $136.00 charge for an

6 extended visit, although there was no physical examination of the

7 patient.

8 On March 3, 1986, the patient made a follow-up visit.

9 There is no documentation of a physical examination, but multiple

10 vaginal smears were ordered. The patient's insurance company was

11 billed $284.00 for this visit. On March 14, 1986, the patient

12 made another follow-up visit. There is no documentation of a

13 physical examination. The patient's insurance company was

14 charged for an extended visit. On August 25, 1986, the patient

15 made another follow-up visit. There is no physical examination

16 documented. The patient's insurance company was billed for an

17 extended visit.

18 PATIENT GREGORY L.


20 went to respondent's office with a complaint of sore throat,

21 headache and fever. The patient was assigned to Dr. M. Lawrence

22 Rubinoff. A history of the patient was obtained and a physical

23 examination was performed. X-ray Chest, RPR, T-4 Ria Total, T-3

24 Uptake, T-7 Thyroid Functions, CBC, Aso Titer, Monospot, Chern

25 Screen and Urinalysis were obtained without official indication.


27 office billed the patient's insurance company $733.95, including

28 a $142.80 charge for an extended visit. On May 12, 1986, the

74.

1 patient made a follow-up visit. The Urinalysis test was repeated

2 and the patient 1 s insurance company was billed $107.10 for that

3 visit, including a $71.40 for an extended visit, although there

4 was no physical examination performed on the patient.

5 PATIENT IRMA C.

6 D. On or about August 5, 1986, this 47-year-old

7 patient went to respondent 1 s office with a complaint of back and

8 chest pain. The patient was assigned to Dr. M. Lawrence /

9 Rubinoff. The patient 1 s medical history was obtained and

10 physical examination was performed. The following diagnostic

11 tests were obtained: EKG Tracing Only, EKG Interpretation and

12 Report, Spirometry, X-ray Chest PA & LA, X-ray Chest P.C., X-ray

13 Lumbosacral Spine, X-ray Lumbosacral spine P.C., Venipuncture,

14 LDH, CBC with Differential, Sed Rate, RPR, T-4 Ria Total, T-3

15 Uptake, T-7 Thyroid Index, Urinalysis, Sterile Midstream Collect,


17 Total Bilirubin, Alkaline Phosphatase, Total Protein, SGOT, Uric

18 Acid, LDH, Gram Stain, KOH Stain and Reading, Wet Mount slide

19 Reading, G.C. Culture, Chlamydiazyrne, Hemoccult, Pap Smear,

20 Disposable Speculum. There was no medical indication for these

21 tests. Respondent 1 s office billed the patient 1 s insurance

22 company $1196.25 for this visit.

23 On August 13, 1986, the patient made a follow-up visit.

24 There was no physical examination conducted, but the patient 1 s

25 insurance company was billed for an extended visit. On August

26 15, 12986, the patient made another follow-up visit. There was

27 no physical examination performed, but the patient 1 s insurance

28 company was billed for an extended visit. On August 18, 1986,

75.

---------- -- -- ------------------------------ -~------------ ---------------------- ------ ---------

' ' 1 the patient made another follow-up visit. There was no physical

2 examination performed, but the patient's insurance company was

3 billed for an extended visit. On October 10, 1986, the patient

4 made another follow-up visit. There was no physical examination

5 performed, but the patient 1 s insurance company was billed for an

6 extended visit.




10 respondent ordered, directed, counseled or encouraged Dr. M.

11 Lawrence Rubinoff to engage· in, or otherwise conspired with, or

12 assisted or abetted Dr. M. Lawrence Rubinoff to engage in billing

1'3 of unnecessary medical- diagnostics tests and medical office

14 visits when respondent knew or should have known that said

15 tests/office visits were excessive, not medically indicated

16 and/or repetitious.






22 that respondent ordered, directed, counseled or encouraged Dr. M.

23 Lawrence Rubinoff to engage in, or otherwise conspired with, or

24 assisted or abetted Dr. M. Lawrence Rubinoff to engage in

25 ordering diagnostic tests without medical indication, and to

26 engage in ordering repetitions of diagnostic tests for the

27 purpose of presenting false; fraudulent or inflated insurance

28 claims.

76.




4 ordered, directed, counseled or encouraged Dr. M. Lawrence

5 Rubino££ or otherwise, conspired with, or assisted or abetted

6 Dr. M. Lawrence Rubinoff to engage in ordering diagnostic tests

7 without medical indication, and to engage in ordering repetitions

8 of diagnostic tests for the purpose of presenting false,

9 fraudulent or inflated insurance claims.

10 53~ As a result of the conduct alleged in paragraph 49



13 counseled, or encouraged Dr. M. Lawrence Rubino££ or otherwise,

14 conspired with, assisted or abetted Dr. M. Lawrence Rubino££ in

15 the violation of sections 2234(e), 725 and 810 of the Code.

16 FACTS PERTAINING TO DR. ROBERT WARING

17 54. Prior June, 1986, respondent employed G. Robert

18 Waring, M.D. as one of the physicians in respondent's office.


20 or otherwise conspired with, assisted or abetted said Dr. G.

21 Robert Waring to engage in excessive use of diagnostic procedures

22 and excessive use of diagnostic or treatment facilities, .in

23 11 double billing 11 of claims for services rendered, and in charging

24 for comprehensive or extended visit when only minimal physical



27 particularly alleged· hereinafter.

28 \ \ \

77.

1 PATIENT KAY B.

2 A. On or about June 12, 1986, this patient went to

3 respondent 1 s office with a complaint of cough and sore throat.

4 The patient was assigned to Dr. G. Robert Waring. No history of

5 the patient was obtained and no physical examination was

6 performed. The following diagnostic tests were obtained: X-ray


8 Series P.C., Venipuncture, LDH, CBC with Differential, Sed Rate,

9 RPR, T-4 Ria Total, T-3 Uptake, T-7 Thyroid Index, Urinalysis,


11 Cholesterol, Triglycerides,.Total Bilirubin, Alkaline

12 Phosphatase, Total Protein, SGOT, Uric Acid, LDH, Throat Culture

13 and Sensitivity, Pap Smear, Disposable Speculum, Gram Stain, KOH

14 and Reading, Wet Mount Slide Reading and Hemoccult. Moreover,

15 the patient was injected with Cyaanocobaladin, B-12 and B-Complex

16 medications. There was no medical indication for these tests and

17 treatment. Respondent 1 s office billed the patient 1 s insurance

18 company $970.00 for the tests and treatment, including a $142.80

19 charge for a comprehensive visit, although there was no physical


21 On June 17 1 1986, the patient made a follow-up visit.

22 There was a repetition of the tests for Venipuncture and CBC with

23 Differential. There was no medical indication for these tests.

24 The patient 1 S insurance company was billed $159.60 for this

25 visit, including a $71.40 charge for an extended visit, although

26 there was no physical examination of the patient.

27 On June 18, 1986, the patient made another follow-up

28 visit. There was no physical examination of the patient. A

78.

1 repetition of the Urinalysis and Sterile Midstream Collect tests

2 were ordered. In addition, the patient was referred to the

3 office's chiropractor for a comprehensive consultation and

4 treatment. More X-ray was ordered. The patient's insurance

5 company was billed a total of $902.55 for the treatment by the

6 chiropractor. There was no medical indication for the tests and

7 the referral to the chiropractor.

8 On June 24, 1986, the patient made a follow-up visit.

9 The patient was diagnosed of Lumbo-sacral strain, but tests for

10 allergies were performed. There was no medical indication for

11 these tests. The patient's insurance company was billed for


13 On July 1, 1986, the patient made another follow-up

14 visit. There is no documentation for this visit 1 but the patient

15 received injections for Cyanocobalamin, B-12 and Depo-Testsdiol.

16 There was no medical indication for this treatment.

17 On September 8, 1986, the patient made another visit to

18 respondent's office with a complaint of stomach cramps. There

19 was a brief examination of the patient. The following di'agnostic

20 tests were ordered. Venipuncture, LDH, CBC with Differential,

21 Sed Rate, RPR, Urinalysis, Sterile Midstream Collect, Glucose,

22 Sodium 1 Potassium, Bun, Cholesterol, Triglycerides, Total

23 Bilirubin, Alkaline Phosphatase, Total Protein, SGOT 1 Uric Acid,

24 LDH 1 Calcium, Creatine and Phosphorus. There was no medical

25 indication for all these tests. The patient's insurance company

26 was billed $432.90 for these tests.

27 On September 17, 1986, the patient made a return visit

28 to respondent's office. There was no physical examination

79.

' 1 performed of the patient, but the patient's insurance company was

2 billed $71.40 for this visit.

3 On September 23, 1986, the patient made a .return visit

4 to respondent's office with complaints of headache, nausea, fever

5 and dizziness. No physical examination of the patient is

6 documented, but there was repetition of the tests for

7 Venipuncture, CBC with Differential and Sed Rate. In addition,

8 there were diagnostic tests for Aso Titer, Monospot Throat

9 Culture, Sensitivity and Heterophile antibody Titer. Moreover,

10 the patient was injected with Cyanocobalamin, B-Complex and B-12

11 medications. There was no medical indication for these tests and

12 treatment. The patient's insurance company was billed $361.50

13 for this visit, including a $71.40 charge for an extended visit,

14 although there was no physical examination of the patient.

15 On September 24, 1986, the following day, the patient

16 made a follow-up visit. The patient was injected with Lincocin.

17 There was no medical indication for this treatment. The

18 patient's insurance company was billed $110.25 for this visit,

19 including a $71.40 charge for an extended visit, although there

20 was no physical examination of the patient. On October 2, 1986,

21 the patient made another follow-up visit. The patient was

22 treated with Lincocin injection. The patient's insurance company


24 an extended visit, although there was no physical examination of

25 the patient.

26 On October 8, 1986, the patient returned to

27 respondent's office. ACT Scan was obtained on the patient.

28 \ \ \

80.

1 There was no medical indication for the CT Scan. The patient's

2 insurance company was billed $1071.40 for this visit.

3 On November 12, 1986, the patient returned to

4 respondent's office with a complaint of vaginal itching. There

5 was no physical examination documented. The following diagnostic

6 tests were ordered. Chlamadiazyme, _G. C.Culture, Vaginal

7 Culture, Wet mount, KOH stain and reading, Urinalysis, Sterile

8 Midstream Collect, Urine Culture, Colony Count and Sensitivity.


10 insurance company was billed $415.80 for this visit, including a

11 $71.40 charge for an extended visit, although there was no

12 medical examination of the patient.

13 On November 19, 1986, the patient made a follow-up

14 visit and complained of stomach pain. There was no physical

15 examination. of the patient, but the following tests were

16 repeated. Venipuncture, CBC with Differential, Amylase, GLucose,

17 SGOT, Potassium, Urinalysis, Sterile Midstream Collect Colony

18 Count Urine Culture and Sensitivity. There was no medical

19 indication for these.tests. The patientts insurance companywas

20 billed $367.80 for these tests, including a $71.40 charge for an


22 was performed.

23 PATIENT DAVE V.

24 B. On or about August 4, 1987, this 25-year-old

25 patient went to respondent 1 s office with complaints of excessive

26 thirst and a family history of diabetes Mellitus. The patient

27 was assigned to Dr. Waring. A brief medical history was

28 obtained, but there was no physical examination. The following

81.

1 diagnostic tests were ordered: Venipuncture, CBC with

2 Differential, Sed Rate, PRP, Thyroid Panel, TSH

3 Stimulate/Hormone, Kidney Panel, Metabolic Panel, Hepatic Func.

4 Panel, Arthritis panel, Direct Bilirubin, SGPT, Urinalysis,

5 Sterile Midstream Collect. There was no medical indication for

6 all these tests. The patient's insurance company was billed


8 visit, although there was no physical examination of the patient.

9 On August 5, 1987, the patient made a follow-up visit.



12 PATIENT GENEE B.

13 c. On or about August 19, 1986, this 20-year-old

14 ·patient went to respondent's office with a complaint injury to

15 her ankle. The patient was assigned to Dr. Waring. A physical

16 examination was performed and x-rays were ordered which proved

17 negative. The patient was treated with rest, ice and Tylenol #3.

18 On August 20, 1986, the next day, the patient made a follow-up

19 visit. The patient was referred for physical therapy. There was

20 no medical indication for this referral. The patient's insurance

21 company was billed $183.75 for this visit.

22 On November 4, 1986, the patient made another visit to

23 respondent's office with complaints of coughing and ear pain.

24 The following diagnostic tests were ordered: X-ray Sinus series,

25 Venipuncture CBC with Differential, Sed Rate, Aso Titer,

26 Monospot, Cold Agglutinins and Throat Culture. There was no


28 company was billed $457.05 for this visit.

82.

' 1 On January 7, 1987, the patient again visited

2 respondent's office with a complaint of coughing. There is no

3 physical examination documented for this visit. The following

4 tests were repeated: Venipuncture, CBC with Differential, Sed

5 Rate, Aso Titer, Monospot, Cold Agglutinins. There was no


7 company was billed $310.05 for this visit, including a $71.40

B charge for an extended visit, although there was no physical


10 On January 21, 1987,the patient made another visit to

11 respondent's office for a pregnancy test. There was no physical

12 examination of the patient,.but the patient's insurance 90mpany

13 was billed for an intermediate visit.

14 On February 20, 1987, the patient returned to

15 respondent's office with a complaint of quadrant pain and

16 irregular menses. More diagnostic tests were ordered, including

17 Venipuncture, CBC with Differential, Sed Rate, Vaginal Culture,

18 Wet Mount Sterile Midstream Collect, Sensitivity and KOH. These

19 tests were repetitions of previous tests. There was no medical


21 billed $769.00 for this visit.

22 On March 3, 1987, the patient made a return visit to

23 respondent 1 s office complaining of persistent vaginal discharge

24 and pelvic pain. The following diagnostic tests were ordered:

25 Chlamydiazyme, Gonozyme, Vaginal Culture, Wet mount, Gram Staint

26 Urinalysis, Sterile Midstream Collect, Urine Culture and

27 Sensitivity. These were a repetition of tests two weeks before.

28 The patient 1 s insurance company was billed $409.60 for this

83.

1 visit, including a $71.40 charge for an extended visit, although

2 there was no physical examination of the patient.

3 PATIENT MARK H.

4 D. On or about September 26, 1986,this 32 year-old

5 patient made a visit to respondent's office with a complaint of

6 coughing, dizziness and chest congestion. The patient was

7 assigned to Dr. Waring. A brief history of the patient was

8 obtained and minimal physical examination was performed. The

9 following diagnostic tests were ordered: Chest x-ray,

10 Venipuncture, CBC with Differential, Sed Rate, Mast Allergy

11 Testing, Total IGE Throat Culture and Sensitivity. There was no

12 medical indication for all these tests. The patient's insurance

13 company was billed $774.15 for this visit, including a $142.80

14 charge for a comprehensive visit, although only minimal physical

15 examination of the patient was performed.

16 On September 29, 1986, the patient made a follow-up

17 visit. There was no physical examination, but the patient's

18 insurance company was billed for an extended visit. On October

19 2, 1986, the patient made a follow-up visit. There was no

20 physical examination performed, but the patient's insurance

21 company was billed for an intermediate visit.

22 On October 13, 1986, the patient made another follow-

23 up visit. A sinus X-ray examination was ordered without medical

24 indication. The patient's insurance company was billed $213.15

25 for this visit, including a $71.40 charge for an extended visit,

26 although there was no physical examination performed on the

27 patient. On October 16, the patient made another follow-up

28 visit. The patient's insurance company was billed for an

84.

' 1 extended visit, although no physical examination of the patient

2 was obtained.

3 PATIENT PHILIP M.

4 E. On or about June 27, 1986, this 39-year-old patient

5 went to respondent's office with a complaint of stiffness in the

6 neck. The patient was assigned to Dr. Waring. A brief history

7 of the patient was obtained and minimal physical examination was


9 of the Cervical spine, Chest X-ray, Venipuncture, LDH,

10 Glucose,Sodium, Potassium, Bun, Cholesterol, Triglycerides, Total


12 Urinalysis, Sterile Midstream Collect, CBC with Differential Sed

13 Rate, RPR, T-4 Ria Total, T-3 Uptake, T-7 thyroid Index. There

14 was no medical indication for many of these tests. The patient's

15 insurance company was billed $784.35 for this visit.

16 On July 10, 1986, the patient made a follow-up visit.

17 There was no physical examination, but the patient's insurance





22 respondent ordered, directed, counseled or encouraged Dr. G.

23 Robert Waring to engage in, or otherwise conspired with, or

24 assisted or abetted Dr. G. Robert Waring to engage in billing of

25 unnecessary medical diagnostics tests and medical office visits

26 when respondent knew or should have known that said tests/office


28 repetitious.

85.






6 that respondent ordered, directed, counseled or encouraged Dr. G.

7 Robert Waring to engage in, or otherwise conspired with, or

8 assisted or abetted Dr. G. Robert Waring to engage in ordering




12 57.. As a result of the conduct alleged in paragraph 54



15 ordered, directed, counseled or encouraged Dr. G. Robert Waring

16 or otherwise, conspired with, or assisted or abetted Dr. G.

17 Robert Waring to engage in ordering diagnostic tests without

18 medical indication, and to engage in ordering repetitions of

19 diagnostic tests for the purpose of presenting false, fraudulent

20 or inflated insurance claims.




24 counseled, or encouraged Dr·. G. Robert Waring or otherwise,

25 conspired with, assisted or abetted Dr. G. Robert Waring in the


27 \ \ \

28 \ \ \

86.

1 WHEREFORE, complainant requests that a hearing be held

2 on the matters alleged herein, and that following said hearing,

3 the Board issue a decision:

4 1. Revoking or suspending Physician's and Surgeon's

5 Number G038595 heretofore issued to respondent Kent Walter

6 Lehman M.D.;

7 2. Taking such other and further action as the Board

8 deems proper.

9 DATED: _____ s_e_p_te_rn_b_e_r __ 2_8_,~1_9_9_o ______ __

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28 9-17-90

I

j 4~/ --6-::f----I,--

UO\ Nenneth Wagsta f

Executive Director Medical Board of California Division of Medical Quality Department of Consumer Affairs State of California

Complainant

87.

Exhibit B Decision 5/6/04

D1-1990-001604

' '· I' ~· -' '

BEFORE THE

i

DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA


In the Matter of the Accusation and Petition to Revoke Probation Against:

) ) )

KENT LEHMAN, M.D. Certificate No. G-38595

) ) ) ) ) )

Respondent )

No.: D1-1990-1604

DECISION

The attached Stipulated Settlement and Disciplinary Order is hereby adopted by the Division ,.

of Medical Quality as its Decision in the above-entitled matter.

This Decision shall become effective at 5:00p.m. on May 6, 2004

IT IS SO ORDERED April 6,. 20Q4

By: ~~~~ STEVEN RUBINS, M.D. PanelB Division ofMedical Quality

-------------~------------------ -·----~ ---------- ---------------------- ------------------------- -----·-- -- - --- -----------------··--------------------------------~---------------------

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BILL LOCKYER, Attorney General ofthe State of California

E. A. JONES III, State Bar No. 71375 Deputy Attorney General

California Department of Justice 300 So. Spring Street, Suite 1702 Los Angeles, CA 90013 Telephone: (213) 897-2543 Facsimile: (213) 897-1071

Attorneys for Complainant

,, '

BEFORE THE DIVISION OF MEDICAL QUALITY

MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation and Petition to 11 Revoke Probation Against:

Case No. D1-1990-1604

12 KENT LEHMAN, M.D. OAR No. L2002120491

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

P.O. Box 7267 13 Orange, CA 92613

14 Physician & Surgeon Certificate No. G 38595

15 Respondent.

16

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18 to. the interest of a prompt and speedy settlement of this matter, consistent with the

public interest and the responsibility of the Division ofMedical Quality, MediCal Board of California 19

20

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of the Department of Consumer Affairs, the parties hereby agree to the following Stipulated

Settlement and Disciplinary Order which will be submitted to the Division for approval and adoption

as the final disposition of the Accusation and Petition to Revoke Probation

PARTIES

1. Ron Joseph (Complainant) is the Executive Director of the Medical Board of

California. He brought this action solely in his official capacity and is represented in this matter by

Bill Lockyer, Attorney General of the State of California, by E. A. Jones ill, Deputy Attorney 26

27

28

General.

2. Respondent Kent Lehman, M.D. (Respondent) 1s represented in tbis

1

-----~--------------

'. \' ,.

1 proceeding by attorney I. Mark Bledstein, whose address is 15 915 Ventura Blvd., Suite 203, Encino,

2 CA 91436.

3 3. On or about December 21, 1978, the Medical Board of California issued

4 Physician & Surgeon Certificate No. G 38595 to Kent Lehman, M.D. (Respondent). The Certificate

5 was in full force and effect at all times relevant to the charges brought in Accusation and Petition

6 to Revoke Probation No. D1-1990-1604 and will expire on December 31, 2004, unless renewed.

7 JURISDICTION

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4. Accusation and Petition to Revoke Probation No. D1-1990-1604 was filed

before the Division of Medical Quality (Division) for the Medical Board of California, Department

of Consumer Affairs, and is currently pending against Respondent. The Accusation and Petition to

Revoke Probation and all other statutorily required documents were properly served on Respondent

on September 10, 2002. Respondent timely filed his Notice of Defense contesting the Accusation

and Petition to Revoke Probation. A copy of Accusation and Petition to Revoke Probation No.

D1-1990-1604 is attached as exhibit A and incorporated herein by reference.

ADVISEMENT AND WAIVERS

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

the charges and allegations in Accusation and Petition to Revoke Probation No; Dl-1990-1604.

Respondent has also carefully read, fully discussed with counsel, and understands the effects of this

Stipulated Settlement and Disciplinary Order.

6. Respondent is fully aware ofhis legal rights in this matter, including the right

to a hearing on the charges and allegations in the Accusation and Petition to Revoke Probation; the

right to be represented by counsel at his own expense; the right to confront and cross-examine the

witnesses against him; the right to present evidence and to testify on his own behalf; the right to the

issuance of subpoenas to compel the attendance of witnesses and the production of documents; the

right to reconsideration and court review of an adverse decision; and all other rights accorded by the

California Administrative Procedure Act and other applicable laws.

7. Respondent voluntarily, knowingly, and intelligentlywaives and gives up each

and every right set forth above.

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1 CULPABILITY

2 8. Respondent understands and agrees that the charges and allegations in

3 Accusation and Petition to Revoke Probation No. D1-1990-1604, if proven at a hearing, constitute

4 cause for imposing discipline upon his Physician & Surgeon Certificate.

5 9. For the purpose ofresolvingtheAccusation and Petition to Revoke Probation

6 without the expense and uncertainty of further proceedings, Respondent agrees that, at a hearing,

7 Complainant could establish a factual basis for the charges in the Accusation and Petition to Revoke

8 Probation, and that Respondent hereby gives up his right to contest those charges.

9 10. Respondent agrees that his Physician & Surgeon Certificate is subject to

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

11 Disciplinary Order below.

12 RESERVATION

13 11. The admissions made by Respondent herein are only for the purposes of this

14 proceeding, or any other proceedings in which the Division of Medical Quality, Medical Board of

15 California, or other professional licensing agency is involved, and shall not be admissible in any

16 other criminal or civil proceeding.

17 CONTINGENCY

18 12. This stipulation shall be subject to approval by the Division of Medical

19 Quality.· Respondent understands and agrees that counsel for Complainant and the staff of the

20 Medical Board of California may communicate directly with the Division regarding this stipulation

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

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

23 rescind the stipulation prior to the time the Division considers and acts upon it. Ifthe Division fails

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

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

26 between the parties, and the Division shall not be disqualified from further action by having

2 7 considered this matter.

28 13. The parties understand and agree that facsimile copies of this Stipulated

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Settlement and Disciplinary Order, including facsimile signatures thereto, shall have the same force

and effect as the originals.

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

that the Division may, without further notice or formal proceeding, issue and enter the following

Disciplinary Order:

DISCIPLINARY ORDER

IT IS HEREBY ORDERED that Physician & Surgeon Certificate No. G 38595 issued

to Respondent Kent Lehman, M.D. is revoked. However, the revocation is stayed and Respondent

is placed on probation for five (5) years on the following terms and conditions.

1. ACTUAL SUSPENSION As part of probation, respondent is suspended

from the practice of medicine for ninety (90) days beginning the sixteenth (16th) day after the

effective date of this decision.

2. MEDICAL RECORD KEEPING COURSE Within 60 calendar days ofthe

effective date of this decision, respondent shall enroll in a course in medical record keeping, at

respondent's expense, approved in advance by the Division or its designee. Failure to successfully

complete the course during the first 6 months of probation is a violation of probation.

A medical record keeping course taken after the acts that gave rise to the charges in

the Accusation, but prior to the effective date of the Decision may, in the sole discretion of the

Division or its designee, be accepted towards the fulfillment of this condition if the course would

have been approved by the Division or its designee had the course been taken after the effective date

of this Decision.

Respondent shall submit a certification of successful completion to the Division or

its designee not later than 15 calendar days after successfully completing the course, or not later than

15 calendar days after the effective date of the Decision, whichever is later.

3. CLINICAL TRAINING PROGRAM Within 60 calendar days of the.

effective date of this Decision, respondent shall enroll in a clinical training or educational program

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

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1 University of California- San Diego School of Medicine ("Program").

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

3 a two-day assessment of respondent's physical and mental health; basic clinical and communication

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

5 respondent's specialty or sub-specialty, and at minimum, a 40 hour program of clinical education

6 in the area of practice in which respondent was alleged to be deficient and which takes into account

7 data obtained from the assessment, Decision(s), Accusation(s), and any other information that the

8 Division or its designee deems relevant. Respondent shall pay all expenses associated with the

9 clinical training program.

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

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

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

13 condition, treatment for anypsychological condition, or anything else affecting respondent's practice

14 of medicine. Respondent shall comply with Program recommendations.

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

16 submit to and pass an examination. The Program's determination whether or not respondent passed

17 the examination or successfully completed the Program shall be binding.

18 Respondent shall complete the Program not later than six months after respondent's

19 initia1 enrollment unless the Division or its designee agrees in writing to a later time for completion.

20 Failure to participate in and complete successfully all phases of the clinical training

21 program outlined above is a violation ofprobation.

22 If respondent fails to complete the clinical training program within the designated

23 time period, respondent shall cease the practice of medicine within 72 hours after being notified by

24 the Division or its designee that respondent failed to complete the clinical training program.

25 4. MONITORlNG- PRACTICE Within 30 calendar days ofthe effective date

26 of this Decision, respondent shall submit to the Division or its designee for prior approval as a

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

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

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

2 relationship with respondent, or otherrelationship that could reasonably be expected to compromise

3 the ability of the monitor to render fair and unbiased reports to the Division, including, but not

4 limited to, any form ofbartering, shall be in respondent's field of practice, and must agree to serve

5 . as respondent's monitor. Respondent shall pay all monitoring costs.

6 The Division or its designee shall provide the approved monitor with copies of the

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

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

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

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

11 the proposed monitoring plan, the monitor shall submit a revised monitoring plan with the signed

12 statement.

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

14 throughout probation, respondent's practice shall be monitored by the approved monitor.

15 Respondent shall make all records available for immediate inspection and copying on the premises

16 by the monitor at all times during business hours, and shall retain the records for the entire term of

17 probation. After the practice monitor has been in place for two years, respondent may petition the

18 Division for relief from this probation term. The Division or its designee will assess the need for

19 continued monitoring based on a review of the monitor's report(s). If the Division or its designee

20 determines that respondent's practices are within the standards of practice of medicine and that

21 respondent is practicing medicine safely, the monitoring may be discontinued.

22 The monitor(s) shall submit a quarterly written report to the Division or its designee

23 which includes an evaluation of respondent's performance, indicating whetherrespondent' s practices

24 are within the standards of practice of medicine or billing, or both, and whether respondent is

25 practicing medicine safely, billing appropriately or both.

26 It shall be the sole responsibility of respondent to ensure that the monitor submits the

27 quarterly written reports to the Division or its designee within 10 calendar days after the end of the

28 preceding quarter.

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If the monitor resigns or is no longer available, respondent shall, within 5 calendar

days of such resignation or unavailability, submit to the Division or its designee, for prior approval,

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

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

days of the resignation or unavailability of the monitor, respondent shall be suspended from the

practice of medicine until a replacement monitor is approved and prepared to assume immediate

monitoring responsibility. Respondent shall cease the practice of medicine within 3 calendar days

after being so notified by the Division or designee.

In lieu of a monitor, respondent may participate in a professional enhancement

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

at the University of California, San Diego School ofMedicine, that includes, at minimum, quarterly

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

education. Respondent shall participate in the professional enhancement program at respondent's

expense during the term of probation.

Failure to maintain all records, or to make all appropriate records available for

immediate inspection and copying on the premises, or to comply with tlris condition as outlined

above is a violation of probation.

5. NOTIFICATION Prior to engaging in the practice of medicine, the

respondent shall provide a true copy of the Decision( s) and Accusation( s) to the Chief of Staff or the

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

respondent, at any other facility where respondent engages in the practice ofmedicine, including all

physician and locum tenens registries or other similar agencies, and to the Chief Executive Officer

at every insurance carrier which extends malpractice insurance coverage to respondent. Respondent

shall submit proof of compliance to the Division or its designee within 15 calendar days.

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

earner.

6. OBEY ALL LAWS Respondent shall obey all federal, state and local laws,

all rules governing the practice of medicine in California, and remain in full compliance with any

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1 court ordered criminal probation, payments and other orders.

2 7. QUARTERLY DECLARATIONS Respondent shall submit quarterly

3 declarations under penalty of perjury on forms provided by the Division, stating whether there has

4 been compliance with all the conditions of probation. Respondent shall submit quarterly

5 declarations not later than 10 calendar days after the end ofthe preceding quarter.

6 8. PROBATION UNIT COMPLIANCE Respondent shall comply with the

7 Division's probation unit. Respondent shall, at all times, keep the Division informed of respondent's

8 business and residence addresses. Changes of such addresses shall be immediately communicated

9 in writing to the Division or its designee. Under no circumstances shall a post office box serve as

10 an address of record, except as allowed by Business and Professions Code section 2021(b).

11 Respondent shall not engage in the praqtice of medicine in respondent's place of

12 residence. Respondent shall maintain a current and renewed California physician's and surgeon's

13 license.

14 Respondent shall immediately inform the Division, or its designee, in writing, of

15 travel to any areas outside the jurisdiction of California which lasts, or is contemplated to last, more

16 than 30 calendar days.

17 9. lNTERVIEWWITHTHEDIVISION,ORITSDESIGNEE Respondentshall

18 be available in person for interviews either at respondent's place ofbusiness or at the probation unit

19 office, with the Division or its designee, upon request at various intervals, and either with or without

20 prior notice throughout the term of probation.

21 10. RESIDING OR PRACTICING OUT-OF-STATE In the event respondent

22 should leave the State of California to reside or to practice, respondent shall notify the Division or

23 its designee in writing 30 calendar days prior to the dates of departure and return. Non-practice is

24 defined as any period oftime exceeding 30 calendar days in whichrespondentis not engaging in any

25 activities defmed in Sections 2051 and 2052 of the Business and Professions Code.

26 All time spent in an intensive training program outside the State of California which

27 has been approved by the Division or its designee shall be considered as time spent in the practice

28 of medicine within the State. A Board-ordered suspension of practice shall not be considered as a

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period of non-practice. Periods of temporary or permanent residence or practice outside California

will not apply to the reduction of the probationary term. Periods of temporary or permanent

residence or practice outside California will relieve respondent of the responsibility to comply with

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

and conditions of probation: Obey All Laws; Probation Unit Compliance; and Cost Recovery.

Respondent's license shall be automatically canceled if respondent's periods of

temporary or permanent residence or practice outside California total two years. However,

respondent's license shall not be canceled as long as respondent is residing and practicing medicine

in another state of the United States and is on active probation with the medical licensing authority

of that state, in which case the two year period shall begin on the date probation is completed or

terminated in that state.

11. F AlLURE TO PRACTICE MEDICJNE- CALITORNIA RESIDENT In the

event respondent resides in the State of California and for any reason respondent stops practicing

medicine in California, respondent shall notify the Division or its designee in writing within 30

calendar days prior to the dates of non-practice and return to practice. Any period of non-practice

within California, as defined in this condition, will not apply to the reduction of the probationary

term and does not relieve respondent of the responsibility to comply with the terms and conditions

of probation. Non-practice is defined as any period oftime exceeding 30 calendar days in which

respondent is not engaging in any activities defined in sections 2051 and 2052 of the Business and

Professions Code.

All time spent in an intensive training program which has been approved by the

Division or its designee shall be considered time spent in the practice of medicine. For purposes of

this condition~ non-practice due to a Board-ordered suspension or in compliance with any other

condition of probation, shall not be considered a period of non-practice.

Respondent's license shall be automatically canceled if respondent resides in

C'!-lifornia and for a total of two years, fails to engage in California in any of the activities described

in Business and Professions Code sections 2051 and 2052.

12. COJ\tlPLETION OF PROBATION Respondent shall comply with all

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1 fmancial obligations (e.g., cost recovery, restitution, probation costs) not later than 120 calendar days

2 prior to the completion of probation. Upon successful completion of probation, respondent's

3 certificate shall be fully restored.

4 13. VIOLATION OF PROBATION Failure to fully comply with any tertn or

5 condition of probation is a violation of probation. If respondent violates probation in any respect,

6 the Division, after giving respondent notice and the opportunity to be heard, may revoke probation

7 and carry out the disciplinary order that was stayed. If an Accusation, Petition to Revoke Probation,

8 or an Interim Suspension Order is filed against respondent during probation, the Division shall have

9 continuing jurisdiction until the matter is final, and the period of probation shall be extended until

10 the matter is final.

11 14. COST RECOVERY Within 90 calendar days from the effective date of the

12 Decision or other period agreed to by the Division or its designee, respondent shall reimburse the

13 Division the amount of $5000.00 for its investigative and prosecution costs. The filing of

14 bankruptcy or period of non-practice by respondent shall not relieve the respondent ofhis obligation

15 to reimburse the Division for its costs.

16 15. LICENSE SURRENDER Following the effective date of this Decision, if

17 respondent ceases practicing due to retirement, health reasons or is otherwise unable to satisfy the

18 terms and conditions of probation, respondent may request the voluntary surrender of respondent's

19 lic.ense. The Division reserves the right to evaluate respondent's request and to exercise its discretion

20 whether or not to grant the request, or to take any other action deemed appropriate and reasonable

21 under the circumstances. Upon formal acceptance of the surrender, respondent shall within 15

22 calendar days deliver respondent's wallet and wall certificate to the Division or its designee and

23 respondent shall no longer practice medicine. Respondent will no longer be subject to the terms and

24 conditions of probation and the surrender of respondent's license shall be deemed disciplinary action.

25 If respondent re-applies for a medical license, the application shall be treated as a petition for

26 reinstatement of a revoked certificate.

27 16. PROBATION MONITORING COSTS Respondent shall pay the costs

28 associated with probation monitoring each and every year of probation, as designated by the

10

From:I. MARK BLEDSTEIN 8188816088 01/20/2004 15:38 #269 P.003/003

Jan-zn-04 01:27Pm From-VIVA ~EDICAL ASSOC 714543923!i T-ZZT P.Dl/01 F-192 Ul/ 1GfZUU4 u~:~t ffL4j r.UIG/Ul/ rr Ull• 1 • JjJMN\ DLJ:.L)u I Cll~ 0 10~0 !OU;:JO

-1 DiviPion, wbi~h are currently~~ at $.2.874.00. but may be adjusted tln an an!1\lal basis. Such costs

1. allall be payable to tlle M~eal Bcnua ofCilifo~and deli""~ to the Di.vil!!ii;Jl'l or its dci~t!~ no

3 l.!iter thSIJ Janu.ary ::3 lDf ~ calcnd;.ryear. Failure to pay costs within 30 caJenda! ch)':l ofthe due

4 date i:~ a violation of probation.

' 6

7 ACCEPTANCE

Iba'IR: carr:f'ullyre.ad the above Stipclilled S eruemenla.ndDi:'iciplinmyO.rder and bave

51 fuUy lfucussed it wjth my attomey, I. Mlllk Blerls'teia. I unllmtand the stipulali.D.n IUld lh" effBctit

1 0 will have on my Physician & SUJ"gl::In Certificate. I enter into this Stipulated Settlement and

11 Pisciplinacy Order voluntarily, ktltrw}ng)y, and intellige.ntlYi and~ lD be bound by the Decision

1~ and Order ofthr: Division ofMmca1 Quality. Medical Board of Calif"mia.

13 DATED: \ - l (a - ·a y •

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~4D~~~ Res:po11dc<nt

I have read wd fully disell!!ed with R!;!ipOn.dent Ken\ Lehman,. M.D. thr: tmns anti

19 eonditions and other rn~ CQntained in the above Stipulated 3etll eml:!nt and Disciplinmy Order.

zo :a 22.

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27 The foregciog Sti.pula~ Settlement and Disciplinary Ordc:r i.i hereby nsp~tfully

1 Division, which are currently set at $2874.00, but maybe adjusted on an annual basis. Such costs

2 shall be payable to the Medical Board of California and delivered to the Division or its designee rio

3 later than January 31 of each calendar year. Failure to pay costs within 30 calendar days of the due

4 date is a violation of probation.

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7 ACCEPTANCE

8 I have carefully read the above Stipulated Settlement and Disciplinary Order and have

9 fully discussed it with my attorney, I. Mark Bledstein. I understand the stipulation and the effect it

10 will have on my Physician & Surgeon Certificate. I enter into this Stipulated Settlement and

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

12 and Order ofthe Division ofMedical Quality, Medical Board of California.

13 DATED: ________ _

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KENT LEHMAN, M.D. Respondent

18 I have read and fully discussed with Respondent Kent Lehman, M.D. the terms and



21 DATED:

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I. MARK BLED STEIN Attorney for Respondent

26 ENDORSEMENT


28 submitted for consideration by the Division ofMedical Quality, Medical Board of California of the

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Department of t'wn/ Aff!tirs.

DATED: I ~0! ot( BILL LOCKYER, Attorney General of the St e of California

1 0 . DOJ Docket/Matter ID Number: 03573160-LA02 1998

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Exhibit A

Accusation and Petition to Revoke Probation No. D1-1990-1604

'·· 1?

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1 BilL LOCKYER, Attorney General of the State of California

"", · 2 NANCY ANN STONER, State Bar No. 72839 Deputy Attorney General, for

3 B.A. JONES, III Deputy Attorney General

4 California Department of Justice 300 So. Spring Street, Suite 1702

5 Los Angeles, CA 90013 Telephone: (213) 897-2543

6 Facsimile: (213) 897-1071


8 BEFORE THE

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DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA


12 In the Matter of the Accusation and Petition to Revoke Probation Against:

Case No. D1-1990-1604

13 KENT WALTER LEHMAN, M.D.

14 P.O. Box 7267 ACCUSATION AND PETITION TO REVOKE PROBATION

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Orange, California 92613

Physician and Surgeon Certificate No. G 38595

Respondent.

Complainant alleges:

PARTIES

1. Ron Joseph (Complainant) brings this Accusation and Petition to Revoke

21 Probation (Accusation and Petition) solely in his official capacity as the Executive Director of the

22 Medical Board of California, Department of Consumer Affairs.

23 2. On or about December 21, 1978, the Medical Board of California issued

24 Physician and Surgeon Certificate Number G 38595 to Kent Walter Lehman, M.D. (Respondent).

25 The Physician and Surgeon Certificate was in effect at all times relevant to the charges brought

26 herein and will expire on December 31, 2002, unless renewed.

27 3. In a disciplinary action entitled In the Matter of Accusation Against Kent r

28 Walter Lehman, M.D., Case No. D-4373, the Division of Medical Quality, Medical Board of

1 -··· ·-·-··-··-·-·--·-·-----·--·- --

'\ '• I

1 California, issued a decision, effective September 12, 1992, in which Respondent's Physician and

2 Surgeon Certificate was revoked. However, the revocation was stayed and Respondent's

3 certificate was placed on' probation for a period often (10) years with certain terms and

4 conditions. A copy of that decision is attached as Exhibit A and is incorporated by reference.

5 JURISDICTION

6 4. This Accusation is brought before the Division of Medical Quality,

7 Medical Board of California (Division), under the authority of the following sections of the

8 Business and Professions Code (Code).

9 5. Section 2227 of the Code states:

10 "(a) A licensee whose matter has been heard by an administrative law judge ofthe

11 Medical Quality Hearing Panel as designated in Section 113 71 of the Government Code, or

12 whose default has been entered, and who is found guilty may, in accordance with the provisions

13 of this chapter:

14 "(1) Have his or her license revoked upon order of the division.

15 "(2) Have his or her right to practice suspended for a period not to exceed one

16 year upon order of the division.

17 "(3) Be placed on probation and be required to pay the costs of probation

18 monitoring upon order of the division.

19 "( 4) Be publicly reprimanded by the division.

20 "(5) Have any other action taken. in relation to discipline as the division or an

21 administrative law judge may deem proper.

22 "(b) Any matter heard pursuant to subdivision (a), except for warning letters,

23 medical review or advisory conferences, or other matters made confidential or privileged by

24 existing law, is deemed public, and shall be made available to the public by the board."


26 "The Division of Medical Quality shall take action against any licensee who is

27 charged with unprofessional conduct. In addition to other provisions of this article,

28 unprofessional conduct includes, but is not limited to, the following:

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

abetting the violation of, or conspiring to violate, any provision ofthis chapter [Chapter 5, the

Medical Practice Act].

"(b) Gross negligence.

"(c) Repeated negligent acts.

"(d) Incompetence.

"(e) The commission of any act involving dishonesty or corruption which is

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

7. Section 2238 of the Code states:

"A violation of any federal statute or federal regulation or any of the statutes or

regulations of this state regulating dangerous drugs or controlled substances constitutes



14 "(a) Prescribing, dispensing, or furnishing dangerous drugs as defined in Section

15 4022 without a good faith prior examination and medical indication therefor, constitutes



18 "Knowingly making or signing any certificate or other document directly or indirectly

19 related to the practice of medicine or podiatry which falsely represents the existence or

20 nonexistence of a state of facts, constitutes unprofessional conduct."

21 10. Section 2262 of the Code states: I

22 "Altering or modifying the medical record of any person, with fraudulent intent,

23 or creating any false medical record, with fraudulent intent, constitutes unprofessional conduct.

24 "In addition to any other disciplinary action, the Division of Medical Quality or

25 the California Board of Podiatric Medicine may impose a civil penalty of five hundred dollars

26 ($500) for a violation of this section."

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

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

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1 constitutes unprofessional conduct."


3 "Repeated acts of clearly excessive prescribing or administering of drugs or

4 treatment, repeated acts of clearly excessive use of diagnostic procedures, or repeated acts of

5 clearly excessive use of diagnostic or treatment facilities as determined by the standard of the

6 community of licensees is unprofessional conduct for a physician and surgeon, dentist, podiatrist,

7 psychologist, physical therapist, chiropractor, or optometrist. However, pursuant to Section

8 2241.5, no physician and surgeon in compliance with the California Intractable Pain Treatment

9 Act shall be subject to disciplinary action for lawfully prescribing or administering controlled

10 substances in the course of treatment of a person for intractable pain."

11 13. Section 4081, subdivision (a) of the Code states, in pertinent part:

12 "All records of manufacture and of sale, acquisition, or disposition of dangerous

13 drugs or dangerous devices shall be at all times during business hours open to inspection by

14 authorized officers of the law, and shall be preserved for at least three years from the date of

15 making. A current inventory shall be kept by every ... physician, ... clinic, ... who maintains

16 a stock of dangerous drugs or dangerous devices."

17 Health and Safety Code Sections:

18 14. Section 110010 of the Health and Safety Code states:

19 "'Prescription' means an oral order given individually for the patient for whom

20 prescribed directly from the prescriber to the furnisher or indirectly by means of a written order

21 signed by the prescriber that bears the name and address of the prescriber, the license

22 classification of the prescriber, the name and address of the patient, the name and quantity of

23 drug or device prescribed, the directions for use, and the date of issue."

24 15. Section 111375 of the Health and Safety Code states, in pertinent part:

25 "Any drug or device is misbranded unless its labeling bears all of the following

26 information:

27 "(a) Adequate directions for use.

28 "(b) Such adequate warnings against use in pathological conditions or by children

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1 where its use may be dangerous to health.

2 "(c) Adequate warning against unsafe dosage or methods or duration of

3 administration or application.

4 "Warnings shall be in a manner and form as are necessary for the protection of

5 users."

6 16. Section 111440 ofthe Health and Safety Code states "It is unlawful for

7 any person to manufacture, sell, deliver, hold, or offer for sale any drug or device that is

8 rnis branded."

9 17. Section 111445 of the Health and Safety Code states "It is unlawful for

10 any person to misbrand any drug or device."


12 "A drug o.r device is deemed misbranded under the laws of this state if it is subject

13 to regulations issued by the United States Food and Drug Administration relating to

14 tamper-resistant packaging, as set forth in Parts 200, 211, 314, and 800 ofVolume 21 of the

15 Code ofFederal Regulations, as amended, but is not in compliance therewith."

16 19. Section 111480 of the Health and Safety Ccide states, in pertinent part:

17 "Any drug or device sold by filling or refilling a written or oral prescription of a

18 practitioner licensed to prescribe the drug or device shall be exempt from the labeling

19 requirements .... if the drug or device bears a label displaying all the following:

' 20 "(a) Except where the prescriber orders otherwise, either the manufacturer's trade

21 name of the drug, or the generic name and the name of the manufacturer. Commonly used

22 abbreviations may be used. Preparations containing two or more active ingredients may be

23 identified by the manufacturer's trade name or the commonly used name or the principal active

24 ingredients.

25 "(b) The directions for the use of the drug or device.

26 "(c) The name of the patient(s).

27 "(d) The name of the prescriber.

28 "(e) The date ofissue.

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1 (f) The name, address of the furnisher, and prescription number or other means of

2 identifying the prescription."

3 "(g) The strength of the drug or drugs dispensed.

4 "(h) The quantity of the drug or drugs dispensed.

5 "(i) The expiration date of the effectiveness of the drug or device if the

6 information is included on the original label of the manufacturer ofthe drug or device."


8 "(a) A prescription for a controlled substance shall only be issued for a legitimate

9 medical purpose by an individual practitioner acting in the usual course of his or her professional

10 practice."

11 COSTRECOVERY

12 21. Section 125.3 of the Code provides, in pertinent part, that the Division

13 may request the administrative law judge to direct a licentiate found to have committed a ·

14 violation or violations of the licensing act to pay a sum not to exceed the reasonable costs of the

15 investigation and enforcement of the case.

16 MEDI-CAL REIMBURSEMENT

17 22. Section 14124.12 of the Welfare and Institutions Code states, in part:

18 "(a) Upon receipt ofwritten notice from the Medical Board of California, the

19 Osteopathic Medical Board of California, or the Board ofDental Examiners of California, that a

20 licensee's license has been placed on probation as a result of a disciplinary action, the department

21 may not reimburse any Medi-Cal claim for the type of surgical service or invasive procedure that

22 gave rise to the probation, including any dental surgery or invasive procedure, that was

23 performed by the licensee on or after the effective date of probation and until the termination of

24 all probationary terms and conditions or until the probationary period has ended, whichever

25 occurs first. This section shall apply except in any case in which the relevant licensing board

26 determines that compelling circumstances warrant the continued reimbursement during the

27 probationary period of any Medi-Cal claim, including any claim .for dental services, as so

28 described. In such a case, the department shall continue to reimburse the licensee for all

6

1 procedures, ,except for those invasive or surgical procedures for which the licensee was placed on

2 probation."

3 CONTROLLED SUBSTANCES AND DANGEROUS DRUGS

4 23. Phentermine is a Schedule N Controlled Substance that is indicated in the

5 management of exogenous obesity as a short term (a few weeks) adjunct in a regimen of weight

6 reduction based on caloric restriction and exercise. (Health and Saf. Code § 11057, sub d. (f)

7 "Stimulants," (2).)

8 Manufacturers ofPhentermine publish warnings that tolerance to the anorectic

9 effect of the drug usually develops within a few weeks, and use may impair the ability to engage

10 in hazardous activity such as operating machinery or driving a motor vehicle.

11 24. Tenuate (diethylpropion hydrochloride) is a Schedule N Controlled

12 Substance that is indicated in the management of exogenous obesity as a short term adjunct to a

13 regimen of weight reduction based on diet and exercise. (Health and Saf. Code § 11057, sub d.

14 (f) "Stimulants," (1).)

15 Tenuate is known to be habit forming and to stimulate the central nervous system

16 which increases the heart rate and blood pressure.

17 25. Hydrochlorothiazide is a diuretic agent. It is a dangerous drug that

18 requires a prescription.

19 FIRST CAUSE FOR DISCIPLINE

20 (Gross Negligence)

21 26. Respondent is subject to disciplinary action under section 2234,

22 subdivision (b) of the Code in that Responden~ was grossly negligent in his care and treatment of '·

23 several patients, including Patients N.L., N.W., M.G., C.T., M.T., K.R., C.P., C.M., and T.S.

24 The circumstances are as follows:

25 Undercover Patient N. L.

26 27. On or about October 3, 2001, a Medical Board investigator posing as

27

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1 Patient N.L. went to Respondent's office. 1 She filled out a health questionnaire. A medical

2 assistant took her blood pressure, pulse and weight of 102 pounds. N.L. told Respondent she

3 wanted to lose weight. Respondent told her to walk 30 minutes a day and reduce her fatty meal

4 intake. Without conducting any further history or physical examination, Respondent prescribed

5 N.L. 30 tablets ofPhentermine 30 mg., and told her to take half a capsule daily. A medical

6 assistant gave Patient N.L. a plastic container labeled "Phentermine 30 mg # 30 QRP Lot#

7 010121 Exp. 06/03." Patient N.L. paid $75.00 for the visit and prescription drugs.

8 28. The following acts and omissions in Respondent's care and treatment of

9 Patient N.L., taken singularly or collectively, constituted gross negligence:

10 a. Respondent failed to conduct a good faith medical examination or

11 take an appropriate history prior to prescribing Phentermine;

12 b. Respondent created a medical record that falsely indicated results

13 of an examination of the patient's "HEENT," "Chest," heart, and abdomen, which did not

14 occur;

15 c. Respondent prescribed weight loss drugs without providing a

16 specific weight management program, including a diet and exercise plan, as well as

17 follow-up visits to monitor the patient's condition;

18 d. Phentermine was not medically indicated for this patient;

19 e. The pills were improperly dispensed by a medical assistant in a

20 plastic container that did not have directions for use on the label, any warnings, or the

21 manufacturer's name.

22 f. Phentermine capsules or tablets should not be crushed, chewed or

23 opened. Respondent improperly directed the patient to take half the daily capsule, instead

24 of prescribing a lower dose, and dispensed a 30 day supply of a drug that is only indicated

25 for short term (a few weeks) treatment.

26

27 1. Initials are used in this pleading to protect the privacy ofthe patients and the identity of the undercover investigators. Respondent will be provided with identifying

28 information if discovery is requested.

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Undercover Patient N. W.

29. On or about December 12, 2001, a Medical Board investigator posing as

Patient N.W. went to Respondent's office. She filled out a health questionnaire. Respondent

took her blood pressure, weight, and checked her upper body with a stethoscope. He stated she

obviously did not fit into the obese range and wanted to place her in a weight management

program, but Patient N.W. told him she wanted to lose weight and get to 105 pounds or less by

New Year's. Respondent asked if she wanted 15 mg or 3 0 mg pills, and indicated water pills and

a B-12 shot came with the plan. Patient N.W. chose the 30 mg pills and water pills, but declined

the shot. Respondent told her to take the medication with breakfast and recommended that she

open the capsule and take only half the content because the medication is so strong. A medical

assistant gave Patient N.W. a plastic container labeled "Phentermine 30 mg # 30 QRP Lot#

010472 Exp. 06/03" and a plastic bag containing "Hydrochlorothiazide 25 mg." Patient N.W.

paid $75.00 for the visit and prescription drugs.

30. The following acts and omissions in Respondent's care and treatment of

Patient N.W., taken singularly or collectively, constituted gross negligence:

a. Respondent failed to conduct a good faith medical examination or

take an appropriate history prior to prescribing Phentermine and Hydrochlorothiazide;

b. Respondent created a medical record that falsely indicated results

of an examination of the patient's "HEENT," and abdomen, which did not occur.

c. Respondent prescribed weight loss and diuretic drugs without

providing a specific weight management program, including a diet and exercise plan, as

well as follow-up visits and tests to monitor the patient's condition;

d. Phentermine was not medically indicated for this patient;

e. Hydrochlorothiazide is a dangerous drug that may cause

hypokalemia and dehydration. It was prescribed without any further laboratory

investigation, or further history or follow-up, and without advising the patient of these

adverse effects;

f. The pills were improperly dispensed by an unlicensed assistant.

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The Hydrochlorothiazide was in plastic bag that was not tamper resistant or labeled with

the name of the patient, date of issue and directions for use. The container of

Phentermine did not contain directions for use on the label.

Undercover Patient M.G.

31. On or about December 19,2001, a Medical Board investigative assistant

posing as Patient M.G. went to Respondent's office. She filled out a health questionnaire. The

receptionist took her blood pressure and weight. Patient M.G. told Respondent she wanted to

lose weight for aNew Year's party. Respondent said she did not hav~ to lose a lot of weight, five

or six pounds would be perfect for her. He looked at her chart and examined her ears, but did not

conduct any further examination. He asked if she worked out, told her not to do aerobics because

they will not help her lose weight, and advised her to walk 30 minutes each day. Respondent told

Patient M.G. he would give her the strongest dose, that she should have a good breakfast, open

the capsule and throw a little of the contents out. If it is okay then she· could take the whole

capsule. Respondent explained the side effects of the pills would be dizzy spells, insomnia, and

dry mouth, but they should go away in three days. Patient M.G. was offered a B-12 shot as part

of the package, but she declined. The receptionist handed Patient M.G. a plastic container

labeled "Phentermine 30 mg # 30 QRP Lot# 010472 Exp. 06/03" and a plastic bag containing

Hydrochlorothiazide, labeled "HCTZ 25 mg #20." Patient M.G. paid $75.00 for the visit and

prescription drugs.


21 Patient M.G., taken singularly or collectively, constituted gross negligence:


23 take an appropriate history prior to prescribing Phentermine and Hydrochlorothiazide;


25 of an examination of the patient's chest, heart, and abdomen, which did not occur;

26 c. Respondent prescribed weight loss and diuretic drugs without

27 providing a specific weight management program, including a diet and exercise plan, as

28 well as follow-up visits and tests to monitor the patient's condition;

10

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d.

e.

Phentermine was not medically indicated for this patient;

Hydrochlorothiazide is a dangerous drug that may cause

3 hypokalemia and dehydration. It was prescribed without any further laboratory

4 investigation, or further history or follow~up, and without advising the patient of these

5 adverse effects;

6 f. The pills were improperly dispensed by an unlicensed assistant.

7 The Hydrochlorothiazide was in plastic bag that was not tamper resistant or labeled with

8 the name of the patient, date of issue and directions for use. The container of

9 Phentermine did not contain directions for use on the label.

10 Patient C.T.

11 33. On or about Aprill8, 2001, Patient C.T. went to Respondent's office. She

12 filled out a health questionnaire. Her chief complaint was stated as "Pt has never tried

13 Phentermine before." Added to the next line is "was up to 145 ~." The medical chart listed the

14 patient's weight as 133 Yz pounds, height as 5' 5" at the time of the visit, and noted a family

15 history ofhigh blood pressure. A simple examination of"HEENT;" "Chest," heart and abdomen

16 was noted, with the abdomen described as "soft obese." The record indicates the patient was

17 prescribed: (1) Phentermine 15 mg, # 30 units; (2) Vitamin B-12; and (3) HCTZ

18 (Hydrochlorothiazide) 25 mg, #20 units.

19 The patient returned to Respondent's office on May 16, 2001. No chief complaint

20 was indicated. Other than blood pressure and weight (listed as 125 pounds) no other physical

21 exam was indicated. She was prescribed: (1) Phentermine 30 mg, #30; (2) Vitamin B~12; and (3)

22 HCTZ (Hydrochlorothiazide) 25 mg, #20 units.

23 Patient C.T. returned to Respondent's office on June 4, 2001. No chief complaint

24 was indicated. Other than blood pressure and weight (listed as 120 pounds), no other physical

25 exam was noted. She was prescribed: (1) Phentermine 30 mg, #30; and (2) Vitamin B~l2.

26 HCTZ (Hydrochlorothiazide) was not listed.

27 On June 27, 2001, Patient C.T. returned to Respondent's office. The record

28 indicates her blood pressure and weight (126 pounds) with a notation "Pt would like to try

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Tenuate because she feels like her heart is racing with phent[ ermine]." No further physical

examination or laboratory tests were noted. The patient was prescribed: (1) Tenuate, 75 mg, #25

units; and (2) HCTZ (Hydrochlorothiazide) 25 mg, #20 units.

Patient C.T. did not return to Respondent's office again until January 2, 2002.

This time her weight was listed at 137. Other than recording her blood pressure, no other

physical examination is noted. The patient was prescribed: (1) Phentermine 30 mg, #30; and (2)

HCTZ (Hydrochlorothiazide) 25 mg, #20 units.

Patient C.T. stated she takes Phenterrnine to avoid eating too much. She went to

Respondent because he did not charge too much ($75.00 for an office visit and medication), and.

did not make her come back every week for monitoring. She recalled seeing the doctor twice and

the nurse twice. The nurse just weighed her, took her blood pressure and gave her the medication

she requested.


Patient C. T., taken singularly or collectively, constituted gross negligence:

a. Respondent failed to conduct an initial or follow-up good faith

medical examinations or take an appropriate history prior to prescribing Phentermine,

Hydrochlorothiazide, and/or Tenuate;

b. Respondent prescribed weight loss drugs without providing a

specific weight management program, including a diet and exercise plan, as well as

monitoring the patient's condition;

c. Phentermine was not medically indicated for this patient;

d. Tenuate was not medically indicated for this patient and was

contraindicated given her complaints of racing heart on Phentermine and her family

history of high blood pressure. Respondent failed to conduct further testing or physical

examination of this patient before prescribing additional anorexic medication.

Office Dispensing Record

3 5. On January 4, 2002, Medical Board investigators conducted a review of

Respondent's prescription records. A review of Respondent's ''Dispense Quick Log Sheets"

12

1 indicated Respondent had prescribed and dispensed the following medications to patients:

2 a. 90 Phentermine tablets to Patient M.T. on November 10, 2001;

3 b. 90 Phentermine tablets to Patient K.R. on August 3, 2001;

4 c. 150 Phentermine tablets to Patient C.P. on November 28, 2001;

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120 Phentermine tablets to Patient C.M. on November 27, 2001;

180 Phentermine tablets to Patient T.S. on November 9, 2001.

36. Respondent was grossly negligent and excessively prescribed medications

to the above patients as these controlled substances are only indicated for short-term treatment of

weight loss, in conjunction with a closely supervised and monitored weight loss program.

SECOND CAUSE FOR DISCIPLINE

(Repeated Negligent Acts)

37. Respondent is subject to disciplinary action under section 2234,

subdivision (c) of the Code in that he was repeatedly negligent in his care and treatment of

several patients, including Patients N.L., N.W., M.G., C.T., M.T., K.R., C.P., C.M., and T.S.

The facts and allegations set forth in paragraphs 26 through 36 above are incorporated here as if

fully set forth.


Patient N.L., taken singularly or collectively in conjunction with his care of the other patients,

constituted repeated negligence:


take an appropriate history prior to prescribing Phentermine;

b. Respondent created a 1.11,edical record that falsely indicated results

of an examination of the patient's "HEENT," "Chest," heart, and abdomen, which did not

occur;

c. Respondent prescribed weight loss drugs without providing a


follow-up visits to monitor the patient's condition;


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e. The pills were improperly dispensed by a medical assistant in a

plastic container that did not have directions for use on the label, any warnings, or the

manufacturer's name.

f. Phentermine capsules or tablets should not be crushed, chewed or

opened. Respondent improperly directed the patient to take half the daily capsule, instead

of prescribing a lower dose, and dispensed a 30 day supply of a drug that is only indicated

for short term (a few weeks) treatment.


9 Patient N.W., taken singularly or collectively in conjunction with his care of the other patients,

10 constituted repeated negligence:


12 take an appropriate history prior to prescribing Phentermine and Hydrochlorothiazide;


14 of an examination of the patient's "HEENT," and abdomen, which did not occur.

15 c. Respondent prescribed weight loss and diuretic drugs without

16 providing a specific weight management program, including a diet and exercise plan, as

17 well as follow-up visits and tests to monitor the patient's condition;

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d.

e.


Hydrochlorothiazide is a dangerous drug that may cause

20 hypokalemia and dehydration. It was prescribed without any further laboratory

21 investigation, or further history or follow~up, and without advising the patient ofthese

22 adverse effects;

23 £ The pills were improperly dispensed by an unlicensed assistant.

24 The Hydrochlorothiazide was in plastic bag that was not tamper resistant or labeled with

25 the name of the patient, date of issue and directions for use. The container of

26 Phentermine did not contain directions for use on the label.

27 40. The following acts and omissions in Respondent's care and treatment of

28 Patient M.G., taken singularly or collectively in conjunction with his care of the other patients,

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take an appropriate history prior to prescribing Phentermine and Hydrochlorothiazide;

b. Respondent created a medical record that falsely indicated results

of an examination of the patient's chest, heart, and abdomen, which did n~t occur;

c. Respondent prescribed weight loss and diuretic drugs without

providing a specific weight management program, including a diet and exercise plan, as

well as follow-up visits and tests to monitor the patient's condition;


e. Hydrochlorothiazide is a dangerous drug that may cause

hypokalemia and dehydration. It was prescribed without any further laboratory

investigation, or further history or follow-up, and without advising the patient of these

adverse effects;

f. The pills were improperly dispensed by an unlicensed assistant.

The Hydrochlorothiazide was in plastic bag that was not tamper resistant or labeled with

the name of the patient, date of issue and directions for use. The container of

Phentermine did not contain directions for use on the label.

41. The following acts and omissions in Respondent's care and treatme11t of

Patient C. T., taken singularly or collectively in conjunction with his care ofthe other patients,


a. Respondent failed to conduct an initial or follow-up good faith

medical examinations or take an appropriate history prior to prescribing Phentermine,

Hydrochlorothiazide, and/or Tenuate;

b. Respondent prescribed weight loss drugs without providing a


monitoring the patient's condition;

c.

d.


Tenuate was not medically indicated for this patient and was

15

contraindicated given her complaints of racing heart on Phentermine and her family

history of high blood pressure.

THJRD CAUSE FOR DISCIPLINE

(Incompetence)

42. Respondent is subject to disciplinary action under section 2234,

subdivision (d) of the Code in that he was incompetent in his care, treatment, prescribing and

lack of monitoring of several patients to whom he prescribed or dispensed weight reduction

drugs, including Patients N.L., N.W., M.G., C.T., M.T., K.R., C.P., C.M., and T.S. The facts and

allegations set·forth in paragraphs 26 through 36 above are incorporated here as if fully set forth.

FOURTH CAUSE FOR DISCIPLINE

(Dishonesty and False Medical Records)

43. Respondent is subject to disciplinary action under Sections 2234,

subdivisions (a) and (e), 2261 and 2262 of the Code, in that he directly or indirectly, through the

assistance of others, created medical records that falsely indicated that a more extensive physical

examination had been conducted on Undercover Patients N.L., N.W., and M.G. The facts and

allegations set forth in paragraphs 26 through 36 above are incorporated here as if fully set forth.

FIFTH CAUSE FOR DISCIPLINE

(Prescribing Without Good Faith Exam or Medical Indication)

44. Respondent is subject to disciplinary action under Section 2242 of the

Code, in conjunction with Section 11153 of the Health and Safety Code, in that he prescribed and

dispensed dangerous drugs and controlled substances to several patients, including Undercover

Patients M.L., N.W. and M.G., and Patient C.T., without conducting a good faith prior

examination, or having a valid medical indication for prescribing Phentermine,

Hydrochlorothiazide, and/or Tenuate The facts and allegations set forth in paragraphs 26 through

36 above are incorporated here as if fully set forth.

SIXTH CAUSE FOR DISCIPLINE

(Excessive Prescribing or Administering of Drugs)

45. Respondent is subject to disciplinary action under Section 725 ofthe Code

16

1 in that he committed repeated acts of clearly excessive prescribing or administering of dangerous

2 drugs and controlled substances to several patients, including Patients M.L., N.W. M.G., C.T.,

3 M.T., K.R., C.P., C.M., and T.S. The facts and allegations set forth in paragraphs 26 through 36

4 above are incorporated here as if fully set forth.

5 SEVENTH CAUSE FOR DISCIPLINE

6 (Violation of Drug Laws- Dispensing Misbranded Drugs)

7 46. Respondent is subject to disciplinary action under Sections 2234,

8 subdivision (a) and 2238 ofthe Code, in conjunction with Sections 110010, 111375, 111440,

9 111445, 111465, and 111480 of the Health and Safety Code, in that he directly or indirectly,

10 through the assistance of others, prescribed and dispensed dangerous drugs and controlled

11 substances to several patients, including Undercoyer Patients M.L., N.W. and M.G., misbranded

12 drugs in containers that were not properly labeled or sealed with tamper resistant lids. The facts

13 and allegations set forth in paragraphs 26 through 32 above are incorporated here as if fully set

14 forth.

15 47. The tablets of Hydrochlorothiazide prescribed and dispensed to

16 Undercover Patients N. W. and M.G were in plastic bags that were not tamper resistant or labeled

17 with the name of the patient or manufacturer, date of issuance, directions for use, warnings

18 against unsafe dosage or methods or duration of administration or manufacturer's name.

19 48. The containers ofPhenterrnine prescribed and dispensed to Undercover

20 Patients N.L., N.W., and M.G., did not contain directions for use, warnings against unsafe dosage

21 or methods or duration of adml.nistration, or the manufacturer's name on the label.

22 EIGHTH CAUSE FOR DISCIPLINE

23 (Failed to Maintain Adequate and Accurate Records)

24 49. Respondent is subject to disciplinary action under Sections 2234,

25 subdivision (a), 2266, and 4081 ofthe Code, in that he directly or indirectly, through the

26 assistance of others, failed to maintain adequate and accurate records relating his patients and the

27 drugs he had dispensed or prescribed to them. The facts and allegations set forth in paragraphs

28 26 through 3 6 above are incorporated here as if fully set forth.

17

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1 50. On January 4, 2002, when Medical Board investigators conducted a

2 review of Respondent's prescription records at his office, Respondent was unable to provide an

3 inventory list showing the amount of dangerous drugs acquired, purchased or delivered to the

4 office, the amount of drugs dispensed to patients, and the amount of drugs on hand. Respondent

5 was unable to provide an accounting of all the dangerous drugs handled by his office.

6 51. Medical Board investigators located records of the following drugs that

7 had been purchased by Respondent for office use that he was unable to account for disposition:

8 I Date I. Purchased From I Name ofDrug I Strength I Quantity

9 10/29/2001 Santa Ana Actaminophen Codeine 60mg 40

10 1/22/2002 Santa Ana Actigall 300mg 30

11 12/5/2001 Santa Ana Am bien 10mg 10

12 3/5/2002 Santa Ana Am bien 10mg 10

6/20/2001 Santa Ana Depo-Estradio1 5mg 5 13

9/28/2001 Santa Ana Depo-Estradiol 5mg 5 14

11/29/2001 SantaAns Depo-Estradiol · 5mg 5

15 6/18/2001 Plaza Ph Depo-Testadiol Inj UP 40



18 12/14/2001 Plaza Ph Depo-Testadio1 Inj UP 40

6/18/2001 Plaza Ph Diethylpropion 75mg 600 19 (Tenuate)

20 6/22/2001 QRP Diethylpropion 75mg 1 X 100 = 100 Tenuate Dos an

21 8/7/2001 P1azaPh Diethylpropion 75mg 600

22 (Tenuate)

23 10/1112001 Plaza Ph Diethylpropion 75 mg 600

(Tenuate)

24 12/14/2001 Plaza Ph Diethylpropion 75mg 1000 (Tenuate)

25 8/16/2001 QRP Dyazide Triasmterene 50/Hctz 25 1 X 1000 = 1000

26 8/16/2001 QRP Hydro-Diuril 25mg 1 X 1000 = 1000

27 Hydrochlorothiazide

9/11/2001 QRP Methylcellulose w/ 1 X 1000 = 1000 28

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1 I Date I Purchased From I Name ofDrug I Strength I Quantity

2 Benzocaine

3 3/23/2001 QRP Phendimetrazine 35mg 30 X 100 = 3000

4 6/22/2001 QRP Phendimetrazine 105 mg 1 X 100 = 100 Bontril SR

5 6/13/2001 QRP Phentermine 30mg 30 X 100 = 3000

6 6/22/2001 QRP Phentermine 30 mgYellow 1 X 100 = 100

7 6/22/2001-QRP-------Ehentermine 30-mg 9_xJ.OOO = .9.000 ___ -


9 8/16/2001 QRP Phentermine 37.5 mg 6 X 100 = 600

8/16/2001 QRP Phentermine 30 mgYellow 3 X 1000 = 3000 10

8/16/2001 QRP Phentermine 30mg 9 X 1 000= 9000 11 9/11/2001 QRP Phentermine 37.5 mg 30 X 100 = 3000


13 1119/2001 QRP Phentermine 30mgYellow 3 X 1000 = 3000

14 11129/2001 QRP Phentermine 30mg 6 X 1000 = 6000

15 4/27/2001 Santa Ana Potassium Chloride 10TR 30

5/21/2001 Santa Ana Rocephin 250mg 1 16 (Ceftriaxone sodium)

17 4/27/2001 Santa Ana Sonata 10mg 10

18 4/6/2001 Santa Ana Vicoprofen 40

19 5/29/2001 Santa Ana Vicoprofen 20

8/3/2001 Santa Ana Vicoprofen 40 20

9/28/2001 Santa Ana Vico rofen 40 21 10/11/2001 Plaza Ph Vicoprofen 7.5 60 X 200=12000

22

23 PETITION TO REVOKE PROBATION

24 CAUSE TO REVOKE PROBATION

25 (Violation ofLaws and Rules Governing Medicine)

26 52. At all times after the· effective date of Respondent's probation, Condition I

27 stated:

28 Respondent shall obey all federal, state, and local laws, and all rules governing the

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practice of medicine in California.

53. Respondent's probation is subject to revocation because he failed to

3 comply with Probation Condition I, referenced above. The facts and circumstances regarding

4 this violation are as follows:

5 a. The revocation of Respondent's probation is based on the facts and

6 allegation set forth in paragraphs 26 through 51 above in the Eight Causes for Discipline.

7 DISCIPLINE CONSIDERATIONS

8 54. To determine the degree of discipline, if any, to be imposed on

9' Respondent, Complainant alleges that on or about September 12, 1992, in a prior disciplinary

10 action entitled In the Matter of the Accusation Against Kent Walter Lehman, M.D. before the

11 Medical Board of California, in Case Number D 52298. Respondent's license was revoked, but

12 the revocation was stayed and the certificate was placed on ten (10) years probation, subject to

13 certain terms and conditions. The underlying charges and allegations in the Accusation, which

14 Respondent agreed not to contest, included assisting in, or attempting to, or abetting or

15 conspiring to commit any acts of dishonesty or corruption substantially related to the duties of a

16 physician and surgeon, in violationofsection2234, subdivisions (a) in conjunction with(e),

17 including the excessive prescribing of drugs, treatment, use of diagnostic or treatment procedures

18 or facilities, in violation of section 725 of the Code, or presenting a false or fraudulent claim for

19 payment of services to an insurance company, in violation of section 810 of the Code, as alleged

20 in paragraphs 3 through 58 of the Accusation, which was attached and incorporated by reference

21 into the Stipulation as if fully set forth.

22 In essence the Accusation involved charges and allegations that Respondent

23 ordered, directed counseled, encouraged, or otherwise conspired with, or assisted or abetted at

24 least eleven (11) other doctors who worked in Respondent's office (e.g., Drs. Andrews, Bianco,

25 Besley, Brown, Comers, Ellis, Fayner, Hardin, Horowitz, Rubin off, and Waring) to excessively

26 use, and bill for, unnecessary diagnostic tests, for the purpose of presenting false, fraudulent or

27 inflated insurance claims involving at least fifty-three (53) patients (e.g., Patients Elizabeth A.,

28 Paul H., Diana H., Ma.Ijorie F,, Gary A., JudyP., Olga F., Keith C., Jaime Y., RichardS., Laurie

20

1 F., Darla D., Shannon H., Randy L., Kenneth L., Carolyn R., Shirley L., Mary L., Joseph H.,·

2 Christopher H., Dianna H., Janet M., Lisa P., Robert V., Mallika M., Tim C., Laura C., Maria Z.,

3 Steve G., Dorianne G., Darice D.G., Milford B., Teri M., Gerald A., Felicia D., Mark 0., Mark

4 0., Sr., Mercy F., Marek B., Doris M.H., Sue H., Jack R., Ethel M.J., Aaron J., Peggy H., Carol

5 L., Gregory L., Inna C., Kay B., Dave V., Genee B., Mark H., and Philip M.). That decision is

6 now final and is incorporated by reference as if fully set forth.

7 PRAYER

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

9 alleged, and that following the hearing, the Division of Medical Quality issue a decision:

10 1. Revoking or suspending Physician and Surgeon Certificate Number G

11 38595, issued to Kent Walter Lehman, M.D.;

12 2. Revoking the probation that was granted by the Medical Board of

13 California in Case No. D-4373 and imposing the disciplinary order that was stayed thereby

14 revoking Physician and Surgeon Certificate No. G 38595 issued to Kent Walter Lehman, M.D.;

15 3. Revoking, suspending or denying approval ofKent Walter Lehman,

16 M.D.'s authority to supervise physician's assistants, pursuant to section 3527 of the Code;

17 4. . Ordering Kent Walter Lehman, M.D. to pay the Division 'of Medical

18 Quality the reasonable costs of the investigation and enforcement of this case, and, if placed on

19 probation, the costs ofprobation monitoring;

20 5. Ordering Kent Walter Lehman, M.D., to pay the Division of Medical

21 Quality a civil penalty in the amount of$500.00 for each violation ofBusiness and Professions

22 Code section 2262;

23 6. Taking such other and further action as deemed necessary and proper.

24 DATE: September _l_Q_, 2002

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Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant

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EXHIBIT A Stipulation in Settlement and Decision

Medical Board Case No. D-4373

,, 1 DANIEL E. LUNGREN, Attorney General

of the State of California 2 MICHAEL P. SIPE

Deputy Attorney General 3 Department of Justice

110 West A Street, Suite 700 4 San Diego, California 92101

Telephone: (619) 238-3391 _ 5

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BEFORE THE

MEDICAL BOARD OF CALIFORNIA

DIVISION OF MEDICAL QUALITY

DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation 14 Against:

NO. D-4373 L-52298

15 KENT WALTER LEHMAN, M.D. 12828 Harbor Blvd.

16 Garden Grove, CA 92642, Physician's & Surgeon's

17 License No. G038595

18 Respondent.

STIPULATION IN . SETTLEMENT AND DECISION

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20 Kenneth Wagstaff, Execu~ive Director of the Medical

his attorne

22 Daniel E. Lungren, Attorney General of the State of California,

23 by Michael P. Sipe, Deputy Attorney General, and

24 Kent Walter Lehman, M.D. (hereinafter "respondent"), by and

25 through his attorney Ronald S. Marks, hereby stipulate as

2 6 ., follows:

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1. The Medical Board of California, Division of

Medical Quality, Department of Consumer Affairs (hereinafter

"Board 11) acquired jurisdiction over respondent by reason of the

following:

A. Respondent was duly served with a copy of the

Accusation, Statement to Respondent, Request for Discovery, Form

Notice of Defense and copies of Government Code sections 11507.5,

11507.6, and 11507.7 as required by sections 11503 and 11505, and

·respondent timely filed a Notice of Defense within the time

allowed by section 11506 of the Code.

B. Respondent has received and read the Accusation

12 which ·is presently on file as Case No. D-4373, before the Board.

13 Respondent understands the n.ature of the charges alleged in the

14 above~entitled Accusation and that said charges and allegations

15 would constitute cause for imposing discipline upon respondent's

16 license to practice medicine heretofore issued by the Board.

17 2. Respondent and his counsel are aware of each of

18 respond~nt's rights, including the right to a hearing on the

19 charges and allegations, the right to conftont and cross-examine

20 witnesses who would testify against respondent, the right to

'tnesses on his behalf,

22 or to testify himself, his right to contest the charges and

23 allegations, and any other rights which may be accorded to

24 respondent pursuant to the California Administrative Procedure

25 Act (Gov. Code, § 11500, et seq.), his right to reconsideration,

26 review by the Superior Court and to appeal to any ether court.

27 Respondent understands that in signing this stipulation rather

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1 than contesting the Accusation, he is enabling the Board to issue

2 the following order from this stipulation without further

3 process.

4 3. Respondent freely and voluntarily waives each and

5 every one of the rights set forth hereinabove.

6 4. The ·stipulations and recitals made by respondent

7 herein are for purposes of this proceeding only and any other

8 disciplinary proceedings by the Board and shall have no force and

9 ·effect in any other case .or proceedings. Furthermore, in the

10 event this settlement is not adopted by the Board, the

11 stipulation made herein shall be inadmissible in any proceeding

12 involving the parties to it.

13 5. As a condition of settlement only, respondent does

14 not contest the charges and allegations of assisting in, or

15 attempting to, or abetting or conspiring to commit any acts of )

16 dishonesty or corruption substantially related to duties of a

17 physician and surgeon (2234(a)(e)) including excessive

18 prescribing of drugs, treatment, use of diagnostic or treatment

19 procedures or facilities (725) or presenting a false or

20 fraudulent claim for payment of s·ervices to an insurance company

A

22 copy of the Accusation is attached as Exhibit 1 and incorporated

23 herein by reference as though fully set forth.

24 6. Based upon the foregoing, it is stipulated and

25 agreed that the Board may issue the following as its decision in

26 this case.

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2 IT IS HEREBY ORDERED that physician's and surgeon'

3 Certificate Number G-038595 issued to respondent is revoked.

4 However, said revocation is stayed and respondent is placed on

5 probation for 10 years on the following terms and conditions:

6 A. Respondent is suspended from the practice of

7 medicine for one year beginning the effective date of this

8 decision and shall not practice during that year except for

9 ·community service as set forth in paragraph B. Respondent may

10 only engage in the practice of medicine thereafter, if he

11 successfully passes the examination set forth in paragraph E.

12 B. Within 60 days from the effective date of this


14 approval a community service program in which respondent shall

15 provide free medical services on a regular basis to a community

16 or charitable facility or agency for at least 480 hours, which

17 may be performed upon successful completion of the oral clinical

18 examination.

19 C. Within 60 days of the effective date of this

20 decision, respondent shall submit" to the Board for its prior

22 complete during the first year of probation.

23 D. Within 90 days of the effective date of this


25 approval, an intensive clinical training program. The exact

26 number of hours and the specific content of the program shall be

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determined by the Board or its designee. Respondent shall

successfully complete the training program.

E. Prior to resuming the practice of medicine,

respondent shall take and pass an oral/clinical examination in

general medicine with emphasis in a subject to be designated and

administered by the Board or its designee. If respondent fails

this examination, respondent must take and pass a re-examination

consisting of a written as well as an oral examination. The

waiting period between repeat examinations shall be at three

month intervals until success is achieved. The Board shall pay

the cost of the first examination and respondent shall pay the

cost o£ any repeat examinations.

Respondent shall not practice medicine until respondent

has passed the required examination and has been so notified by

the Board in writing. Failure to pass the required examination

not later than 100 days prior to the termination date of

probation shall constitute a violation of probation.

F. Respondent shall not participate in nor derive

compensation for medical services from any billing procedures for

claims relating to payment for meaical services provided. Unless

22 for medical services shall be by salary.

23 G. Respondent shall pay a monetary penalty of

24 $5,000.00 to the Medical Board of California, a governmental

25 unit, payable within 120 days of the effective date.of this

26 decision.

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Said sum is to be paid by check or money order and made

payable to vernon Leeper, Enforcement Chief, Medical Board of

California, Division of Medical Quality, 1426 Howe Avenue, Suite

22, Sacramento, California 95825-3236, as reimbursement to the

Medical Board for costs of investigation. Said $5,000.00 shall be

used by Vernon Leeper solely for training and purchase of

equipment for the Medical Board's Enforcement Program.

H. Respondent shall not act as an officer, director,

or owner of a medical clinic or medical laboratory prior to Board

approval.

I. Respondent shall obey all federal, state, and local

laws, and all rules governing the practice of medicine in

California.

J. Respondent shall submit quarterly declarations

under penalty of perjury on forms provided by the Board, stating

whether there has been compliance with all the conditions of

probation.

K. Respondent shall comply with the Board's probation

surveillance program.

L. Respondent shall appear in person for interviews

various

22 intervals and with reasonable notice.

23 M. The period of probation shall not run during

24 the time respondent is residing or practicing outside the

25 jurisdiction of California. If, during probation,

26 respondent moves out of the jurisdiction of California to

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1 reside or practice elsewhere, respondent is required to

2 immediately notify the return, if any.

3 N. Upon successful completion of probation,

4 respondent's certificate will be fully restored.

5 0. !f respondent violates probation in any respect,

6 the Board, after giving respondent notice and the opportunity to

7 be heard, may revoke probation and carry out the disciplinary

8 order that was stayed. If an accusation or petition to revoke

9 ~robation if filed against respondent during probation, the Board

10 shall have continuing jurisdiction until the matter is final, and

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the period

final.·

of probation shall be extended until the matter is

I concur in the stipulation and order.

Dated: 7/ ~ j /1(?-

DANIEL E. LUNGREN, Attorney General of the State of Cali ornia

MICHAEL P. SI DEPUTY ATTORNEY GENERAL


I concur in the stipulation and order.

Dated=----~~=~~~~~~~~=~~------------

RON~ Attorney for Respondent

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2 I have carefully read and fully understand the

3 stipulation and order set forth above. I have discussed the

4 terms and conditions set forth in the stipulation and order with

5 my attorney Ronald s. Marks, Esq. I understand that in signing

6 this stipulation I am waiving my right to a hearing on the

7 charges set forth in the Accusation No. D-4373 on file in this

8 matter. I further understand that in signing this stipulation

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·the Board shall enter the foregoing order placing certain

requirements, restrictions and limitations on my right to

practice medicine in the State of California.

Dated:· %1.""' l"<.. 'g2

~~~~~ ~'D KENT WALTER LEHMAN, M.D.

· Respondent

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DECISION AND ORDER OF THE BOARD ., '

The foregoing Stipulation and Order, in Accusation No.

D-4373, is hereby adopted as the Order of the Medical Board of

California. An effective date of September 12 , 19U_, has been

assigned to this Decision and Order.

Made this 13th day of _A_u'"'"g'-u_st ___ _ t 19.21_,

THERESA L. CLA SSE~~ Secretary/Treasurer FOR THE MEDI BO~D OF CALIFORNIA DIVISION OF MEDICAL QUALITY

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