judith alvarado medical board of california fl. v-1!i§5 ...4patientsafety.org/documents/hodnett,...

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XAVIER BECERRA Attorney General of California JUDITH T. ALVARADO Supervising Deputy Attorney General NICHOLAS B.C. SCHULTZ Deputy Attorney General State Bar No. 302151

California Department of Justice 300 South Spring Street, Suite 1702 Los. Angeles, California 90013 Telephone: (213) 269~6474 Facsimile: (213) 897-9395 E-mail: [email protected]

Attorneys for. Complainant

FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA SAC7.,NTO/Jp7Jt'tn/:u ~ 20 fL. BY ., V-1!i§5 ANALYST

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BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

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In the Matter of the Accusation Against:

Richard Mclnnis Hodnett, M.D. 115 Jensen Court, Suite 201 Thousand Oaks, California 91362

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Physician's and Surgeon's Certificate 16 No.C51707, .

17 Respondent.

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19 Complainant alleges:

CaseNo. 800-2016-020630

ACCUSATION

20 PARTIES

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

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

23 Affairs (Board);

24 2. On or about August 25, 2004, the Board issued Physician's and Surgeon's Certificate

25 Number C 51707 to Richard Mclnnis Hodnett, M.D. (Respondent) .. That license was in full force

. 26 and effect at all times relevant to the charges brought herein and will expire on January 31, 2020,

27 unless renewed.

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(RICHARD MCINNIS HODNETT, M.D.) ACCUSATION NO. 800-2016-020630

JURISDICTION

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 Professions Code unless otherwise indicated.

4 4. Section 2001.1 of the Code states:

5 "Protection of the public shall be the highest priority for the Medical Board of California in

6 exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the

7 public is inconsistent with other interests so~ght to be promoted, the protection of the public shall

8 be paramount."

5. Section 2227 of the Code states:

10 "(a) A licensee whose matter has been heard by an administrativ~ law judge of the Medical

11 Quality Bearing.Panel as designated in Section 11371 of the Government Code, or whose default

12 has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary

13 actiOn with the board, may, in accordance with the provisions of this chapter:

14 "(1) Have his or her license revoked upon order of the board.

15 "(2) Have his or her right to practice suspended for a period not to exceed one year upon

16 order of the, board.

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

18 order of the board.

19 "( 4) Be publicly reprimanded by the board. The public reprimand may include a

20 requirement that the licensee complete relevant educational courses approved by the board.

21 "( 5) Have any other act~on taken_ in ~elation to discipline as part of an order of probation, as

22 the board or an administrative law judge may deem proper.

23 "(b) Any matter heard pursuant to subdivision (a), except for warning letters, medical

24 review or advisory conferences, professional competency examinations, continuing education

25 activities, and cost reimbursement associated therewith that are agreed to with the board and

26 successfully completed by the licensee, or other matters made confidential or privileged by

27 existing law, is deemed public; and shall be made available to the public by the board pursuant to

28 Section 803.1."

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(RICHARD MCIN,NIS HODNETT, M.D.) ACCUSATION NO. 800-2016-020630

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. 6. Section 2234 of the Code, states:

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

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

. limited to, the following:

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

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

"(b) Gross negligence.

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

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

the applicable standard of care shall constitute repeated negligent acts.

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

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

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

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

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

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

standard of care.

" .. "

7. Section 2069 of the Code states:.

"(a)(l) Notwithstanding any other law, a medical assistant may administer medication only

by intradermal, subcutaneous, or intramuscular injections and perform skin tests and additional

technical supportive services upon the specific authorization and supervision of a licensed

physician and surgeon or a licensed podiatrist. A medical assistant may also perform all these .

tasks and services upon the specific authorization of a physician assistant, a nurse practitioner, or

a certified nurse-midwife.

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"(b) As used in this section and Sections 2070 and 2071, the following definitions shall

apply:

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"(l) 'Medical assistant' means a person who may be unlicensed, who performs basic

2 administrative, clerical, and technica_l supportive services in compliance with this section and

3 Section 2070 for a licensed physician and surgeon or a licensed podiatrist, or group thereof, for a

4 medical or podiatry corporation, for a physician assistant, a nurse practitioner, or a certified

5 nurse-midwife as provided in subdivision (a), or for a health care service plan, w.ho is at least 18

6 years of age, and who has had at least the minimum amount of hours of appropriate training

7 · pursuant to standards established by the board. The medical assistant shall be issued a c~rtificate

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by the training institution or instructor indicating satisfactory completion of the required training.

A copy of the certificate shall be retained as a record by each employer of the medical assistant. ·

"(2) 'Specific authorization' means a specific written order prepared by the supervising ·

physician and surgeon or the supervising podiatrist; or th~ physician assistant, the nurse

practitioner, or the certified nurse-midwife as provided in subdivision (a), authorizing the

procedures to be performed on a patient; which shall be placed in the patient's medical record, or

a standing order prepared by the supervising physician and surgeon or the supervising podiatrist,

or the physician assistant, the nurse practitioner, or the certified nurse-midwife as provided in

subdivision (a), aut~orizing the procedures to be performed, the duration of which shall b·e

consistent with accepted medical practice. A nqtation of the standing order shall be placed on the

patient's medical record.

"(3) 'Supervision' means the supervision of procedures authorized by this section by the

following practitioners, within the scope of their respective practices, who shall be physically

present in the treatment facility during the performance of those procedures:

"(A) A licensed physician and surgeon.

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"(4) 'Technical supportive services' means simple routine medical tasks and procedures

that inay be safely performed by a medical assistant who has limited training and who functions

under the supervision of a licensed physici~n and surgeon· or a licensed podiatrist, or a physician

assistant, a nurse practitioner, or a certified nurse-midwife as provided in subdivision (a).

"(c) Nothing in this section shall be construed as authorizing.any of the following:

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(RICHARD MCINNIS HODNETT, M.D.) ACCUSATION NO. 800-2016-020630.

"(l) The licensure of medical assistants.

2 " "

3 8. Section 2216 of the Code states:

4 "On or after July 1, 1996, no physician and surgeon shall perform procedures in an

5 · outpatient setting using anesthesia, except local anesthesia or peripheral nerve blocks, or both,

6 · complying with the community standard of practice, in doses that, when administered, have the

7 probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes,

8 unless the setting is specified in Section 1248.1. Outpatient settings whe~e anxiolytics and

9 .analgesics are administered are excluded when administere,d, in compliance with the community

1 O standard of practice, in doses that do not have the probability of placing the patient at risk for loss

11 of the patient's life-preserving protective reflexes.

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" "

HEAL TH AND SAFETY CODE

9. Section 1248.1 of the Health and Safety Code states:·

"No association, corporation, firm, partnership, or person shall operate, manage, conduct, or . .

maintain an outpatient setting in this state, unless the setting is one of the following:

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"(g) An outpatient setting accredited by an accreditation1agency approved by the division

pursuant to this chapter.

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FACTUAL SUMMARY

22 10. In 2015 and 2016, Respondent worked as a physician and surgeon under his business

23 "Richard Hodnett, M.D., Incorporated," through which he worked as an independent contractor

24 for Beverly Hills Physicians, South Bay Surgical Center Group, and Gold Med Surgery Center.

25 Respondent routinely performed outpatient surgeries at clinics in Thousand Oaks, Encino,

26 Torrance, and Beverly Hills. Respondent did not have any employees through his business,

27 although he regularly worked with medical assistants at each location.

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11. Respondent regularly performs surgery at the Thousand Oaks Surgical Center

2 associated with Beverly Hills Physicians, which is located at 115 Jensen Court, Suite 200, in

3 Thousand Oaks, California.· However, this location is not and has not previously been accredited.

4 l 2. Respondent also regularly performs surgery at South Bay Surgical Center Group,

5 which is located at 3445 Pacific Coast Highway, Suite 240, in Torrance, California. This location

6 is accredited through the Accreditation Association for Ambulatory Health Care, Inc. However,

7 ·this facility's accreditation was denied on March 26, 2012.

8 13. Respondent also regularly performs surgery at the Gold Med Surgery Center, which

9 is located at 16311 Ventura Boulevard, Suite 1010, in Encino, .California. However, this location

1 O is not and has not previously been accredited.

11 Pati.ent A

12 14. Respondent first visited with PatientA1 on May 30, 2015. Patient A presented to

13 Respondent seeking an abdominoplasty2 evaluation and operative planning. Respondent ·

14 evaluated Patient A and recommended abdominoplasty, liposuction, and pubic lift. Patient A was

15 then referred for pre-surgical clearance consultation. Patient A proceeded to visit with her

16 primary care physician and was ultimately cleared for surgery. Patient A's primary care

17 physician noted that she was "low risk ... pending result of blood work and eval[uation] for

18 diabetes." Respondent later received Patient A's surgical clearance and lab work.

19 15. Patient A returned to Respondent for a pre-operative history and physical

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examination at the Thousand Oaks location for Beverly Hills Physicians on July 15, 2015~

Respondent diagnosed Patient A with abdominal panniculus, 3 pubic ptosis, and lipodystrophy4 of

1 The patient herein is referred to as Patient A to protect her privacy.

2 Abdominoplasty, also known as a "tummy tuck," is a surgical procedure in which excess fat and skin is removed by a surgeon in order to tighten and restore weakened or separated muscles in the abdominal ·wall in order to create an abdominal profile that is smoother and firmer. Surgical complications can include infection, bleeding under the skin flap, or blood clots. A patient witp poor circulation, diabetes, or heart, lung, or liver disease may be.at increased risk for surgical complications.

3 Panniculus is a medical term describing a dense layer of fatty tissue growth consisting of subcutaneous fat in the lower abdominal area.

4 Lipodystrophy is a medical term describing abnormai accumulation or distribution of fat tissue.

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(RI;CHARD MCINNIS HODNETT; M.D.) ACCUSATION NO. 800-2016-020630

the flanks, inner thighs, lower back, and .arms. That same day, Respondent performed an

2 extended abdominoplasty, pubic llft, and suet.ion-assisted lipectoiny5 of the flanks, inner thighs,

3 lower back, and arms. Patient A was placed under general anesthesia for the procedure. During

4 surgery, Respondent placed two Jackson-Pratt (JP) draihs6 in the patient's abdomen and sutured

5 them into position. The surgery was completed and Patient A was discharged home with an

6 abdominal binder and post-operative instructions that same day.

7 16. Patient A was seen by Respondent for a post-operative visit on July 16, 2015.

8 Respondent noted that the JP drains weren't working well. Patient A was very swollen an~

9 experiencing pain in her left lower quadrant. Respondent adjusted the drains and instructed

1 O Patient A to follow up with him in five days.

11 17. On July 22, 2015, Patient A returned to Respondent's office for a scheduled follow up

12 appointment. Patient A was seen by a medical assistant employed by Beverly Hills Physicians,

13 J.C.,7 while Respondent was not in the office. Patient A and her daughter noted that the wound

14 site(s) appeared black and necrotic, while J.C. noted blisters around the .incision. Although

15 ·Respondent was absent and there was no other physfoian in the office that day, J.C. proceed to

16 place new dressings on the JP drains, advised the patient to keep do~ng "lipo massages," and

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5 Suction lipectomy, also known as "liposuction," is a surgical procedure involving the surgical removal of fat tissue from the abdomen. This procedure may be done using general anesthesia, local anesthesia, or a local anesthetic with sedation. The operation involves removing excess fat tissue by inserting a narrow metal tube called a cannula through a small incision in the skin and applying suction. The tube has one or several openings close to the tip: By passing the instrument forward and backward as suction is applied, fat tissue is sheared off, and fat globules pass into the tube. During the procedure, intravenous fluids are given to replace body fluids that are lost.

6 A Jackson-Pratt (JP) drain is a closed-suction medical device that is commonly used as a·postoperative drain for collecting bodily fluids from surgical sites.

The device consists of an internal drain connected to a grenade-shaped bulb via plastic tubing. The purpose of a JP drain is to prevent fluid (blood or other) build-up in a closed space, which may cause either disruption of the wound and the healing process or become an infected abscess, with either scenario possibly. requiring a formal drainage and/or repair procedure. If the JP drainage tubing bec6mes clogged or other~ise clotted off, the benefits are not real~zed from drainage.

7 J.C. is refi~rred to by her initials to protect her privacy.

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applied Silvadene8 to the site of several blisters on Patient A's skin. J.C. also recommend a

2 "betadine and sugar" procedure for Patient A, which involved the mixing of betadine antiseptic

3 solution and sugar together. J.C. instructed Patient A to pour it over the wound in order to "eat

4 away at bad tissue and make good tissue come forward." Patient A followed J.C.'s advice until ·

5 her next visit with Respondent the foOowing month. Meanwhile, J.C. created a visit note that

6 Respondent later reviewed and signed in Patient A's medical record.

7 18. Patient A next saw Respondent on July 25, 2015, and again on July 28, 2015.

8 Respondent noted that. Patient A was developing an eschar9 in the inferior abdominal flap ..

9 Respondent's plan was to manage the eschar by "watching it," given that there was no

1 O surrounding cellulitis, until the eschar opened up.

11 19. On August 4, 2015, Patient A was seen by a nurse practitioner who applied new

12 dressings to. the JP drain sit~s. The nurse practitioner created a visit note that Respondent

13 reviewed, but did not sign in Patient A's certified medical record.

14 20. Patient A was seen again by Respondent on August 7, 2015. Respondent diagnosed

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Patient A with eschar of the lower abdomen noting that the eschar was demarcated and starting to

separate. At that point, Respondent recommend surgery for debridement that day. Respondent

conducted a pre-operative history and physical examination. Patient A was again placed under

general anesthesia, the eschar was removed, and Respondent proceed to debride the necrotic

tissl_le. During the procedure, Respondent removed the JP drains from Patient A's abdomen.

Patient A was discharged home that same day.

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8 Silver sulfadiazine, sold under the brand "Silvadene," is a topical antibiotic used in partial thickness and full thickness bums to prevent infection.

9 Eschar is dead tissue found in a full-thickness wound. Eschar may occur after a patient sustains a bum injury, gangrenous ulcer, fungal infection, necrotizing fasciitis, spotted fevers, and exposure to cutaneous anthrax. Blood flow in the tissue under the eschar is generally poor and the wound is therefore susceptible to infection. If the eschar becomes unstable (wet, draining, loose, boggy, edematous, red) it should be debrided according to clinic or facility protocol. ·

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(RICHARD MCINNIS HODNETT, M.D.) AC~USATIONNO. 800-2016-020630

21. Respondent had a post-surgical visit with Patient A on August 10, 2015. Respondent

2 carried out wound closure therapy by placement of a vacuum-assisted closure. 10 Respondent also

3 recommended hyperbaric oxygen treatment for Patient A and made arrangements for her to

4 receive treatment at Kaiser Permanente. However, Kaiser Permanente did not expeditiously

5. approve the hyperbaric oxygen treatment and, as such, Respondent arranged for Patient A to

6 receive five hyperbaric oxygen treatments at 2.4 atmospheres for 90 minutes apiece at the

7 Hyperbaric Center in Camarillo;

8 22. On August 12, ~015, the vacuum-assisted closure was removed in preparation for

9 hyperbaric oxygen treatment. However, Patient A encountered difficulty obtaining the hyperbaric

1 O oxygen treatments through Kaiser Permanente. Respondent arranged for five additional

11 treatments at the Hyperbaric Center in Camarillo.

12 23. On September 8, 2015, Respondent was notified that Patient A was transferring her

13 wound healing care from Respondent to Kaiser Permanente. Patient A's abdomen was

14 subsequently noted to be necrotic and that bowel was exposed in the wound.,

15 Patient B .

16 24. Respondent first visited. with Patient B 11 on April 2 7, 2015. Patient B presented to

17 Respondent complaining of gynecomastia 12 and "hard knots" 'of glandular tissue below the areola.

18 Respondent evaluated Patient B and recommended liposuction of the chest. Patient I;3 was then

19 referred for pre-surgical clearance consultation with his primary care physician ..

20 25. Patient B returned to Respondent for a pre-operative history and physical examination

21 at the South. Bay Surgical Center Group on May 10, 2015. That same day, Respondent performed

22 an excision of Patient B.'s gynecomastia and suction-assisted lipectomy of the chest. Patient B

23 . IO Vacuum-assisted closure is a therapeutic technique that utilizes a vacuum dressing. During the

24 treatment, a sealed wound dressing connected to a vacuum pump decreases air pressure on the wound,

25 . which can help the wound heal more quickly.

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11 The patient herein is referred to as Patient B to protect his privacy.

12 Gynecomastia is an endocrine system disorder in which a non-cancerous increase in the size of male breast tissue occurs. Gynecornastia is thought to be caused by an altered ratio of estrogens to androgens mediated by an increase in estrogen production, a decrease in androgen production, or a combination of these two factors.

9 · (RICHARD MCINNIS HODNETT, M.D.) ACCUSATION NO. 800-2016-020630

was placed under general anesthesia for the procedure. During the procedure, Respondent made

2 an incision around the areola and removed a firm area of fatty tissue beneath the bland. Dressings

3 W€re applied post-operatively and Patient B was discharged home the same day.

4 26; Patient B was seen by Respondent for a post-operati.ve visit on May 17, 2015.

5 Respondent noted "perfect result" in Patient B's medical record and instructed him to return in

6 one week. Patient B returned to visit with Respondent on May 26, 2015. Patient B was seen by a

7 registered nurse, his dressing was re-appli.ed, and he was instructed to return on May 31, 2015.

8 Patient B was seen by Respondent again on July 6, 2015. There were no post-surgical

9 complications noted and, as such, Patient B was told to follow up with Resp'ondent as needed.

10 27. Some time between July 2015 and September 2015, Patient B returned to·

11 Respondent's care complaining of "little bumps" on his chest near the surgical sites. Respondent

12 counseled Patient B about the "higher risk of problems" with a second procedure, but Patient B

13 insisted on a revision surgery. Patient B was referred for medical clearance for chest surgery by

14 an internist prior to the revision surgery, which he received on September 28, 2015.

15 Consequentiy, Respondent scheduled Patient B for i"evi~ion surgery.

16 28; ·On November 15, 2015, Patient B underwent a second.surgery with Respondent.

17 Respondent diagnosed Patient B with a bilateral breast mass under the nipple on both .sides of the . . \

18 chest. Patient B was placed under general anesthesia for the procedure and Respondent

19 proceeded to excise the masses from Patient B's chest. Patient B was discharged home that day.

20. 29. Patient B was seen post-operatively by Respondent on November 19, 2015.

21 Respondent noted a slight bruise to Patient B's right upper chest and recommended a follow up

22 appointment in one week. Approximately one week after this appointment, h~wever, Patient B

23 called Respondent complaining of swelling on his right side. Although.Respondent initially

24 recommended that Patient B go to an emergency room, he agreed to treat Patient B. .

. 25 30. On November 30, 2015, Patient B underwent a third surge9' with Respondent.

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Respondent diagnosed Patient B with a hematoma 13 on his right side. Patient B was placed under

13 A hematoma is a solid swelling of clotted blood within the tissues of the human body. A hematoma is typically caused by an injury to the wall of a blood vessel, prompting blood to seep out of the blood vessel into the surrounding tissues. '

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(RICHARD MCINNIS HODNETT, M.D.) ACCUSATION NO. 800-2016-02063.0

general anesthesia for the procedure and Respondent proceeded to 1nake an incision and drain the

2 hematoma. Respondent also placed a drain in Patient B's chest for control "oozing." Patient B

3 was discharged home that day.

4 31. Patient B was seen by Respondent for a follow up visit on December 6, 2015. The

5 drain was removed and Respondent told Patient B to return in one week. Patient B was seen

6 again on December 13, 2015. However, Patient B discontinued treatment with Respondent after

7 this final visit. After. ending care with Respondent, Patient B complained of loss.of are~lar tissue

8 (nipple) as a result of the hematoma.

9 STANDARDS OF CARE

1 O 32. Diagnosis of a Non-Functioning Wound Drain. The community standard of care in

11 medical practice in the State of California is to diagnose a non-functioning wound drain

12 attributable to a drain blockage in a timely manner and to immediately remove the non-

13 functioning wound drain.

14 33. Performing Liposuction and Abdominoplasty,Simultaneously. The community

15 standard of care in medical practice in the State of California is to perform surgery in such a

16 manner fo preserve the integrity of the abdominal wall tissues including muscle and peritoneum.

17 Performing liposuction and abdominoplasty simultaneously in an overlapping area can cause

18 tissue necrosis and wound separation due to vascular compromise.

19 34. Transfer of Post-Surgical Complication Management. The community standard

20 of care in medical practice in the State of California is to recognize the depth of necrosis,

. 21 · especially the exposure of bowel. It is also the community standard of care in medical practice in

22 the State of California to continue the maintenance of post-surgical complication management

23 until it exceeds the training and experience of the operating surgeon. The transfer of

24 complication management to another physician should only be done as a last resort.

25 35. Differentiating Gynecomastia Caused by Fat Tissue and Glandular Tissue. The

26 community standard of care in medical practice in the State ·of California is for the operating

27 surgeon to differentiate between ·gynecomastia caused by fatty tissue only and gynecomastia that

28 is caused by a combination of fat and glandular tissue: Fat tissue can readily be removed with

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liposuction, whereas glandular breast tissue is much firmer and non-responsive to liposuction and

2 may require an open technique to excise firm breast tiss,ue.

3 36. Premature Revision Surgery. The community standard of care in medical practice

4 in the State of California is to revise surgery when primary hearing is near enough to completion.

5 in order to reduce the chance of bleeding from immature healing tissue vessels. This decision

6 must be made by the surgeon based upon healing progress and nofby patient pressure.

7 FIRST CAUSE FOR DISCIPLINE

8 (Gross Negligence)

9 37. Respondent's license is subject to disciplinary action under Section 2234, subdivision

1 O (b) of the Code, in that Respondent was grossly negligent in his care and treatment of Patients A

11 and B. The circumstances are as follows:

12 38. Complainant refers to and, by this reference, incorporates paragraphs 10 through 36

13 above, as though fully set forth herein.

14 39. The following acts and omissions, considered individually and collectively, constitute

15 gross negligence in Respondent's practice as a physician and surgeon:

16 A. Failing to timely recognize and remedy a blockage in Patient A's JP drains, which

17 can contribute to t{ssue necrosis.

18 B. Simultaneously performing liposuction and abdominoplasty upon Patient A in an-

19 overlapping area of the body, which can cause tissue necrosis and wound separation due to

20 vascular compromise.

21 C. Failing to differentiate fat tissue from breast tissue as the main cause of Patient B's

22 gynecomastia, which resulted in Respondent's use of liposuction only, as opposed to an open

23 technique to excise firm breast tissue.

24 SECOND CAUSE FOR DISCIPLINE

25 (Repeated Negligent Acts)

26 40. Respondent's license is further subject to disciplinary action under Section 2234,

27 subdivision (c) 'of the Code, in that Respondent committed repeated negligent acts during his care

28 and treatment of Patients A and B. The circumstances are as follows:

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41. Complainant refers to and; by this reference, incorporates paragraphs 10 through 36

2 above, as though fully set forth herein.

3 42. · The following acts and omissions, considered individually and collectively, constitute

4 . repeated negligent acts in Respondent's practice as a physician and surgeon:

5 A. Failing to timely recognize and remedy a blockage in Patient A's JP drains, which

6 can contribute to tissue necrosis.

7 B. Simultaneously performing liposuction and abdominoplasty upon Patient A in an

8 overlapping area of the body, which can cause tissue necrosis and wound separation due to

9 va~cular compromise.

10 C. Transferring the management of Patient A's post-surgical complications to other

· 11 physicians while the wound healing process was still in its early phase.

12 D. Failing to differentiate fat tissue from breast tissue as the main cause of Patient B's

13 gynecomastia, which resulted in Respondent's use ofliposuction only, as opposed to an open

14 technique to excise firm breast tissue.

15 E. Prematurely re-entering Patient B's operative site(s) resulting in bleeding,

16 compromised blood flow, and necrosis of breast tissue.

17 THIRD CAUSE FOR DISCIPLINE

18 · (Failure to Supervise Medical Assistant)

19 43. By reason of the facts set forth in paragraph 17 above,.Respondent's license is further

20 subject to disciplinary action under Section 2069 of the Code, in that Respondent failed to

21 properly supervise medical assistant J.C. in the care and treatment of Pat.ient A.

22 44. Respondent's acts and/or omissions as set forth in paragraph 17 above, whether

23 proven individually; jointly, or in any combination thereof, constitutes Respondent's failure to

24 properly supervise medical assistant J.C. in the care and treatment of Patient A, in violation of

25 Section 2069 of the Code.

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FOURTH CAUSE FOR DISCIPLINE

2 (Unprofessional Conduct)

3 45. By reason of the facts set forth in paragraph 10 through 36- above, Respondent is

4 subject to disciplinary action under Section 2234, subdivision (a), and Section 2216 of the Code,

5 in that Respondent has engaged in unprofessional conduct based upon his gross negligence in the

6 care and treatment of Patients A and B, repeated negligent acts in the care and treatment of

7 Patients A and B, his failure to supervise medical (lssistant J.C. in the care and tr~atment of

8 Patient A, and his performance of procedures upon Patients A and B in unaccredited outpatient

9 settings while using general anesthesia.

10 46. Respondent's acts andlo~ omissions as set forth in paragraphs 10 through 36 above,

11 whether proven individually, jointly, or in any combination thereof, constitute Respondent's

12 unprofessional conduct based upon his gross negligence in the care and treatment of Patients A'

13 and B, repeated negligent acts in the care and treatment of Patients A and B, his failure to

14 supervise medical assistant J.C. in the care and treatment of Patient A, and his performance of

15 procedures upon Patients A and B in unaccredited outpatient settings using general anesthesia,

16 pursuant to Section 2234, subdivision (a), and Section 2216 of the Code.

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PRAYER

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

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

4 1. · , Revoking or suspending Physician's and Surgeon's Certificat~ Number C 51707

5 issued to Richard Mclnnis Hodnett, M.D.;

6 2. Revoking,.suspending or denying approval of his authority to supervise phys_ician

7 assistants pursuant to Se'ction 3527 of the Code, and advanced practice nurses;

8 3. · If placed on probation, ordering Richard Mclnnis Hodnett, M.D. to pay the Board the

. 9 costs of probation monitoring; and

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

12 DATED:

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November 29, 2018

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15 (RICHARD MCINNIS HODNETT, M.D.) ACCUSATION NO. 800-2016-020630 ·

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