BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation ) Against: )

) )

SA TISH KUMAR LAL, M.D. ) )

Physician's and Surgeon's ) Certificate No. A 34462 )

) Respondent )

Case No. 800-2014-008189

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 May 5, 2017.

IT IS SO ORDERED: April7, 2017.

MEDICAL BOARD OF CALIFORNIA

Wright, JD, Chair Panel A

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XAVIER BECERRA Attorney General of California JUDITH T. ALVARADO Supervising Deputy Attorney General CHRISTINA L. SEIN Deputy Attorney General State Bar No. 229094

California Department of Justice 300 So. Spring Street, Suite 1702 Los Angeles, CA 900 13 Telephone: (213) 897-9444 Facsimile: (213) 897-9395

Attorneys for Complainant

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

SA TISH LAL, M.D. 10841 White Oak Avenue, #100 Rancho Cucamonga, CA 91730

Physician's and Surgeon's Certificate No. A34462,

Respondent.

Case No. 800-2014-008189

OAH No. 2016061011

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

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

19 entitled proceedings that the following matters are true:

20 PARTIES

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

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

23 this matter by Xavier Becerra, Attorney General of the State of California, by Christina L. Sein,

24 Deputy Attorney General.

25 2. Respondent Satish Lal, M.D. (Respondent) is represented in this proceeding by

26 attorney Thomas R. Bradford, Esq., whose address is: Peterson Bradford Burkwitz, 100 North

27 First Street, Suite 300, Burbank, CA 91502.

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STIPULATED SETTLEMENT (800-20 14-008189)

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3. On or about September 18, 1979, the Board issued Physician's and Surgeon's

Certificate No. A34462 to 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. 800-2014-008189,

and will expire on January 31, 2019, unless renewed.

JURISDICTION

4. Accusation No. 800-2014-008189 was tiled before the Board, and is currently

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

properly served on Respondent on February 17, 2016. Respondent timely filed his Notice of

Defense contesting the Accusation.

5. A copy of Accusation No. 800-2014-008189 is attached as exhibit A and incorporated

11 herein by reference.

12 ADVISEMENT AND WAIVERS

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

14 charges and allegations in Accusation No. 800-2014-008189. Respondent has also carefully read,

15 fully discussed with counsel, and understands the effects ofthis Stipulated Settlement and

16 Disciplinary Order.

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

18 hearing on the charges and allegations in the Accusation; the right to confront and cross-examine

19 the witnesses against his; the right to present evidence and to testify on his own behalf; the right

20 to the issuance of subpoenas to compel the attendance of witnesses and the production of

21 documents; the right to reconsideration and court review of an adverse decision; and all other

22 rights accorded by the California Administrative Procedure Act and other applicable laws.

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

24 every right set forth above.

25 CULPABILITY

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

27 Cause for Discipline in Accusation No. 800-2014-008189. Respondent does not contest that, at

28 an administrative hearing, Complainant could establish a prima facie case with respect to the

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STIPULATED SETTLEMENT (800-20 14-008189)

charges and allegations contained in the Second Cause for Discipline in Accusation No. 800-

2 2014-008189 and that he has thereby subjected his license to disciplinary action.

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

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

5 Disciplinary Order below.

6 CONTINGENCY

7 11. This stipulation shall be subject to approval by the Medical Board of California.

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

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

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

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

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

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

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

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

16 considered this matter.

17 12. The parties understand and agree that Portable Document Format (PDF) and facsimile

18 copies ofthis Stipulated Settlement and Disciplinary Order, including PDF and facsimile

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

20 13. In consideration ofthe foregoing admissions and stipulations, the parties agree that

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

22 Disciplinary Order:

23 DISCIPLINARY ORDER

24 A. PUBLIC REPRIMAND

25 IT IS HEREBY ORDERED THAT Physician's and Surgeon's Certificate No. A34462

26 issued to Satish Lal, M.D., shall be and is hereby publicly reprimanded pursuant to California

27 Business and Professions Code section 2227, subdivision (a)( 4). This Public Reprimand, which

28 is issued in connection with Accusation No. 800-2014-008189, is as follows:

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STIPULATED SETTLEMENT (800-20 14-008189)

"On or about June 18,2014, you reviewed an MRI ofthe knee ofC.M., a male, then 20

2 years old. Based on the MRI and your evaluation, you incorrectly diagnosed C.M. with

3 hypertrophic synovitis with effusion ofthe left knee. When reviewing the MRI, you failed to

4 recognize a large fluid collection within the suprapatellar pouch of the left knee joint, as well as a

5 2 x 3 em collection of fluid in the subcutaneous fat anterior aspect of the left knee. Knowing

6 C.M. was at high risk for either a subcutaneous or intraarticular abscess, you should have been

7 specifically looking at the MRI scan for these fluid collections that were most likely due to an

8 abscess."

9 B. EDUCATION COURSE

10 Within 60 calendar days of the effective date of this Decision, Respondent shall enroll in an

11 education course or courses, not less than 20 hours, in the areas of reading and interpreting MRis,

12 approved in advance by the Board or its designee. The course or courses shall be at Respondent's

13 expense and shall be in addition to the Continuing Medical Education (CME) requirements for

14 renewal of licensure.

15 A course in interpreting MRis taken after the acts that gave rise to the charges in the

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

17 or its designee, be accepted towards the fulfillment ofthis condition if the course would have

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

19 this Decision.

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

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

22 not later than 15 calendar days after the effective date of the Decision, whichever is later.

23 C. FAILURE TO COMPLY TERMS

24 Respondent's failure to successfully complete the course or courses within the first 6

25 months of the effective date of this Decision shall be deemed unprofessional conduct and grounds

26 for further disciplinary action.

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STIPULATED SETTLEMENT (800-20 I 4-008189)

AC..CEeTANct

z I have canfully .read the above Stipulated Settlement a12d Oiseiplillary Order and have fully

3 discussed it with my attorocy, Thoma5 R. Bradford, £sq. I tJndeuuod the stipulation and the

4 effect it will have on my Physician's and Sursc:on's Ccrti.ti.ca~c. I enter into this Stipulated

S Settlement and Dlldplinary Order voluntarily, knowingly, and intelligently, and agree to oo

6 bound by the Decision and Otder of the Medical B

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I 0 l have read and fully discussed with !{e~pondent ~~JS.aod conditlotlS

y Order. I npprovc J I and other '%!alters contained in the ahov" Stipul~tc

1.2 its form and com.ent.

13 DATED~ l/8t/J7 ]4

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&f!OORStMENI The foregoing Stipulated Stlttlcment and Disciplinary Order is hereby .respectfully

~ub.mjttcd foJ consideration by the Medical Board of California.

Dat.ed: '/~J.J l ( 1 P.cspcctfuUy submitted,

l XAVIER. BP.CER.RA Attorney General o( Ca (i f(lrnia JuDITH T.. Ar.. V AAAOO Supervisi.ll2 Deputy Attorney Gct1craJ

CJA:f~ CHRISTINA L. SF.JN Deputy Attorney Oerual A rtorn.ey,, fo,. Compfaii'IQ/Il

. LA2015M42.28 28 60?26695 l.dot

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Exhibit A

Accusation No. 800-2014-008189

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KAiviALA D. lTARRIS

Attorney General ofCali!ornia JUDITH T. AlVARADO

Supervising Deputy Attorney General CHRISTINr\ L. SEIN

Deputy Attorney General State Bar No. 229094 California Department of Justice

300 So. Spring Street, Suite 1702 Los Angeles, CA 90013 Telephone: (213) 897-9444 Facsimile: (213) 897-9395

Attomeysfor Complainant

FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA

SACRAMENT<{.~~-1120.lt:L BY~f~NLYST

BEFORE THE

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9 MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

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11 Tn the Matter of the Accusation Against: Case No. 800-2014-008189

12 Satish Lal, M.D. ACCUSATION 10841 White Oak Avenue, #100

13 Rancho Cucamonga, CA 91730

14 Physician's and Surgeon's Certificate No. A34462, .

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Respondent.

18 Complainant alleges:

19 PARTIES

20 I. Kimberly Kirehmeyer (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 September 18, 1979, the Medical Board issued Physician's and Surgeon's

24 Certificate Number J\34462 to Satish Lal, M.D. (Respondent). The Physician's and Surgeon's

25 Certificate was in J'ull force and efiect at all times relevant to the charges brought herein and will

26 expire on January 31, 2017. unless renewed.

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(S/\'riSI-1 LAL, M.D.) ACCUSATION NO. 800-2014-008189

.JllRJSDICTION

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

3 laws. All section references are to the Business and ProCessions Code unless otherwise indicated.

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

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

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

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

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5. Section 2234 of the Code states, in pertinent part:

"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:

"(b) Gross negligence.

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

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

the applicable standard of care shall constitute repeated negligent acts.

··c 1) An initial negligent diagnosis followed by an act or omission medically appropriate

for that negligent diagnosis ofthe patient shall constitute a single negligent act.

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

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

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

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

standard of care.

FACTUAL BACKGROUND

PATIENT C.M.

6. At all times relevant to the charges herein, Respondent was a licensed physician and

28 surgeon practicing as an orthopaedic surgeon.

(SATISIJ LAL, M.D.) ACCUSATION NO. 800-2014-008189

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7. On June II, 2014, patient C.M., a 20-year-old male al the time, presented to Pomona

Valley Hospital Medical Center (PVHMC) with left knee pain and swelling of the left leg. On

June 15, 2014, Respondent provided an orthopaedic consultation, which was requested by the

admitting physician to rule out infection in the knee. In his exam, Respondent noted swelling

around the left leg area, satisfactory circulation of the left lower extremity, mildly tender left leg,

and ddinite tenderness over tibia noted. Diffuse tenderness over left knee and no obvious

swelling were noted. Range of movement for the left knee was painful from full extension to

beyond 90 degrees, otherwise the knee was stable. Respondent reviewed an x-ray of the left knee

finding no obvious swelling and an essentially normal exam. No complaint of an acute infection

was found on the tibia or knee by Respondent. Respondent's impression was a healed fracture of

the left tibia with tibial nailing with positive blood culture for infection. Respondent's aspiration

of the left knee did not show any pus and very little serosanguinous fluid was aspirated, which

fluid was sent for culture and sensitivity. Respondent did not feel the patient needed aggressive

orthopaedic treatment and his plan was for C.M. to be treated for infection as per the infectious

disease specialist's recommendations.

8. On June 17,2014, an internal medicine physician noted that C.M. had severe sepsis

due to methicillin-resistant staphylococcus aureus bacteremia. C.M. was receiving IV

vancomycin, however, he continued to have persistent bacteremia- suspect secondary to the

focus in the knee- clinical joint effusion. The internal medicine physician attempted to have

Respondent evaluate C.M. on that day, however, Respondent felt there was no need to sec the

patient on June 17, 2014. The internal medicine physician then requested a second opinion from

another orthopaedic surgeon, N.G., M.D.

9. On June 17, 2014, C.M. was examined by N.G. Upon his exam, N.G. noted a

circumferential anterior cellulitis type of finding on anterior left knee and that the skin appeared to

be indurated in this region. N.G.'s impression was left knee infection, possible prepatellar

bursitis. N.G. was not convinced that the aspiration performed by Respondent was in the knee

joint as he saw the location of the aspiration was directly through the red prepatellar bursa region.

N.G. found that C.M. will likely need surgery for treatment of infection, however, the treatment

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(SATTSH LAL, M.D.) ACCUSATION NO. 800-2014-008189

will depend on whether C.M. has prepatellar bursitis or septic knee. N.G. noted that he called

2 Respondent on June 17, 2014 in an attempt to discuss his findings. hmvevcr, Respondent did not

3 feel the need to follow up with the patient on that day.

4 1 0. On June 18. 2014, Respondent examined C. M. for the second time. Respondent

5 noted redness over the anterior surface of the knee, however, he did not find any evidence of

6 prepatellar bursitis except for redness, and that there was ditTuse tenderness around the left knee.

7 Respondent reviewed an MRJ of the knee finding synovitis with effusion. Respondent aspirated

8 the knee again, obtaining 2 ml of bloody l1uid, and finding no evidence of pus. Based on the MRI

9 and his evaluation. Respondent's impression was that the patient had hypertrophic synovitis with

10 effusion of'the left knee per MRJ. Respondent's plan was for C.M. to be treated with IV

11 antibiotics, as recommended by the infectious diseases specialist, until the infection was under

12 control. Respondent did not recommend surgery of the left knee.

13 11. N.G. also reviewed the MRI of the lett knee and found a large effusion with evidence

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of soft tissue edema. N.G. noted a clear abscess in subcutaneous tissue and loculated 11uid in the

knee joint. N.G.'s impression was severe sepsis due to probable left septic knee and possible

secondary cellulitis over left knee. Accordingly, on June 18, 2014, C.M. underwent a left knee

arthroscopy, incision and drainage with lavage of the left knee joint: left knee arthroscopy,

synovectomy; left knee arthroscopy, synovial biopsy; left knee prepatellar bursa incision and

drainage, left knee proximal tibia hardware removal of one single locking bolt of tibia

intramedullary nail. N.G. lindings included positive gross pus in prepatellar bursa consistent with

prepatellar bursa and abscess of 150 ml of gross pus; positive gross puss and left knee joint

synovitis; and medial proximal locking bolt of tibia intramedullary nail exposed in the prepatellar

bursa region.

PATIENT J.C.

25 12. On August 1. 2014, patient J.C., a 23-year-oldmale at the time, presented to the ER

26 of PVHMC with a transverse fracture of the right femoral shalt, with complete displacement.

27 13. On August 2, 2014, Respondent performed long trochanteric intramedullary nail

28 insertion: open reduction and internal fixation of a Ji·acture or the right femur. The operative

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(SATISH LJ\L, M.D.) ACCUSATION NO. 800-2014-008189

room time started at 10:35 and ended at 20:12, for a total of 9 hours and 23 minutes. The actual

2 incision operating time started at 1 1 :30 and ended at 19:50, tor a total of 8 hours and 20 minutes.

3 During the surgery, Respondent had trouble performing a closed reduction of the fracture

4 fragments of the shaft of the right femur, which necessitated an incision and open reduction ofthe

5 fracture fragments before Respondent could start placement of the intramedullary nail.

6 Respondent also admitted that hard bone reaming of the intramedullary canal took extra time.

7 Respondent further stated that he had technical difficulty placing an interference screw, with

8 eventual misplacement of the screw, and inability to remove the misplaced screw which led to

9 extra surgery time. Respondent requested additional orthopaedic surgical assistance, which again

10 necessitated additional time.

11 FIRST CAUSE FOR DISCIPLINE

12 (Gross Negligence)

13 14. Respondent's license is subject to disciplinary action under section 2234, subdivision

14 (b), ofthc Code in that he was grossly negligent in his care and treatment of patient C.M. The

15 circumstances are as follows:

16 15. The standard of care is that an orthopaedic surgeon should be able to review an MRI

17 of the musculoskeletal system to a reasonable degree of competency. If, upon an orthopaedic

18 surgeon's review of films, he determines that the findings are equivocal, he is duty-bound to

19 review said films with additional healthcare professionals, such as a radiologist or fellow

20 orthopaedic surgeon.

21 16. Respondent's treatment of patient C.M., as set forth above in paragraphs 6 through

22 11, includes the following acts and/or omissions which constitute an extreme departure from the

23 standard of care: When Respondent reviewed the June 18,2014 MRl ofC.M.'s left knee, he

24 missed a large fluid collection within the suprapatellar pouch of the left knee joint, as well as a 2

x 3 em collection of fluid in the subcutaneous fat anterior aspect of the left knee. Given C.M.'s

26 vvorscning medical condition regarding infection as noted by infections disease and internal

27 medicine consultations, which was unresponsive to severallY antibiotics, Respondent should

28 have been highly suspicious that his negative aspiration was, indeed. a !~lise-negative test.

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(SATISII LAL, M.D.) ACCUSATION NO. 800-2014-008189

Additionally, knowing C.M. was at high risk for either a subcutaneous or intraarticular abscess,

' Respondent should have been specifically looking at the .June 18, 2014 MRT scan for these t1uid

3 collections that were most likely clue to an abscess.

4 SECOND CAUSE FOR DISCIPLINE

5 (Repeated Negligent Acts)

6 17. Respondent's license is subject to disciplinary action under section 2234, subdivision

7 (c), of the Code in that he committed repeated negligent acts in his care and treatment of patients

8 C.M. and J.C. The circumstances are as follows:

9 18. Complainant refers to and, by this reference, incorporates paragraphs 6 through 13,

10 above, as though set forth fully herein.

11 19. The allegations of the First Cause for Discipline arc incorporated by reference as if

12 fully set forth herein.

13 20. The standard of care with regard to the appropriate amount of time between

14 consultation request and consultation performed is, in general, to be executed on the day of

15 request. Additional factors with regard to timing of consultation depend on urgency of medical

16 condition of patient as determined by requesting physicians.

17 21. The standard of care with regard to the time it takes to perform an open reduction

18 internal fixation of a femoral shaft fracture with intermedullary nail is that which a majority of

19 orthopaedic surgeons stating competency in this pa1iicular operation would be able to complete

20 said operation. This is on average, approximately two hours, plus an additional two hours for

21 diflicult cases.

22 22. Respondent's treatment of patients C.I'vi. and J .C., as set forth above in paragraphs 6

23 through 13, includes the following acts and/or omissions which constitute repeated negligent acts:

24 A. When Respondent reviewed the .June 18,2014 MRI ofC.M.'s left knee, he

missed a large tluicl collection within the suprapatellar pouch of the left knee joint, as well as a 2

26 x 3 em collection of fluid in the subcutaneous t~1t anterior aspect of the left knee. Given C.M.' s

27 worsening medical condition regarding infection as noted by infections disease and internal

28 medicine consultations, unresponsive to several IV antibiotics, Respondent should have been

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(SATISII LAL, M.D.) ACCUSATION NO. 800-2014-008189

highly suspicious that his negative aspiration was, indeed, a false-negative test. Additionally,

2 knowing C.M. was at high risk for either a subcutaneous or intraarticular abscess, Respondent

3 should have been specifically looking at the June 18, 2014 MRI scan for these f1uid collections

4 that were most likely due to an abscess.

5 R. Respondent failed to sec C.M. in a timely manner on June 17, 2014, as

6 requested by the internal medicine physician.

7 c In spite of the difficulties encountered, Respondent's surgical time for the

8 procedure performed on J.C., four times the average and tvvo times the average for extremely

9 clifticult cases, was unjustified.

10 Respondent's acts and/or omissions as set forth in paragraphs 18 through 22, above,

II whether proven individually, jointly, or in any combination thereof~ constitute repeated negligent

12 acts, pursuant to section 2234, subdivision (c), of the Code. Therefore, cause for discipline exists.

13 PRAYER

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

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

16 1. Revoking or suspending Physician's and Surgeon's Certificate Number A34462,

17 issued to Satish La!, M.D.;

18 2. Revoking, suspending or denying approval of Satish La!, M.D.'s authority to

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

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3. Ordering Satish Lal, M.D., if placed on probation, to pay the Board the costs of

probation monitoring; and

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

DATED: February 17, 2016

I.A20 1.5604228/ 61 R48513.doc

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KIMBERL KIRCHMEY"Ef(' Executive , ll·ector Medical Board ofCalif(Jrnia Department of Consumer Affairs State ofCalifornia Con1plainont

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(SA TIS!! LAL, IVI.D.) ACCUSATION NO. 800-2014-008189