THE MISSION OF THE MEDICAL BOARD OF CALIFORNIAThe mission of the Medical Board of California is to protect healthcare consumers through the proper licensing

and regulation of physicians and surgeons and certain allied healthcare professionsand through the vigorous, objective enforcement of the Medical Practice Act.

Medical Board of California

ction ReportOctober 2003Vol. 87A QuarterlyPublication

www.medbd.ca.gov

Medical Boardof California

Meetings2003

November 6-7San Diego

2004January 29-30Sacramento

May 6-7SacramentoJuly 29-30

SacramentoNovember 4-5Sacramento

All meetings are opento the public.

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“No physician and surgeon shall besubject to disciplinary action by the Boardfor prescribing or administering controlledsubstances in the course of treatment of aperson for intractable pain.” — Businessand Professions Code section 2241.5(c)

PreambleIn 1994, the Medical Board of Californiaformally adopted a policy statement titled,“Prescribing Controlled Substances forPain.” The statement outlined the Board’sproactive approach to improvingappropriate prescribing for effective painmanagement in California, while

It has been 13 years since the IntractablePain Treatment Act of 1990 first establishedlaws to assist physicians in the course oftreatment for a person diagnosed withintractable pain. In 1994, the Medical Boardadopted Guidelines for “PrescribingControlled Substances for Intractable Pain.”In the ensuing years, the practice of painmanagement and the affected patientpopulation have continued to evolve and hasreceived much attention from the medicalcommunity and affected patients.

Effective Jan. 1, 2002, Business andProfessions Code section 2241.6 (referredto as AB 487) was added requiring theDivision of Medical Quality (DMQ) todevelop standards to assure the competentreview in cases concerning the management,

Revised Pain Management Guidelines

Guidelines for Prescribing Controlled Substances for Pain

(Continued on page 4)

(Continued on page 4)

preventing drug diversion and abuse. Thepolicy statement was the product of a yearof research, hearings and discussions.California physicians and surgeons areencouraged to consult the policy statementand these guidelines, which can be found atwww.medbd.ca.gov or obtained from theMedical Board of California.

In May 2002, as a result of AB 487, a taskforce was established to review the 1994Guidelines and to assist the Division ofMedical Quality to “develop standards toassure the competent review in cases

including, but not limited to, the undertreatment, under medication and overmedication of a patient’s pain. When thisitem was discussed at the May 2002 Boardmeeting, a task force was established toreview the 1994 Guidelines and to assistthe DMQ in the development of thestandards. The scope of the Guidelines wasexpanded from intractable pain patients toall patients with pain.The task force was comprised ofrepresentatives from the American PainSociety, the American Academy of PainMedicine, the California Society ofAnesthesiology, the California Chapter ofAmerican College of EmergencyPhysicians, the California Medical

Medical Board’s Fiscal Year 2002-03Annual Report Inside

President’s Report 2

Medical Board SeeksNominees For Physician

RecognitionProgram 3

New Chief ofEnforcement 3

West Nile VirusUpdate 7

Student LoanRepayment

Program Under Way 8

Informed Consent RequiredPrior to Hysterectomy 9

Call for Expert Reviewers 10

What is a PA? 11

Administrative Actions 12

Adopted Unanimously by the Board in 1994 and Recently Revised

Medical Board of California ACTION REPORTPage 2 October 2003

Hazem Chehabi, M.D.President of the Board

President’s ReportThe Medical Board of California continueswith a year of both incredible opportunityand serious challenges.

Opportunity arose from the Board’scontinuing commitment to providing moreefficient programs and services, enablingit to meet its mission of consumerprotection through the proper licensingand regulation of physicians. Notablebenchmarks that reflect the Board’sprogress toward this goal are described inthe enclosed Annual Report.

In particular, the Medical Board issued thehighest single-year number of newphysician and surgeon licenses in its history: 4,993. Thisachievement was realized with a shorter averageprocessing time and with fewer staff than in recent yearsand results from the Board’s policy direction and fromthe staff’s efforts to streamline operations whilemaintaining quality.

Similarly, the Medical Board’s Enforcement Program hasmaintained its high quality of work while adoptingsignificant new standards andprocedures resulting fromlegislation and fromreorganization (SB 1950). Theprogram has redesigned howit receives and screensincoming complaints to assurethose that indicate apotentially more seriousviolation are movedexpeditiously for investigation.

At the same time, this systemallows for a detailed responseto those complaints that arenot violations of the Medical Practice Act, but wherepatients have experienced a level of dissatisfaction withtheir medical care that prompted them to complain to theBoard about their doctor.

Greater opportunity for enhancements to theEnforcement Program is anticipated with the appointmentof an Enforcement Monitor, who began work on Oct. 1,2003. The Enforcement Monitor will serve a two-yearassignment aimed at, among other issues, improving thequality, consistency and timeliness of complaint handling.I look forward to sharing the findings of this effort withyou in upcoming issues of the Action Report.

In my opening, I also wrote of seriouschallenges, and these must be recognizedas well as accomplishments.

The Annual Report contains some figuresthat are troubling to the Board, as theyshould be to physicians and consumersalike. These are the growing timeframesthat are required to investigate complaintsand to take regulatory action when that iscalled for.

These timeframes are an outgrowth of thecurrent State budget situation that hasresulted in the Medical Board, along withall other agencies, experiencing a hiring

freeze and, in some cases, the elimination of positions.

Earlier I wrote of the Licensing Program being able toinstitute efficiencies that enabled it to overcome itsreduced workforce. Unfortunately, the EnforcementProgram is more dependent on personnel who mustgather records, conduct interviews and perform otherfunctions related to case investigation. With the loss ofnearly 20% of its personnel, the Enforcement Program is

beginning to encounterdelays that result ininvestigations taking longerthan they have in recentyears. Staffing levels in thisprogram are where theywere in 1993, although thenumber of licensees hasgrown almost 15% and thenumber of complaints hasgrown by 40%.

We will continue to watchcarefully the impacts of thecurrent State budget and

staffing limitations, and to redirect Board resources aspossible. We as Board members have reduced ourancillary projects and are concentrating more on ourcore mandates of licensing and regulation, and a reducedBoard staff has consolidated its work to manage thegrowing workload as effectively as possible.

I am proud of the reaction of the Board and its staff toour fiscal challenges, and pledge our continued efforts toimprove efficiencies as we maintain our commitment toconsumer protection.

We as Board members havereduced our ancillary projects and

are concentrating more on ourcore mandates of licensing andregulation, and a reduced Boardstaff has consolidated its work tomanage the growing workload as

effectively as possible.

Medical Board of California ACTION REPORTOctober 2003 Page 3

The Medical Board of California has announced itsPhysician Recognition Program to recognize thedemonstration of excellence by individual physicians and/orgroups of physicians who strive to improve access and tofill gaps in the healthcare delivery system in California. Theprogram is designed to identify and reward individuals and/or institutions, otherwise unrecognized, who creativelymeet the needs of underserved populations, or who areoutstanding in areas of service that advance the healthcarestatus of California residents. This may include theprovision of healthcare services to other unique populationsor through their contribution to education that exceeds thenorm and improves the healthcare status of Californiaresidents.

The Physician Recognition Committee of the Board willreview nominations and make recommendations for awardsthat will be granted annually. Persons or organizationsmaking the nominations must complete and send thenomination form to the Board by Nov. 30, 2003.Nominations should be mailed to: Medical Board ofCalifornia, 1426 Howe Ave., Suite 54, Sacramento, CA95825, Attention: Physician Recognition Award.Applications also may be downloaded from the Board’sWeb site at www.medbd.ca.gov, “Services for Licensees,”“Physician Recognition Program.”

Board Seeks Nominees for Physician Recognition ProgramIn addition to the completed application form,nominations should also include letters in support of thenomination as well as citations and reference toorganizing efforts, successful projects and newspaper orother articles; and the candidate(s)’ curriculum vitae orbiography that includes work history with dates.

Nominees should demonstrate a creative model ofdedication to the development and delivery ofinspirational, successful and replicable models ofhealthcare delivery, or demonstrate service in an area ofmedicine that advances the public’s healthcare statusthrough clearly outstanding service, education orinnovation. They must be California-based licensees ingood standing and may be individual physicians or thosephysicians who comprise medical groups or teams.

The Medical Board will select the award recipient(s),basing its decision on the criteria set forth or comparableachievements and the strength of supporting letters. Theproject/service need not be pro bono but must involveservice of ultimate benefit to the public. Immediately afterthe Board’s decision, the recipient will be notified inwriting. The award presentation will be held during asubsequent meeting of the Medical Board of California.

Joan Jerzak has been selected as the Board’snew Chief of Enforcement, replacing DaveThornton, who retired. She is the fourthchief since the establishment of the Board’sEnforcement program in 1976, and bringsspecial skills to this position.

She is responsible for the oversight andmanagement of the Board’s EnforcementProgram including the Central ComplaintUnit, the Discipline Coordination Unit, theMBC Probation Program and all investigativeservices provided by the Board’s swornstaff. The Chief also interacts with other lawenforcement agencies, provides outreach tophysician groups and various allied associations, and hasregular communication with representatives from the Officeof the Attorney General.

Ms. Jerzak has a bachelor’s and a master’s degree inCriminal Justice from California State University atSacramento, and has 26 years of state service with 16years of experience at the Medical Board.She was a Board field investigator in San Diego, a first-levelsupervisor of the Torrance district office, and was asecond-level supervisor over four district offices in the Los

Medical Board Welcomes New Chief of EnforcementAngeles Metropolitan area. Ms. Jerzakparticipated in numerous task forces andcommittees representing the Board andproviding expertise on topics ranging fromsexual misconduct to healthcare fraud andpain management.In 1997, Ms. Jerzak accepted a position astrainer for the Board’s sworn investigativestaff and developed a 16-week trainingprogram for all newly hired investigators.She created lesson plans on 54 differenttopics related to all types of healthcarecomplaints, documenting historical actionas well as current laws and future trendsin medicine.

Ms. Jerzak’s expertise as a trainer and her knowledge ofBoard investigations have made her a critically acclaimedspeaker. For the past four years, she has provided trainingto other investigators in California and has trainedinvestigators from other states.Last year, Ms. Jerzak supervised the Board’s ProbationProgram. She focused attention on the programoperations to ensure staff provide more standardizedmonitoring in meeting the Board’s mission of publicprotection.

Joan Jerzak

Medical Board of California ACTION REPORTPage 4 October 2003

concerning the management, including, but not limited to,the under treatment, under medication, and over medicationof a patient’s pain.” The task force expanded the scope ofthe Guidelines, from intractable pain patients to all patientswith pain.

Inappropriate prescribing of controlled substances,including opioids, can lead to drug abuse or diversion andcan also lead to ineffective management of pain,unnecessary suffering of patients, and increased healthcosts. The Medical Board recognizes that some physiciansdo not treat pain appropriately due to a lack of knowledgeor concern about pain, and others may fail to treat painproperly due to fear of discipline by the Medical Board.These Guidelines are intended to improve effective painmanagement in California, by avoiding under treatment,over treatment, or other inappropriate treatment of apatient’s pain and by clarifying the principles of professionalpractice that are endorsed by the Medical Board so thatphysicians have a higher level of comfort in usingcontrolled substances, including opioids, in the treatment ofpain. These Guidelines are intended to promote improvedpain management for all forms of pain and for all patients inpain.

A High PriorityThe Board strongly urges physicians and surgeons to vieweffective pain management as a high priority in all patients,including children, the elderly, and patients who areterminally ill. Pain should be assessed and treated promptly,effectively and for as long as pain persists. The medicalmanagement of pain should be based on up-to-dateknowledge about pain, pain assessment and pain treatment.Pain treatment may involve the use of several medicationsand non-pharmacological treatment modalities, often incombination. For some types of pain, the use ofmedications is emphasized and should be pursuedvigorously; for other types, the use of medications isbetter de-emphasized in favor of other therapeuticmodalities. Physicians and surgeons should have sufficientknowledge or utilize consultations to make such judgmentsfor their patients.

Medications, in particular opioid analgesics, are consideredthe cornerstone of treatment for pain associated withtrauma, surgery, medical procedures, or cancer. A numberof medical organizations have developed guidelines foracute and chronic pain management. Links to thesereferences may be found on the Medical Board ofCalifornia’s Web site at www.medbd.ca.gov.

The prescribing of opioid analgesics for patients with pain,may also be beneficial, especially when efforts to alleviatethe pain with other modalities have been unsuccessful.

Intractable pain is defined by law in California as: “a painstate in which the cause of the pain cannot be removed orotherwise treated and which in the generally acceptedcourse of medical practice no relief or cure of the cause ofthe pain is possible or none has been found after reasonableefforts including, but not limited to, evaluation by theattending physician and surgeon and one or morephysicians and surgeons specializing in the treatment of thearea, system, or organ of the body perceived as the sourceof the pain.” (Section 2241.5(b) of the California Businessand Professions Code)

Physicians and surgeons who prescribe opioids either foracute or persistent pain should not fear disciplinary or otheraction from California law enforcement or regulatoryagencies for the mere fact of having prescribed opioids.The appropriate use of opioids in the treatment ofintractable pain has long been recognized in California’sIntractable Pain Treatment Act, which provides that “Nophysician and surgeon shall be subject to disciplinary actionby the Medical Board for prescribing or administeringcontrolled substances in the course of treatment of a personfor intractable pain.” (Section 2241.5(c) of the CaliforniaBusiness and Professions Code)

The Medical Board expects physicians and surgeons tofollow the standard of care in managing pain patients.

Guidelines for Prescribing Controlled Substances for Pain (continued from page 1)

Association, Compassion in Dying Federation, the Office ofthe Attorney General Health Quality Enforcement Sectionand the Board.The revised guidelines are intended to improve effectivepain management of California patients by incorporating aseries of annotations which better reflect how theseGuidelines should be used, and will allow for periodicupdate, as indicated. It is anticipated that physicians willhave a higher level of comfort when using controlledsubstances, including opioids, in the treatment of pain. And,the revised guidelines will promote improved painmanagement for patients in pain, while providing betterguidance to the MBC’s Enforcement Program, indetermining whether or not allegations of inappropriateprescribing are supported by evidence.

At the August 2003 Board meeting, the DMQ adopted therecommendations of the task force in the revised“Guidelines for Prescribing Controlled Substances forPain.”

Revised Pain Management Guidelines(continued from page 1)

(Continued on page 5)

Medical Board of California ACTION REPORTOctober 2003 Page 5

Guidelines• History/Physical Examination A medical history and

physical examination must be accomplished. Thisincludes an assessment of the pain, physical andpsychological function; a substance abuse history;history of prior pain treatment; an assessment ofunderlying or coexisting diseases or conditions; anddocumentation of the presence of a recognized medicalindication for the use of a controlled substance.

Annotation One: The prescribing of controlledsubstances for pain may require referral to one ormore consulting physicians.

Annotation Two: The complexity of the history andphysical examination may vary based on thepractice location. In the emergency department, theoperating room, at night or on the weekends, thephysician and surgeon may not always be able toverify the patient’s history and past medicaltreatment. In continuing care situations for chronicpain management, the physician and surgeonshould have a more extensive evaluation of thehistory, past treatment, diagnostic tests andphysical exam.

• Treatment Plan, Objectives The treatment planshould state objectives by which the treatment plan canbe evaluated, such as pain relief and/or improvedphysical and psychosocial function, and indicate if anyfurther diagnostic evaluations or other treatments areplanned. The physician and surgeon should tailorpharmacological therapy to the individual medical needsof each patient. Multiple treatment modalities and/or arehabilitation program may be necessary if the pain iscomplex or is associated with physical andpsychosocial impairment.

Annotation One: Physicians and surgeons may usecontrol of pain, increase in function, and improvedquality of life as criteria to evaluate the treatmentplan.

Annotation Two: When the patient is requestingopioid medications for their pain andinconsistencies are identified in the history,presentation, behaviors or physical findings,physicians and surgeons who make a clinicaldecision to withhold opioid medications shoulddocument the basis for their decision.

• Informed Consent The physician and surgeon shoulddiscuss the risks and benefits of the use of controlledsubstances and other treatment modalities with thepatient, caregiver or guardian.

Annotation: A written consent or pain agreementfor chronic use is not required but may make iteasier for the physician and surgeon to documentpatient education, the treatment plan, and theinformed consent. Patient, guardian, and caregiverattitudes about medicines may influence thepatient’s use of medications for relief from pain.

• Periodic Review The physician and surgeon shouldperiodically review the course of pain treatment of thepatient and any new information about the etiology ofthe pain or the patient’s state of health. Continuation ormodification of controlled substances for painmanagement therapy depends on the physician’sevaluation of progress toward treatment objectives. Ifthe patient’s progress is unsatisfactory, the physicianand surgeon should assess the appropriateness ofcontinued use of the current treatment plan andconsider the use of other therapeutic modalities.

Annotation One: Patients with pain who aremanaged with controlled substances should be seenmonthly, quarterly, or semiannually as required bythe standard of care.

Annotation Two: Satisfactory response totreatment may be indicated by the patient’sdecreased pain, increased level of function, orimproved quality of life. Information from familymembers or other caregivers should be consideredin determining the patient’s response to treatment.

• Consultation The physician and surgeon shouldconsider referring the patient as necessary foradditional evaluation and treatment in order to achievetreatment objectives. Complex pain problems mayrequire consultation with a pain medicine specialist.

In addition, physicians should give special attention tothose pain patients who are at risk for misusing theirmedications including those whose living arrangementspose a risk for medication misuse or diversion. Themanagement of pain in patients with a history ofsubstance abuse requires extra care, monitoring,documentation and consultation with addictionmedicine specialists, and may entail the use ofagreements between the provider and the patient thatspecify the rules for medication use and consequencesfor misuse.

Annotation One: Coordination of care inprescribing chronic analgesics is of paramountimportance.

Guidelines for Prescribing Controlled Substances for Pain (continued from page 4)

(Continued on page 6)

Medical Board of California ACTION REPORTPage 6 October 2003

Annotation Two: In situations where there is dualdiagnosis of opioid dependence and intractablepain, both of which are being treated withcontrolled substances, protections apply tophysicians and surgeons who prescribe controlledsubstances for intractable pain provided thephysician complies with the requirements of thegeneral standard of care and California Businessand Professions Code section 2241.5.

• Records The physician and surgeon should keepaccurate and complete records according to itemsabove, including the medical history and physicalexamination, other evaluations and consultations,treatment plan objectives, informed consent,treatments, medications, rationale for changes in thetreatment plan or medications, agreements with thepatient, and periodic reviews of the treatment plan.

Annotation One: Documentation of the periodicreviews should be done at least annually or morefrequently as warranted.

Annotation Two: Pain levels, levels of function, andquality of life should be documented. Medicaldocumentation should include both subjectivecomplaints of patient and caregiver, and objectivefindings by the physician.

• Compliance with Controlled Substances Laws andRegulations To prescribe controlled substances, thephysician and surgeon must be appropriately licensed inCalifornia, have a valid controlled substancesregistration and comply with federal and stateregulations for issuing controlled substancesprescriptions. Physicians and surgeons are referred tothe Physicians Manual of the U.S. Drug EnforcementAdministration and the Medical Board’s Guidebook toLaws Governing the Practice of Medicine byPhysicians and Surgeons for specific rules governingissuance of controlled substances prescriptions.

Annotation One: There is not a minimum ormaximum number of medications which can beprescribed to the patient under either federal orCalifornia law.

Annotation Two: Physicians and surgeons whosupervise Physician Assistants (PA’s) or NursePractitioners (NP’s) should carefully review therespective supervision requirements.

Additional information on PA supervision requirements isavailable at www.physicianassistant.ca.gov.

PA’s are able to obtain their own DEA number to use whenwriting prescriptions for drug orders for controlled

substances. Current law permits physician assistants towrite and sign prescription drug orders when authorized todo so by their supervising physician for Schedule II-IV.Further, a PA may only administer, provide or transmit adrug order for Schedule II through Schedule V controlledsubstances with the advanced approval by a supervisingphysician for a specific patient.

To ensure that a PA’s actions involving the prescribing,administration, or dispensing of drugs is in strict accordancewith the directions of the physician, every time a PAadministers or dispenses a drug or transmits a drug order, thephysician supervisor must sign and date the patient’s medicalrecord or drug chart within seven days. (Section 1399.545(f)of the California Code of Regulations)

NP’s are allowed to furnish Schedule III-V controlledsubstances under written protocols.

PostscriptWhile it is lawful under both federal and California law toprescribe controlled substances for the treatment of pain,there are limitations on the prescribing of controlledsubstances to or for patients for the treatment of chemicaldependency (see Sections 11215-11222 of the CaliforniaHealth and Safety Code). The California Intractable PainTreatment Act (CIPTA) does not apply to those personsbeing treated by the physician and surgeon only forchemical dependency because of use of drugs or controlledsubstances (Section 2241.5(d)). The CIPTA does notauthorize a physician and surgeon to prescribe, dispense, oradminister controlled substances to a person the practitionerknows to be using the prescribed drugs or controlledsubstances for non-therapeutic purposes (Section2241.5(e)). At the same time, California law permits theprescribing, furnishing, or administering of controlledsubstances to or for a patient who is suffering fromdisease, ailments, injury, or infirmities attendant on old age,other than addiction (Section 11210 of the California Healthand Safety Code) and the CIPTA does apply to “apractitioner who is prescribing controlled substances forintractable pain, and as long as that practitioner is not alsotreating the patient for chemical dependency.”

The Medical Board emphasizes the above issues, both toensure physicians and surgeons know that a patient in painwho is also chemically dependent should not be deprived ofappropriate pain relief, and to recognize the special issuesand difficulties associated with patients who suffer bothfrom drug addiction and pain. The Medical Board expectsthat the acute pain from trauma or surgery will beaddressed regardless of the patient’s current or prior historyof substance abuse. This postscript should not beinterpreted as a deterrent for appropriate treatment of pain.

Guidelines for Prescribing Controlled Substances for Pain (continued from page 5)

Medical Board of California ACTION REPORTOctober 2003 Page 7

HEALTH NEWS

CORRECTION

West Nile Virus UpdateBy Evelyn Tu, Project Coordinator

California Department of Health Services, Division of Communicable Disease Control

Information was omitted from the table titled“Medical Management of Lead-PoisonedChildren,” published with the lead poisoning storyon Page 9 of the July 2003 Action Report. Thefirst line in the table should read that anticipatoryguidance is required for values of <10 g/dL.

In August 2003, West Nile virus was identified inmosquito pools and sentinel chicken flocks in California inImperial and Riverside Counties near the Salton Sea. Deadcrows were identified in Los Angeles and RiversideCounties in September. Additionally, several importedhuman cases were identified. It is believed that theseindividuals all acquired their infection while traveling to anendemic area.

The California Department of Health Services (DHS)seeks the participation of physicians and other healthcareproviders in an effort to monitor West Nile (WN) virus inCalifornia. A strong surveillance system is needed to trackWN activity, and healthcare providers play an importantrole in the detection of WN virus.

West Nile virus is an arbovirus that was first isolated inUganda in 1937. In the flavivirus family, it is closelyrelated to St. Louis encephalitis virus, Kunjin virus, andJapanese encephalitis virus. WN virus was first detectedin the Western Hemisphere in 1999 in the New York areaand has spread at an alarming rate. As of September 19,2003, 4,417 human cases were identified in 37 states with84 deaths.

The virus is transmitted to humans by the bite of aninfected mosquito. Infection with WN virus may havevarying clinical presentations. Most people who areinfected with WN virus have no symptoms. Approximately15% of infections will result in a mild febrile illness. Forapproximately every 150 infected persons, only oneperson will have severe illness (aseptic meningitis,encephalitis, or acute flaccid paralysis). The elderly are athighest risk of disease and mortality.

In 2002, transmission of WN virus was identified viablood transfusion and organ transplantation. All blood

banks now screen all blood products for WN virus. Anyproducts that look suspicious for infection arequarantined. In 2003, two cases of transfusion associatedtransmission have been identified nationally.

It is critical that healthcare providers immediately report allsuspected cases of viral encephalitis, viral meningitis, andacute flaccid paralysis/atypical Guillain-Barré Syndrome totheir local health departments. Thirty local healthdepartments throughout the state can screen for WN andthen send specimens onto DHS as needed. The healthdepartment will help facilitate specimen submittal.

Testing is available on a subset of cases (cerebrospinalfluid (CSF) and sera) through your local public healthlaboratory. The county laboratory will run a screeningImmunofluorescent antibody (IFA) test for WN.Specimens will then be forwarded to DHS. The mostsensitive screening test for WN virus is the IgM-captureenzyme linked immunosorbent assay (ELISA).

Surveillance for WN virus in California includes severalcomponents: human case surveillance, mosquito testingand control, veterinary equine surveillance, sentinelchicken testing, and dead bird surveillance and testing.Veterinarians should refer cases of non-human mammalianencephalitis to the Veterinary Public Health Section of theDepartment of Health Services. Dead birds should bereported to DHS at the toll-free number 877-WNV-BIRD.Mosquito pools are collected and tested for variousarboviruses, including WN virus.

For further information, you may contact Evelyn Tu, Viraland Rickettsial Disease Laboratory, CDHS, 850 MarinaBay Parkway, Richmond, CA 94804, (510) 307-8606, ore-mail etu@dhs.ca.gov. Information is also available athttp://westnile.ca.gov.

Medical Board telephone numbersfor the hearing-impaired (TDD):Division of Licensing(916) 263-2687Central Complaint Unit(916) 263-0935

TDD NUMBERS

Medical Board of California ACTION REPORTPage 8 October 2003

FAMILY PRACTICEBeatrice Baez, MDLa Maestra Family ClinicSan DiegoBethany Blacketer, MDLivingston Medical GroupLivingstonDerrick Butler, MDWatts Health FoundationLos AngelesJessica Diaz, MDOpen Door Comm Health CtrSmith RiverJoseph Dodge, MDBrookside Comm Health CtrSan PabloTamika Henry, MDFamily Clinics of Long BeachLong BeachCaroline Kennedy, MDClinica de SaludSalinasMichael Komin, MDAviation MedicalShafterAndrea Mendoza Mason, MDCommunity Health AlliancePasadena

Rakesh Patel, MDNeighborhood HealthcareEl CajonJose Perez, MDCentral City Community ClinicLos AngelesTryna Ramos, MDCenters for Family HealthVenturaAnn Valdes, MDSt. Anthony Free ClinicSan FranciscoWendell Williams, MDLower Lake Medical ClinicLower Lake

PEDIATRICSWill Charlton, MDClinica Medica San MiquelLos AngelesJeff Corral-Ribordy, MDEureka PediatricsEurekaDane Fliedner, MDThe Children’s ClinicLong Beach

Maia Gaither, MDClinica Medica San MiquelLos AngelesSonya Garcia, MDMandalay Bay Children’s CenterOxnardGuadalupe Hedrick, MDAlliance Medical CenterHealdsburgBen Meisel, MDSanta Barbara Co. Public HealthLompocAlfredo Negrete, MDABC Pediatrics Medical GroupValley Family Care CenterEl Centro and CalexicoMaria Galvez Picon, MDMission NeighborhoodHealth CenterSan FranciscoShanna Treanor, MDClinica Sierra VistaBakersfield and Lamont

OBSTETRICSAND GYNECOLOGYJanice Stain, MDSequoia CommunityHealth FoundationFresno

INTERNAL MEDICINEJay Dhiman, MDNortheast Valley Health CorpPacoima and San FernandoCecilia Galindo, MDUnited Health CentersParlier and Orange CoveKosala Samarasinghe, MDNeighborhood HealthcareEscondido

PSYCHIATRYShepard Greene, MDLassen County Mental HealthSusanvillePamela Swedlow, MDCommunity FocusSan Francisco

COMBINED PEDIATRICS AND INTERNAL MEDICINERudo Benjamin, MDAxminster Medical GroupLos AngelesOtto Liao, MDBreathmobile / Asthma VanSanta Ana

Award Recipients Listed by Postgraduate Training

Student Loan Repayment Program Under WayU.S. Surgeon General Richard Carmona, M.D.,(standing, second from left) is present to witnessMedical Board Immediate Past President GaryGitnick, M.D., and recipient Maria Galvez Picon,M.D., sign a memorandum of understanding bywhich Dr. Picon will receive up to $105,000 inmedical school loan repayments in exchange forup to three years of service in a medicallyunderserved area. The ceremony took place onJuly 17 at the Mission Neighborhood HealthCenter in San Francisco, where Dr. Picon works.Also pictured, standing left to right, are BoardMember Bernard Alpert, M.D., Dr. Carmona,Anmol Mahal, M.D., and Jack Lewin, M.D.Drs. Mahal and Lewin represent the CaliforniaMedical Association, co-sponsors of the loanrepayment program.

Medical Board of California ACTION REPORTOctober 2003 Page 9

Hospice & Palliative CareFocuses on pain management

and end-of-life issues.Provides 5.25 CME credits toward

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Practical Pain Management: FromClassroom to Treatment Room

Current concepts of pathophysiologyand treatment of common painful

conditions, plus risk management forprimary care physicians.

12 Category 1 creditsNovember 14-16, 2003

Fairmont Sonoma Mission Inn & SpaPresented by the Medical Education

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For more information, contactDeborah Hattrup at (412) 364-8211

fax: (412) 369-0508e-mail: deborah@cmmglobal.com

As a result of comments received at a recent meeting of the Board’s PublicEducation Committee, the Board is publishing a reminder to physicians ofthe specific mandates in Health and Safety Code sections 1690 and 1691,that prior to the performance of a hysterectomy, physicians must obtainverbal and written informed consent.Per section 1690, the informed consent procedure requires that all of thefollowing information be given to the patient verbally and in writing:1) Advice that the individual is free to withhold or withdraw consent to

the procedure at any time before the hysterectomy without affectingthe right to future care or treatment and without loss or withdrawalof any state or federally funded program benefits to which theindividual might be otherwise entitled.

2) A description of the type or types of surgery and other proceduresinvolved in the proposed hysterectomy, and a description of anyknown available and appropriate alternatives to the hysterectomyitself.

3) Advice that the hysterectomy procedure is considered to beirreversible, and that infertility will result.

4) A description of the discomforts and risks that may accompany orfollow the performing of the procedure, including an explanation ofthe type and possible effects of any anesthetic to be used.

5) A description of the benefits or advantages that may be expected as aresult of the hysterectomy.

6) Approximate length of hospital stay.7) Approximate length of time for recovery.8) Financial cost to the patient of the physician’s fees.The law says a woman shall sign a written statement prior to theperformance of the hysterectomy procedure, indicating she has read andunderstood the written information and that the information has beendiscussed with her by her physician, or his or her designee. Thestatement will indicate that the patient has been advised by her physicianor designee that the hysterectomy will render her permanently sterile andincapable of having children and will accompany the claim, unless thepatient has previously been sterile or is postmenopausal.The informed consent procedure does not pertain when the hysterectomyis performed in a life-threatening emergency situation in which thephysician determines prior written informed consent is not possible.The California Department of Health Services has developed regulationsestablishing verbal and written informed consent procedures that shouldbe obtained prior to performance of a hysterectomy, that indicate themedically accepted justifications for performance of a hysterectomy,pursuant to this chapter. To obtain a copy of the regulations, contactDHS, Licensing and Certification at (916) 445-3054.Per section 1691, the failure of a physician to inform a patient by meansof written consent, in layperson’s language and in a language understoodby the patient of alternative efficacious methods of treatment which maybe medically viable, when a hysterectomy is to be performed, could leadto the determination of unprofessional conduct.

Reminder: Informed Consent RequiredPrior to Hysterectomy Procedure

CME COURSES:FULFILLING AB 487

MANDATE

Medical Board of California ACTION REPORTPage 10 October 2003

The Medical Board of California established the ExpertReviewer Program in July 1994 as an impartial andprofessional means to support the investigation andenforcement functions of the Board. Specifically, medicalexperts assist the Board by providing expert reviews andopinions on Board cases and conducting professionalcompetency exams.

The rate of payment for expert review services are: $100/hourfor conducting case reviews and $200/hour for providingexpert testimony. Experts also continue to be reimbursed fortravel expenses within the limits imposed by the state.

The program needs additional qualified physicians toparticipate in the vital function of expert reviewer. With newreview requirements in the Board’s Central Complaint Unit,expert reviewers are being called upon to provide additionalservices. The Board will accept applications from allqualified physicians but has a need for experts in thefollowing areas: anesthesia/pain management, addictionmedicine, cardiovascular surgery, cardiology, familypractice, general surgery, internal medicine, neurosurgery,obstetrics/gynecology, ophthalmology (especially with abackground in LASIK or laser surgery), orthopaedicsurgery, neurology, otolaryngology, plastic surgery,psychiatry, radiology (especially with a background inmammogram interpretation), spinal surgery, thoracicsurgery and vascular surgery and any specialty with acomplementary or alternative medicine background.

The requirements for participating in the Board’s programare: a) a current California medical license in good standing;

Call for Expert Reviewersb) no prior discipline, no Accusation pending and nocomplaints closed as “insufficient evidence”; c) board-certified in one of the 24 ABMS boards or equivalent, asdefined in 16 C.C.R. §1363.5 (the Board also recognizescertificates from the American Board of Facial Plastic &Reconstructive Surgery, the American Board of PainMedicine, the American Board of Sleep Medicine and theAmerican Board of Spine Surgery); d) a minimum of threeyears’ active practice in the area of specialty orsubspecialty; and e) have an active practice (defined as atleast 80 hours a month in direct patient care, clinicalactivity, or teaching, at least 40 hours of which is in directpatient care) or have been non-active for no more than twoyears prior to appointment. Peer review experience isrecommended but not required.

If you are interested in providing expert reviewer servicesto the Medical Board or would like more informationregarding the program, please contact:

Victoria Curry, Program AnalystExpert Reviewer ProgramMedical Board of California1426 Howe Avenue, Suite 54Sacramento, CA 95825

Phone: (916) 263-2458 E-mail: vcurry@medbd.ca.gov

You also may access the Medical Board’s Web site atwww.medbd.ca.gov, click on “Services for Licensees,”then click on “Expert Reviewer Program” to obtaininformation and a program application.

Warning for Salmeterol ProductsThe FDA announced the addition of new safety informationand warnings to the labeling for drug products that containsalmeterol, a long-acting bronchodilator used to treatasthma and chronic obstructive pulmonary disease(COPD).

The products affected by these changes are SereventInhalation Aerosol, Serevent Diskus, and Advair Diskus. Thenew labeling includes a boxed warning about a small, butsignificant, increased risk of life-threatening asthma episodesor asthma-related deaths observed in patients taking salmeterolin an extensive, recently completed U.S. safety study.

For more information: www.fda.gov/bbs/topics/ANSWERS/2003/ANS01248.html

Cypher Coronary Stent WarningThe new Cypher coronary drug-eluting stent was approvedin April 2003 for patients undergoing angioplasty

procedures to open clogged coronary arteries. Since theapproval by FDA, about 100,000 patients have received thisstent. A number of stent thrombosis and hypersensitivityreactions have been reported occurring within 30 days ofstenting. The connection between the stent and thethrombotic events is not clear at this time. FDA isevaluating the reports and working with the stentmanufacturer, Cordis Corporation, to analyze the problem.Cordis issued a letter to healthcare professionalsencouraging adherence to labeled indications andinstructions for use. The Cypher stent is indicated forvessels that have not been previously treated, and not forthe treatment of restenosis. It also stresses the importanceof matching the stent size to the vessel size, deploying thestent fully so it’s in contact with the vessel wall, and usingan adequate antiplatelet regimen.For more information: www.fda.gov/bbs/topics/NEWS/2003/NEW00919.html

News From the U.S. Food and Drug Administration

(Continued on page 11)

Medical Board of California1426 Howe Avenue, Suite 54, Sacramento, CA 95825 (916) 263-2389 • www.medbd.ca.gov

Inyo 45Kern 965Kings 122Lake 82Lassen 51Los Angeles 25,599Madera 153Marin 1,465Mariposa 13Mendocino 215Merced 231Modoc 6Mono 25

Alameda 3,882Alpine 0Amador 59Butte 449Calaveras 50Colusa 12Contra Costa 2,569Del Norte 55El Dorado 274Fresno 1,640Glenn 9Humboldt 302Imperial 124

Monterey 855Napa 465Nevada 255Orange 8,065Placer 777Plumas 30Riverside 2,419Sacramento 3,466San Benito 46San Bernardino 3,041San Diego 8,355San Francisco 4,967San Joaquin 880

San Luis Obispo 707San Mateo 2,391Santa Barbara 1,128Santa Clara 5,725Santa Cruz 624Shasta 479Sierra 1Siskiyou 80Solano 710Sonoma 1,322Stanislaus 773Sutter 178Tehama 54

Trinity 10Tulare 484Tuolumne 124Ventura 1,626Yolo 527Yuba 64

California Total89,025

Out of State Total26,329

Current Licenses115,354

CURRENT PHYSICIAN AND SURGEON LICENSES BY COUNTY

2002-2003 ANNUAL REPORT

(Continued on page 2)

In the last fiscal year, the Medical Boardtook many affirmative actions on behalf ofCalifornia healthcare consumers beyondits historical licensing and disciplinaryfunctions.

This has been a proactive and progressiveBoard, looking for ways to improve thelives of patients in this state. A few of themajor activities are summarized below:

Senate Bill 1950

New legislation was enacted in this fiscalyear that permits the Medical Board todisclose, for the first time, certaininformation related to malpracticesettlements by physicians. This significantprovision was part of SB 1950 (Figueroa), acomprehensive bill that affects manyaspects of the Board’s enforcement andinformation-disclosure activities.

The full Board voted in 2002 to makepublic all information it receives aboutsettlements. However, SB 1950 reflects thecompromise worked out in the Legislatureto disclose if a physician has had three or

Executive Summarymore settlements (four for certain high-riskspecialties), beginning in 2003, during a 10-year period. SB 1950 also required theBoard to implement a priority schedule(see page v) so that matters that presentthe greatest threat of patient harm areidentified and investigated expeditiously.

California Physician Corps LoanRepayment Program

This program, created by AB 982(Firebaugh), was co-sponsored by theMedical Board along with the CaliforniaMedical Association, the CaliforniaPrimary Care Association and theCalifornia Latino Healthcare Association,and tackles the ever-increasing problem ofunderserved healthcare consumers in thisstate.

The program encourages recently licensedphysicians to practice in underservedlocations in California by authorizing aplan of repayment of their loans inexchange for their service in designatedareas for a minimum of three years. Amaximum of $105,000 is made available to

awardees, in addition to their salaries asphysicians.

The response to the new program wasoverwhelming, with the Board receivingover 150 applications. The law governingthe program ensures that service isprovided to the most underserved areasin the state. The 32 awardees provideservices in 42 California locations. Thefirst year’s funding of the program camefrom the Medical Board of California,which committed $3 million. However, thelaw permits the program to receivephilanthropic funds to enable itscontinuation after the first year.

The Board is committed to workingdiligently, in the coming year, to securesuch funds that will provide for theexpansion of this vital program.

Ethics Training

Currently, all physicians who aredisciplined for a violation of an ethicalnature must attend an ethics-training

THE MISSION OF THE MEDICAL BOARD OF CALIFORNIAThe mission of the Medical Board of California is to protect healthcare consumers through the proper licensing and regulation of physicians

and surgeons and certain allied healthcare professions and through the vigorous, objective enforcement of the Medical Practice Act.

ii 2002–2003 ANNUAL REPORT Medical Board of California

BUDGET DISTRIBUTION

REVENUES & REIMBURSEMENTS

MEDICAL BOARD OF CALIFORNIA

Physician and Surgeon Renewals79.8%

Application and Initial License Fees 12.3%

Other Regulatory Fees,Delinquency/Penalty/Reinstatement Fees,Interest on Fund,Miscellaneous 3%Physician & Surgeon

Renewals $29,788,000Application and Initial License Fees $4,604,000Reimbursements $1,810,000Other Regulatory Fees,

Delinquency/Penalty/Reinstatement Fees,Interest on Fund,Miscellaneous $1,131,000

Total Receipts $37,333,000

Enforcement Operations $18,150,000Legal & Hearing Services 8,368,000Licensing 2,821,000Information Systems 2,158,000Probation/Operation Safe Medicine 2,148,000Executive 2,131,000Administrative Services 1,796,000Diversion Program 1,037,000

Total $38,609,000

InformationSystems

5.6%

DiversionProgram

2.7%Executive 5.5%

ProbationMonitoring

5.6%

Legal & Hearing Services21.7%

EnforcementOperations

47%

AdministrativeServices

4.6%

Executive Summary (Continued from page 1)

Reimbursements4.9%

course. The Ethics Task Force wasestablished to ensure the training isappropriate to the violation, current withthe times, and responsive to specific typesof ethical violations.

The task force developed criteria for theinclusion/exclusion of participants andidentified a need to tailor the training forthe type of violations. The task force alsohas created a Model Ethics Program. The

model includes two categories: Level Iconsists of a Professionalism Program, andLevel II consists of a psychiatricevaluation and an ethics course.

Licensing7.3%

2002-2003 FISCAL YEAR

iiiMedical Board of California 2002–2003 ANNUAL REPORT

DIVISION OF LICENSINGThe Medical Board of California’s Divisionof Licensing continues to achieve itsmission of protecting the healthcare ofconsumers through the proper licensing ofphysicians and surgeons and certainaffiliated healing arts professionals. As inthe previous fiscal year, it is expected thatupcoming years will continue to challengeus to be more creative, more resourcefuland more efficient to account for ever-diminishing staffing resources duringthese serious economic times. Wecontinue to streamline workload andexplore avenues forimproving the licensingprocesses.

During this reportingperiod, the Division ofLicensing issued a recordhigh of 4,993 newphysician and surgeonlicenses. This brings thecurrent physician andsurgeon licensee countto 115,354.

The Division alsolicensed/certified/registered 245 affiliatedhealing artsprofessionals, includinglicensed midwives,dispensing opticians,contact lens dispensers,non-resident contact lenssellers, spectacle lensdispensers and researchpsychoanalysts.

The time frames for thelicensure of physiciansand surgeons continue tobe reduced and the timeframes for first review ofapplications continue tostay well below our mandated time frames.This is due primarily to the dedication andhard work of the licensing section staffand the receipt of more completeinformation from applicants. Nevertheless,to meet its deadlines during times of heavydemand, the Licensing Program hashistorically used paid overtime to meet itsoperational needs. However, these fundswill not be available this fiscal year, and

production times, the ability to reviewapplications and to respond to physicianand public inquiries, will be impacted.

During a three-month portion of the pastyear, the Consumer Information Unitreduced its operational schedule due tostaffing reductions. It recently returned toa full operational schedule, butcontinuation of that schedule will bedependent upon the availability of supportstaff. To meet the current challenges, wecontinue to consider alternative ways ofdoing business, such as incorporating

additional information onto the Board’sWeb site regarding a number of theprograms for which the Division ofLicensing is responsible. This hasprovided consumers and physicians withuseful information, forms and procedures,thus eliminating some of the more generalquestions that had to be answered by theConsumer Information Unit.

Staff will be working on revisingapplication forms, making better use of theInternet and reviewing its regulatory andlegislative mandates in its attempts tofurther streamline processing so that theimpact of staff reductions will beminimized. The priority of this Division willcontinue to be the licensing and licenserenewal of physicians and surgeons.

The newest licensing pathway authorizedunder Section 2135.5 of the Business andProfessions Code has successfullyallowed us to expeditiously license 32

physicians, whoseapplications mighthave otherwise takenmany more months ofprocessing timeawaiting theverification ofqualifications. Section2135.5 allows theDivision to determinesatisfaction of medicalcurriculum and clinicalinstructionrequirements whenthe applicant meetscertain definedcriteria, including butnot limited to,licensure in anotherstate and ABMScertification.

The LicensingProgram also finalizeda new process toexpedite the approvalof special programapplicants inpostgraduate study,fellowship programsand faculty positions.Staff now processes

these applicants who meet all of theconditions for appointment in thesespecial programs on a monthly rather thanquarterly basis, and limits the Division ofLicensing’s review to only thosecandidates who require determinationrelated to appointment criteria. Previouslyall applicants were brought to the Divisionof Licensing and therefore were approvedonly on a quarterly basis.

AFFILIATED HEALING ARTS

1 Non-resident contact lens seller formerly wasreported within the Dispensing Optician category.

2002–2003 Licenses

ISSUED CURRENT

Licensed Midwife 12 121Dispensing Optician 57 1,095Contact Lens Dispenser 18 436Non-Resident Contact Lens Seller1 1 12Spectacle Lens Dispenser 152 1,802Research Psychoanalyst 5 75Accrediting Agencies for

Outpatient Settings 0 4Podiatrist 71 2,045

iv 2002–2003 ANNUAL REPORT Medical Board of California

LICENSE STATUS VERIFICATIONS

Phone verifications 103,260 77,925Written verifications 2,897 1,103Authorized LVS Internet users1 934 1,003Online LVS access verifications 659,689 708,344Non-verification telephone calls 63,511 53,571

Certification Letters andLetters of Good Standing 7,297 5,879

DIVISION OF LICENSING ACTIVITY

LICENSING ENFORCEMENT ACTIVITYProbationary license granted 9 10License denied (no hearing requested) 8 2Statement of Issues to deny license filed 6 3Statement of Issues granted (license denied) 1 2Statement of Issues denied (license granted) 4 4Statement of Issues withdrawn 1 1

1 FLEX = Federation Licensing ExamUSMLE = United States Medical Licensing Exam

NBME = National Board Medical Exam2 Includes physicians with disabled, inactive, retired, military, orvoluntary service license status.

3 Includes Medical Board of California and Board of PodiatricMedicine.

4 Medical Board of California only.

PHYSICIAN LICENSES ISSUEDFLEX/USMLE1 4,110 4,158NBME1 506 478Reciprocity with other states 304 357Total new licenses issued 4,920 4,993Renewal licenses issued—with fee 49,053 49,647Renewal licenses—fee exempt2 4,933 4,756Total licenses renewed 53,986 54,403PHYSICIAN LICENSES IN EFFECTCalifornia address 86,934 89,025Out-of-state address 25,339 26,329Total 112,273 115,354

REPORTS TO MEDICAL BOARDDisciplinary reports mailed to healthfacilities upon written requestpursuant to B&P Code §805.5 271 374Adverse Actions reported to the NPDB2 5633 5264

NPDB reports received from insurancecompanies or self-insured individuals/organizations 907 820B&P Code §805 reports of healthfacility discipline received 1555 1736

1 LVS = Licensing Verification System2 NPDB = National Practitioner Data Bank3 Includes 531 MDs, 11 podiatrists, and 21 physician assistants.4 Includes 498 MDs, 14 podiatrists, and 14 physician assistants.5 Includes 151 MDs, 2 podiatrists and 2 psychologists.6 Includes 162 MDs, 5 podiatrists, 5 psychologists and 1 physician

assistant.

FY FY01-02 02-03

VERIFICATION & REPORTING ACTIVITY SUMMARYFY FY

01-02 02-03FY FY

01-02 02-03

FY FY01-02 02-03

SPECIAL FACULTY PERMITSPermits issued 1 1License exemptions renewed 2 3Total active exemption 5 6

FICTITIOUS NAME PERMITSIssued3 1,003 930Renewed4 3,505 3,508Total number of permits in effect4 8,692 8,910

The Annual Report also is available in the“Publications” section of the Medical Board’s Website: www.medbd.ca.gov. For additional copies of thisreport, please fax your company name, address,telephone number and contact person name to theMedical Board’s Executive Office at (916) 263-2387, or mail your request to 1426 Howe Avenue,Suite 54, Sacramento, CA 95825.

vMedical Board of California 2002–2003 ANNUAL REPORT

2 Prior-year activities received after the close ofthe fiscal year should have been reflected inthe 01-02 year.

3 Deaths occurred prior to successfullycompleting the program

4 Applicants are participants who either (1)have not been seen by a DiversionEvaluation Committee or (2) have not yetsigned a Diversion Agreement.

5 Other Applicants are those individuals whocontacted the program during the fiscal yearbut either declined (23) to enter the programor were ineligible (5).

Activity1

FY 01-02 FY 02-03Beginning of fiscal year 273 269Prior year adjustments2 3Accepted into program 52 47Completions: Successful 46 38 Unsuccessful 10 10Deceased3 3Active at end of year 269 262

Other ActivityApplicants4 53 43Other Applicants5 28Out-of-state-monitoredCalifornia licentiates 11 15Completions: Successful 4 0 Unsuccessful 2 0Total monitored at end of FY 02-03 348Total monitored during FY 02-03 399

DIVERSION PROGRAM

DIVISION OF MEDICAL QUALITY

Type of Impairment1

FY 02-03 %Alcohol 48 18Alcohol & mental illness 29 11Other drugs 76 29Other drugs & mental illness 36 14Alcohol & other drugs 34 13Alcohol & other drugs & mental illness 31 12Mental illness 8 3Total 262 100%

The Diversion Program is a statewide, five-year monitoring and rehabilitation program.It is administered by the Medical Board ofCalifornia to support and monitor therecovery of physicians who have substanceabuse or mental health disorders.

The Diversion Program was created bystatute in 1980 as a cost-effectivealternative to discipline by the MedicalBoard. Diversion promotes public safety byencouraging physicians to seek earlyassistance for substance-abuse andmental-health disorders in order to avoidjeopardizing patient safety.

Physicians enter the Diversion Program byone of three avenues. First, physicians mayself-refer. This is often the result ofencouragement by concerned colleagues orfamily members who want the physician toseek help. Second, physicians may bereferred by the Enforcement Program in lieuof pursuing disciplinary action. Finally,physicians may be directed to participateby the Board as part of a disciplinary order.

During the FY 02/03, 47 physicians wereaccepted into the program by the DiversionEvaluation Committee, signed a formalDiversion Agreement, and entered theprogram. Of those, 41 physicians had noopen cases with the Board, four physicians

were diverted from discipline, and anadditional two physicians entered as aresult of disciplinary orders.

During FY 02/03, the Diversion Programmonitored a total of 399 physicians. Of the

51 who left the program, three aredeceased and 10 were unsuccessful, while38 successfully completed five years, witha minimum of three years of continuoussobriety and a change in lifestyle thatwould support ongoing recovery.

The Board’s mission of public protectionprompted thoughtful assessment of howthe Board processes incoming complaints.This past year, the Board’s CentralComplaint Unit was reorganized into twosections to assure quality of care casesreceive the highest priority and level ofreview. One section is the Quality of CareSection, and is responsible for reviewingcomplaints that may directly relate topatient harm caused by providernegligence or incompetence. The othersection is the Physician Conduct andAffiliated Healing Arts Section, and isresponsible for cases involvingprofessional misconduct, technicalviolations and Affiliated Healing Artscases. Although these cases may beserious, they do not pose an immediatedanger to the health and safety of patients.This new design has resulted in a moretimely review of quality of care cases andmore education for the physician on casesinvolving non-quality of care and technicalviolations.

SB 1950 (Figueroa) was a major piece oflegislation for the Board and becameeffective Jan. 1, 2003. It affected a numberof areas of operation at the Board andimpacted many sections of the MedicalPractice Act, which governs the medicalprofession. The new law added two publicmembers to the Division of MedicalQuality and called for the appointment ofan Enforcement Monitor to review theoperations of the Enforcement Program. Italso added new information aboutphysicians for disclosure on the Board’sWeb site, e.g., physicians’ medicalspeciality certifications and certainmalpractice settlements. The penalty whichcan be imposed for criminal violations ofunlicensed practice was increased.Complaints involving quality of care mustnow receive an initial review by a medicalexpert in the same field of practice as theissues raised in the complaint. For the firsttime, investigative priorities of the Boardare reflected in statute: 1) negligence/incompetence resulting in serious bodily

injury or death; 2) substance abuse duringpractice resulting in patient injury; 3)excessive prescribing or prescribingwithout a good faith exam; 4) sexualmisconduct during treatment; and 5)practicing while under the influence ofalcohol/drugs. Many of the provisions ofthis law have been implemented; however,to achieve full compliance, Board staffcontinues to make program changes.

The hiring freeze, which affected all stateagencies, prevented replacement ofinvestigative staff who retired or left theBoard. This reduction is reflected in the fewernumber of investigations opened. The CentralCompliant Unit’s careful analysis of incomingcomplaints has assisted in reducing thisnumber, while ensuring other appropriateactions are taken, such as citations and finesand advisory letters. Budgetary constraintswill continue to place limitations on theBoard’s resources; however, staff willcontinue to seek efficient methods to processthe work received, being ever mindful of theBoard’s public protection mission.

1 Does not include applicant or out-of-stateparticipant data.

vi 2002–2003 ANNUAL REPORT Medical Board of California

FY 01-02 FY 02-03COMPLAINTS/INVESTIGATIONS1

Complaints Received 11,218 11,556Complaints Closed

by Complaint Unit 9,477 8,859Investigations

Cases Opened 2,608 2,138Cases Closed 2,449 2,361Cases referred to the Attorney General (AG) 589 494Cases referred for criminal action 82 47

Number of probation violationreports referred to the AG 27 12

Consumer inquiries 57,112Jurisdictional inquiries 31,412Complaint forms sent 12,565Complaint forms returned by consumers 4,398

Average and median time (calendar days) inprocessing complaints during the fiscal year, forall cases, from date of original receipt of thecomplaint, for each stage of discipline, throughcompletion of judicial review:

FY 01-02 FY 02-03 Avg. Median Avg. Median1. Complaint Unit Processing 58 32 53 272. Investigation 198 153 208 1833. AG Processing

to preparationof an Accusation 103 64 91 57

4. Other stages of the legal process (e.g.,

after charges filed) 437 364 471 410

Enforcement Field Operations Caseload Per

Statewide InvestigatorActive Investigations 1,251 21AG Assigned Cases2 608 10

Probation Unit CaseloadMonitoring Cases3 516 40Active Investigations 73 6AG Assigned Cases2 39 n/a4

1 Some cases closed were opened in a prior fiscal year.2 These cases are at various stages of AG processing

and may require supplemental investigative work,such as subpoena service, interviewing new victims orwitnesses, testifying at hearings, etc.

3 135 additional monitoring cases were inactivebecause the probationer was out of state as ofJune 30, 2003.

4 For Probation Unit caseload, the AG Assigned Casesare included as Monitoring Cases.

REPORTS RECEIVED BASED UPON LEGAL REQUIREMENTS

FY 01-02 FY 02-03MEDICAL MALPRACTICE

Insurers: B&P Code §§801 & 801.1 872 872Attorneys or Self-Reported or EmployersB&P Code §§801(e), 802 & 803.2 313 281Courts: B&P Code §803 30 16Total Malpractice Reports 1,215 1,169CORONERS’ REPORTS

B&P Code §802.5 38 24CRIMINAL CHARGES & CONVICTIONS

B&P Code §§802.1 & 803.5 38 24HEALTH FACILITY DISCIPLINE

Medical Cause or ReasonB&P Code §805 151 162OUTPATIENT SURGERY SETTINGS REPORTS

Patient DeathB&P Code §2240(a) 12 6

Tota

l

Public 243 225 1,194 4,800 6 18 1,267 79 7,832B&P Code6 0 4 1 1,284 1 32 63 0 1,385Licensee/Prof. Group7 22 27 48 50 1 11 97 39 295Govt. Agency8 27 64 41 288 50 360 843 64 1,737Anonymous/Misc. 36 38 33 35 0 25 97 43 307Totals 328 358 1,317 6,457 58 446 2,367 225 11,5561 Health and Safety complaints include inappropriate prescribing, sale of dangerous

drugs, etc.2 Non-jurisdictional complaints are not under the authority of the Board and are referred

to other agencies such as the Department of Health Services, Department of ManagedHealth Care, etc.

3 Competence/Negligence complaints are related to the quality of care provided bylicensees.

4 Personal Conduct complaints include licensee self-use of drugs/alcohol, conviction ofa crime, etc.

5 Unprofessional Conduct complaints include sexual misconduct with patients, disciplineby another state, failure to release medical records, etc.

6 Reference is to B&P Code sections 800 and 2240(a) and includes complaints initiatedbased upon reports submitted to the Medical Board by hospitals, insurance companiesand others, as required by law, regarding instances of health facility discipline,malpractice judgments/settlements, or other reportable activities.

7 “Professional Group” includes the following complaint sources: Other Licensee,Society/Trade Organization, and Industry.

8 “Governmental Agency” includes the following complaint sources: Internal, LawEnforcement Agency, Other California State Agency, Other State, Other Unit ofConsumer Affairs, and Federal or Other Governmental Agency.

COMPLAINTS RECEIVED BY TYPE & SOURCE

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Non

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Com

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Neg

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Oth

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Pers

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Con

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Unp

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Con

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Unl

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Unr

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Hea

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Saf

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1

34 5

2

DIVISION OF MEDICAL QUALITY ACTION SUMMARYPHYSICIANS & SURGEONS

viiMedical Board of California 2002–2003 ANNUAL REPORT

Negligence 7 29 (1)7 0 12 45 0 25 17 135 (1)Inappropriate Prescribing 6 7 0 2 4 0 4 2 25

Unlicensed Activity 2 1 0 1 0 0 3 1 8Sexual Misconduct 4 8 0 2 5 0 1 0 20

Mental Illness 4 8 2 1 3 3 0 4 25Self-Use of Drugs/Alcohol 7 5 2 0 8 2 1 2 27

Fraud 1 (1) 4 0 4 3 0 2 0 (1) 14 (2)Conviction of a Crime 4 2 0 3 3 0 0 0 12

Unprofessional Conduct 5 3 0 2 5 (1) 5 22 4 (1) 46 (2)Miscellaneous Violations 0 0 0 0 11 0 0 0 11

Totals by Discipline Type 40 (1) 67 (1) 4 27 87 (1) 10 58 30 (2) 323 (5)

Revocation Surrender Suspension Probation Probation Probationary Public Other TotalOnly With License Reprimand Action Actions by

Suspension Issued Case Type

1 Accusations withdrawn for the following reasons: physician passed a competency exam; physician was issued a citation/fine instead; physician died; etc.2 Diversion Program referrals are made pursuant to B&P Code section 2350(b).3 Penalty Relief includes Petitions for Modification and/or Termination of Probation.4 Per B&P Code section 2220.05(c), ISOs were granted in the following priority categories: 2 - excessive prescribing, 2 - sexual misconduct with a patient,

and 3 - practicing under the influence of drugs/alcohol.5 Includes 7 Automatic Suspension Orders per B&P Code section 2236.1, 8 license restrictions per Penal Code section 23, 8 out-of-state suspension orders

per B&P Code section 2310, and 5 stipulated agreements to suspend or restrict the practice of medicine.6 These actions were taken on complaints received prior to the enactment of B&P Code 2220.05, therefore, the priority category is not available for these

administrative outcomes.7 Figures in parentheses represent action taken by the Division of Licensing against dispensing opticians, research psychoanalysts, and licensed midwives.

DIVISION OF MEDICAL QUALITY ACTION SUMMARY FY 01-02 FY 02-03

ADMINISTRATIVE ACTIONSAccusation 329 258Petition to Revoke Probation 21 18Number of completed investigations referred to the Attorney General’s Office awaiting the filing of an Accusation as of June 30 138 115

ADMINISTRATIVE OUTCOMESRevocation 38 40Surrender (in lieu of Accusation or with Accusation pending) 47 67Suspension Only 6 4Probation with Suspension 19 27Probation 69 87Probationary License Issued 9 10Public Reprimand 52 58Other Actions (e.g., exam required, education course, etc.) 21 30Accusation Withdrawn1 32 35Accusation Dismissed 16 10Dispositions of Probation Filings

Additional Suspension or Probation 9 5Probation Revoked or License Surrendered 16 9Other Decisions 3 0Petition Withdrawn/Dismissed 1 2

REFERRAL AND COMPLIANCE ACTIONSCitation and Administrative Fines Issued 520 532Physicians Referred to Diversion Program2 27 28

FY 01-02 FY 02-03PETITION ACTIVITYPetition for Reinstatement of license filed 10 15Petition for Reinstatement of license granted 7 13Petition for Reinstatement of license denied 7 5Petition for Penalty Relief 3 granted 20 18Petition for Penalty Relief 3 denied 7 16Petition to Compel Exam filed 16 16Petition to Compel Exam granted 18 16Petition to Compel Exam denied 0 0

LICENSE RESTRICTIONS/SUSPENSIONS IMPOSED

WHILE ADMINISTRATIVE ACTION IS PENDINGInterim Suspension Orders4 23 12Temporary Restraining Orders 3 0Other Suspension Orders 40 285

NOTE: Some orders granted were sought in prior fiscal year.

License Restrictions/Suspensions/Temporary RestrainingOrders Sought and Granted by Case Type in FY 02-03

Orders Sought Orders GrantedCriminal Charges/Conviction of a Crime 3 4Drug Prescribing Violations 5 5Fraud 1 3Gross Negligence/Incompetence 3 3Mental/Physical Illness 6 5Self-Abuse of Drugs or Alcohol 7 9Sexual Misconduct 11 9Unlicensed Activity 1 2Unprofessional Conduct 1 0Total 38 40

Administrative Outcomes by Case Type in FY 02-036

viii 2002–2003 ANNUAL REPORT Medical Board of California

FY 01-02 FY 02-03COMPLAINTS/INVESTIGATIONSComplaints Received 1,046 1,138Complaints Closed by Complaint Unit 747 819Investigations: Cases Opened 347 226 Cases Closed 328 314

Cases referred to the AG 100 89Cases referred for criminal action 17 4

Number of Probation Violation Reports referred to AG 4 4LICENSE RESTRICTIONS/SUSPENSIONS IMPOSED

WHILE ADMINISTRATIVE ACTION IS PENDINGInterim Suspension Orders 1 4Other Suspension Orders2 3 0ADMINISTRATIVE ACTIONSAccusation 30 30Petition to Revoke Probation 4 2Statement of Issues to deny application 5 3Number of completed investigations referred to AG awaiting the filing of an Accusation as of June 30 16 14ADMINISTRATIVE OUTCOMESRevocation 2 6Surrender (in lieu of Accusation or with Accusation pending) 2 8Probation with Suspension 4 4Probation 13 17Public Reprimand 2 0Other Actions (e.g., exam required, education course) 2 2Statement of Issues Granted (License Denied) 4 1Statement of Issues Denied (License Granted) 2 4Accusation/Statement of Issues Withdrawn 3 2Accusation Dismissed 1 0Disposition of Probation Filings

Additional Suspension or Probation 1 1Probation Revoked or License Surrendered 1 1Petition Withdrawn/Dismissed 0 0

REFERRAL AND COMPLIANCE ACTIONSCitation and Administrative Fines Issued 20 14Office Conferences Conducted 5 2

Ronald H. Wender, M.D., PresidentLorie G. Rice, M.P.H., Vice PresidentRonald L. Morton, M.D., SecretarySteve AlexanderRudy BermúdezWilliam S. Breall, M.D.

Catherine T. Campisi, Ph.D.Hazem H. Chehabi, M.D.Jose FernandezLinda LucksArthur E. Lyons, M.D.Mary C. McDevitt, M.D.Ronald L. Moy, M.D.Steven B. Rubins, M.D.

MEDICAL BOARD OF CALIFORNIADivision of LicensingOfficers Division of Medical Quality

Hazem H. Chehabi, M.D., PresidentMitchell S. Karlan, M.D., Vice PresidentRonald H. Wender, M.D., Secretary

Mitchell S. Karlan, M.D., PresidentJames A. Bolton, Ph.D., M.F.T., Vice PresidentRichard D. Fantozzi, M.D., SecretaryBernard S. Alpert, M.D.Donna GerberGary Gitnick, M.D.Salma Haider

REPORTS RECEIVEDBASED UPON LEGAL REQUIREMENTS

FY 01-02 FY 02-03MEDICAL MALPRACTICEInsurersB&P Code §§801 & 801.1 14 13Attorneys or Self-Reported or EmployersB&P Code §§801(e), 802 & 803.2 9 5CourtsB&P Code §803 4 1Total Malpractice Reports 27 19

CORONERS’ REPORTSB&P Code §802.5 0 0

CRIMINAL CHARGES & CONVICTIONSB&P Code §803.5 3 0

HEALTH FACILITY DISCIPLINEMedical Cause or ReasonB&P Code §805 4 11

OUTPATIENT SURGERY SETTINGS REPORTPatient DeathB&P Code §2240(a) 0 0

1 This data includes podiatrists, physician assistants, researchpsychoanalysts, dispensing opticians and licensed midwives. With theexception of the categories of complaints and investigations, the figures donot include psychologists.

2 Includes Automatic Suspension Orders per B&P Code section 2236.1 andlicense restrictions per Penal Code section 23.

3 Penalty Relief includes Petitions for Modification and/or Termination ofProbation.

FY 01-02 FY 02-03PETITION ACTIVITYPetition for Reinstatement of license filed 3 0Petition for Reinstatement of license granted 1 0Petition for Reinstatement of license denied 1 2Petition for Penalty Relief 3 granted 1 0Petition for Penalty Relief 3 denied 1 1Petition to Compel Exam granted 0 4Petition to Compel Exam denied 0 4

ENFORCEMENT ACTION SUMMARY FOR AFFILIATED HEALING ARTS 1

Medical Board of California ACTION REPORTOctober 2003 Page 11

Physician assistants (PAs) have been licensed in Californiafor almost 30 years. PAs are healthcare professionals whohave completed a rigorous, nationally accredited trainingprogram, passed a national written examination, and arelicensed to practice medicine under physician supervision.

HistoryIn 1965, primary care physicians were in short supply,particularly in rural and inner city areas. In an effort toaugment scarce medical supply, Dr. Eugene Stead of DukeUniversity created the PA concept and established its firsttraining program. He believed that under the supervision ofa physician, PAs could safely and effectively provideservices previously provided solely by physicians. He wasaccurate in his vision. Today there are more than 46,000physician assistants licensed nationwide. In California thereare more than 5,000 licensed PAs. PAs practice withphysician supervision in all areas of medicine. They practicein the areas of primary care medicine—including familymedicine, internal medicine, pediatrics, and obstetrics andgynecology—as well as in surgery and the surgicalsubspecialties.

Education and LicensureTo be licensed in California, a PA must attend a physicianassistant training program associated with a medical school,and the curriculum must include both classroom studiesand clinical experience. An academic degree and/orcertificate is awarded upon graduation. Many PAs have twoor four-year academic degrees before entering a PA trainingprogram. Most PA training programs require priorhealthcare experience (e.g., medical assistant, emergencymedical technician, registered nurse, etc.).

After completing their training, PAs must pass a rigorousnational written examination to complete the licensingprocess and obtain a license to practice from the PhysicianAssistant Committee (PAC).

What is a PA?Supervision, Scope of Practice,

and Drug OrdersPAs cannot practice independently. Every PA must besupervised by a licensed physician. The physiciansupervises the PA either when both are at the same locationor by electronic means (e.g., telephone). The supervisingphysician must always be available. The supervisingphysician is responsible for following each patient’sprogress. Generally, physicians may supervise two PAs atany one time. In state-designated medically underservedareas, they may supervise up to four PAs at any one time.To determine if a practice area is designated as medicallyunderserved, please contact the Physician AssistantCommittee at (916) 263-2670.

The PA’s practice is defined by their supervising physician.Whatever medical specialty a physician practices (e.g.,general practice, cardio-thoracic surgery, dermatology, etc.)defines the PA’s practice. A Delegation of ServicesAgreement between the PA and his or her supervisingphysician defines exactly what tasks and procedures aphysician is delegating to the PA. These tasks andprocedures must be consistent with the supervisingphysician’s specialty or usual and customary practice andwith the patient’s health and condition. Copies of theDelegation of Services forms may be found on the PACWeb site: www.physicianassistant.ca.gov.

If it is part of a supervising physician’s practice and thesupervising physician delegates the authority, a PA mayissue drug orders to patients. PAs must obtain their ownDEA Certificate when authorized by their supervisingphysician to issue drug orders for Schedule II-Vmedications.

Additional InformationAdditional information can be found on the PAC Web site,www.physicianassistant.ca.gov, or by calling the PhysicianAssistant Committee at (916) 263-2670.

New Regulation to SpeedAccess to Lower Cost

Generic DrugsOn August 18, 2003 FDA implementeda final rule to speed the approval ofgeneric drugs. Billions of dollars inhealthcare savings for consumers are

anticipated. The final rule will limit thenumber of automatic 30-month staysthat may delay generic drug availabilityand prevent drug companies fromsubmitting certain new patent claimsthat are unlikely to representsubstantial new innovation in order to

extend their marketing protection. FDAwill continue to make the generic drugapproval process more efficient withthe goal of lowering national healthcarecosts by reducing the cost of bringingsafe and effective generic drugs tomarket.

News From the U.S. Food and Drug Administration (continued from page 10)

Medical Board of California ACTION REPORTPage 12 October 2003

“Effective date of decision” —Example: “June 10, 2003” at the bottomof the summary means the date thedisciplinary decision goes into operation.

“Gross negligence” — An extremedeviation from the standard of practice.

“Incompetence” — Lack of knowledgeor skills in discharging professionalobligations.

“Judicial review is being pursued” —The disciplinary decision is beingchallenged through the court system—Superior Court, maybe Court of Appeal,maybe State Supreme Court. Thediscipline is currently in effect.

“Probationary License” — Aconditional license issued to an applicanton probationary terms and conditions.This is done when good cause exists fordenial of the license application.

as the licensee complies with specifiedprobationary terms and conditions,which, in this example, includes 60 daysactual suspension from practice.Violation of probation may result in therevocation that was postponed.

“Stipulated Decision” — A form ofplea bargaining. The case is negotiatedand settled prior to trial.

“Surrender” — Resignation under acloud. While charges are pending, thelicensee turns in the license — subject toacceptance by the relevant board.

“Suspension from practice” — Thelicensee is prohibited from practicing fora specific period of time.

“Temporary Restraining Order” —A TRO is issued by a Superior CourtJudge to halt practice immediately.When issued by an Administrative LawJudge, it is called an ISO (InterimSuspension Order).

“Probationary Terms and Conditions” —Examples: Complete a clinical trainingprogram. Take educational courses inspecified subjects. Take a course in Ethics.Pass an oral clinical exam. Abstain fromalcohol and drugs. Undergo psychotherapyor medical treatment. Surrender your DEAdrug permit. Provide free services to acommunity facility.

“Public Letter of Reprimand” — A lesserform of discipline that can be negotiated forminor violations before the filing of formalcharges (accusations). The licensee isdisciplined in the form of a public letter.

“Revoked” — The license is canceled,voided, annulled, rescinded. The right topractice is ended.

“Revoked, stayed, 5 years probation onterms and conditions, including 60 dayssuspension” — “Stayed” means therevocation is postponed, put off.Professional practice may continue so long

Explanation of Disciplinary Language and Actions

ADMINISTRATIVE ACTIONS: May 1, 2003 to July 31, 2003PHYSICIANS AND SURGEONS

ACADEMIA, HERMINIO, SAMONTE, JR., M.D.(A31404) Moreno Valley, CAB&P Code §§2234, 2264, 2285, 3502.1. StipulatedDecision. Failed to properly supervise a physicianassistant and rendered care under a fictitious namewithout first obtaining a fictitious name permit. PublicReprimand. June 5, 2003

AHADDIAN, SOHEIL, M.D. (A47732)Beverly Hills, CAB&P Code §§726, 2234(b). Committed acts ofsexual abuse and misconduct, gross negligence andunprofessional conduct in the care and treatment of1 patient. Revoked, stayed, 7 years probation withterms and conditions. June 16, 2003. Judicial reviewbeing pursued.

AITKEN, PHIL ALLEN, M.D. (C34652)Burlington, VTB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Vermont for violation of professionalboundaries with a patient in both 2001 and 2002.Revoked, stayed, 5 years probation with terms andconditions. July 23, 2003

AMIDON, PHILLIP BAILEY, M.D. (C51227)Loma Linda, CAB&P Code §§480(a)(1), 2239. Convicted twice fordriving under the influence in Maine. License denied,stayed, granted, 5 years probation with terms andconditions. June 19, 2003

ANGTUACO, ERNESTO VIRGILIO, M.D. (A37196)Canfield, OHB&P Code §§141(a), 2305. Entered into anagreement with Ohio Medical Board to place his Ohiomedical license in inactive status due to a conditionaffecting his ability to practice medicine. Revoked.June 6, 2003

BALL, CRAIG JAMES, M.D. (G38467)Palm Desert, CAB&P Code §2234(c). Stipulated Decision. Committedacts of repeated negligence by failing to discuss withthe anesthesiologist the potential flammability of anET tube, associated equipment, and the oxygenmixture used by an anesthesiologist during alaryngeal laser surgery, with the failure to changesuch equipment resulting in harm to a patient.Revoked, stayed, 7 years probation with terms andconditions. June 2, 2003

Medical Board of California ACTION REPORTOctober 2003 Page 13

BAUMER, NAT BRYAN, M.D. (G38391)Fort Worth, TXB&P Code §141(a). Stipulated Decision. Disciplinedby Texas for his failure to provide adequatedocumentation and ensure adequate follow-up carefor emergency patients. Revoked, stayed, 3 yearsprobation with terms and conditions. July 30, 2003

BLOOMSTEIN, MICHAEL STEPHEN, M.D.(G27508) Walnut Creek, CAB&P Code §2234. Stipulated Decision. Committedunprofessional conduct in the care and treatment of 1patient resulting in postsurgical complications. PublicReprimand. July 21, 2003

BOLDUAN, JEFFREY PATRICK, M.D. (A36477)Goshen, INB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Indiana for failing to exercisereasonable care in the treatment of a patient. PublicReprimand. July 2, 2003

BOWER, ANDREA, M.D. (G36954) Escondido, CAB&P Code §§822, 2234(e), 2238, 2239. StipulatedDecision. Inappropriate self-use of drugs (Demerol),resulting in a condition affecting competency.Suspended indefinitely from practicing medicine untilthe Board receives competent evidence of theabsence or control of a condition affectingcompetency. Suspended. May 5, 2003

CALLISTER, DAVID R., M.D. (G10828)Glendale, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with gross negligence, repeatednegligence, and incompetence in the care andtreatment of 1 patient. License restricted effective July31, 2003 until December 31, 2003, then placed ininactive status.

CARROLL, JAMES F., M.D. (A25507)Healdsburg, CAB&P Code §2234. Stipulated Decision. Failed to enterprogress notes for an in-patient for 2 days, includingfailure to document in sufficient detail the patient’scondition, care and treatment, or discussions with thepatient and family concerning discharge. Public Letterof Reprimand. May 15, 2003

CARUSO, ALFRED L., M.D. (A20990)Rancho Santa Fe, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with gross negligence, repeatednegligence, incompetence, excessive treatment,failure to maintain adequate and accurate medicalrecords, practicing under a false name, anddishonesty in the care and treatment of 5 patients.

Revoked, stayed, 5 years probation with terms andconditions including 30 days actual suspension.July 7, 2003

CHARLAP, ROBERT STEVEN, M.D. (G85076)Studio City, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with gross negligence, repeatednegligent acts, incompetence, failure to maintainadequate and accurate medical records, dishonestyor corruption, and providing false statements indocuments during the performance or interpretationof nerve conduction studies or somatosensoryevoked potentials (neuro diagnostics) in the care andtreatment of 7 patients. Revoked, stayed, 3 yearsprobation with terms and conditions. June 12, 2003

CRANE, PAUL HAROLD, M.D. (C32748)Beverly Hills, CAB&P Code §2266. Stipulated Decision. Failed tomaintain adequate and accurate medical records ofhis care and treatment of 4 obstetrical patients duringthe delivery of their infants. Public Reprimand.June 2, 2003DILSAVER, STEVEN CHARLES, M.D.(No license issued yet) Rio Grande City, TXB&P Code §§480(a)(3), 2234. Stipulated Decision.Diagnosed with a chronic condition which could impairhis ability to practice medicine. Probationary licenseapproved, 10 years probation with terms andconditions. July 11, 2003DYE, RICHARD BERRY, M.D. (A56198)Half Moon Bay, CAB&P Code §§480(c), 726, 2081, 2234(a)(b)(c)(e)(f),2235, 2261, 2263. Committed acts of sexual abuseand misconduct with 9 patients, gross negligence,repeated negligence, dishonesty and corruption,conduct warranting denial of a license, and providedfalse information on his license renewal. Revoked.May 5, 2003EDLES, ANTONIO, M.D. (A41140) Long Beach, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with repeated negligence, excessiveprescribing or treatment, unprofessional conduct, andfailure to maintain adequate and accurate medicalrecords in the care and treatment of 3 patients.Revoked, stayed, 4 years probation with terms andconditions. June 2, 2003FERNBACH, LOUISE OFTEDAL, M.D. (G1649)Charlottesville, VAB&P Code §§141(a), 2305. Disciplined by Virginiaresulting in a surrender of her Virginia license forwriting a prescription using another physician’s name.Revoked. May 1, 2003

Medical Board of California ACTION REPORTPage 14 October 2003

FIELD, MORTON, H., M.D. (C20421)Beverly Hills, CAB&P Code §2234. Failed to report treatment ofalleged accidental gunshot wound or injury pursuantto PC 11160. Public Letter of Reprimand.May 12, 2003

FITZPATRICK, DALE WALTER, M.D. (G65940)Modesto, CAB&P Code §726. Stipulated Decision. Engaged insexual misconduct in the care and treatment of 1patient. Revoked, stayed, 5 years probation withterms and conditions including 30 days actualsuspension. July 1, 2003

FREEDLANDER, DEAN G., M.D. (G35487)Morgan Hill, CAB&P Code §2236(a). Stipulated Decision. Convictedof a misdemeanor for child endangerment related tothe care and treatment of 1 patient. Revoked, stayed,5 years probation with terms and conditions.July 2, 2003

GILPIN, EUGENE L., M.D. (A21664) Fresno, CAB&P Code §2234(c). Stipulated Decision. Committedrepeated negligent acts for his interpretations of thescreening mammograms taken in the care andtreatment of 5 patients. Public Reprimand.May 28, 2003

GRISWOLD, ALEXANDER V., M.D. (C9521)Brea, CAB&P Code §§822, 2234(d). Unable to practicemedicine safely due to physical illness affectingcompetency. Revoked. July 23, 2003

HUFF, MICHAEL BORCHARD, M.D. (A34873)Oxnard, CAB&P Code §§725, 2234, 2242, 4172. StipulatedDecision. Excessively prescribed Oxycontin, Norco,and Methadone to 5 patients; prescribed Vicodin to apatient without a good faith examination; and failed tostore Dilaudid in a secure area. Revoked, stayed, 7years probation with terms and conditions including 9months actual suspension. July 7, 2003

JINICH, DANIEL BROOK, M.D. (A37512)Fort Collins, COB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Colorado for engaging in a consensualintimate relationship with a staff member who was alsohis patient. Public Reprimand. May 15, 2003

KANNAPPAN, TILLAIKARASI, M.D. (A52211)Bakersfield, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with gross negligence and incompetencein the care and treatment of 1 patient during delivery

by failing to recognize fetal distress and failing to takeappropriate action, resulting in the baby sufferingsevere neurologic damage. Public Reprimand.July 18, 2003

KAPPELER, THOMAS ROBERT, M.D. (C34424)Los Angeles, CAB&P Code §§490, 2234, 2236(a), 2239(a). Convictedfor driving under the influence of alcohol or drugs,and convicted on 2 occasions for driving while havinga .08% or higher blood alcohol level. 30 dayssuspension, stayed, 4 years probation with terms andconditions. June 13, 2003

KEENE, JOSEPH WILEY, M.D. (A84228)Sacramento, CAB&P Code §§480(a)(1)(3), 2239. Stipulated Decision.Applicant for licensure with the Medical Board ofCalifornia has 1 conviction for driving under theinfluence of alcohol or drugs and a history ofsubstance abuse and alcohol dependence.Probationary license issued, 5 years probation withterms and conditions. July 25, 2003

KHAN, SANA ULLAH, M.D. (G79841)Anaheim Hills, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with dishonesty and excessive treatment,failure to maintain adequate and accurate medicalrecords, creating false and fraudulent medicalrecords, insurance fraud, practicing under a fictitiousname without a permit, and unprofessional conduct inthe care and treatment of 2 patients. Revoked,stayed, 3 years probation with terms and conditions.July 18, 2003

KOCH, KENNETH K., M.D. (C27415) Camarillo, CAB&P Code §2234. No admissions but charged withgross negligence, repeated negligence andincompetence in the care and treatment of 2 patientsby failing to respond to the emergency room afterbeing informed of 1 patient’s bone fracture and failingto personally evaluate and treat the patient’s injury;and performing an inadequate surgical procedure inthe care and treatment of a second patient. Revoked,stayed, 5 years probation with terms and conditions.June 30, 2003

KUNKEL, JOHN FITZGERALD, M.D. (A83756)Santa Rosa, CAB&P Code §§480(a)(3), 2234. Stipulated Decision.Applicant for licensure with the Medical Board ofCalifornia has a condition that may impact or impairhis ability to practice medicine with reasonable skilland safety. Probationary license issued, 5 yearsprobation with terms and conditions. June 10, 2003

Medical Board of California ACTION REPORTOctober 2003 Page 15

Your Address of Record is Publicwww.medbd.ca.gov

Signed address changes may be submitted tothe Board by fax at (916) 263-2944, or by regularmail at:

Medical Board of CaliforniaDivision of Licensing1426 Howe Avenue, Suite 54Sacramento, CA 95825

Please Check Your Physician Profileat the Medical Board’s Web Site

LASH, JEFFREY DAVID, M.D. (A61336)Escondido, CAB&P Code §§726, 2234. Stipulated Decision.Engaged in sexual misconduct in the care andtreatment of 1 patient and committed unprofessionalconduct for self-prescribing the drug Serzone.Revoked, stayed, 3 years probation with terms andconditions. May 5, 2003

LEE, HOWARD, M.D. (G20099) Pinole, CAB&P Code §§2216, 2234, 2240(a). StipulatedDecision. Failed to report a patient death from ananesthetic complication within the legal time frame.Public Letter of Reprimand. May 27, 2003

LEWIS, WILLIAM STANLEY, M.D. (C33550)Bridgeport, CTB&P Code §§141(a), 2234, 2305. Stipulated Decision.Disciplined by Connecticut based on a plea of guiltyto 2 counts of tax evasion and 1 count of filing a falsetax return. Public Letter of Reprimand. July 30, 2003

LING, LOUIS AUGUST, M.D. (A20609)Porterville, CAB&P Code §141(a). Stipulated Decision. Disciplinedby Alaska for failure to report a malpractice claim for$24,000 within the 30-day statutory reportingrequirement. Public Letter of Reprimand.June 6, 2003

LOH, SAMUEL JAMES, M.D. (C36150)Montebello, CAB&P Code §2234(b)(d). Stipulated Decision.Committed gross negligence and incompetence in theprovision of anesthesia during the course of a laserlaryngeal surgery on a patient. Revoked, stayed, 6years probation with terms and conditions.May 22, 2003

LOPEZ, JOSE VELASCO, JR., M.D. (A39052)Los Angeles, CAB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Iowa based on charges that, as ananesthesiologist, he fell asleep during 2 surgicalprocedures, and then falsified operative notes forthose procedures. Revoked, stayed, 5 yearsprobation with terms and conditions. June 13, 2003

LUE, TOM FUTAI, M.D. (A33382)San Francisco, CAB&P Code §2234. Stipulated Decision. Failed toadequately document his discussion of the risks ofsurgery with a patient and wrote a letter to thepatient’s medical insurance company containinginaccurate information about the patient and thepatient’s medical condition. Public Letter ofReprimand. May 29, 2003

LUXENBERG, MATTHEW B., M.D. (G61964)Los Alamitos, CAB&P Code §2266. Stipulated Decision. Failed tomaintain complete and accurate medical records andimproperly used certain diagnosis and procedurecodes in connection with the care and treatment ofseveral patients with severe cystic acne. Public Letterof Reprimand. July 18, 2003

MARTINEZ, REY, M.D. (A13126) Burbank, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with committing acts of dishonesty orcorruption, providing false statements in documents,failing to maintain adequate and accurate medicalrecords, practicing under a false name, committingconspiracy with an unlicensed individual, insurancefraud, excessive treatment or prescribing,incompetence, and violating the fictitious name permitrequirements. Revoked, stayed, 5 years probationwith terms and conditions. June 16, 2003

MARTINEZ, ZOE ALLEN, M.D. (A84180)Los Angeles, CAB&P Code §480(a)(1)(2)(3)(c). Stipulated Decision.Failed to disclose a misdemeanor conviction for pettytheft on her application for licensure with the MedicalBoard of California. Probationary license issued, 3years probation with terms and conditions.July 28, 2003

MAZMANYAN, MANVEL MICHAEL, M.D. (A83571)Glendale, CAB&P Code §§475(a)(1)(2)(3)(4), 480(a)(1)(2)(3)(c),2234(e). Stipulated Decision. Failed to disclose hisconvictions for burglary and petty theft on hisapplication for licensure with the Medical Board ofCalifornia. License issued, revoked, stayed, 7 yearsprobation with terms and conditions. May 13, 2003

Medical Board of California ACTION REPORTPage 16 October 2003

MORGAN, KELLY COLLEEN, M.D. (A83507)Redwood City, CAB&P Code §480(a)(1)(2)(3)(c). Stipulated Decision.Failed to disclose a misdemeanor conviction forpossession of a dangerous weapon on herapplication for licensure with the Medical Board ofCalifornia. Probationary license issued, 2 yearsprobation with terms and conditions. May 7, 2003

MORRISON, PETER FREDERICK, M.D. (A84183)Los Angeles, CAB&P Code §480(a)(1)(2)(3)(c). Stipulated Decision.Failed to disclose a misdemeanor conviction fordriving while intoxicated on his application forlicensure with the Medical Board of California.Probationary license issued, 3 years probation withterms and conditions. July 28, 2003

NADLER, PAUL LAWRENCE, M.D. (G74653)Tiburon, CAB&P Code §§2234, 2242, 2266. Stipulated Decision.Committed acts of unprofessional conduct, prescribedwithout a medical examination, and failed to maintainadequate and accurate medical records in the careand treatment of 1 patient. Revoked, stayed, 3 yearsprobation with terms and conditions. May 7, 2003

PERUCCA, PHILIP JAMES, M.D. (G24485)San Antonio, TXB&P Code §§141(a), 2233, 2234, 2305. StipulatedDecision. The Department of the Air Force restrictedhis privileges based on his misrepresentation of hisclinical currency during a routine biennial review forreprivileging and reappointment. Public Letter ofReprimand. June 6, 2003

POWELL, RICHARD WAYNE, M.D. (A46496)Redding, CAB&P Code §2234(e). Stipulated Decision. Committedacts of dishonesty and unprofessional conduct bybilling for psychotherapy sessions which were notprovided. Revoked, stayed, 5 years probation withterms and conditions including 60 days actualsuspension. July 21, 2003

PROSSER, JOHN, M.D. (A32507) Long Beach, CAB&P Code §2266. Stipulated Decision. Failed tomaintain adequate and accurate medical records inthe care and treatment of 1 patient. PublicReprimand. May 1, 2003

RADEMAN, ALAN NATHAN HIRS, M.D. (G27960)Beverly Hills, CAB&P Code §2266. Stipulated Decision. Failed tomaintain adequate and accurate medical records inthe care and treatment of 3 patients. Revoked,stayed, 5 years probation with terms and conditionsincluding 14 days actual suspension. June 23, 2003

RAND, JERRY NEIL, M.D. (G25749) San Diego, CAB&P Code §§2234(b)(d), 2266. Committed acts ofunprofessional conduct, gross negligence,incompetence, and failed to maintain accurate andadequate medical records in the care and treatmentof 1 patient. Revoked, stayed, 7 years probation withterms and conditions including 60 days actualsuspension. May 6, 2003REDDY, HARI NARAYANA MA, M.D. (A56371)Victorville, CAB&P Code §§726, 2234, 2236(a). Convicted ofbattery, engaged in sexual misconduct, andcommitted acts of unprofessional conduct during thecare and treatment of 4 patients. Revoked. May 23,2003. Judicial review being pursued.RIECHMANN, ROBERT EDWARD III, M.D.(A83991) Los Angeles, CAB&P Code §§480(a)(3), 2234. Stipulated Decision.Applicant for licensure with the Medical Board ofCalifornia has a history of alcohol abuse.Probationary license issued, 5 years probation withterms and conditions. July 8, 2003RIVERA, JOHN RAMON, JR., M.D. (A65911)National City, CAB&P Code §2236(a). Stipulated Decision. Convictedfor being under the influence of a controlledsubstance. Revoked, stayed, 3 years probation withterms and conditions. May 28, 2003SAHAFI, FEREYDOUN, M.D. (A52188)Mission Viejo, CAB&P Code §2216. Stipulated Decision. Performedsurgeries or allowed surgeries to be performed at anunaccredited outpatient facility even though thesurgeries required the administration of generalanesthesia. Public Letter of Reprimand.June 10, 2003

Drug or Alcohol Problem?If you are concerned about a fellow physician who may beabusing alcohol or other drugs or suffering from a mentalillness, you can get assistance by contacting the MedicalBoard’s confidential Diversion Program.Your call may save a physician’s life and can help ensurethat the public is being protected.

ALL CALLS ARE CONFIDENTIAL (916) 263-2600 www.medbd.ca.gov

Medical Board of CaliforniaPhysician Diversion Program1420 Howe Avenue, Suite 14Sacramento, CA 95825

Medical Board of California ACTION REPORTOctober 2003 Page 17

SCHULTE, ROBERT DANIEL, M.D. (G68403)Scottsdale, AZB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Arizona for failing to discloseinformation regarding prior substance abusetreatment and monitoring required by theMassachusetts Medical Board. Revoked, stayed, 5years probation with terms and conditions.June 5, 2003SEET, RAY POON-PHANG, M.D. (G20523)Novato, CAB&P Code §2234. Stipulated Decision. Failed tocomply with the terms of his Board-ordered probationby failing to maintain a separate record of allcontrolled substances he prescribed, dispensed oradministered to patients. Revoked, stayed, 2additional years of probation with terms andconditions. May 19, 2003SHAH, MUKESH H., M.D. (A44952) Santa Ana, CAB&P Code §§2234(a), 2305. Stipulated Decision.Disciplined by Virginia for violating the terms of theirBoard-ordered probation. Revoked, stayed, probationto continue until October 2, 2008. July 7, 2003SHARPE, SHELTON E., M.D. (G51390) Rome, GAB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Georgia for failure to conform to theminimal standards of acceptable and prevailingmedical practice by prescribing doses of mellaril attwice the recommended level, and for failing toconsult with a child psychiatrist and/or pediatricneurologist to avoid the potential hazards of excessphenothiazine. Revoked, stayed, 5 years probationwith terms and conditions. June 9, 2003SIEGEL, HOWARD M., M.D. (G57480)Huntington Beach, CAB&P Code §§810, 2234(a)(b)(e), 2261, 2262, 2266.Stipulated Decision. Engaged in unprofessionalconduct in the care and treatment of several patientsby creating false medical records with fraudulentintent, committing insurance fraud, failing to maintainadequate and accurate records, and committing actsof gross negligence and repeated negligence byrepeatedly and regularly, simultaneously performinganesthesia on patients in 2 or more surgery rooms.Revoked, stayed, 10 years probation with terms andconditions including 1 year actual suspension.June 16, 2003SIMAN, HOMAN, M.D. (A83240) Los Angeles, CAB&P Code §§480(a)(1), 2239. Stipulated Decision.Convicted on 3 occasions for reckless drivinginvolving the use of alcohol. License granted, stayed,5-year probationary license issued with terms andconditions. May 7, 2003

STELLER, ROBERT THOMAS, M.D. (G16986)Los Angeles, CAB&P Code §2234. Failed to comply with the terms ofhis Board-ordered probation by failing to successfullycomplete the Diversion program, pass a SPEXexamination, report a change of address, submit aquarterly report, and pay probation monitoring costs.Revoked. May 9, 2003

SWANSON, CRAIG EDWARD, M.D. (A41844)Crescent City, CAB&P Code §3502. Stipulated Decision. Failed toproperly supervise his physician assistant by allowingthe assistant to make billing decisions for 5 patients.Revoked, stayed, 4 years probation with terms andconditions. June 5, 2003

TILLAIKARASI, KANNAPPAN, M.D. (A52211)Bakersfield, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with gross negligence and incompetencefor failing to recognize or take corrective steps in thedelivery of a baby in fetal distress. Public Reprimand.July 18, 2003

TONSEKAR, KISHORE SUBRAO, M.D. (A54184)Downey, CAB&P Code §2234(c). Committed repeated negligentacts by failing to perform surgery in a timely mannerto relieve a patient’s bowel obstruction and toevacuate bile and/or stop a bile leak of a secondpatient. Revoked, stayed, 3 years probation withterms and conditions. June 9, 2003. Judicial reviewbeing pursued.

TREUHERZ, ROBERT R., M.D. (A44467)Wilton Manors, FLB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Florida for failure to inform a patient ofan abnormal pap smear and for failure to refer thepatient to a gynecologist. Public Reprimand.June 20, 2003

UDOH, NNAEMEKA, M.D. (A30452)Los Angeles, CAB&P Code §2234. Stipulated Decision. No admissionsbut charged with gross negligence, repeatednegligence, and incompetence in the care andtreatment of a patient for failing to perform a divertingcolostomy at the time of initial intervention, failing torecognize signs and symptoms of infection, and failingto initialize and use appropriate antibiotics. Revoked,stayed, 3 years probation with terms and conditions.July 18, 2003

Medical Board of California ACTION REPORTPage 18 October 2003

VARON, JOSEPH, M.D. (A47713) Houston, TXB&P Code §§141(a), 2234, 2305. Engaged in anintimate relationship with a former patient, and while inthe relationship, he examined the former patient ontwo occasions for minor complaints. Public Letter ofReprimand. June 2, 2003

VICENCIO, VIOLETA B., M.D. (A39857)Bellflower, CAB&P Code §2234. Stipulated Decision. Failed tocomply with the terms of her Board-orderedprobation. Revoked, stayed, and the original 3-yearprobationary term is extended for 2 additional yearsof probation with terms and conditions. July 28, 2003

WEDDLE, JOSEPH L., M.D. (A22229)Cashmere, WAB&P Code §§141(a), 2305. Stipulated Decision.Disciplined by Washington for unprofessional conductby prescribing excessive amounts of controlledsubstances for management of chronic pain, andfailing to recognize and attend to the effects of long-term narcotic therapy in numerous patients. Revoked,stayed, 5 years probation with terms and conditions.May 15, 2003

YANG, CHWI-YOUNG, M.D. (G43734)Anaheim Hills, CAB&P Code §2262. Stipulated Decision. Committedacts of destroying, altering or modifying chart entriesin a patient’s medical record after receivingnotification of the patient’s intent to file a malpracticeclaim against her for care and treatment of thepatient. Revoked, stayed, 4 years probation withterms and conditions including 30 days actualsuspension. July 16, 2003

YERMIAN ARDESHIR, M.D. (A41012)Los Angles, CAB&P Code §2236(a). Stipulated Decision. Convictedof a felony for directly and indirectly, with theassistance of others, paying for the referral andtransportation of Medi-Cal patients to his medicaloffice, furnishing services, merchandise and othergratuitous considerations to patients, and creatingfalse medical records to justify additional billings.Revoked, stayed, 5 years probation with terms andconditions, including 30 days actual suspension.May 22, 2003

YOONESSI, MAHMOOD, M.D. (C50545)Williamsville, NYB&P Code §§141(a), 2305. Disciplined by New Yorkfor gross negligence, fraud, moral unfitness, failing tomaintain adequate and accurate medical records, andfailing to obtain proper informed consent. Revoked.June 23, 2003. Judicial review being pursued.

ZUCKER, NORMAN, M.D. (G36394)Sebastopol, CAB&P Code §2234(e). Committed dishonest acts andfailed to comply with the terms of his Board-orderedprobation by submitting 5 quarterly probationaryreports declaring, under penalty of perjury, that hewas in compliance with his Board-ordered probation,even though he was in violation of the no solopractice clause. Revoked, stayed, 2 years probationwith terms and conditions. July 14, 2003

ZOLFAGARI, RAMIN, M.D. (A84105) Orange, CAB&P Code §480(a)(2)(2)(3)(c). Stipulated Decision.Failed to disclose 2 misdemeanor convictions fortheft, underage consumption and/or possession ofalcohol on his application for licensure with theMedical Board of California. Probationary licenseissued, 3 years probation with terms and conditions.July 21, 2003

PHYSICIAN ASSISTANTS

AUSTIN, KIRK JAY, P.A. (PA10387)Carmichael, CAB&P Code §3502(1)(c)(2). Stipulated Decision. Failedto comply with the terms of the Physician AssistantCommittee-ordered probation. Revoked, stayed, 2years probation with terms and conditions including30 days actual suspension. June 2, 2003

KUEHL, AARON H., P.A. (PA14224) San Diego, CAB&P Code §§2234(e), 2239. Stipulated Decision.Committed acts of dishonesty or corruption and self-use of drugs or alcohol in a dangerous manner.Revoked, stayed, 7 years probation with terms andconditions including 90 days actual suspension.May 16, 2003

NIXON, ALEXIS CONSTANTINE, P.A. (PA14878)Los Angeles, CAB&P Code §§2234(b)(c), 3502(1),3527. StipulatedDecision. Committed acts of gross negligence,repeated negligence, unprofessional conduct andunlawful prescribing by issuing a drug order withoutthe advance approval of a physician and surgeon inthe care and treatment of 2 patients. Revoked,stayed, 5 years probation with 30 days actualsuspension. May 15, 2003

Medical Board of California ACTION REPORTOctober 2003 Page 19

DOCTORS OF PODIATRIC MEDICINEHAN, PAUL YOUNGJIN, D.P.M. (E3270)Fountain Valley, CAB&P Code §§490, 2234(e), 2236(a). Convicted of afelony for making false financial statements procuringmoney, laundering loan money and grand theft.Revoked, stayed, 2 years probation with terms andconditions. May 29, 2003. Judicial review beingpursued.

SCHULTZ, ALAN EDWIN, D.P.M. (E1587)Agoura Hills, CAB&P Code §§490, 2234(a)(e), 2236(a), 2261.Stipulated Decision. Convicted of presenting a falseMedi-Cal claim. Revoked, stayed, 5 years probationwith terms and conditions including 60 days actualsuspension. June 16, 2003

TINKLE, JON DENNIS, D.P.M. (E3974)Hollywood, CAB&P Code §§820, 821, 822, 2234(e). Unable topractice podiatric medicine safely due to animpairment. Revoked. July 7, 2003

SURRENDER OF LICENSEWHILE CHARGES PENDING

PHYSICIANS AND SURGEONS

APPLEMAN, WALTER, M.D. (A20067)Los Angeles, CAJune 30, 2003

BAIRD, CURTIS JAMES, M.D. (G75160)Yucaipa, CAMay 8, 2003

BELL, RALPH S., M.D. (G7465)Palm Beach Gardens, FLJune 30, 2003

BLAIR, RICHARD A., M.D. (C26082)Columbia, KYJune 13, 2003

BREWSTER, FLOYD M., M.D. (A20268)Orinda, CAJune 9, 2003

CLARK, DAVID STUART, M.D. (C33959)Carmel, CAJuly 30, 2003

DONAT, PETER CHARLES, M.D. (A26192)Laguna Hills, CAJune 9, 2003

GAMM, STANFORD R., M.D. (A10698)San Mateo, CAJune 9, 2003

KOGAN, ISRAEL, M.D. (G26696) Washington, DCJune 6, 2003

LAWRENCE, GEORGE S., M.D. (A20116)San Francisco, CAMay 21, 2003

LEMES, ANDREW JOHN, M.D. (C35646)Los Angeles, CAJune 6, 2003

LEON, VICTOR VINCENTE, M.D. (A24607)Covina, CAJuly 16, 2003

MIDDO, ROBERT T., M.D. (G5490)La Mirada, CAJune 26, 2003

PAGE, PHILLIS E., M.D. (GFE6611)Rancho Palos Verdes, CAJuly 16, 2003

RICHARD, ROBERT M., M.D. (A 20450)Laguna Beach, CAJune 27, 2003

RUJA, RICHARD GARY, M.D. (G28684)Napa, CAMay 15, 2003

TILLIM, STEPHEN LEONARD, M.D. (G25344)Mountain View, CAJune 3, 2003

WHITE, ARTHUR H., M.D. (G12017)Walnut Creek, CAJuly 28, 2003

PHYSICIANS ASSISTANT

FUENTES, JESUS MENDEZ, P.A. (PA13121)Hesperia, CAJuly 21, 2003

MONDRAGON, SHARON LOUISE, P.A. (PA11400)Victorville, CAJuly 9, 2003

For further information...Copies of the public documents attendant to these casesare available at a minimal cost by calling the MedicalBoard’s Central File Room at (916) 263-2525.

For copies of this report, fax your request to (916) 263-2387 or mail to: Medical Board, 1426 Howe Avenue, Suite 54, Sacramento, CA95825. The Action Report also is available in the “Publications” section of the Board’s Web site: www.medbd.ca.gov.

ACTION REPORT — OCTOBER 2003Candis Cohen, Editor (916) 263-2389

Business and ProfessionsCode Section 2021(b) &(c) require physicians toinform the MedicalBoard in writing of anyname or address change.

Department of Consumer AffairsMedical Board of California1426 Howe AvenueSacramento, CA 95825-3236

MEDICAL BOARD OF CALIFORNIAHazem H. Chehabi, M.D., PresidentMitchell S. Karlan, M.D., Vice PresidentRonald H. Wender, M.D., Secretary

Division of LicensingMitchell S. Karlan, M.D., PresidentJames A. Bolton, Ph.D., M.F.T., Vice PresidentRichard D. Fantozzi, M.D., SecretaryGary Gitnick, M.D.Salma Haider

Division of Medical QualityRonald H. Wender, M.D., PresidentLorie G. Rice, M.P.H., Vice PresidentRonald L. Morton, M.D., SecretarySteve AlexanderWilliam S. Breall, M.D.Catherine T. Campisi, Ph.D.Hazem H. Chehabi, M.D.Jose FernandezLinda LucksArthur E. Lyons, M.D.Ronald L. Moy, M.D.Steven B. Rubins, M.D.

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