State Medical Board of Ohio 77 3. High St., 17th Floor Columbus, OH 43215-6127 - (614)466-3934 - November 8, 2006 Charles M. Momah, M.D. Twin Rivers Unit, DOC 888910 16774 170lh Drive SE P. O. Box 888 Monroe, WA 98272-0888 Dear Doctor Momah: Please ?nd enclosed certi?ed copies of the Entry of Order; the Report and Recommendation of R. Gregory Porter, Esq., Hearing Examiner, State Medical Board of Ohio; and an excerpt of dra? Minutes of the State Medical Board, meeting in regular session on November 8, 2006, including motions approving and con?rming the Report and Recommendation as the Findings and Order of the State Medical Board of Ohio. Section 119.12, Ohio Revised Code, may authorize an appeal from this Order. Such an appeal must be taken to the Franklin County Court of Common Pleas. Such an appeal setting forth the Order appealed from and the grounds of the appeal must be commenced by the ?ling of an original Notice of Appeal with the State Medical Board of Ohio and a copy of the Notice of Appeal with the Franklin County Court of Common Pleas. Any such appeal must be ?led within ?fteen (15) days after the mailing of this notice and in accordance with the requirements of Section 119.12,. Ohio Revised Code. THE STATE MEDICAL BOARD OF OHIO Lance A. Talmage, M.D. Secretary LAT:jam Enclosures CERTIFIED MAIL NO. 7003 0500 0002 4339 8736 RETURN RECEIPT REQUESTED Cc: P. 0. Box 5178 Masscna, NY 13662 CERTIFIED MAIL N0. 7003 0500 0002 4339 8743 RETURN RECEIPT REQUESTED wail/46 mm, CERTIFICATION I hereby certify that the attached copy of the Entry of Order of the State Medical Board of Ohio; Report and Recommendation of R. Gregory Porter, State Medical Board Attorney Hearing Examiner; and excerpt of dra? Minutes of the State Medical Board, meeting in regular session on November 8, 2006, including motions approving and con?rming the Findings of Fact, Conclusions and Proposed Order of the Hearing Examiner as the Findings and Order of the State Medical Board of Ohio; constitute a true and complete copy of the Findings and Order of the State Medical Board in the matter of Charles M. Momah, M.D., as it appears in the Journal of the State Medical Board of Ohio. This certi?cation is made by authority of the State Medical Board of Ohio and in its behalf. Lance A. Talmage, M.D. Secretary (SEAL) November 8, 2006 - Date BEFORE THE STATE MEDICAL BOARD OF OHIO IN THE MATTER OF CHARLES M. MOMAH, M.D. ENTRY OF ORDER This matter came on for consideration before the State Medical Board of Ohio on November 8, 2006. Upon the Report and Recommendation of R. Gregory Porter, State Medical Board Attorney Hearing Examiner, designated in this Matter pursuant to RC. 4731.23, a true copy of which Report and Recommendation is attached hereto and incorporated herein, and upon the approval and con?rmation by vote of the Board on the above date, the following Order is hereby entered on the Journal of the State Medical Board of Ohio for the above date. It is hereby ORDERED, that: The certi?cate of Charles M. Momah, M.D., to practice medicine and surgery in the State of Ohio shall be PERMANENTLY REVOKED. This Order shall become effective immediately upon the mailing of notification of approval by the Board. Lance A. Talmage, M.D. (SEAL) Secretary November 8. 2006 Date '33 A 8= 52 REPORT AND RECOMMENDATION IN THE MATTER OF CHARLES M. MOMAH, MD. The Matter of Charles M. Momah, M.D., was heard by R. Gregory Porter, Hearing Examiner for the State Medical Board of Ohio, on August 30, 2006. INTRODUCTION 1. Basis for Hearing A. In a Notice of Automatic Suspension and Opportunity for Hearing dated May 10, 2006, the State Medical Board of Ohio [Board] noti?ed Charles M. Momah, M.D., that, pursuant to Section Ohio Revised Code, Dr. Momah?s certi?cate to practice medicine and surgery in the State of Ohio had been automatically suspended. The Board further noti?ed Dr. Momah: This automatic suspension is based upon the ?ndings of guilt of one felony count of Rape in the second degree in violation of Section Revised Code of Washington, which is a criminal offense substantially equivalent to either Rape, Section 2907.02, Ohio Revised Code, or Sexual Battery, Section 2907.03, Ohio Revised Code; and one felony count of Rape in the third degree in violation of Section Revised Code of Washington, which is a criminal offense substantially equivalent to either Rape, Section 2907.02, Ohio Revised Code, or Sexual Battery, Section 2907.03, Ohio Revised Code. (State?s Exhibit 1A) The Board further advised Dr. Momah that his continued practice as a physician would be considered practicing without a certi?cate. Moreover, the Board noti?ed Dr. Momah that it had proposed to take disciplinary action against his certi?cate to practice medicine and surgery in Ohio. The Board based its proposed action on allegations that Dr. Momah had been found guilty of four felony violations, including those noted above. Furthermore, the Board alleged that the judicial ?ndings of guilt constitute plea of guilty to, a judicial ?nding of guilt of, or a judicial ?nding of eligibility for intervention in lieu of conviction for, a felony,? as that clause is used in Section Ohio Revised Code.? Finally, the Board advised Dr. Momah of his right to request a hearing in this matter. (State?s Exhibit 1A) By letter received by the Board on May 30, 2006, Davidson Momah requested a hearing on behalf of Dr. Momah, but asked that it be held in abeyance until Dr. Momah?s criminal appeal is resolved. (State?s Exhibit 1B) Report and Recommendation In the Matter of Charles M. Momah, M.D. Page 2 II. Appearances A. On behalf of the State of Ohio: Jim Petro, Attorney General, by Kyle C. Wilcox, Assistant Attorney General. B. Dr. Momah, who is currently incarcerated, did not appear for the hearing in person or by representative. EVIDENCE EXAMINED I. Testimony Heard No witnesses were presented. II. Exhibits Examined A. State's Exhibits 1A through 1F: Procedural exhibits. Note that portions of State's Exhibit 1A relating to charges for which Dr. Momah was found "not guilty" were redacted by the Hearing Examiner post hearing. B. State's Exhibit 2: Not admitted. See Proffered Exhibits, below. C. State's Exhibit 2A: Redacted version of State's Exhibit 2, which consists of copies of documents maintained by the Superior Court of Washington for King County in State of Washington v. Charles Momah, Case No. 04-1-05925-5KNT. Note that portions of this document relating to charges for which Dr. Momah was found "not guilty" were redacted by the Assistant Attorney General post hearing. Additional redactions were made by the Hearing Examiner post hearing with regard to references to those charges contained elsewhere in the exhibit. D. State's Exhibit 3: Certified copy of the judgment and sentence filed on February 7, 2006, in State of Washington v. Charles Momah, Case No. 04-1-05925-5KNT, including four appendices. III. Proffered Exhibit The following exhibit was neither admitted to the record nor considered by the Hearing Examiner, but was sealed and held as proffered material: State's Exhibit 2: Certified, unredacted copy of documents maintained by the Superior Court of Washington for King County in State of Washington v. Charles Momah, Case No. 04-1-05925-5KNT. Report and Recommendation In the Matter of Charles M. Momah, M.D. Page 3 PROCEDURAL MATTERS The individual (Davidson Momah) who requested the hearing on behalf of Dr. Momah asked that Dr. Momah's hearing be held in abeyance until Dr. Momah's criminal appeal had been resolved. It has long been this Board's policy that hearings will not be delayed for such a purpose. Nevertheless, if the Board should take action against Dr. Momah, and should Dr. Momah's criminal conviction be overturned on appeal, Section 4731.22(H), Ohio Revised Code, provides an avenue for Dr. Momah to seek reconsideration of the Board's final order in this matter. SUMMARY OF THE EVIDENCE All exhibits and transcripts of testimony, even if not specifically mentioned, were thoroughly reviewed and considered by the Hearing Examiner prior to preparing this Report and Recommendation. 1. In March 1993, the State of Washington issued a license to Charles M. Momah, M.D., to practice as a physician in that state. Since 1994, Dr. Momah has practiced in Washington as an obstetrician/gynecologist [ob/gyn] in the communities of Issaquah, Federal Way, and Burien. (State's Exhibit [St. Ex.] 2A at 5) 2. On September 15, 2004, an Information was filed in the Superior Court of Washington for King County in Case No. 04-1-05925-5 KNT charging Dr. Momah with several offenses. (St. Ex. 2A) Among these, in Counts I through IV, Dr. Momah was charged as follows: o In Count I, Dr. Momah was charged with Rape in the Third Degree, in violation of Revised Code of Washington [RCW] Section 9A.44.060(1)(a). The Information alleged that on or about August 12, 2003, Dr. Momah engaged in sexual intercourse with H.P., who was not married to Dr. Momah, and who "did not consent to sexual intercourse with [Dr. Momah] and such lack of consent was clearly expressed by H.P.'s words or conduct." (St. Ex. 2 at 1) A Certificate of Probable Cause attached to the Information states, among other things, that H.P. had been Dr. Momah's patient at the time of the offense. (St. Ex. 2A at 6-8) o In Counts II and III, Dr. Momah was charged with Indecent Liberties, in violation of RCW Section 9A.44.100(1)(d). With regard to Count II, the Information alleged that, during the period of time between September 1, 2002, and August 31, 2003, Dr. Momah, "being a health care provider did knowingly have sexual contact with another person named S.S., who was a client or patient of his, during a treatment session, consultation, interview, or examination." (St. Ex. 2A at 1-2) Report and Recommendation In the Matter of Charles M. Momah, M.D. Page 4 With regard to Count III, the Information alleged that Dr. Momah had committed the same offense against another individual, C.B., during the period of time between April 30 and June 2, 2003. (St. Ex. 2A at 2) o In Count IV, Dr. Momah was charged with Rape in the Second Degree, in violation of RCW Section 9A.44.050(1)(d). The Information alleged that, during the period of time between March 25 and April 1, 2003, Dr. Momah, "being a health care provider did engage in sexual intercourse with another person named R.B., who was a client or patient, during a treatment session, consultation, interview, or examination." (St. Ex. 2A at 2) A Certificate of Probable Cause attached to the Information describes the circumstances underlying the allegations. However, note that this document was signed by a member of the Federal Way Police Department, and appears to have been filed to support the allegations contained in the information. There is no evidence that any of the statements made in the Certificate of Probable Cause were proved at Dr. Momah's trial. (St. Ex. 2A at 5-14) 2. On November 16, 2005, a jury found Dr. Momah guilty of Counts I through IV of the Information. (St. Ex. 3 at 1) By entry of judgment and sentence filed February 7, 2006, the court sentenced Dr. Momah to determinate terms of confinement of 60 months for Count I, and 12 months each for Counts II and III. Further, for Count IV, the court sentenced Dr. Momah to an indeterminate term of confinement for a minimum of 245 months to a maximum of life. Moreover, the court ordered that Dr. Momah's terms of incarceration be served concurrently. Finally, the court ordered Dr. Momah to: (a) pay restitution in an amount to later be determined and pay a victim penalty assessment of $500, (b) have no contact with seven individuals, including H.P., S.S., R.B., and C.B., for the rest of Dr. Momah's life, (c) provide a biological sample for DNA analysis, (d) undergo HIV testing and counseling, and (e) register as a sex offender wherever Dr. Momah should reside. (St. Ex. 3) FINDINGS OF FACT On or about November 16, 2005, in the Superior Court of Washington for King County, Washington, a jury found Charles M. Momah, M.D., guilty of the following offenses: Count I: Rape in the Third Degree, in violation of Revised Code of Washington [RCW] Section 9A.44.060(1)(a). Count II: Indecent Liberties, in violation of RCW Section 9A.44.100(1)(d). Count III: Indecent Liberties, in violation of RCW Section 9A.44.100(1)(d). Count IV: Rape in the Second Degree, in violation of RCW Section 9A.44.050(1)(d). Report and Recommendation In the Matter of Charles M. Momah, MD. Page 5 By entry of judgment and sentence ?led February 7, 2006, the court sentenced Dr. Momah to determinate terms of con?nement of 60 months for Count I, and 12 months each for Counts II and Further, for Count IV, the court sentenced Dr. Momah to an indeterminate term of con?nement for a minimum of 245 months to a maximum of life. Moreover, the court ordered that Dr. Momah?s terms of incarceration be served concurrently. Finally, the court ordered Dr. Momah to: pay restitution in an amount to later be determined and pay a victim penalty assessment of $500, have no contact with seven individuals, including H.P., S.S., RB, and C.B., for the rest of Dr. Momah?s life, provide a biological sample for DNA analysis, undergo HIV testing and counseling, and register as a sex offender wherever Dr. Momah should reside. CONCLUSIONS OF LAW The judicial ?ndings of guilt of Charles M. Momah, M.D., as set forth in the Findings of Fact, above, constitute plea of guilty to, ajudicial ?nding of guilt of, or a judicial ?nding of eligibility for intervention in lieu of conviction for, a felony,? as that clause is used in Section Ohio Revised Code. The record re?ects that a jury found Dr. Momah guilty of four separate crimes against his patients while they were in his trust and care. His crimes were serious enough for the court to sentence him to a total period of incarceration of over twenty years to life. Given the deplorable nature of Dr. Momah?s crimes against his patients, his certi?cate to practice medicine and surgery in Ohio should be permanently revoked. PROPOSED ORDER It is hereby ORDERED, that: The certi?cate of Charles M. Momah, M.D., to practice medicine and surgery in the State of Ohio shall be PERMANENTLY REVOKED. This Order shall become effective immediately upon the mailing of noti?cation of approval by the Board. R. Gregbry?o?er, Hearing Examin State Medical Board of Ohio 77 S. High St.,17th Floor - Columbus, OH 43215-6127 0 (614) 466-3934 - Website: EXCERPT FROM THE DRAFT MINUTES OF NOVEMBER 8, 2006 REPORTS AND RECOMMENDATIONS Dr. Robbins announced that the Board would now consider the ?ndings and orders appearing on the Board's agenda. He asked whether each member of the Board had received, read, and considered the hearing records, the proposed ?ndings, conclusions, and orders, and any objections ?led in the matters of: Fred Andrew Brindle, Sudheera Kalepu, Kimberly Ann Lee, Praveen Menon, Charles Momah, K011i Mohan Prasad, Mark Robert Rosenberg, and Mary Mei-Ling Yun, MD. A roll call was taken: ROLL CALL: Mr. Albert - Dr. Egner Dr. Varyani Mr. Browning - Ms. Sloan - Dr. Davidson - Dr. Steinbergh - Dr. Robbins Dr. Robbins asked whether each member of the Board understands that the disciplinary guidelines do not limit any sanction to be imposed, and that the range of sanctions available in each matter runs from dismissal to permanent revocation. A roll call was taken: ROLL CALL: Mr. Albert - Dr. Egner - Dr. Varyani - Mr. Browning - Ms. Sloan - Dr. Davidson - Dr. Steinbergh - Dr. Robbins - Dr. Robbins noted that, in accordance with the provision in Section Revised Code, specifying that no member of the Board who supervises the investigation of a case shall participate in further adjudication of the case, the Secretary and Supervising Member must abstain from further EXCERPT FROM THE DRAFT MINUTES OF NOVEMBER 8, 2006 Page 2 IN THE MATTER OF CHARLES M. MOMAH, M.D. participation in the adjudication of these matters. In the matters before the Board today, Dr. Talrnage served as Secretary and Mr. Albert served as Supervising Member. Dr. Robbins stated that, if there were no objections, the Chair would dispense with the reading of the proposed ?ndings of fact, conclusions and orders in the above matters. No objections were voiced by Board members present. The original Reports and Recommendations shall be maintained in the exhibits section of this JournalDR. STEINBERGH MOVED TO APPROVE AND CONFIRM MR. FINDINGS OF FACT, CONCLUSIONS, AND PROPOSED ORDER IN THE MATTER OF CHARLES M. MOMAH, M.D. DR VARYANI SECONDED THE MOTIONvote was taken on Dr. Steinbergh?s motion to approve and con?rm: Vote: Mr. Albert - abstain . Dr. Egner - Dr. Varyani - Mr. Browning - Ms. Sloan Dr. Davidson - Dr. Madia Dr. Steinbergh - The motion carried. a NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING May 10, 2006 Charles M. Momah, M.D. PO. Box 5178 Massena, NY 13662 Dear Doctor Momah: Pursuant to Section 473 1 22(1), Ohio Revised Code, you are hereby noti?ed that your license to practice medicine and surgery in the State of Ohio, which is inactive for non- renewal, has been automatically suspended as of November 16, 2005, by operation of law pursuant to Section 473 1 22(1), Ohio Revised Code. This automatic suspension is based upon the ?ndings of guilt of one felony count of Rape in the second degree in violation of Section Revised Code of Washington, which is a criminal offense substantially equivalent to either Rape, Section 2907.02, Ohio Revised Code, or Sexual Battery, Section 2907.03, Ohio Revised Code; and one felony count of Rape in the third degree in violation of Section Revised Code of Washington, which is a criminal offense substantially equivalent to either Rape, Section 2907.02, Ohio Revised Code, or Sexual Battery, Section 2907.03, Ohio Revised Code. Furthermore, in accordance with Chapter 119., Ohio Revised Code, you are hereby noti?ed that the Board intends to determine whether or not to limit, revoke, permanently revoke, suspend, refuse to register or reinstate your certi?cate to practice medicine and surgery, or to reprimand you or place you on probation for one or more of the following reasons: (1) On or about November 16, 2005, in the Superior Court of Washington for King County, Washington, you were found guilty of the following crimes: Count I: Rape in the third degree in violation of Section Revised Code of Washington. Count II: Indecent Liberties in violation of Section Revised Code of Washington. 727W 5" 11-106, Notice of Automatic Suspension Opportunity for Hearing Page 2 Count 111: Indecent Liberties in violation of Section Revised Code of Washington. Count IV: Rape in the second degree in violation of Section Revised Code of Washington. Based upon the findings of guilt of the four felony counts above, you were'sentenced to a minimum term of 245 months to a maximum term of life imprisonment and ordered to register as a sex offender wherever you reside. Further, the Court ordered no contact, direct or indirect, in person, in writing, by telephone or through third parties for the period of your lifetime, with, among others, the four patients in your State of Washington obstetrics-gynecology clinical practice, who were the victims of your conduct related to Counts I through IV above. The conduct underlying the findings of guilt of second and third degree Rape and two counts of Indecent Liberties is described in more detail in the Information and Certificate of Probable Cause. Copies of the Judgment and Sentence Felony and the Information, which includes a Certificate of Probable Cause, are attached hereto and incorporated herein. Your pleas of guilty or the judicial findings of guilt as alleged in paragraph (1) above, individually andfor collectively, constitute plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a felony,? as that clause is used in Section Ohio Revised Code. Pursuant to Chapter 119., Ohio Revised Code, and Chapter 4731., Ohio Revised Code, you are hereby advised that you are entitled to a hearing concerning these matters. If you wish to request such hearing, the request must be made in writing and must be received in the offices of the State Medical Board within thirty days of the time of mailing of this notice. You are further advised that, if you timely request a hearing, you are entitled to appear at such hearing in person, or by your attorney, orby such other representative as is permitted to practice before this agency, or you may present your position, arguments, or contentions in writing, and that at the hearing you may present evidence and examine witnesses appearing for or against you. In the event that there is no request for such hearing received within thirty days of the time of mailing of this notice, the State Medical Board shall, in your absence and upon consideration of this matter, enter a final order permanently revoking your certificate to practice medicine and surgery. Please note that, whether or not you request a hearing, Section Ohio Revised Code, provides that ?[w]hen the board refuses to grant a certificate to an applicant, revokes an individual?s certificate to practice, refuses to register an applicant, or refuses to reinstate Notice of Automatic Suspension Opportunity for Hearing Page 3 an individual?s certi?cate to practice, the board may specify that its action is permanent. An individual subject to a permanent action taken by the board is forever thereafter ineligible to hold a certi?cate to practice and the board shall not accept an application for reinstatement of the certi?cate or for issuance of a new certi?cate.? Copies of the applicable sections are enclosed for your information. Very truly yours, Lance A. Talmage, M.D. Secretary LAT/jjv Enclosures CERTIFIED MAIL 7003 0500 0002 4330 8674 RETURN RECEIPT REQUESTED CC: Charles M. Moma?h, M.D. DOC 888910 MCC-TRCC 16774 1701h Drive Monroe, WA 98272-0888 CERTIFIED MAIL 7003 0500 0002 4330 8667 RETURN RECEIPT REQUESTED dual: SUPERIOR COURT OF WASHINGTON FOR KING COUNTY STATE OF WASHINGTON, Plaintiff, vs. No. CHARLES MOMAH INFORMATION Defendant, COUNT I. 1, Norm Maleng, Prosecuting Attorney for King County in the name and by the authority of the. State of Washington, do accuse CHARLES MOMAH of the crime of Rape in the Third Degree, committed as follows: That the defendant CHARLES MOMAH in King County, Washington on or about August 12, 2003, did engage in sexual intercourse with another person, named H.P., who was not married to the defendant under circumstances where, HP. did not consent to sexual intercourse with the defendant and such lack of consent was clearly exPressed by H.P.'s words or conduct; Contrary to RCW and against the peace and dignity of the State of Washington. COUNT II . And 1, Norm Maleng, Prosecuting Attorney aforesaid further do accuse CHARLES MOMAH of the crime of Indecent Liberties, a crime of the same or similar character and based on the same conduct as another crime charged herein, which crimes were part of a common scheme or plan and which crimes were so closely connected in respect to time, place and occasion that it would be dif?cult to separate proof of one charge from proof of the other, committed as follows: That the defendant CHARLES MOMA-H in King County, Washington during a period of time intervening between September 1, 2002 through August 31, 2003, being a health care provider Norm Maleng Proan Attorney 554 King County Courthouse Seattle, Washington 98104?2312 .00 did knowingly have sexual contact with another person named, 85., who was a client or patient of his, during a treatment session, consultation, interview or examination; 1 Contrary to RCW and against the peace and dignity of the State of Washington. coUNr in And 1, Norm Maleng, Prosecuting Attorney afOresaid further do accuse CHARLES MOMAH of the crime of Indecent Liberties, a crime of the same or similar character and based on the same conduct as another crime charged herein, which crimes were part of a common scheme or plan and which crimes were so closely connected in respect to time, place and occasion that it would be dif?cult to separate proof of one charge from proof of the other, committed as follows: That the defendant CHARLES MOMAH in King County, Washington during a period of time intervening between April 30th, 2003 through June lst, 2003, being a health care provider did knowingly have sexual contact with another person named, C.B., who was a client or patient of his, during a treatment session, consultation, interview or examination; Contrary to RCW and against the peace and dignity of the State of Washington. COUNTIV And 1, Norm Maleng, Prosecuting Attorney aforesaid ?nther do accuse CHARLES MOMAH of the crime of Rape in the Second Degree, a crime of the same or similar character and based on the same conduct as another crime charged herein, which crimes were part of a common scheme or plan and which crimes wore so closely connected in respect to time, place and occasion that it would be dif?cult to'separate proof of one charge from proof of the other, committed as follows: That the defendant CHARLES MOMAH in King County, Washington during a period of time intervening between March 25, 2003 through April 1, 2003, being a health care provider did engage in sexual intercourse with another person named RB, who was a client or patient, during a treatment session, consultation, interview or examination; Contrary to! RCW and against the peace and dignity of the State of Washington, COUNT And I, Norm Maleng, Prosecuting Attorney aforeSaid further do accuse CHARLES MOMAH of the crime of Violation Of The Health Care False Claims Act, a crime of the same or Norm Maleng Prosecuting Attorney 554 King County Com'thousc Seattle, Washington 98104-2312 INF 2 2'7 similar character and based on the same conduct as another crime charged herein, which crimes were part of a common scheme or plan and which crimes were so closely connected in respect to time, place and occasion that it would be dif?cult to separate proof of one charge ?om proof of the other, committed as follows: - That the defendant CHARLES MOMAH in King County, Washington during a period of time intervening between March 20, 2003 through December 31, 2004, did present to a health care payer a claim for health care payment knowing such claim to be false, and did willfully collect an amount ?'omen insured, RB, knowing that to be in violation of an agreement or contract with a health care payer to which the provider is a party. Contrary to RCW 48.80.0300) (5) and against the peace and dignity of the State of Washington. COUNT V1 And 1, Norm Maleng, Prosecuting Attorney aforesaid further do accuse CHARLES MOMAH of the crime of Violation Of The Health Care False Claims Act, a crime of the same or similar character and based on the same 00nduct as another crime charged herein, which crimes were part of a common scheme or plan and which crimes were so closely connected in re3pect to time, place and occasion that it would be dif?cult'to separate proof of one charge from proof of the other, committed as follows: That the defendant CHARLES MOMAH in King County, Washington during a period of time intervening between February 1, 2003 through May 31, 2003, did present to a health care payer a claim for health care payment knowing such claim to be false, and did will?rlly collect an amount ?om an insured, C.R, knowing that to be in violation of an agreement or contract with a health care payor to which the provider is a party. Contrary to RCW 48.80.0300) (5) and against the peace and dignity of the State of Washington. COUNT VII And 1, Norm Maleng, Prosecuting Attorney aforesaid further do accuse CHARLES MOMAI-I of the crime of Violation Of The Health Care False Claims Act, a crime of the same or similar character and based on the same conduct as another crime charged herein, which crimes were part of a common scheme or plan and which crimes were so closely connected in respect to time, place and occasion that it would be dif?cult to separate proof of one charge ?orn proof of the other, committed as follows: I That the defendant CHARLES MOMAH in King County, Washington during a period of time intervening between September 4, 2002 through January 1, 2003, did present to a health care Norm Maleng Prosecuting Attomey 554 King County Courthouse Wastingtun 98104?2312 3 2'7 payer a clainr for health care payment knowing such claim to be false, and did willfully collect an amount from an insured, knowing that to be in violation of an agreement or contract with a health care payer to which the provider is a party. Contrary to RCW 48.80.0300) (5) and against the peace and dignity of the State of Washington. INF 4 NORM MALENG Prosecuting Attorney ogoff, WSBA #23362 Jill Otake, WSBA #28298 Scott Fogg, WSBA #28819 Deputy Prosecuting Attorneys Norm Malen Prosecuting Attorney 554 King County Courthouse Seattle, Washington 98104?2312 ORIGINAL CAUSE NO. 04-1?05925-5 KNT CERTIFICATE OF PROBABLE CAUSE That John Everly is a Lieutenant with the Federal Way Police Department and has reviewed the investigation conducted in the Federal Way Police Department?s case number 03-11353. There is probable cause to believe that Charles Momah DOB - committed the crimes of Rape in the Third Degree RCW Rape in the Second Degree RCW Violation of the Health Care False Claims Act RCW 48.80.0300) (5), Indecent Liberties RCW This belief is predicated on the following facts and circumstances In March of 1993, Charles Momah, an obstetrician/gynecologist was issued a license to practice as a physician by the State of Washington. Mornah began practicing in Washington State in 1994. He eventually ran three clinics: one in Issaquah (which he eventually'closed), one in Federal Way, and one in Burien. Typically, at most, only one or two employees worked at a clinic the same hours as Momah. On March 3, 1999, the New York State Department of Health (NY SDOI-I) censured and reprimanded Mornah for, among other things, negligence and incompetence. That same year, a criminal jury acquitted Momah of Medicaid fraud in New York. In 2000, Momah settled with the state of New York and paid $5 00,000 for alleged Medicaid fraud, but denied any wrongdoing. That same year, Auburn Regional Medical Center in Washington permanently denied Momah?s request for reappointment and clinical privileges because of, among other things, his repeated unavailability to respond to emergency room back-up calls. 011 September 11, 2003, a?er receiving a report that Momah had raped one of his patients in the course of an exam, theFederal Way Police Department served a search warrant on Momah?s Federal Way clinic, seizing his patient ?les and taking pictures of the clinic. Pursnant to the judicially-authorized search warrant, the Federal Way Police Department-also took an oral swab from Charles Momah for DNA analysis. H.P. H.P. ?rst visited Momah in May of 2001 for pelvic pain. H.P. ?3 mother attended H.sz ?rst appointment with Momah. They both teld Momah that H.P. was just recovering from a prescription painkiller addiction. Momah performed a vaginal ultrasound on HP. and, despite her previous addiction, provided her with 40 extra- strength pills of Percocet, a painkiller. H.P. reports that, following her initial visit, she continued to see Momah two to three times per week to satisfy her renewed addiction. This schedule lasted for several months. Momah frequently provided herwith prescriptions for Percocet, Xanax (for depression), Valium (a highly addictive drug), and Vicodin (a combination of Hydrocodone and Tylenol). Over time, H.P. became increasingly addicted. According to H.P., beginning in January 2003, Momah started to ?irt with her. During an ultrasound, when there were no chaperones in the room, Momah asked H.P. if she was dating anyone. She jokingly said, ?No, do you know any single doctors?? Momah responded seriously, ?What about me?? At the end of the appointment, he - provided H.P. with his cellular phone number. H.P. recalls a later visit, where she asked Momah, as usual, about obtaining additional prescriptions. Momah told her, and started to _write her notes on a pad of paper. According to H.P., Momah indicated in the ?rst note that he would only provide her with more medication if she agreed to meet him outside of work. Beginning in January 2003, H.P. visited Momah at his of?ce a minimum of twice a month- During these appointments, in the exam room, while alone, Momah wrete notes on a notepad to her, asking her to meet him at various places for sex, including his home and at a Holiday Inn. According to HR, the notepads were used to prevent Momah?s staff from hearing any of their conversations. He told her in these notes that the only way she would be able to obtain more painkillers was if she met with him after hours at places such as a Holiday Inn. According to HR, she wrote notes in which she agreed to meet him and that she wanted to have sex because she was desperate for more pain medication. However, she never intended on actually meeting Momah. As a result, H.P. almost always left her appointments with a prescription, but never once showed up for the - planned meetings. Mornah and HF. did not have a platonic or romantic relationship. On August 12, 2003, HP, suffering from abdominal pain, called Momah on his cellphone. It was after hours and Momah agreed to meet HP. at his Federal Way o?ice. They were the only ones in the of?ce. Momah conducted a vaginal ultrasound on HF. He then placed his ungloved ?ngers into her vagina and started to fondle her genitalia, touching her clitoris. H.P. asked Momah what he was doing and told to st0p. He stated, ?You?ve been wanting this for along time and so have Momah undid his pants and pulled down his underwear. HR was still on the exam table when he inserted his penis into her vagina. She told him to stop, but he continued until he ejaculated inside of her. He then told her to get dressed and to meet him in his of?ce. H.P. got dressed and went to,his of?ce as instructed. When she got there, he told her she better not tell anyone what he did, or he would call Child Protective Services and easily have her son taken away from her due to her prescription drug use. H.P. le? the building and went straight to her boyfriend?s workplace and told him what happened. He took her to Auburn General Hospital, where she again reported what happened to her. A sexual assault exam and rape kit was completed. The rape kit and underwear were sent for analysis to the Washington State Patrol Crime Laboratory. The Crime Laboratory concluded that evidence from the rape lcit matches the DNA typing pro?le collected from Momah and that ?[t]he estimated probability of selecting an unrelated individual at random ?om the US. population with a matching pro?le is 1 in 460 H.P., when interviewed by Federal Way Police Detective Dennis Wilcox, reported that she had bruising on her back due to the rape. A female of?cer took digital photographs of the bruises. - RB. RB. ?rst saw Momah on March 25, 2003, at his Burien of?ce. She went to him to seek in?vitro fertilization (IVF). Momah questioned her about why she wanted to have IVF . She eitplained that in November 2001, she had had a diagnostic laparoscopy performed to determine Whether a tubal reanastomis (reconstruction of her fallopian tubes) could be completed. She advised Momah that her previous doctor told her that a reconstruction of her fallopian tubes was impossible. Momah informed R.B. that he did not trust any other doctors. She explained to him that she had a VHS tape of her prior laparoscopy, but Momah insisted that he would take care of her fertility problem in his own way. Momah told RB. to go to the exam room and take off all her clothes. She did so. Momah did not leave the room while R.B. took off her clothes. He had her lie down on the exam table in stirrups. He advised her that it would help her to relax if he injected her with fentanyl, an opiod analgesic. She recalls that he injected her with a small dose of fentanyl and that she became relaxed. He then conducted a manual eXam, ?rst starting with gloves and then takinghis gloves off. When she asked why he took his gloves off, he told her that he wanted to see if the lumps he felt on her vagina were cancerous. Momah then, while standing at her side, started to rub clitoris in a circular motion, using two ?ngers. At the same time, using his other hand, he massaged breasts in a circular motion and squeezed her breasts, asking her if she enjoyed that. R.B. told Moniah that she did not like having her breasts touched. Momah claimed that he was checking heart rate. A?er rubbing her breasts and vagina simultaneously, Momah moved and sat down, facing vagina. Using one hand?s ?ngers, he pulled her labia apart. With his other hand, he took the vaginal ultrasound wand and repeatedly inserted it into her vagina and then removed it. Meanwhile, he asked RB. more about what sexual positions she enjoyed, about the size of her husband?s penis, and about what her husband does to her that makes her have an orgasm. RB. could see from her vantage point that the ultrasound monitor was not turned on. Momah then turned on the monitor and found what he described as three little on ovaries. He told her, ?This is cool, and this is how we?ll get your insurance to pay for your reversal.? After the exam, Momah reiterated to RB. that he could reconstruct her fallopian tubes, saying, don?t want to discredit any doctor, but I have put tubes back together for women who have nothing left.? He told RB. that he wanted her to go to his Federal Way Of?ce the next day for surgery. RB. did not appear at the Federal Way o?ce the next day and instead drafted a letter to the Department of Health that day, complaining about Momah?s behavior. - i For the next few days, Momah called RB. personally two to three times per day in an effort to persuade her that he could ?x her tubes and asking her if she needed pain medication. She repeatedly told Momah that she had already spent $6,000 in an attempt at tubal reconstruction and that she did not need pain medication. Momah assuredher that she would not have to pay anything for the surgery. Hoping that she could conceive, RB. acquiesced and agreed to the surgery. RB. went to the Federal Way" clinic a few days a?er the ?rst appointment. Momah told her he needed to conduct an exam again. During this appointment, she was given a gown and Momah did not ask her any sexual questions. RB. told Momah that she was uncomfortable about the whole situation, but Momah assured her, ?You have nothing to lose. I guarantee you this will cost nothing.? Momah?s examination on this day was similar to the ?rst: he did not wear gloves and he touched her vagina and breasts at the same time. After the exam, once in his of?ce, Momah told RB. that he was unwilling to even consider IVF without ?rst attempting tubal reconstruction. He then said, ?because of the position of your uterus, you probably have painful sex.? She denied that sex was painful. Nevertheless, he told her that he could get her a prescription to treat . pain during sex and gave her a prescription for 60 tablets of Percocet, which she did not use. Within the following week, RB. appeared for the surgery with her husband at the Federal Way clinic. Momah met husband and immediately gave him prescriptions for pain medication and told him to get them ?lled for R.B. as she would be ?out? for the next two to three days. Momah then left to the back of the clinic, saying that he needed to get ready and that an anesthesiologist would arrive soon to talk to her. R.B. started to cry and told her husband not to leave her there. She told her husband that something I wasn?t right, that Momah?s ultrasounds were ?crazy? and that Momah was falsely billing her insurance. She believed that Momah was falsely billing her insurance company because he had repeatedly told her that he could get the insurance company to pay for the entire surgery if he told the company that the surgery was to remove potentially cancerous ovarian husband asked her if she wanted to leave. Then, a nurse?anesthetist arrived, sat down with RB, and asked her if she was okay. R.B. told the nurse that she wasn?t sure she could go through the surgery and that she knew her tubes could not be reversed. The nurse assured her that the ?nal decision was but that Momah had done many of these procedures before. The nurse then went back to talk with Momah. Momah came back into the waiting room and told R.B. that she had to have the laparosc0py before she could have IVF. RB. went into the exam room and was placed on an IV. The next thing she recalls, she was in a wheelchair, being wheeled out of the room. The surgery was completed. On Marchl3l, 2003, RB. returned to Momah to have the staples from the surgery removed. It was only then that Momah informed her then that he could not reconstruct her tubes. R.B. then asked when they could start IVF. Despite previously intimating that he could perform IVF, Momah informed her that he did not perform IVF procedures. I R..B. never again returned to Momah, although Momah repeatedly called her cellular phone for a month after the surgery and told her she could get her painkillers through him. R.B. has never had an addiction to painkillers and never accepted Moinah?s .offer. RB. wrote a second letter to the Department of Health, in September 2003, complaining of Momah?s behavior. (A copy of this letter has been plaCed in evidence.) An obstetrician] gynecologist with 16 years of practical experience has reviewed medical records and statements. Upon review, this doctor has concluded that there would be no medical reason to perform a breast examination and a vaginal exam simultaneously. Momah billed insurance company four different times for the same surgery, despite the fact that he performed the surgery once and saw RB. only once later. He used the same insurance codes for each billing and each billing reflected the same date. He billed and collected a total of approximately $14,000 for the surgery, not including billing for the of?ce visit and diagnostic procedi?n-es. S.S. .- In September 2002, 8.8. went to the emergency room suffering from seVere bleeding and pelvic pain. The emergency room doctor told her that she needed to ?nd a specialist in gynecology. S.S- called three different of?ces she found in the phone book, but each gynecologists? staff informed her that a doctOr could not see her for. two to three months. 3.3. then found Momah in the phone book. His staff told 8.8. that Momah could see her at the Burien of?ce in a couple of days. 3.8. saw Momah ?ve or six times at both'his Burien and Federal Way of?ces beginning in October 2002. At the ?rst appointment, on October I, 2002, no one but Mo'mah was at the Burien of?ce. Momah did not ask S.S. anything about her medical history, nor did he have her ?ll out any paperwork He only asked her for her insurance card. Mornah conducted both a routine pelvic examination and vaginal ultrasound and immediately diagnosed 3.3. as having multiple ovarian Momah prescribed Tylenol with codeine and Percocet to 8.8. Inthe prescription, he allowed for three re?lls. Within two days, on October 3, 2002, a staff member at Momah?s of?ce called SS. and informed her that she needed immediate surgery. 'f'hat day, 8.3. went, as instructed, to an appointment at Momah?s Federal Way of?ce. Momah asked how the Tylenol with codeine was working. S.S. explained that she had gotten ?used to it? and that it wasn?t as powerful anymore. Momah then prescribed her Percocet. A laparosc0pic surgery to examine the was scheduled for later that month. S.S. asked Momah if he would have a blood supply on hand during the surgery and explained to him that she had a rare blood type (RH negative blood). She told him that, in the past, doctors had asked her to give blood prior to a surgery because her blood type was so rare. Mornah assured her that he would have an ample supply of blood on hand. .8. also asked why the surgery was not going to be performed at a hOSpital. Momah told her that it was cheaper'for him to perform the surgery at his clinic. Momah did not disclose that he had lost hospital privileges as areason for performing the surgery at his clinic. S.S. recalls arriving at her for the surgery with a male friend. Momah gave the friend a prescription for Percocet and told him to ?ll it for 8.8. while she was in surgery. 3.8. then went into the examination room, was anesthetized, and awoke later. S.S. quickly became addicted to the Percocet in the following days. She visited Momah for a'post? surgery appointment two days after the surgery. During this appointment, in mid-October, Momah told her that the surgery was going to cost twice what he had originally expected, or between $6000 and $7000. He quizzed her for a half? hour regarding how much of the surgery she could pay herself (they had both been informed that her insurance would only cover She told him that she was a single mother and paid him $200 cash that day. Momah also started 8.8. on injeCtions of a drug to accelerate menopause to alleviate her menstrual cramps. Momah told 85. that she had to receive three injections. Momah also told 8.8. that he needed to conduct a pelvic exam and vaginal ultrasound before each of the injections. At this ?rst appointment post~surgery, Momah advised 8.8. that she could go back to work in a couple of days. 8.8. told Momah that her job required heavy weights. Momah neVertheless told her she was ?ne to return to work, which 8.3. did. 83. then went to work in November 2002 and, while lifting an item, felt something tear in her abdomen. She could hardly walk and called Momah, who agreed to see her. The next day, during a pelvic exam, while feet were in stirrups and while she was naked from the waist?down, Momah, standing at side, wrapped one of his arms around her leg. He then inserted two ?ngers into her vagina and, using his thumb, massaged her clitoris in a Circular motion, asking, ?Can you feel this?? 8.8. jumped back immediately. Momah became upset with her, telling her to get dressed and that he would, no longer prescribe her Percocet. S.S. visited Momah two more times, once in December 2002 and once in January 2003 to complete the injection cycle, but had a chaperone with her on one occasion and had her daughter accompany her into the exam room on another - occasion. The chaperone, however, walked in and out of the room. During that appointment, Momah commented to 3.8. that it might hurt her for him to insert his ?ngers into her vagina because she was so ?tight.? The same obstetrician] gynecologist with 16 years of practical experience also reviewed case, She stated that at no time in a normal pelvic exam would there be purposeful contact with a patient?s clitoris. She explained that if a patient complained of feeling numb in that area, it would be appropriate for a doCtor to determine what part of the vaginal area was numb. However, without such a complaint (SS. had never made such a complaint), there would be no medical reason for the palpation of the clitoris. The reviewing doctor-also stated that the comments attributed to Momah by the patient would be whollv inappropriate. Finally, she found Momah?s liberal use of narcotics inappropriate, both in the initial amount prescribed and the lack of follow?up care provided. A 8.8. reported the matter to the police after seeing the news coverage of the Medical Quality Assurance Commission?s investigation of Momah. (LB. QB. ?rst saw Momah at the end of 2001 because she had was having dif?culty conceiving, and was also suffering ?om irregular menstrual cycles. She found Momah in the Yellow Pages and chose him because he was the only doctor who would accept her medical coupons. ?rst few visits to Momah were not unusual. Momah diagnosed her as having ovarian He prescribed Prevarin and Coma?ne to regulate her menstrual and ovulation cycles. He also prescribed Percocet. After the ?rst few visits, Momah began to ??irt? with C.B., asking her what kind of men she dated, and inquiring about what positions she performed during intercourse, how o?en she had sex, etc. He told her that, although she is a big woman, she is proportionate, and he liked her curves and the softness of her body. He also called her several times on her-cell phone, asking her out to dinner. Momah frequently performed vaginal ultrasounds on C.B., eventually using the ultrasound wand, as she described it, as though it was a sex toy, sliding it in and out of her vagina. He also once performed a manual exam Without a glove and, when asked by GE. why he was gloveless, stated that he couldn?t feel things as well with the glove on. -In May 2003, during a vaginal exam, Momah told CB. that she had the ?prettiest pussy" he had ever seen. QB. got off the exam table, got dressed, and was about to leave the of?ce when Momah reached out, as if to give her a hug, but instead touched her on the sides of her breasts with his open palms. C.B. walked away from him, then turned around and scolded him for his behavior, telling him she was going to report what he had done. Momah said that it would be her word against his, and that no one would believe her because she was a ?nobody? and he was a doctor. CB. contacted the police after seeing the news coverage of Momah?s ease. C.R. CR. began seeing Momah in February of 2003 because she was experiencing menstrual painand because she wanted a tubal reversal, in the hopes of being able to get pregnant. Momah agreed to perform the tubal reversal, but wanted $3,000 paid in advance. QR. could afford only $1000, which Momah accepted. Momah performed the surgery while husband waited for her in the of?ce. I Following the procedure, Momah confronted husband and told him that he could not see his wife unless he paid an additional $500. wrote MOmah a check for $500. However, insurance records show that Momah also received a $2937 payment from insmance company payment in full for the tubal reversal. In essence, Momah billed for the same procedure twice. On March 30, 2003, Momah performed a laparotomy on (IR. He produced two separate operative reports from this one surgery. The two reports are dated on the same day, but describe different surgeries. S.A. S.A. saw Momah a number of times from 1999 through September 2002.? Momah scheduled SA. for a laparosc0py on September 18, 2002, telling her he needed to examine supposed ovarian On the day of the surgery, Momah appeared in street clothes and S.A. became uncomfortable with the uncleanliness of both the surgical suite IO and Momah. Prior to the surgery, SA. walked out and never returned. Momah billed SA. and her insurance company and collected ?om the insurance company for the surgery even though it never occurred. Similarly,-Momah billed insurance company twice for a September 4, 2002 ultrasound. The billing records re?ect a bill for the same date, same procedure and same price. On another date, September 18, 2002, Mornah only performed one ultrasound for a regular of?ce visit and again billed the insurance company twice. He collected twice for each ultrasound he performed on SA. This double billing violates the Health Care False Claims Act. Additional Witnesses Victims Many of the women who reported abuse at the hands of Momah, including those who cannot be charged asvictims due to the Statute of Limitations, corroborate Momah?s bedside manner, his sexualized conduct, fraudulent billing practices, and his general practice as described by the charged victims. Many patients report inappropriate sexual advances from Momah and several alleged that they were propositioned outright for dates. Several others report Momah offered to impregnate them. Additionally, former members of Momah?s of?ce staff verify victim accounts that exams were often conducted without assistants or chaperones present. One staff member recalled that Momah told her that several patients (including HP.) were not comfortable with having an assistant in the room, and would instruct her to leave. Several former staff members also corroborate sexualized behavior by Momah, including attempts to kiss staff, slapping staffs buttocks, and offers to ?make beautiful babies.? Under penalty of perjury under the laws of the State of Washington, I certify that the foregoing is true and correct. Signed and dated by me this i day of 2004 at King County, Washington. I rentenant John Everly (I i Federal Way Police Departme sac/MAL 11 CAUSE NO. 04-1?05925?5 KNT PROSECUTING ATTORNEY CASE SUMMARY AND REQUEST FOR BAIL - commons 0F RELEASE The State incorporates by reference the Certi?cation for Determination of Probable Cause for Federal Way Police Department incident #03?11353, signed by Lt. John Eyerly of the Federal Way Police Department on September 13?: 2004. REQUEST FOR BAIL The State bail in the amount of $250,000. In addition to the description of the charges contained in the Certi?cation, there are a number of factors that should give the court concern in setting an appropriate bail amount. As noted in the Certi?cation, the charged offenses are part of a pattern of inappropriate behavior and ?raudulent business practices that span several years. For instance, when the defendant was practicing medicine in New York, he was civilly accused of Medicaid fraud in a lawsuit brought by the Medicaid Fraud Control Unit of the New York State Attorney General?s Of?ce. He ultimately settled with New York State for $500,000. Since moving to Washington, and during this investigation, numerous former patients of the defendant have come forward and accused him of sexual and medical misconduct. While the statute of limitations has barred the prosecution of many of those claims, their existence should not be oVerlooked. - In addition, the defendant?s ties to this community are also of concern, including the fact that the defendant has dual citizenship in the United States and Nigeria. It should be noted1 . however, that the defendant voluntarily surrendered his passport to police during this investigation, and has not made any attempt to ?ee since his clinics were shut down by the authorities and over a year ago. His license to practice medicine in Washington State is currently suspended. Finally, the court should also consider the fact that the Washington State Department of Health Medical Quality Assurance Commission has charged the defendant with, among other things, unprofessional conduct stemming ?'om the willful misrepresentation of facts in his re- credentialing application, This fact alone should give the court some hesitation when evaluating the defendant?s sole promise to appear. Norm Maleng, Prosecuting Attorney Regional Justice Center 40'] Fourth Avenue North Kent, Washington 98032-4429 For all these reasons, and given the serious nature and number of charges, the court should set bail in the amount requested. The court should also require the defendant to not make any additional applications for pa35ports, restrict him from leaving the State of Washington and set other appropri ate conditions, including a no?contact order with charged and uncharged victims. MFogg, WSBA #28819 Norm Maleng, Prosecuting Attorney Regional Justice Center 401 Fourth Avenue North Kent, Washington 98032-4429 Km cm.? some: can? I. 1' Wm LE, CERTIFIED COPY TO COUNTY JAIL 7 2806 SUPERIOR COURT OF WASHINGTON FOR KING COUNTY STATE OF WASHINGTON, Plaintiff, No. 04?1?05925-5 KNT Vs. JUDGIVIEN AND SENTENCE FELONY rt; CHARLES MOMAH a_ g. Defendant, :0 Chg; .. "Tm I. BEARING ?g t" 1.1 The defendant, the defendant?s lawyer, DAVID ALLEN, and the deputy prosecuting attorney were pgegent at CO the sentencing hearing conducted today. Others present were: g; =3 II. FINDINGS There being no reason why judgment should not be pronounced, the court ?nds: 2.1 CURRENT The defendant was found guilty on 11/16/2005 by jury verdict of: Count No; I Crime: RAPE IN THE THIRD DEGREE RCW 9A.44.060 Date of Crime: 08/12/2003 Count No.2 11 Crime Code: 00764 Incident No. 00868 Crime: INDECENT LIBERTIES RCW 9A.44.100 (11 Ld) Cn'me Code Date of Crime: 04/30/2002 - 06/01/2003 Incident No. Crime: INDECENT LIBERTIES 00868 Count No.: 111 ROW 9A.44.100 (1) Crime Code Date of Crime: 04/30/2002 - 06/01/2003 Incident No. Count No.: IV Crime: RAPE IN THE SECOND DEGREE RCW 11011 Crime Code: Date of Crime: 03/01/2003 - 04/01/2003 Incident No. Additional cunent offenses are attached in Appendix A Rev. 12/03 ij 1 00748 3350 STATE SOARD ADD 1 *1 mono SPECIAL VERDICT or While armed with a ?rearm in count(s) RCW While armed with a deadly Weapon other than a ?rearm in count(s) RCW With a sexual motivation in count(s) RCW 9.94A.835. A V.U.C.S.A offense committed in a protected zone in count(s) RCW 69,50,435. Vehicular homicide ]Violent tia?ic offense Reckless ]Disregard. (1) Vehicular homicide by DUI with prior conviction(s) for de?ned in RCW 41.61.5055, RCW Non?parental kidnapping or unlaw?il imprisonment with a minor victim. RCW 9A.44.130. Domestic violence offense as de?ned in RCW 1099020 for count(s) Current o?enses encompassing the same criminal conduct in this cause are count(s) RCW 2.2 OTHER CURRENT Other current convictions listed under different cause numbers used in calculating the offender score are (list offense and cause number): 2.3 CRIMINAL HISTORY: Prior convictions constituting criminal history for purposes of calculating the offender score are (RCW 9.94A.525): Criminal history is attached in Appendix B. One point added for o??ense(s) committed while under community placement for count(s) 1 2.4 SENTENCIN DATA: Sentencing Offender Seriousness Standard Total Standard Maximum Data Score Level Range Enhancement Range Term Count I 9 60 MONTHS 60 MONTHS 5 YRS 10,000 Count YRS MONTHS $20,000 0T0 12 0T012 IOYRS MONTHS $20,000 Count 280 LIFE MONTHS $50,009,. Additional current offense sentencing data is attached in Appendix C. ?3 55?? 2.5 EXCEPTIONAL SENTENCE (RCW 9.94A.535): I Substantial and compelling reasons exist which justify a sentence above/below the standard range for 5 Cows) . Findings of Fact and Conclusions of Law are attached in Appendix D. The State did did not recommend a similar sentence. 1: 'lV??lGBh JUDGMENT IT IS ADJUDGED that defendant is guilty of the current offenses set forth in Section 2.1 above and Appendix A. The Court DISMISSES Count(s) Rev. 12/03 - 2 IV. ORDER IT IS ORDERED that the defendant serve the determinate sentence and abide by the other terms set forth below. 4.1 RESTITUTION AND VICTIIVI ASSESSNCENT: 4.2 4.3 1 Defendant shall pay restitution to the Clerk of this Court as set forth in attached Appendix E. Defendant shall not pay restitution because the Court ?nds that extraordinary circumstances exist, and the court, pursuant to RCW sets forth those circumstances in attached Appendix E, Restitution to be determined at future restitution hearing on (Date) at [>0Date to be set. Defendant waives presence at ?iture restitution hearing(s). Restitution is not ordered. . Defendant shall pay Victim Penalty Assessment pursuant to RCW 7.68.035 in the amount of m. OTHER FINANCIAL OBLIGATIONS: Having considered the defendant?s present and likely ?ittn'e ?nancial resources, the Court concludes that the defendant has the present or likely future ability to pay the ?nancial obligations imposed. The Court waives ?nancial obligation(s) that are checked below because the defendant lacks the present and future ability to pay them. Defendant shall pay the following to the Clerk of this Comt: Court costs; Court costs are waived; (RCW 9.94A.030, 10.01.160) 3100 DNA collection fee; DNA fee waived (RCW committed after 7/1/02); Recoupment for attorney?s fees to King County Public Defense Programs; Recoupment is waived (RCW Fine; ]$1,000, Fine for ]$2,000, Fine for subsequent JVUCSA ?ne waived (RCW 6950.430); (6) King County Interlocal Drug Fund; Drug Fund payment is waived; (RCW 9.94A.030) 3 State Crime Laboratory Fee; Laboratory fee WaiVed (RCW 43.43.690); Incarceration Costs; Incarceration costs waived (RCW Other costs for: PAYNIENT SCHEDULE: Defendant?s TOTAL FINANCIAL OBLIGATION is: 500+ payments shall be made to the King County Superior Court Clerk according to the rules of the Clerk and the following terms: ]Not less than $3 per month; On a schedule established by the defendant?s Community Corrections Of?cer or Department of Judicial Administration (DJA) Collections Of?cer. inancial obligations shall bear interest pursuant to RCW 10.82.090. The Defendant shall remain under the Court?s jurisdiction to assure payment of ?nancial obligations: for crimes committed before 7/1/2000, for up to ten years from the date of sentence or release from total confinement, whichever is later; for crimes committed on or after 7/1/2000, until the obligation is completely satisfied. Pursuant to RCW 9.937602 if the defendant is more than 30 days past due in payments, a notice of payroll deduction may be issuednm'thodt'? ?n'ther notice to the offender. Pursuant to RCW the defendant shall report as directer V15: and provide fmancial information as requested. Court Clerk?s trust fees are waived. - N3 :23 Interest is waived exoept with respect to restitution. :35: 11> -- 8 f: c? Rev. 12/03 3 ?4.4 The defendant, having been convicted (if a FELONY SEX OFFENSE, is sentenced to the following: DETERMINATE SENTENCE Defendant is sentenced to a term of con?nement in the custody of the King County Jail King County WarkEducarion Release (subject to conditions of conduct ordered this date) D4 Department of Corrections, as follows, commencing: Mmediately; Date: by am. p.m. ays on count Z: months/days on count months/days on count ays on count 3; months/days on count months/days on count days on count months/days on count months/days on count . ALTERNATIVE CONVERSION - RCW (LESS THAN ONE YEAR ONLY): days of total con?nement are hereby converted to: days of partial con?nement to be served subject to the requirements of the King County JaiL days/how's community service under the supervision of the Department of Corrections to be completed as follows: on a schedule established by the defendant?s Comrmmity Corrections O?mr; ]Altemative conversion was not used because: Defendant?s criminal history, Defendant?s failure to appear, Other: CONFINEIVIENT LESS THAN ONE YEAR: COMIVIUNITYI SUPERVISION, for crimes committed before 7-1-2000, CUSTODY, for crimes committed on or after 7?1-2000, is ordered pursuant to RCW 9.94A.545 for a period of 12 months. The defendant shall report to the Department of Corrections within 72 hours of this date or of his/her release if now in custody; shall comply with all the rules, regulations and conditions of the Department for supervision of offenders (RCW shall comply with all af?rmative acts required to monitor compliance; and shall otherwise comply with terms set forth in this sentence. APPENDIX Additional Conditions are attached and incorporated herein. COWUNITY PLACEMENT OVER ONE YEAR: pursuant to RCW 9.94A.700, for qualifying crimes committed before 6-6-1996, is ordered for months or for the period of earned early release awarded pursuant to RCW 9.94A.728, whichever is longer. [24 months for any serious violent offense, vehicular homicide, vehicular assault, or sex offense prior to 6-6?96; 12 months for any assault assault of a child felony violation of RCW 69.50/52, any crime against person de?ned in RCW 9.94A.440 not otherwise described above] APPENDIX H: Community Placement conditions are attached and incorporated herein. COMMUNITY commnr OVER ONE YEAR: pursuant to Rcws'igmm 3; for any SEX OFFENSE committed after 6?6-96 but before 7-1-2000, is ordered for a period months or for the period of earned early release awarded under RCW 9.94A.728 whichever is 10%. C: E: Community Custody conditions are attached and incorporated herein. i >0 COMMUNITY CONEINEISIENT OVER ONE YEAR: pursuant to for qualifying crimes (non RCW 9.94A.712 offenses) committed after 6-30-2000 is ordered following established range: I. PdSex Offense, RCW - 36 to 43 months 5 - .- Serious Violent Offense, RCW - 24 to 48 months (-11 7 Violent O?'ense, RCW - 18 to 36 months Crime Against Person, RCW 9.94A.411 - 9 to 18 months Felony Violation of RCW 69.50/52 - 9 to 12 months or for the entire period of earned early release awarded under RCW 9.94A.728, whichever is longer. Sanctions and punishments for non-compliance will be imposed by the Department of Corrections pursuant to RCW 9.94A.737. H: Community Custody conditions are attached and incorporated herein. Rev. 6/04 4 SENTENCE - QUALIFYING SEX OFFENSES occurring after 9/1/01: The Court having found that the defendant is subject to sentencing under RCW 9.94A.712, the defendant is sentenced to a term of total con?nement in the custody of the Department of Corrections as follows, Cb) commencing: immediately;[ by Count Minimum Term: ays; Maximum Term: a yuan/Egg Count Minimum Term: months/days; Maximum Term: years/life; Count Minimum Term: months/days; Maximum Term: years/life; Count Minimum Term: months/days; Maximum Term: years/life. COMMUNITY CUSTODY pursuant to RCW 9.94A.712 for qualifying SEX OFFENSES committed or after September 1, 2001, is ordered for any period of time the defendant is released ?'om total con?nement before the expiration of the maximum sentence as set forth above. Sanctions and punishments for non-compliance will be imposed by the Department of Corrections pursuant to RCW 9.94A.713, 9.94A.737. MAPPENDIX H: Community Custody conditions are attached and incorporated herein. 4.5 ADDITIONAL CONDITIONS OF SENTENCE 33117.? The above terms for counts are consecutive oncurrent. The above terms shall run CONSECUTIVE CONCURRENT to cause No.(s) The above terms shall run CONSECUTIVE CONCURRENT to any previously imposed sentence not referred to in this order. In addition to the above term(s) the court imposes the following mandatory terms of con?nement for any special WEAPON ?nding(s) in section 2.1: which term(s) shall run consecutive with each other and with all base term(s) above and terms in any other cause. (Use this section only for crimes committed after 6-10-98.) The enhancement tel-111(5) for any special WEAPON ?ndings in section 2.1 is/are included Within the term(s) imposed above. (Use this section when appropriate, but for crimes before 6-11-98 only, per In Re Charles] The TOTAL of all terms imposed in this cause is 2 months. Credit is given for 35 days served days as determined by the King County Jail, solely for. . con?nement under 3 cause number pursuant to RCW Jail term is satis?ed defenc? shall be released under this cause. 4.4 4.6 NO CONTACT: For the maximum term of years, defendant shall have no contact, dir 1161? in persci? in writin_g,_by telephone, or through third parties withA1137 minors wimou?pervision of a responsible adult who has knowledge of this conviction. 2 . OIHO 30 OHVOB WOIOHH 31Rev. 6/04 (Non-3303A) UI 4.7 DNA TESTING: The defendant shall haVe a biological sample collected for purposes of DNA identi?cation analysis and the defendant shall fully cooperate in the testing, as ordered in APPENDIX G. HIV TESTING: For sex offense, prostitution Voffense, drug offense associated with the use of hypodermic needles, the defendant shall submit to HIV testing as ordered in APPENDIX G. 4.8 SEX OFFENDER REGISTRATION: . The defendant shall register as a Sex offender as ordered in APPENDIX J. 4.9 ARMED CRIMCE COMPLIANCE, RCW The State?s plea/sentencing agreement is ]attached ]as follows: The defendant shall report to an assigned Community Corrections Of?cer upon release from con?nement for monitoring of the remaining terms of this sentence. LEW, Date: Presented by: A I utyPI outing A 36?. Prei?t Name: @Dmey? ?st? Attorney for Defendan WEN: Print Name: MI SS Zl? 1602 mm as owns ?Ivamaw 3mg Rev. 5/04 I 6 BEST Am, I: mug: 1: FINGERPRINTS DEFENDANT SIGNATURE RIGHT HAND OF: ADDRESS: Am/j 7 Wu CHARLES MOMAH DATED ATTESTED BY: JUDGE, COUNT UP IOR COURT I Ev - ?1 vi; CERTIFICATE OFFENDER IDENTIFICATION I, S.I.D. NO. CLERK OF THIS COURT, CERTIFY THAT 3 THE ABOVE IS A TRUE COPY OF THE DOB: JUDGEMENT AND SENTENCE IN THIS - 3g ACTION ON RECORD IN MY OFFICE. SEX: .. "153 DATED: RACE: 1, Br- CD 9 CLERK - an :33 BY: DEPUTY CLERK Fax COPY T0 ocean 4m FEB 7 SUPERIOR COURT OF WASHINGTON FOR KING COUNTY STATE OF WASHINGTON, I Plaintiff, No. 04-1-05925-5 KNT vs. APPENDIX ORDER FOR BIOLOGICAL TESTING CHARLES MOMAH AND COUNSELING Defendant, (1) DNA IDENTIFICATION (RCW 43.43.754): The Court orders the defendant to c00perate with the King County Departrnent of Adult Detention, King County Sheriffs Of?ce, and/or the State Department of Corrections in providing a biological sample for DNA identi?cation analysis. The defendant, if out of custody, shall call the King County Jail at 296-1226 between 8:00 am. and 1:00 to make arrangements for the test to be conducted within 15 days. (2) ?P?jmv "meme AND COUNSELING (RCW 70.24.340): (Required for defendant convicted of sexual offense, drug offense associated with the use of hypodermic needles, or prostitution related offense.) The Court orders the defendant contact the Seattle?King County Health Department and participate in human immunode?ciency virus (HIV) testing and counseling in accordance with Chapter 70.24 RCW. The defendant, if out of custody, shall call Seattle-King County Health Department at 205 47837 to make arrangements for the test to be conducted within 30 days. If (2) is checked, two independent biological samples shall be taken. Date: I a JUDGE, King County SLlperior Court :13 {23. APPENDDC G?Rev. 09/02 SUPERIOR COURT OF WASHINGTON FOR KING COUNTY STATE OF WASHINGTON Plaintiff . No. 0-414-05925-5 KNT v. I MOMAH, Charles Madu Defendant JUDGMENT AND SENTENCE (FELONY) - APPENDIX COMMUNITY CUSTODY. CRIME-RELATED PROHIBITIONS 1. Follow anmonditions imnosed bv the Department of Corrections based on risk and need. 2. ObengLaws. 3. Do not have direct or indirect contac 3?5 3 :Jd? a/ ?at, 0/ .rvtmuw 019 Wm} M?uu Ly giv E3qu a?m?v. ,?Cb =3 7f? ?3 55;, In :5 rt{:3 33?33sat? Date: I JUDGE, KING COUNTY SUPERIOR CIQIJHT - i a APPENDIX H7COMMUNITY CUSTODY I *7 go I 1 Further dissemination IS prohibited. I I '1 Milli-g..- - - SUPERIOR COURT OF WASHINGTON FOR KING COUNTY STATE OF WASHINGTON, Plaintiff, No. 0 - .. -. JUDGMENT AND SENTENCE Irv-?2. r: Vim-l0"k SEX OFFENDER NOTICE OF Defendant, REGISTRATION REQUIREMENTS .. a SEX AND IGDNAPPIN OFFENDER REGISTRATION. RCW 9AA4.130, 10.01.200. Because i. crime involves a sex offense or kidnapping offense kidnapping in the ?rst degree, kidnapping in the second degree, or unlawful imprisonment as de?ned in chapter 9A.40 RCW where the victim is a minor and you are not the miner?s parent), you are required to register with the sheriff of the county of the state of 1 . Washington where you reside. If you are not a resident of Washington, you must register with the sheriff of. . - 15 the county of your school, place of employment, or vocation. You must register Nd sentenced unless you are in custody, in which case you must register within 24 hours of your release. If you leave the state following your sentencing or release from custody but later move back to Washington, you must register within 30 days after moving to this state or within 24 hours after doing so if you are under the jurisdiction of this state?s Dapartment of Corrections. If you leave this state following your sentencing or release ?om custody but later while not a resident of Washington you become employed in Washington, carry out a vocation in Washington, or attend school in Washington, you must register within 30 days after starting school in this state or becoming employed or carrying out a vocation in this state, or within 24 hours after doing so if you are under the jurisdiction of this state?s Department of Corrections. If you change your residence within a county, you must send written notice of your change of residence to the sheriff within 72 hours of moving. Ifyou change your residence to a new county within this state, you must send written notice of your change of residence to the sheriff of your new county of residence at least 14 days before moving, register with the sheriff within 24 hours of moving and you must give written notice of your change of address to the sheriff of the county where last registered within 10 days of moving. Ifyou move, work carry on a vocation, or attend school out of Washington State, you must send written notice within 10 days of establishing residence, or after beginning to work, carry on a vacation, or attend school in the new state, to the county sheriff with whom you last registered in Washington State. Ifyou are a resident of Washington and you are admitted to a public or private institution of higher education, you are required to notify the sheri?' of the county of your residence of your intent to attend the institution within 10 days of enrolling or by the ?rst business day after arriving at the institution, whichever is earlier. Even if you laclc a ?xed residence, you are required to register. Registration must occur within 24 hours of release in the county where you are being supervised if you do not have a residence at the time Of your release from custody or within 48 hours, excluding weekends and holidays, after ceasing to have a 9" ?xed residence. If you enter a different county and stay there for more than 24 hours, you will be rgiired to register in the new county. You must also report in person to the sheriff of the county where you". .4 registered on a Weekly basis. The weekly report shall be on a day speci?ed by the county sheriff?s $ce, 3 and shall occur during normal business hours. The county sheriff may require the person to list the:3 mg locations where the person has stayed during the last seven days. The lack 'of a ?xed residence is ?ctorDI-?i that may be considered in detennining an offender?s risk level and shall makethe ?o?'ender subject to disclosur orniation to the public at large pursuant to RCW 4.24.550. a *m a: Copy eceived: 5 e. 2% a 06% ?Dalte rune; N, W94 APPENDIX Rev. 11/03 Distribution: Original/White Clerk Yellow - Defendant Pink - King County Jail BEFORE THE NORTH CAROLINA MEDICAL BOARD In re: FINDINGS OF FACT, CONCLUSIONS OF LAW, AND ORDER OF DISCIPLINE Charles M. Momah, M.D. Respondent. This matter was heard by the North Carolina Medical Board (hereafter ?Board?) on. October 20, 2004. Amy? Yonowitz Bason represented the Board, and Respondent, Charles M. Momah, M.D., (hereafter ?Dr. Momah") did not appear. Based upon the evidence presented and the arguments of counsel, the Board enters the following: FINDINGS OF FACT 1. The Board is a body duly organized under the laws of North Carolina and is the proper party to bring this proceeding under the authority granted it in Article 1 of Chapter 90 of the North Carolina General Statutes. 2. The Board issued Charles M. Momah, M.D. (hereafter ?Dr. Momah"), a license to practice medicine on or about January 30, 1993, license number 36398. 3. During the times relevant herein, Dr. Momah was also licensed and practiced medicine in New York State and Washington State. Final Order Charles M. Momah, M.D. Page 1 of 3 4. In March 1999, following a hearing that occurred during May, June, September and October of 1998, the New York State Board for Professional Medical Conduct (hereafter ?New York Board") ordered that Dr. Momah?s New York medical license be censured and reprimanded based on the findings that he: committed negligence in treating two patients below the standard of care; and he willfully filed a false report in that he stated on his New York re-registration application that his hospital privileges had not been restricted when in fact they had. 5. Dr. Momah subsequently relocated in) Washington State and on September 10, 2003, the State of Washington Medical Quality Assurance Commission (hereafter ?Washington Board"), issued an Order of Summary Action summarily suspending Dr. Momah's medical license and found that he posed an imminent danger to the public health, safety, and welfare based upon the allegation that Dr. Momah raped a patient in his office after regular office hours. 6. On October 15, 2003, the New York Board issued a Commissioner?s Summary Order requiring that Dr. Momah not practice medicine in New York, based upon the summary suspension of his Washington medical license. Based upon the foregoing Findings of Fact, the Board enters the following: Final Order Charles M. Momah, M.D. Page 2 of 3 CONCLUSIONS OF LAW 1. The Board has jurisdiction over Dr. Momah and the subject matter. 2. The actions of the New York and Washington Boards against Dr. Momah's medical licenses constitute having a license to practice medicine or the authority to practice medicine revoked, suspended, restricted, or acted against or having a license to practice medicine denied by the licensing authority of any jurisdiction, within the meaning of N.C. Gen. Stat. 90? 14(a)(13) and grounds exist under this section of the North Carolina General Statutes for the Board to annul, suspend, revoke, or limit Dr. Momah's license to practice medicine issued by the Board or to deny any application he might make in the future. ORDER The North Carolina medical license of Dr. Momah is hereby REVOKED. This the ?day of October, 2004. NORTH CAROLINA MEDICAL BOARD ??gw Stephen M. Herring, M.D., D.D.S. President By: Final Order Charles M. Momah, M.D. Page 3 of 3 BEFORE THE NORTH CAROLINA MEDICAL BOARD In re: Charles Madu Momah, MD, AFFIDAVIT OF SERVICE Respondent. Amy Y. Bason first being duly sworn, deposes and says as follows: 1. As per N.C.G.S. 90?14.3, a copy of the Notice of Charges and Allegations; Notice of Hearing in the above? captioned contested case was sent to Respondent at PO Box 8279, Seattle, WA. 98148, his last known address as shown. by the records of the Board, by certified mail on September 8, 2004. 2. On or about September 28, 2004, the document referred to above was returned to the North Carolina Medical Board with the envelope marked unclaimed. 3. A true and accurate copy of the front and back of the my Sworn to and subscribed before me, this September, 2004. NW 05051961.. Notary Public 0 envelope is attached hereto. {Seal} My Commission expires: 4*!8 "020% OLINA MEDICAL BOARD PO Box 2mm CAROLINA 27619?000? g; ??ff?g PM CONFIDENTIAL REQUESTED USED DUUEI EST-I SENDEH: COMPLETE THIS SECTION .5 arm name 1310:! 'eeaucmiur EH1. 5e JJ-IEIIH am at 5D ecu. ur ?attens THIS ON DELIVERY .?fleon-Imam iteme1.2,erid 3.Neucomplete A Signature -. item 4 ifFIesh-ieted Deliveryle deelredreverse .1 EIAddreeseethat We can return the card to you. i I Attach this card to the heck of the meltplece. - or on the front ifspece 1. to: Charles Madu Memah, MD I 3. PO Box 43279 Seattle, WA 98148 2. Mime Number {Tmmfer? ?'em B. Received by (Penman:me- c. Date of Delivery 35/?45' . I. . D. Item 1? El enter deliveuy endless beluw: I I I I CINE: I I I Servl ?iifv -. - . 2 I same] I: Bantam Melt Registered [3 limited Mai] El ODD. 4. Restricted Delivery? {Ema Foe) dent: 15556 35mm -. - :1 Return mm for Memhanuea El?l?be Ipt. I I. Newman BEFORE THE NORTH CAROLINA MEDICAL BOARD In re: NOTICE OF CHARGES AND NOTICE OF HEARING Charles M. Momahr M.D. Respondent. The North Carolina Medical Board (hereafter, ?Board") has preferred and does hereby prefer the following charges and allegations: 1. The Board is a body duly organized under the laws of North Carolina and is the proper party to bring this proceeding under the authority granted it in Article 1 of Chapter 90 of the North Carolina General Statutes. 2. Charles Madu Momah, M.D. (hereafter, ?Dr. Momah"), is a physician licensed by the Board on or about January 30, 1993, to practice medicine, license number 35398. 3. During the times relevant herein, Dr. Momah was also licensed and practiced medicine in New York State and Washington State. 4. In March 1999, following a hearing that occurred during May, June, September and October of 199Br the New York State .Board for Professional Medical Conduct (hereafter, ?New York Board") ordered that Dr. Momah's New York medical license be Censured and Reprimanded based on the findings that he: Notice of Charges Charles M. Momah, M.D. Page 1 of 4 committed negligence in treating two patients below the standard of care; and he willfully filed a false report in that he stated on his New York re?registration application that his hospital privileges has not been restricted when in fact they had. 5. Dr. Momah subsequently relocated tn: Washington State and on September 10, 2003. the State of Washington Medical Quality Assurance Commission (hereafter, ?Washington Board"), issued an Order of Summary Action summarily suspending Dr. Momah's medical license and finding that he posed an imminent danger to the public health, safety, and welfare based upon the allegation that Dr. Momah raped a patient in his office after regular office hours. 6. On October 15, 2003, the New York Board issued a Commissioner?s Summary Order requiring that Dr. Momah not practice medicine in New York, based upon the summary suspension of his Washington medical license. 7. The actions of the New York and Washington Boards against Dr. Homah's medical licenses constitute having a license to practice medicine or the authority to practice medicine revoked, suspended, restricted, or acted. against or having a license to practice medicine denied by the licensing authority of any jurisdiction. within the meaning of N.C. Gen. Stat. 5 90? and grounds exist under this section of the North Carolina General Statutes for the Board to annul, suspend, Notice of Charges Charles M. Momah, M.D. Page 2 of 4 revoke, or limit Dr. Momah's license to practice medicine issued by the Board or to deny any application he might make in the future. NOTICE TO DR. MOMAH Pursuant to N.C. Gen. Stat. 90-14.2, it is hereby ordered that a hearing on the foregoing Notice of Charges and Allegations will be held before the Board beginning at 8:00 a.m. on Wednesday, October 20,. 2004, or as soon thereafter as the Board may hear it at the offices of the Board, 1203 Front Street, Raleighq North. Carolina, to continue 'until completed. The hearing will be held pursuant to N.C. Gen Stat. 1503?40, 41, and. 42, and. N.C. Gen. Stat. 90?14.2, 14.4, 14.5, and 14.6. You may appear personally and through counsel, may cross- examine witnesses and present evidence in your own behalf. You may, if you desire, file written answers to the charges and complaints preferred against you within 30 days after the service of this notice. Pursuant to N.C. Gen. Stat. it is further ordered that the parties shall arrange a pmehearing conference at which they shall prepare and sign a stipulation on prehearing conference. The prehearing stipulation shall be submitted to the undersigned no later than seven days prior ix: the hearing date. Notice of Charges Charles M. Momah, M.D. Page 3 of 4 The right to be present during the hearing of this case, including any such right conferred or implied by N.C. Gen. Stat. 150E?40id), shall be deemed waived by a party or his counsel by voluntary absence from the Board's office at a time when it is. known that. proceedings, including" deliberations, are Ibeing conducted, or are about to be conducted. Inl such event, the proceedings, including additional proceedings after the Board has retired to deliberate, may go forward without waiting for the arrival or return of counsel or a party. This the T?l day of September, 2004. NORTH CAROLINA MEDICAL BOARD We? Stephen M. Herring, MD, DDS President Notice of Charges Charles M. Momah, M.D. Page 4 of 4 STATE OF NEW YORK DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER COMMISSIONERS OF SUMMARY ORDER CHARLES L. MOMAH, NLD. CO-O3-09-4449-A T0: CHARLES L. MOMAH, M.D- CHARLES L. MOMAH. NLD. 14212 Ambaum Blvd. SW #303 Seattle. WA 98166 The undersigned. Antonia C. Novello. M.D.. M.P.H., Dr. P.H.. Commissioner of Health. pursuant to NY. Public Health Law ?7230. upon the recommendation of a committee on Professional Medical Conduct of the State Board for Professional Medical Conduct. has determined that the duly authorized professional disciplinary agency of anotherjurisdiction. the State of Washington, Department of Health. Medical Quality Assurance Commission (hereinafter ?Washington Board") has made a finding substantially equivalent to a ?nding that the practice of medicine by CHARLES L. MOMAH. M.D.. Respondent, licensed to practice medicine in New York state on August 7, 1987. by license number 1?1684. in that jurisdiction. constitutes an imminent danger to the health. safety, and welfare of its people, as is more fully set forth in documents of the Washington Board, attached hereto. as Appendix and made a part hereof. It is. therefore: ORDERED. pursuant to NY. Public Health Law Section 230(12)(b). that effective immediately. CHARLES L. MOMAH., Respondent. shall not practice medicine in the state of New York or in any other jurisdiction where that practice is dependent on a valid New York state license to practice medicine. Any practice of medicine in the state of New York or in any other iurisdiction where that practice is dependent on a valid New York state license to practice medicine in violation of this Commissioner's Summary Order shall constitute Professional Misconduct within the meaning of NY. Educ. Law {5,6530 and may constitute unauthorized medical practice. a felony de?ned by NY. Educ. Law i$6512. This Order shall remain in effect until the ?nal conclusion of a hearing that shall commence within thirty (30) days after the final conclusion of the disciplinary proceeding in the state of Washington. The hearing will be held pursuant to the provisions of NY. Pub. Health Law ?230, and NY. State Admin. Proc. Act ?301-30? and 401. The hearing will be conducted before a committee on professional conduct of the State Board for Professional Medical Conduct, on a date and at a location to be set forth in a written Notice of Summary Hearing. together with a Statement of Charges. to be provided to the Respondent after the ?nal conclusion of the Washington proceeding. Said written Notice may be provided in person, by mail or by other means. if ReSpondent wishes to be provided said written notice at an address other than those set forth above. Respondent shall so notify. in writing. both the attorney whose name is set forth on this Order and the Director of the Office of Professional Medical Conduct. at the addresses set forth below. Respondent shall notify the Director of t_he Office of Professional Mew?cal New York State Department of Healt_h. 433 River Street. Sgite 303. Troy, NY Luau-gee via Certi?ed Mail. Return Receigt Requested. of the ?nal conclusion of the Washingto_n proceedian immediately upon such conclusion. THESE PROCEEDINGS MAY RESULT IN A DETERMINATION THAT YOUR LICENSE TO PRACTICE MEDICINE IN NEW YORK STATE BE REVOKED OR SUSPENDED ANDIOR THAT YOU MAY BE FINED OR SUBJECT TO OTHER SANCTIONS SET FORTH IN NEW YORK PUBLIC HEALTH LAW SECTION 230-A. YOU ARE URGED TO OBTAIN AN ATTORNEY FOR THIS MATTER. DATE: Albany. New York 2003 ANTONIA C. NOVELLO. M.D.. MPH. Dr. P. H. Commissioner Inquires should be addressed to: Robert Began Associate Counsel Office of Professional Medical Conduct 433 River Street Suite 303 Troy, New York 12180 (518) 40243828 STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice as a Physician and Surgeon of: Docket No. CHARLES L. MOMAH, M.D., EX PARTE ORDER OF License No. SUMMARY ACTION Respondent. This matter came before the Medical Quality Assurance Commission (the Commission) on September 10. 2003 on an Ex Parts Motion for Order of Summary Action brought by the Department of Heaith (the Department) by and through its attorney, Kim O'Neal. Assistant Attorney General. The Presiding Of?cer for the Commission was Senior Health Law Judge Lyle 0. Hanson. The Commission members deciding the Ex Parte Motion for Order of Summary Action were: Julian Ansell. M.D., Panel Chair, Kart Porch, PA-C: and Mike Snell, Public Member. The Commission, having reviewed the motion and the documents submitted in support of the motion, and having heard an oral presentation, hereby enters the following: I. ALLEGATIONS 1.1 Chanes L. Momah. M.D., the Respondent. was issued a license to practice as a physician by the State of Washington in March 1993. A Statement of Charges was issued in Docket No- on or about June 17, 2003. That case is pending at the present time. 1.2 Patient One was a regular patient of Respondent. On or about August 2003 at approximater 6PM, Patient One called Respondent to ask for 'moming aftei? EX PARTE ORDER OF SUMMARY ACTION Page 1 of 4 Docket No. contraception- The Respondent asked the patient to meet him at his of?ce immediately. When Patient One arrived at Respondent's of?ce. which was closed, ReSpono'ent tet her in. No one else was in the of?ce. The Respondent wrote out prescriptions for Patient One for Percocet. Valium. and four birth control pills. The Respondent had the patient change into an exam gown and mount the exam table. The Respondent performed an ultrasound and manual pelvic exam. The patient felt Respondent's hands caressing her clitoris. The patient recognized that the pelvic exam was not proceeding normally. 1.3 The Respondent pulled down his pants and underwear and got on top of Patient One. He placed his penis inside her and raped her. Patient One asked Respondent to stop. and he responded, ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted 10 minutes until Respondent ejaculated. Reapondent then got off of Patient One, pulled up his pants and told her to come to his of?ce. After putting her clothes back on. she met with ReSpondent in his of?ce. The Respondent threatened Patient One that if she reported the event to the police he would reveal her history of narcotic dependence and her child would be taken away from her. ll. FINDINGS OF FACT 2.1 The Reapondent. a physician licensed by the State of Washington at all times applicable to this matter. practicing in Federal Way, Washington. 2.2 The Commission issued a Statement of Charges alleging Respondent violated RCW and The Statement of Charges was accompanied by all other documents required by WAC 246-1 1-250. EX PARTE ORDER OF SUMMARY ACTION Page 2 of 4 Docket No. 03-09-A-1033MD 2.3 The Commission ?nds there is imminent danger to the public health. safety and welfare requiring emergency action suspending Respondent's license to practice medicine pending further proceedings due to the nature of the allegations as stated above and in the Statement of Charges. 2.4 The alleged conduct. as set forth in the Allegations above and as supported by the documents attached to the Ex Parte Motion for Order of Summary Action, is directly related to Respondent?s ability to practice as a physician in the state of Washington. The Commission ?nds. based on the declarations and evidence submitted with the Ex Parts Motion for Order of Summary Action. that a summary suspension of Respondent's license to practice as a physician is the least restrictive action necessary to prevent or avoid immediate danger to the public health, safety. or weifare. Ill. CONCLUSIONS OF LAW 3.1 The Commission has jurisdiction over Respondent's license to practice as a physician. 3.2 The Commission has authority to take emergency adjudicative action to address an immediate danger to the public health. safety. or welfare. ROW RCW 34.05.479. RCW 181300500). and WAC 246-1 1-300. 3.3 The above Findings of Fact and Allegations establish: The existence of an immediate danger to the publichealth, safety, or welfare; That the requested summary action adequately addresses the danger to the public health. safety. or welfare: and The requested summary action is necessary to address the danger to the public health. safety. or welfare. EX PARTE ORDER OF SUMMARY ACTION Page 3 of 4 Docket No. 03-09-A- 1 0 33MB 3.4 The requested summary action is the least restrictive agency action justified by the danger posed by Respondent's oontinuocl practice as. a physician. 3.5 The above Findings of Fact and legetione establish oond uct which warrants summery action to protect the public ailh. safety, or welfare. N. DR ER Based on the Findings of Foch-{Al atlons and Conclusions of Law. the Commission enters the foiloMng order: 4.1 IS HEREBY ORDERED thett 9 license of Reepondent be SUMMARILY SUSPENDED pending further disciplinary pro edinge by the Commission- 4.2 In addition. Reapondenl to undo not to contact any current or fennel- female patients by any means and for any pu so, e?edlve immediately. Respondent shall arrange ior coverage for all of his patient . The Respondent will put a message on his answering service advising patients of the hange- of care and directing patients to the new provider. For continuity of care. Respond nt wiil communicate directly with the provider. not the patients. 05th this ?itlay of September. 2003. MEDICAL QUALITY ASSURANCE COMMISSON REDACTED LI A SELL. MD. Pa Cha I FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: Frobram No. EX PARTE ORDER OF SUMMARY ACTION Page 4 of 4 Docket No. STATE OF NEW YORK DEPARTMENT OF HEALTH 433 River Street, Suite 303 Troy, New York 12180-2299 Dennis P. Whalen Executive Deputy Commissioner March 31,1999 CERTIFIED MAIL - RETURN RECEIPT REQUESTED Charles M. Momah, M.D. C/c7 Rdxrt H. Iseman, Esq. Iseman, Cunningham, Reister 9 Th‘bado-w Terrace Albany, New York 12203 & Hyde RE: In the Matter of Charles M. Michael A. Hiser, Esq. NYS Department of Health Corning Tower Room 2509 Empire State Plaza Albany, New York 12237 Momah, M.D. Dear Parties: Enclosed please find the Determination and order (No.99-69) of the Hearing Committee in the above refer-enccd matter. This Determination and 0rder shall be deemed effective upon the receipt or seven (7) days after mailing by certified mail as per the provisions of C1230, subdivision 10, pwsgraph {b) of the New York State Public Health Law. . rive days after receipt of this Order, you will be required to deliver to the Board of Professiona! Medlca’r Cs2~&s.~i your licxmw to pracd.ice medicine if said license has been revoked, amu?ed, suspended or :su.rrendercd, together with the registration certificate. Delivery shall be by either ce:-tifii=tr nrraii or ira person to. mice of Professioxlaf iMedical Conduct New York. State Depa.rtme~.t of Health Hedley Park Place 433 River Street - Fmtih Floor Troy, New York 12180 If your license or registration certificate is lost? misplaced or its whereabouts is otherwise u_&no-wx, y:z &li submit ax;12 affidavit to that effect. If subsequently you locate the requested items. they must then be delivered to the Office of Professional Medical Conduct in the manner Ented above.. As prescribed by the New York State Public Health Law 0230, subdivision 10, paragraph (i), and 0230-c subdivisions 1 through 5, (McKinney Supp. 1992), “the determination of a committee on professional medical conduct may be reviewed by the Administrative Review Board for professional medical conduct.” Either the licensee or the Department may seek a review of a committee determination. Request for review of the Committee’s determination by the Administrative Review Board stays penalties other than suspension or revocation until final determination by that Board. Summary orders are not stayed by Administrative Review Board reviews. All notices of review must be served, by certified mail, upon the Administrative Review Board and the adverse party within fourteen (14) days of service and receipt of the enclosed Determination and Order. The notice of review served on the Administrative Review Board should be forwarded to: James F. Horan, Esq., Administrative Law Judge New York State Department of Health Bureau of Adjudication Hedley Park Place 433 River Street, Fifth Floor Troy, New York 12180 The parties shall have 30 days from the notice of appeal in which to file their briefs to the Administrative Review Board. Six copies of all papers must also be sent to the attention of Mr. Horan at the above address and one copy to the other party. The stipulated record in this matter shall consist of the official hearing transcript(s) and all documents in evhlence. Parties will be notified by mail of the Administrative Review Board’s Determination and Order. Sincerely, ,lyiiilrc\-lT$&&7 Tyrone T. Butler, Director Bureau of Adjudication TTB:nm Enclosure DEPARTMENT OF HEALTH : STATE OF NEW YORK STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER DETERMINATION OF AND CHARLES M. MOMAH, M.D. ORDER BPMC- 99-69 ANDREW J. MERRITT, M.D., Chairperson, JAMES 0. ROBERSON, M.D., and MARY PATRICIA MEAGHER, duly designated members of the State Board for Professional Medical Conduct, appointed by the Commissioner of Health of the State of New York pursuant to Section 230( 1) of the Public Health Law, served as the Hearing Committee in this matter pursuant to Sections 230(10)(e) and 230( 12) of the Public Health Law. SUSAN S. PATTENAUDE, ESQ., Administrative Law Judge, served as Administrative Officer for the Hearing Committee. Evidence was received and witnesses sworn and heard and transcripts of these proceedings were made. After consideration of the entire record, the Hearing Committee submits this Determination and Order. SUMMARY OF THE PROCEEDINGS Notice of Hearing and Statement of Charges Served: April 28, 1998 Answer to Statement of Charges: May 15, 1998 Prehearing Conference: May 18, 1998 Hearing Dates: ’ May 27,1998 June 24, 1998 September 2, 1998 September 9, 1998 Post-Hearing Briefs Served: October 9, 1998 Deliberation Date: October 28, 1998 Places of Hearing: Hampton Inn S acuse, New York IiT oliday IM Syracuse, New York Petitioner Appeared By: Henry M. Greenberg, Esq. General Counsel NYS Department of Health By: Michael A. Hiser, Associate Counsel Respondent Appeared By: Robert H. Iseman, Esq. Valerie Lape Handy, Esq. Iseman, Cunningham, Riester & Hyde WITNESSES For the Petitioner: K.P. Marlinda L Valley Edward Jac% s. M.D. ’ B.K. Sue Beaulieu For the Respondent: $ry Joyce McGinnis, M.D L.3. Charles M. Momah, M.D. STATEMENT OF CHARGES Respondent was authorized to practice medicine in New York State on August 7, 1987 by the issuance of license number 171684 by the New York State Education Department. The ‘The s’ da time period for the issuance of a determination set forth in Public Health 10 h) was waived by both parties (T. 74 l-72). Law Section 23Tr 2 I Respondent is not currently registered for the practice of medicine. He was last registered for the practice of medicine for the period January 1, 1995 through June 30, 1997. Respondent was served with a Notice of Hearing and Statement of Charges. dated April 28, 1998. Respondent was charged with misconduct under New York Education Law Sec. 6530. The Statement of Charges essentially charges the Respondent ivith professional misconduct by reason of having practiced the profession of medicine fraudulently, with moral unfitness, with gross negligence and gross incompetence, with negligence on more than one occasion, with incompetence on more than one occasion, and with vvillfully making or filing a false report. The charges are more specifically set forth in the Statement of Charges, a copy of which is ‘. attached hereto and made a part hereof GENERAL FINDINGS OF FACT Having heard testimony and considered evidence presented by the Department of Health and the Respondent, the Hearing Committee hereby makes the f&owing findings. Citations in parentheses refer to transcript pages or exhibits, and they denote evidence that the Hearing Committee found persuasive in determinin g a particular finding. Conflicting evidence, if any, was considered and rejected in favor of the cited evidence. unanimous unless otherwise specified. 3 All Hearing Committee findings were 1. Respondent Charles M. Momah, M.D. was licensed as a physician in New York State on August 7, 1987, by the issuance of license number 171684 by the New York State Education Department. Respondent is not currently registered with the New York State Education Department. He was last registered to practice as a physician for the period January 1, 1995 through June 30,1997 with an office address of P.O. Box 5178, Massena, New York, 13662 (Ex. 2). 2. Respondent received his medical training at the University of Nigeria. He served a one year internship in Nigeria, followed by one year of compulsory studies in family medicine. He then trained at McGill University in Montreal, Canada, followed by one year of general surgical training and four years of OB/GYN training, finishing in 1987 (T. 541-42). 3. Respondent was board certified in obstetrics and gynecology by the Royal College of Surgeons of Canada in 1989 (T. 542). 4. After Respondent lefi Montreal, he worked for eighteen months in New York City for the LaGuardia Medical Group, a Health Maintenance Organization (‘,FO”) (T. 542-43). c. 5. Respondent was responsible for all the obstetrics and gynecology work for one of the HMO’s eight centers and performed about fifteen deliveries a month at LaGuardia Hospital (T. 543). 6. Respondent practiced in Massena, New York from 1989 through 1993 (T. 548, 593). 7. When the Respondent was recruited to Massena by Massena Memorial Hospital (“MMH” or the ‘Hospital”), he was concerned about whether there would be adequate coverage, due to the fact that there was only one other OB/GYN practicing in Massena (T. 545-46). 8. The Hospital promised Respondent that he would have adequate backup coverage by the other OB/GYN (T. 546-48,584). 9. The coverage was not provided, and Respondent had to work or be on call seven days a week, 24 hours a day (T. 582-83). 10. The Respondent testified that at a medical staff meeting during his first week of work at MMH, the Director of Nursing, Roxanne Roberts, gave him a pen and “‘told me to write to see if I knew how to write.” (T. 549). 11. During a meeting with three public health workers at which Ms. Roberts and Respondent were present, the participants discussed why more deliveries occurred at Canton-Pot&m Hospital than Massena Memorial Hospital. After Respondent explained that there were more deliveries at Canton-Potsdam Hospital because there were more doctors performing deliveries, Respondent testified that Ms. Roberts stated that “no, that wasn’t the reason; that Massena Hospital doesn’t have a white doctor, that patients like to go to doctors who they want the babies to look [like].” (T. 580). 12. The labor and delivery room at the Hospital contained out-of-date equipment and lacked important equipment such as equipment to perform a fetal scalp sampling or an intrauterine pressure monitoring, and the Hospital nursing staff lacked important skills, like interpreting fetal heart rate monitor strips (T. 552-54). 13. The Respondent made oral complaints about problems relating to the equipment and nursing staff skills to the director of nursing, the medical director and Hospital administrator from the time he arrived in Massena (T. 555-56). 14. After the Respondent was told by his friend, Dr. Shehadi, that the Director of Nursing, Ms. Roberts, had stated “[llast month we got rid of Dr. Shehadi; this month in June we’ll get rid of Dr. Momah,” Dr. Momah began putting his complaints in writing. The Respondent’s written complaints included his concerns about the nurses’ lack of skills; the fact that one of his patients had been sent away from the Hospital while he was out of town and almost delivered in the taxi on her way to another hospital; and a nurse’s inappropriate and unprofessional comments to a patient (T. 556-59, 562,572; Exs. WW, XX, YY, AAA, CCC). 15. Respondent submitted complaints to the Department and the President of the Board of Managers of the Hospital which summarized the complaints he had previously made to the Hospital (T. 573-74, 576; Exs. EEE. FFF). 16. In response to the Respondent’s complaints, the Hospital denied everything and took no corrective action (T. 577-78). 17. While the Respondent was winding up his practice in Massena, he performed ‘+ tenens work in the state of Georgia (T. 593-94). locum 18. At about the same time, Respondent took numerous continuing medical education courses in the areas of obstetrics, gynecology and infertility, including cases on high-risk pregnancy ~management and Rh sensitization (T. 596-602, Exs. KK-TT). 19. In November of 1993, the Respondent was board certified in obstetrics and gynecology by the American Board of Obstetrics and Gynecology (T. 594-95). 6 GENERAL CONCLUSIONS The Respondent was forced to practice in Massena with long hours, little backup coverage or support either from fellow OB/GYN’s or Hospital administrators, substandard or absent equipment, nursing skills which were questionable at best, and open hostility and racism. The Respondent’s complaints about coverage, equipment and skills were well documented in letters he sent to the Hospital and the Department. It stands to reason that the Respondent would understand that testimony about a racist and hostile environment, even if found to be true by this Committee, would have no bearing on the issue of the Respondent’s misconduct. believes that nothing would be gained by fabricating such testimony and The Hearing Committee finds the Respondent’s testimony to be credible as to the environment he endured at the Hospital. The environment and lack of adequate backup, equipment and sta.fT do not in any way excuse Respondent from conducting himself professionally and with due standards of care at all times. However, the Hearing Committee must conclude that these factors made the Respondent’s practice more difficult and may have enabled his incidents of misconduct. \ FINDINGS OF FACT - PATIENT A 1. The allegations concerning patient A were withdrawn by the Petitioner. / FINDINGS OF FACT - PATIENT B 1. Allegation B. 1 was withdrawn by the Petitioner based on the documentary evidence produced and the testimony of the witnesses. 7 2. The Respondent’s privileges at MMH were to end on December 3 1, 1992 (T. 628). As this time approached, Dr. Momah both sought privileges at Canton-Pot&m Hospital (T. 60-6 1,628) and transferred patients to other doctors in the area (T. 629). 3. Dr. Momah frequently called or visited Marlinda LaValley, Vice President for Administrative Services at Canton-Pot&m Hospital, regarding the status of his privileges there (T. 54, 59-60). 4. Dr. Momah did everything he could to complete his application for privileges at CantonPotsdam Hospital, including giving his permission to MMH to release to Canton-Pot&m everything it needed (T. 75). 5. Because MMH never submitted several documents continuously requested by CantonPotsdam Hospital, Respondent’s application for privileges was never deemed complete (T. 71). 6. Respondent treated Patient B from on or about December % 14, 1992 through on or about February 16, 1993, at Respondent’s office. Respondent provided irenatal obstetric care to Patient B. 7. Prior to Patient B’s first visit to Dr. Momah, she asked Respondent’s receptionist whether ~the Respondent had privileges at Canton-Potsdam Hospital. The receptionist indicated the Respondent had such privileges (T. 36-37,47-48). 8. During Patient B’s first visit to Dr. Momah on December 14, 1992, she made a specific inquiry of the Respondent as to whether he had privileges to deliver at Canton-Potsdam Hospital. Patient B recalled that the Respondent assured her he had privileges there and that it would not be 8 a problem, that when her baby was born, Patient B would be able to deliver at Canton-Potsdam Hospital (Ex. 5, p. 3; T. 36-37, 47-48, 5 1). 9. After Patient B’s fist visit, Respondent opened an office in Potsdam. Patient B heard rumors that Respondent did not have privileges at Canton-Potsdam Hospital. Because of this, she contacted the hospital directly and asked if Respondent had privileges. hospital told Patient B that Respondent did not have privileges at The representative of the Canton-Potsdam Hospital (T. 39- 41). 10. After she learned this information directly from the hospital, she made plans to get another physician. She also spoke to Respondent abdut this issue the last time she saw him, on or about February 16, 1993. She testified that when she questioned Respondent as to why he initially said he had privileges, but later said he “would get” them, Respondent became upset (Ex. 5, p. 3; T. 41-42, 52). 11. During Patient B’s first visit to Respondent, he referred Patient B to Dr.. Garcia (T. 630; r Ex. 5, p. 3). 12. Dr. Momah saw Patient B on three occasions after her initial visit, through February 16, 1993 (Ex. 5, p. 3). 13. Patient B eventually was transferred to Dr. Garcia, on or after February 16, 1993 (Ex. 5, P.3). 14. It has been almost six years since Patient B has spoken to Dr. Momah (T. 43). 15. Patient B did not take any notes or write any letters concerning her relationship with Dr.. Momah (T. 46). 16. Patient B did not discuss these events with the department until two and one half years after they occurred (T. 46). 17. C.S. was a patient of Dr. Momah whose twins were delivered by Dr. Momah during her second pregnancy (T. 522). 18. When Patient C.. S. returned to Dr. Morn& for her third pregnancy, Dr. Momah informed her that he did not have hospital privileges, but that he could provide her prenatal care (T. 523). 19. Dr. Momah never told C.S. that he had privileges at canton-Pot&m Hospital (T. 523). 20. Both Patient B and C.S. indicated they liked the care that Dr. Momah provided (T. 50, 525, 527). ,+ CONCLUSIONS - PATIENT B Both Patient B and C.S. indicated they liked the care that Dr. Momah provided them. Patient B, however, testified that the Respondent told her he had privileges at Canton-Potsdam Hospital, while C.S. testified that the Respondent told her he did not. Both witnesses evinced credibility, but we cannot place enough reliance on the testimony of Patient B to sustain the allegation, as it is simply inconsistent with other evidence and testimony. 10 Patient B’s medical record indicates that she was referred to Dr. Garcia at her initial visit to Dr. Momah in December, although she did not ultimately transfer to him until February (Ex. 5, p. 3). There is simply no logical explanation for such a referral other than the fact that it must have been made because Dr. Momah knew he did not yet have privileges at Canton-Potsdam Hospital. Moreover, the Respondent testified that pending the outcome of his application for privileges, many of his patients wished to continue their prenatal care with him and take a “wait and see” approach regarding privileges (T. 633-34). As Patient B indicated she was pleased with the care she received from Dr. Momah, his testimony would explain why patient B was not eager to transfer to Dr. Garcia and continued to see Dr. Momah, despite having been referred to Dr. Garcia at the first visit(Ex. 5, P, 3). It is unclear what happened with Patient B. Perhaps she misunderstood Dr. Momah’s assertions regarding privileges; perhaps she received incorrect information about his privileges from his staff or mistakenly (but understandably) concluded that because the Respondent opened a Potsdam office, he had been granted privileges; or perhaps the cor&sion resulted from the fact that Patient B relied solely on her memory both when testifying and whfn discussing the events with the Department a full two and one half years after they occurred (T.‘44,46). What is known is that Patient B was referred by Dr. Momah to another doctor at her very first visit, and according to at least one other patient of Dr. Momah’s, he did not misrepresent his privilege status. The Hearing Committee must conclude that as the burden of proof is on the Petitioner to prove the allegation by a preponderance of the evidence, in light of the conflicting testimony on this point, the Petitioner did not meet its burden and we cannot sustain the allegation. DETERMINATIONS - PATIENT B 1. Allegation B. 1 is not sustained. 11 FINDINGS OF FACT - PATIENT C 1. Respondent provided medical care to Patient C, a 20 year old female when first seen, from on or about April 4, 1991 through on or about April 10, 1991, at Respondent’s office. Patient C presented with what Respondent diagnosed as “extensive vaginal and vulva condyloma.” (Exs. 6, 8). 2. Patient C had been evaluated on April 1, 1991 by Planned Parenthood of Northern New York for complaints including abnormal vaginal discharge, and pain during intercourse. The plan of treatment was for application of 85% trichloroacetic acid (“TCA”). This was done by a nurse practitioner of Planned Parenthood on or about April 1, 199 1. Patient C experienced a slight burning from that treatment which subsided in about an hour. Patient C was thereafter referred to Respondent for additional treatment (Ex. 6, p. 5; Ex. 8, pp. 5-6). 3. Patient C saw Respondent first on April 4, 199 1. Respondent diagnosed multiple small external condylomata, also vaginal and cervical condyloma. He performed a colposcopy, then planned to perform treatment with TCA following receipt of the &hology results (Ex. 6, p. 1). 4. There is nothing in Respondent’s record that indicates that the patient had any bums from the earlier application of TCA when she came into the care of Respondent a few days later (Ex. 6, P, 1 ; T. 341-42). 5. Respondent applied TCA to Patient C’s cervix, vagina and vulva on or about April 10, 1991. Respondent used something that felt to the patient like an oversized Q-tip which had been drenched in acid. Dr. Momah applied the acid very quickly, sort of paint brush style, both internally and externally (T. 233-35). 12 6. After the treatment, Patient C was in such severe pain that she could not move. Atter a few minutes, she was able to get up and go into the bathroom. After she left, a friend drove her home and she went straight to bed. Within a day or so, she went for medical treatment to Planned Parenthood, since she was in such severe pain, and she was bleeding ftitly heavily. In the few days after the treatment, the patient experienced pain and burning, which made it difficult for her to walk and sit. Because of this, she did not rub the area that was treated, and she tried not to even touch the area (T. 241-42). 7. After she received the acid treatment from Respondent, Patient C did not see Respondent again that day (T. 239). 8. Following her treatment by Respondent on April 10, 199 1, Patient C. saw the following health care providers for treatment related to her ongoing pain and bums: April 12 - Contente, M.D. (Ex. 8, p. 9) April 15- Gaffney, M.D. (Ex. 9, p. 1) April 17 - GafXrey, M.D. (Ex. 9, p. 2) April 23 - St. Lawrence University M.D. (Ex. 10,s. 1) May 1 - Ga.l%ey, M.D. (Ex. 9, . 2) May 10 - St. Lawrence University M.D. (Ex. 10, p. 1) May 17 - Planned Parenthood of Northern New York M. D. (Ex. 8, p. 3) June 24 - Planned Parenthood center of Syracuse, Nurse Practitioner (Ex. 7, p. 5) 9. Records of Patient C’s subsequent treatment in April, May and June 199 1 vary from one another with respect to the extent and areas of possible burning from the TCA, but all such records indicate the presence of burns around the buttocks and posterior areas. The records make no mention of the presence of bums on Patient C’s thighs, knee or back (Exs. 7-10). 13 10. There is no indication on the record that the patient had genital warts on her buttocks or around the anus and posterior areas. The presence of bums in those areas is not consistent with the appropriate application of TCA (T. 12 l-28, 346-48). 11. TCA is a powerful caustic substance. It should be applied very carefully, making sure that there is no rundown of excessive TCA, and that the TCA does not pool at any point on the table where the patient’s skin comes in contact with it. It should not be applied in an amount exceeding what is needed for treatment (T. 121-X$345-46). 12, The risks of using TCA include excessive burning (T. 119). 13. The excessive application of TCA by Respondent caused the bums seen by the subsequent treating physicians (T. 344-45). 14. Allegation C.2 was withdrawn by the Petitioner, based on the documentary evidence produced and the testimony of the witnesses. ‘4. CONCLUSIONS - PATIENT C Based on the testimony of Patient C, both expert witnesses, and medical records, the Hearing Committee concludes that the Respondent negligently overtreated Patient C with TCA (T. 121-28, 234,237,346-48: Exs 8, p. 3; 7, p. 5; 9, p. 1). The extent to which Patient C was overtreated is not entirely clear from the drawings or narrative in records of the physicians who treated her subsequent to her treatment by Respondent, but all such records indicate the presence of bums in areas in which no condylomata were ever noted. The mere presence of TCA-related bums in areas in which no condylomata were purported to be treated by Respondent; i.e., the buttocks and posterior areas, is 14 enough to sustain a finding of negligence, because the careful application of TCA would not have resulted in burns in areas which contained no condylomata and thus should not have come in contact with the acid. Patient C testified straightforwardly and graphically, and was unwavering under direct, cross and panel examination, She said she had scars for over two years from the treatment by Respondent, and that he dripped some acid on her knee. The Hearing Committee finds no mention in medical records of any bums on her knee, and notes that no evidence corroborating Patient C’s claim of such long-term scarring was presented. Such findings are inconsequential, however, in light of sufficient evidence supporting a finding of negligence by the Respondent. 1. Allegation C. 1 is sustained. FINDINGS OF FACT - PATIENT D \ I I 1. Respondent provided medical care to Patient D, a female patient 48 years old when first seen, on or about February 23, 1990 at Massena Memorial Hospital. Patient D was admitted to the Hospital with a complaint of severe right lower quadrant abdominal pain of sudden onset, 12 hour duration (Ex. 11, pp. 92-93). 2. The patient had signs consistent with intra-abdominal infection, which was confirmed by a blood white count which was significantly elevated. The presence of immature white cells; i.e., bands, such as are identified on the lab report, is a sign of acute and significant infection, classically associated with some sort of intra-abdominal or pelvic infectious process (T. 152, 54; Ex. 11, p. 9). 15 3. On February 23, 1990, the Respondent performed a diagnostic laparoscopy, and a laparotomy with the participation of Dr. Lin. At laparoscopy, approximately 450 cc of serous liquid and a large quantity of pus were found in the lower abdomen and pelvis. At subsequent laparotomy, findings that were classic for an intra-abdominal infectious process were found. There were scar tissue and adhesions between the bowel and pelvic side of the wall. The right lower quadrant in particular was involved, with involvement of the right fallopian tube and ovary, as well as the appendix itself (T. 156; Ex. 11, pp. 165-66). 4. Pus in the abdominal cavity is an abnormal finding. Freestanding pus should never be found in the abdominal or pelvic cavity. Also, adhesions are generally a response to long-standing infection (T. 156). 5. During the course of the procedures, Dr. Momah advised Dr. Lim that the patent needed to have her appendix removed and that Dr. Lim would have to do it because Dr. Momah did not have privileges to do an appendectomy (T. 670-71). 6. Following the performance of the appendectomy, the?emainder of the procedure was carried out by Respondent (Ex. 11, pp. 165-67). 7. Dr. Momah performed a primary closure of the skin, which essentially involves closing the various layers of the peritoneum and other internal structures and layers, and working outward (T. 16264,672; Ex. 11, pp. 165-66). 8. In the presence of significant peritonitis, the potential for gross contamination of the fat layer and the layers below the skin down to, but not including, the fascia, is substantial; therefore, it is generally considered appropriate to leave the area open for 24 to 48 hours. 16 If at that pont there is no infection, the skin may then be closed, or lefi open to heal from the bottom up. (T. 164-65; 360). 9. In such circumstances, the infection rate is increased if a primary closure is performed (T. 362, 366). 10. While many doctors recommend that the skin should be left open, the decision to do so does not constitute a standard of care corn which physicians may not deviate; rather, it is a judgment call. While there is an increase in the wound infection rate if a primary closure is performed, there are also some drawbacks to performing a secondary closure (T. 360,363). The question of which closure is appropriate may even depend upon regional training (T. 175). 11. Patient D. experienced a wound dehiscence; i.e., the abnormal opening up of an incision that has already been closed (Ex. 11, p.99). 12. The Respondent took appropriate, prompt action when he first saw Patient D, who presented in emergent condition, and when her wound eviscerate$(T. 361-62; Ex. 12, pp. 277-78; EX. 1, pp. 92-93). 13. It is a standard hospital practice that at any major surgical procedure, two operating surgeons are necessary (T. 160, 179). 14. Dr. McCullough, a physician who reviewed Patient D’s records for quality assurance purposes, stated that “the patient’s treatment was appropriate and slcillfX’ and that “the patient’s care was commendable with adequate treatment and recognition of a difficult and potential life-threatening infectious process.” (Ex. 12, pp. 277-78). 17 CONCLUSIONS - PATIENT D Whether the decision to perfortn a primary closure was made jointly by Dr. Momah and Dr. Lin, or was solely Dr. Momah’s, is sotnewhat unclear l?orn the docurtlentary evidence and testimony. The Respondent testified that the decision to perform a primary closure was made jointly with Dr. Lin. However, Respondent’s post-operative notes contain a complete and thorough description of the closure that was perl?ormed, while Dr. Lin’s post-operative notes following the description of the appendectomy he performed simply state that the remainder of the procedure was carried out by Dr. Momah. The Hearing Committee finds the documentary evidence, consisting of post-operative notes made just after the surgical procedures were performed and containing each physician’s detailed description of the procedures carried out by him, to be more reliable than Dr. Momah’s testimony alone. There is nothing in Dr. Momah’s notes to indicate that the decision was made jointly, nor are there any references to the closure in Dr. Lin’s notes. Accordingly, the Hearing Committee concludes that the decision to perform a primary closure was Dr. Momah’s. The Hearing Committee also concludes that the Respondent’s decision to perform a primary closure on Patient B did not fall below minimum standards of care &d was an appropriate judgment call. No testimony was presented which could articulate a specific standard of care for closures in these cir cumstances. In fact, both the Petitioner’s and Respondent’s experts testified that the closure decision may be a function of regional training, and evidence was presented which indicates that in some cases, there may be drawbacks to performing a secondary closure. If there were a true standard to be followed in this case, regional training would have been irrelevant. The mere fact that the wound infection rate is greater when a primary closure is performed does not require that a secondary closure be made; rather, the decision is a judgment that must be made based on the facts of a particular situation. 18 In this instance, Dr. McCullough’s quality assurance review commended Dr. Momah’s appropriate and skill&l treatment under potentially life threatening conditions, and did not question the closure decision. In addition, Patient D’s severe infection at the time the procedures were performed may have caused the wound dehiscence, which was treated promptly and effectively by the Respondent. Finally, even ifDr. Momah was solely responsible for the decision to close primarily, it is clear that two operating surgeons were present during the procedures performed on Patient D. No testimonial or documentary evidence was introduced which would indicate that Dr. Lin ever questioned the decision to perform a primary closure. Surely, if Dr. Ein disagreed with that decision and felt it did not meet the due standard of care, he could have said so, either at the time of the procedure or even during his post-operative notes, Accordingly, The Hearing Committee concludes that that Respondent’s decision to perform a primary closure on Patient D was appropriate. DETERMINATIONS - PATIENT D 1. D. 1 is not sustained. FINDINGS OF FACT - PATTEN+ E 1. Allegations E. 1 and E.3 were withdrawn by the Petitioner, based on the documentary evidence produced and the testimony of the witnesses. 2. Allegation E.2 was withdrawn without presentation of evidence. 19 FINDINGS OF FACT - PATIENT F 1. Respondent provided medical care to Patient F, a female patient 25 years old when first seen, Tom on or about February 12,199O tlmugl~ March 1990 at Respondent’s office and at MMH. Patient F received prenatal and obstetric care from Respondent. (Exs. 17-19). 2. Patient F was seen for an initial prenatal visit on or about February 12, 1990 (Ex. 17, pp. 60-62). 3; Respondent’s initial prenatal evaluation of Patient F documents that the patient had class D diabetes in pregnancy. The patient was insulin dependent and had diabetes for approximately 20 years (Ex. 17, pp. 60-62). 4. A patient who has class D diabetes faces certain risks. Such patient may require increasing amounts of insulin during pregnancy and have varying needs for insulin use during pregnancy. The risks to the fetus include hypoglycemia; i.e., low blood sugar, which is associated with a number of sign&ant birth defects and birth problems including mental retar&tion. The patient may also face hyperglycemia, associated with significant problems with the fetus, especially relating to the size of the fetus and hypertrophy or excessive growth of many organ systems. Accordingly, class D diabetes , requires a rather intensive evaluation of the patient initially. (T. 434). 5. Patient F had a fasting blood sugar on initial evaluation of 247. That is considered an abnormal value and is a significant elevation in the blood sugar. The medical significance is that the obstetrician should be immediately concerned that the patient is not well-controlled with her current insulin regimes. Such a patient needs rather intensive control. Even though the period of organ formation and fetal development basically is already completed, and the growth of the fetus is now 20 an issue, there are always concerns about having tight control. It is a delicate balance that has to be achieved in managing a patient with an elevated blood sugar, but one which needs rather aggressive therapy. (Ex. 17, p. 62; T. 435-36). 6. During Patient F’s initial visit, Respondent recognized that she was a high-risk patient and would need to be transferred to a high risk center for management. Respondent discussed with her the risks of her diabetes and her pregnancy (T. 703-04; Ex. 17, pp. 61-62). 7. Dr. Momah commonly referred high-risk patients to a center in Burlington, Vermont (T. 705). 8. Dr. Momah told Patient F that she was going to be transferred to Burlington (T. 705; Ex. 17, p. 61). 9. Dr. Momah assumed that Patient F would not be returning to his office for care and that all of her pregnancy care would be taken care of in Burlington (T. 705-06). \ 10. Patient F presented at MMH early in the morning of March 12, 1990, complaining of vaginal bleeding. Patient F was near the end of her first trimester with significant vaginal bleeding in the absence of any abdominal pain. The patient had never had a full term pregnancy and was severely diabetic (T. 440, 706-07; Ex. 18, pp. 125-27). 11. At that time, Dr. Momah called Dr. Jhaveri, an internal medicine doctor, in consultation to manage Patient F’s diabetes (T. 707). 12. Patient F had indicated to Dr. Momah that Dr. Jhaveri was her doctor. She had been seeing Dr. Perdue, who sold his practice to Dr. Jhaveri, so Dr. Perdue’s patients became Dr. Jhaveri’s patients (T. 707-08). 13. Family practitioners can handle diabetes and Dr. Momah’s referral to Dr. Jhaveri, whom he believed to be Patient F’s doctor, was not inappropriate, negligent or incompetent (T. 400,45 1, 457,459). 14. Dr. Momah told Patient F, both while she was in his office and in the Hospital, that she would need to go to the high risk management center in Burlington (T. 705-06, 711; Ex. 17, pp. 23, 24, 61). 15. Patient F did not follow Respondent’s instructions to transfer to Burlington. during Patient F’s initial hospitalization, Dr. In addition, Momah instructed her to stay for three additional days to obtain control of her diabetes. Patient F, however, left despite this advice (T. 710-l 1; Ex. 17, p. 24). ‘1 16. Df. Momah made numerous ef%orts to refer Patient F to a maternal fetal medicine consultant in Burlington (Ex. 17, pp. 23, 24, 61). 17. The Respondent did not document whether he or his stsrff actually made any appointments for Patient F with a maternal fetal medicine consultant, nor is there any record that any letters of non-compliance were ever sent to Patient F (Ex. 17). 18. While sending letters to non-compliant patients may be wise, the failure to do so does not constitute professional misconduct (T. 472). 22 . 19. When the patient was in the MMH emergency room on March 12, 1990, she received 3 00 micrograms of RhoGAM by order of the Emergency Room Physician (Ex. 18, p. 126). RhoGAM is an immune globulin. It is an antibody that blocks a patient’s initial response to the RI-I antigen. Such antigens can lead to hemolytic disease in the riewborri (T. 440-41). 20. Hemolytic disease in the newborn is a condition in which the mother who is RH negative creates antibodies to RH positive red blood cells. It is similar to our own immune response. The mother’s RI-I antibodies can cross the placenta and ultimately destroy the red blood cells in a living intra-uterine fetus. The purpose of RhoGAM is to block this response by preventing the mother from producing antibodies to an RI-I positive label on the red blood cells (T. 441-42). 2 1. Patient F had blood work done and an antibody screen which indicates that the patient’s blood was B-, also DU-. These lab results were consistent with the initial administration of RhoGAM to the patient in the Emergency Room. The lab slip indicates that the patient was, at that point, not RI-I sensitized and had no evidence of antibodies in her blood (Ex. 18, p. 68; T. 442-43). 22. Respondent diagnosed the patient as having alloirnm&ization to the RH factor. This means that Respondent was under the impression that the patient had become sensitized to the RH factor. This was incu~ect, as the initial obstetric visit showed that the patient had a negative antibody titer. The in-hospital lab report indicated that the patient had a negative antibody titer, and the only time the patient had a positive antibody titer was after she had received the RhoGAM. (Ex. 17, p 1, p. 62; Ex. 18, p. 3). 23. The Respondent later acknowledged that Patient F should not have received the potency of RhoGAM that she received (T. 709; Ex. 17, p. 1). 23 24. The Respondent apparently had believed that Patient F had had a fetal maternal transfusion of red blood cells; that is, from the fetus to the maternal blood stream, of greater than fifteen GC’S. This would have been the appropriate indication to give a second vial of RhoGAM, or three hundred micrograms, if it could have been verified that the patient was, indeed, a recipient of that excessive dose of fetal red blood cells. The Respondent did not have available to him the standard Kleihauer-Betke test, which gives a quantitative assessment of the degree of fetal red blood cells that have been transfused into the mother (T. 444, 709). 25. The standard of care in relation to the administration of RhoGAM requires that if there is any concern about the need or lack thereof for RhoGAM, the physician should err on the side of giving the RhoGAM (T. 401,446-47). 26. The Respondent’s administration of RhoGAM did not harm Patient F (T. 447, Ex. 18). 37. After Dr. Momah cared for Patient F, he completed a number of continuing medical education courses, including courses on Rh sensitization (T. 596-602; Exs. KK, \* LL). CONCLUSIONS - PATIENT F As to issues surrounding the management of Patient F’s diabetes and referrals to specialists, the Hearing Committee concludes that on at least several occasions, the Respondent specifically referred Patient E, who ultimately revealed herself to be a non-compliant patient, to a maternal fetal medicine specialist in Burlington. The Respondent testified that his office even made an appointment for Patient F, however, we find no proof that this occurred. If an appointment were made by Dr. Momah’s s@ it should have been documented in the record. Nevertheless, the Respondent’s failure to make an appointment for Patient F or to write a letter to the patient regarding the referral or her 24 level of compliance does not constitute professional misconduct, as even the Petitioner’s expert testified. The Hearing Committee also concludes that the Respondent showed sensible judgment in making a referral to Dr. Jhaveri when Patient F was in the hospital. Responding to Patient F’s test results, the Respondent immediately took steps to manage the patient’s condition by making the most appropriate referral that was available to him at the time. The patient indicated to Dr. Momah that Dr. Jhaveri was her physician, and in the absence of a local maternal fetal specialist, Dr. Jhaveri, as a family practitioner, should have possessed the requisite skills and training to manage the patient’s diabetes, as both experts testified, As to the issue of the administration of RhoGAM to Patient F, the Hearing Committee finds that the Respondent’s actions indicated that he was obviously confused about the patient’s condition of sensitization. While Dr. Momah’s administration of an additional 300 micrograms of RhoGAM to this patient was arguably correct, particularly absent the availability of the Kleihauer-Betke test, his understanding of the indications for giving RhoGAM could potentially have resulted in serious ‘\ ~ consequences for patients and fell below the level of knowledge and skill required of a practicing OB/GYN. The Hearing Committee thus concludes that the Respondent exhibited incompetence in this case. 25 DETERMINATIONS - PATIENT F 1. Allegation F. 1 is not sustained. 2. Allegation F.2 is sustained. 3. Allegation F.3 is not sustained. FINDINGS OF FACT - PATIENT G 1. Respondent provided medical care to Patient G, a female patient 25 years old when first seen from on or about November 6, 1989 through November 11,1989 at Respondent’s office and at Massena Memorial Hospital. Patient G presented to Respondent’s office on November 6, 1989 with a chief complaint of left lower quadrant pain, abrupt onset 3 days prior, and was admitted to MMH (Ex. 21, p. 3). 2. Respondent’s history and physical exam of patient G>dentifies that the patient had an “entirely unremarkable” past medical and surgical history (Ex. 21, p. 4). 3 Respondent also describes the patient’s menstrual cycle as being regular, and the patient being not sexually active and not believing she is pregnant (Ex. 21, p. 4). 4. Approximately two years after treating Patient G, Respondent prepared a document for an MM&I quality assurance (“QA”) review regarding patient G’s treatment (Ex. 20, p. 25). 26 5. The QA document states, “It was known that she had had a previous tubal ligation.” (Ex. 20, p. 25). 6. The document also indicates that the patient had a prior cesarean section, but that it had not been apparent since the patient “was in excruciating pain and was a poor historian.” (Ex. 20, p. 25). 7. Respondent’s QA document also stated that the diagnosis of tubal pregnancy was made based on Patient G’s abnormal menstruating pattern (Ex. 20, p. 25). 8. Patient G had scars on her abdomen from the cesarean sections and an appendectomy. (,Ex. 21, p. 66). 9. Due to the increasing severity of Patient G’s pain Respondent decided to perform a laparoscopy (T. 724; Ex. 21). \ 10. Respondent saw and removed what he believed to be a t;bal pregnancy (T. 724; Ex. 2 1) 11. The day a&r Patient G’s surgery, a serum pregnancy test was obtained that showed an HCG level of nine, which Respondent considered to be positive. The level was higher than the laboratory’s level of four for a non-pregnant female, but just below the level of ten for a pregnant female in the first week after conception (T. 725-26; Ex. 21, p. 29). 12. Following Patient G’s surgery, a surgical specimen was evaluated by the pathology department. The surgical tissue report identified in its final diagnosis a portion of the 27 left fallopian tube with a benign cyst, a foreign body (plastic clip), and a foreign body reaction; also, a benign follicle cyst from the left ovary (Ex. 2 1, p. 49). 13. The “dip” was likely a so-called Hulka clip, which is used to perform a tubal ligation (T. 413). 14. The pathology report indicated nothing about there being an ectopic pregnancy (T. 496). 15. Respondent, in preparing his final diagnosis of the cause of Patient G’s complaints for her discharge summary, had available to him the pathology report, Respondent’s final diagnosis included left unruptured ectopic pregnancy (Ex. 21, p. 3). 16. Respondent did not change the discharge summary to reflect the pathologist’s report because he felt the clinical symptoms should override the pathology results (T. 725, 726-27,737). CONCLUSIONS - PATIENT G . The evidence clearly shows that there were several significant, unexplained discrepancies between Respondent’s documented patient history, Patient G’s actual history and Respondent’s QA document. For example, Patient G’s record, as documented by Respondent, indicated that her medical and surgical histories were “entirely unremarkable,” and that she had a regular menstrual cycle. No mention was made in the record of her two previous or her appendectomy, and no scars were identified. cesarian sections, her tubal ligation, The QA report indicated that Patient G’s tubal ligation was known at the time of the surgery, yet there is no mention of it in Patient G’s record. QA report also states that Patient G had an abnormal menstrual cycle, contrary to the history recorded by Respondent. 28 The Respondent also testified that he was able to elicit sufficient information from Patient G for a complete history and physical, yet he also indicated both in his testimony and in his QA report that he had to cut the examination short due to Patient G’s excruciating pain and that the patient was a poor historian (T. 728-29; Ex. 20, p. 25). Based on the foregoing, the Hearing Committee concludes that the Respondent clearly did not perform a complete history and physical, yet documented that he did. Even if Dr. Momah’s failure to perform the complete history and physical were justified by the emergent circumstances, this should have been documented at the time and not simply explained away during a subsequent Quality Assurance review. The Hearing Committee concludes that the failure to accurately document the history and physical that was actually conducted falls below the required standard of care and constitutes negligence. As to the issue of the Respondent’s discharge summary, the Hearing Committee concludes that Respondent was not negligent in declining to conform his discharge summary to the pathologist’s report. The Respondent presented credible testimony as to the basis for his diagnosis of an ectopic % pregnancy, including the serum pregnancy test and clinical symptoms; and the Petitioner’s own expert witness agreed that the it was appropriate for Dr. Momah to not change the summary in light of his strongly held belief that an ectopic pregnancy had in fact occurred. DETERMINATIONS - PATIENT G 1. Allegation G. 1 is sustained. 2. Allegation G.2 is not sustained. 29 FINDINGS OF FACT - PARAGRAPH H 1. Respondent, on or about October 2, 1992, completed his re-registration application which was required to be 6led with the New York State Education Department to be licensed as a physician for the period January 1, 1993 through December 3 1, 1995 (Ex. 2, unnumbered p. 22). 2. Respondent’s privileges at MMH had been summarily suspended for ftilure to provide timely coverage of obstetrical services to the emergency department beginning February 12, 1992, and continuing through February 2 1, 1992, all of which was after Respondent’s last registration. Respondent knew such facts (Ex. 22, T. 283) 3. Following the submission by Respondent of documentation substantiating his unavoidable delay in returning from Nigeria, the suspension was lifted and clinical privileges at MMH were reinstated (Ex. 22). 4. Respondent was under the impression that his attorney and MMH administrators told him % to act as though the suspension had never occurred (T. 591-92). 5. Respondent failed to provide details regarding the suspension of his hospital privileges, as required by the m-registration application. He answered “no” in response to Question l(c) of the application, which read as follows: Since you last registered has any hospital or licensed facility restricted or terminated your professional privileges (Ex. 2, unnumbered p, 22). 30 ? CONCLUSIONS - PARAGRAPH H The Hearing Committee concludes that the documentary evidence and Respondent’s own testimony prove that the Respondent was in fact suspended from MMH and that he answered “no” when asked about privilege restrictions on his re-registration application, so we must sustain the allegation. The Respondent explained in his testimony that Hospital administrators indicated to him that the suspension should not have occurred and was a mistake (T. 592). He further testified that Respondent’s attorney advised him that when Iilling out the re-registration application, he should not mention the suspension and should treat it as though it had never occurred, since the Hospital admitted it was a mistake (T. 592). Given the circumstances surrounding the suspension and the restoration of privileges, the Respondent’s explanation was credible; however, he presented no evidence to substantiate these claims and so we give little weight to them. While the Hearing Committee concludes that the Respondent willfully filed a false report, we cannot conclude that the Respondent intended to mislead the licensing agency and thus do not sustain a finding of fraud. Rather, based on the fact that the Hospital l$ed the suspension immediately following Dr. Momah’s offer of proof of his unavailability and the’possibility that Dr. Momah may have unreasonably relied on the advice of others to treat the suspension as though it had never occurred, we find that Respondent wrongly concluded that he could answer “no” on his registration application. DETERMINATIONS - PARAGRAPH H 1. Allegation H is sustained. 31 re- VOTES OF THE HEARtNC; COMMITTEE The Hearing Committee voted unanimously as follows: FIRST THROUGH THIRD SPECIFICATIONS (FRAUDULENT,PIWCTICE) A and A.2 WITHDRAWN B and B.2 NOT SUSTAINED H NOT SUSTAINED FOURTa- (MORAL UNFITNESS) A and A.2 WITHDRAWN B and B.2 NOT SUSTAINED \ H NOT SUSTAINED S==THROUGH (GROSS NEGLIGENCE) A and A.3 CandC.1 DandD.1 WITHDRAWN NOT SUSTAINED NOT SIJSTAINED 32 TENTH THROUGH TWELFTH SPECIFICATIONS @ROSS INCOMPETENCE) A and A.3 WITHDRAWN C and C.l NOT SUSTAINED D andD.l NOT SUSTAINED THIRTEENTH SPECIFICATION (NEGLIGENCE ON MORE Aand A.1 WITHDRAWN A and A.3 WITHDRAWN B andB.l NOT SUSTAINED C and C.l SUSTAINED C and C.2 WITHDRAWN DandD.l NOT SUSTAINED E andE.l WITHDRAWN E and E.2 WITHDRAWN E and E.3 WITHDRAWN F and F.1 NOT SUSTAINED F and F.2 NOT SUSTAINED F and F.3 NOT SUSTAINED GandG.l SUSTAINED G and G.2 NOT SUSTAINED 33 THAN ONE OCCASION) FOURTEENTH SPECIFICATION (INCOMPETENCE ON MORE THAN ONE OCCASION} A. and A. 1 WITHDRAWN A and A.3 WITHDRAWN BandB.l NOT SUSTAINED C and C.l NOT SUSTAINED C and C.2 WITHDRaWN DandD.l NOT SUSTAINED E andE.l WITHDRAWN E. and E.2 WITHDRAWN E. and E.3 wITHDR4wN F and F.l NOT SUSTAINED F and F.2 SUSTAINED F and F.3 NOT SUSTAINED GandG.l NOT SUSTAINED G and G.2 NOT SUSTAINED . FIFTEENTH SPECIFICATION (WILFULLY lMAKING OR FILING A FALSE REPORT) H SUSTAINED CONCLUSIONS OF LAW The Respondent is charged with fifteen Specifications alleging professional misconduct within the meaning of Education Law Sec. 6530, This statute sets forth numerous forms of conduct which constitute professional misconduct, but does not provide definitions of the various types of misconduct. During the course of its deliberations on these charges, the Hearing Committee 34 consulted a memorandum prepared by Henry M. Greenberg, Esq., General Counsel for the Department of Health. This document, entitled “Definitions of Professional Misconduct Under the New York Education Law,” sets forth suggested definitions for gross negligence, negligence, gross incompetence, incompetence, and the fraudulent practice of medicine. As enumerated below, using the above-referenced memorandum as a framework for its deliberations, the Hearing Committee unanimously concluded, by a preponderance of the evidence, that the Petitioner has sustained its burden of proof regarding two of the Specifications and did not prove nine Specifications. Four Specifications were withdrawn by the Petitioner. 1. The First through Third Specifications charge the Respondent with practicing the profession of medicine fraudulently, based upon factual allegations A and A.2 (withdrawn), B and B.2, and H of the Statement of Charges. The Hearing Committee does not sustain these specifications and finds that the Respondent did not practice the profession of medicine fraudulently within the meaning of New York State Education Law $6530(2) in that he did not intentionally and falsely represent to Patient B that he had privileges at Canton-Potsdarn Hospital in Potsdam, New York, nor did he intentionally and falsely represent on his New York State Education Qepartment registration application that his hospital privileges had been suspended. The Second and Third Specifications are NOT SUSTAINED. 2. The Fourth through Sixth Specifications charge the Respondent with being morally unfit to practice the profession of medicine, based upon factual allegations A and A.2 (withdrawn), B and B.2 and H of the Statement of Charges. The Hearing Committee does not sustain the allegations and finds that Respondent did not evidence moral unfitness to practice the profession within the meaning ofNew York State Education Law 9 6530(20), in that Respondent did not fraudulently misrepresent 35 to Patient B that he had hospital privileges, nor did he fraudulently represent on his registration application that his hospital privileges had been suspended. The Fifth and Sixth Specifications are NOT SUSTAINED 3. The Seventh through Ninth Specifications charge the Respondent with practicing medicine with gross negligence, based upon factual allegations A and A.3 (withdrawn), C and C. 1, and D and D. 1 of the Statement of Charges. The Hearing Committee does not sustain the allegations and finds that Respondent’s treatment of Patients C and D was not grossly negligent within the meaning of New York State Education Law § 6530 (4) in that it did not fail to conform to the standard of care that would be exercised by a reasonably prudent physician under the same circumstances, and which failure is manifested by conduct that is egregious or conspicuously bad. The Eighth and Ninth Specifications are NOT SUSTAINED. 4. The Tenth through Twelfth Specifications charge the Respondent with practicing medicine with gross incompetence, based upon factual allegations A and A.3 (withdrawn), and D. 1 of the Statement of Charges. C and C. 1, and D The Hearing Committee dozs not sustain the allegations and finds that Respondent’s treatment of Patients C and D was not ‘grossly incompetent within the meaning of New York State Education Law 9 6530 (6) in that it did not constitute an unmitigated lack of the skill or knowledge necessary to perform an act undertaken by the Respondent in the practice of medicine. The Eleventh and Twelfth Specifications are NOT SUSTAINED. 5. The Thirteenth Specification charges the Respondent with practicing with negligence on more than one occasion, based upon factual allegations A and A. 1 (withdrawn), A and A.3 (withdrawn), B and B. 1, C and C. 1, C and C.2, D and D. 1, E and E. 1 (withdrawn), E and E.2 (withdrawn), E and E.3 (withdrawn), F and F.l. F and F.2, F and F.3, G and 36 G.1, and/or G and G.2. The Hearing Committee sustains this specification and finds that Respondent’s treatment of Patients C and G was negligent within the meaning of New York State Education Law Q 6530 (3) in that it did not conform to the standard of care of a reasonably prudent physician under the same circumstances. In so finding, the Hearing Committee refers to the factual allegations which have been sustained. The Thirteenth Specification is SUSTAINED. 6. The Fourteenth Specification charges the Respondent with practicing with incompetence on more than one occasion, based upon factual allegations A and A. 1 (withdrawn), A and -4.3 (withdrawn), B and B. 1, C and C. lj C and C.2, D and C. 1, E and E. 1 withdrawn), E and E.2 (withdrawn), E and E.3 (withdrawn), F and F. 1, F and F.2, F and F.3, G and G. 1, and/or G and G.2. The Hearing Committee does not sustain this specification because it finds that on only one occasion was the Respondent incompetent within the meaning of New York State Education Law 4 5630 (5) in that Respondent demonstrated a lack of requisite skill and knowledge. The Fourteenth Specification is NOT SUSTAI1IVED. 7. The Fifteenth Specification charges the Respondent wi& w-ilfully making or filing a false report, based upon f&tiual allegation H. The Hearing Committee sustains fhis specification and finds that Respondent wilfblly filed a false report within the meaning of New York State Education Law $ 6530 (21) in that Respondent wilfitlly represented on his re-registration application to the New York State Education Department that his hospital privileges had not been restricted when in fact they had. In so finding, the Hearing Committee refers to the factual allegations which have been sustained. The Fifteenth Specification is SUSTAINED. 37 DETERMINATION AS TC) PENALTY The Hearing Committee, pursuant to the Findings of Fact and Conclusions of Law set forth above, unanimously determined that the Respondent should be censured and reprimanded. This determination was reached upon due consideration of the till range of penalties available pursuant to statute, including revocation, suspension and/or probation, censure and reprimand, and the imposition of monetary penalties. The evidence produced during this hearing did not prove that there was a pattern of fraudulenti morally unfiti negligent or incompetent conduct by the Respondent; rather, it indicated several apparently isolated cases of negligence and incompetence, as well as one instance of filing a false report. The Respondent does not require a period of retraining or supervised practice. Since the time he saw the patients whose care was at issue in this proceeding, the Respondent has taken many continuing education courses on a variety of topics, including management of high-risk pregnancies and Rh sensitization. Additionally, in November of 1443, the Respondent became certified by the American Board of Obstetrics and Gynecology. The Board conducts an extensive review of cases before certifying physicians, and such cases must meet strict national standards. Finally, while Respondent wilfblly fled a false report with the New York State Education Department, he did so not with the intention to deceive, but because of his mistaken reliance on the advice of others. Based on the foregoing, The Hearing Committee concludes that if Dr. Momah were now to return to New York to practice medicine, he would not pose a danger to the citizens of the state. 38 Based upon the foregoing, IT IS HEREBY ORDERED TEIAT: 1. The Thirteenth and Fifteenth Specifications of professional misconduct are SUSTAINED; 2. The Second, Third, Fifth, Sixth, Eighth, Ninth, Eleventh, Twelfth and Fourteenth Specifications are DISMISSED; 3. The Respondent is hereby CENSURED AND REPRIMANDED; and 4. This ORDER shall be effective upon service on the Respondent or the Respondent’s attorney by personal service or certified or registered mail. , 1555 JAMES 0. ROBERSON, M.D. MARY PATRICIA MEAGHER 39 . STATE OF NEW YORK DEPART OF : HEALTEI STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT -_______-___________--- ““‘~~_-~~-_~~~~~~-_~~_~ IN TIIE MATTER OF t NOTICE : OF CHARLES M. MOWUI, M.D. : -___ ______________________________-_-__-_-----_x TO: HEARING CHARLES M. MOMAH, M.D. C/O Robert H. Imman, Esq. IS-, Cunningham, Reieter 6c Hyde 9 Thurlow Terrace Albany, New York 12203 PLEXSE TAKE NOTICE: A hearing will be held pursuant to the provisions of N.Y. Pub. Health Law Section 230 and N.Y. State Admin. Sections 301-307 and 401. Proc. Act The hearing will be conducted before a committee on professional conduct of the State Board for . Professional Medical Conduct on the 27th day of May, 1998, at 1O:OO in the forenoon of that day at the Hampton Inn, 417 North 7th Street, Liverpool, New York such other adjourned dates, 13088, (315) 457-660.0, and at times and places as the committee may direct. At the hearing, allegations set forth attached. evidence will be received concerning the in the Statement of Charges, which is A stenographic record of the hearing will be made and the witnesses at the hearing will be sworn and examined. shall appear in person at the hearing counsel. your behalf, You have the You and may be represented by right to produce witnesses and evidence on in to issue or have subpoenas issued on your behalf order to require the production of witnesses and documents and you may cross-examine witnesses and examine evidence produced against you. A summary of the Department of Health Hearing Rules is enclosed. The hearing will proceed whether or not you appear at the hearing. Please note that requests for adjournments must be made in writing and by telephone to the Bureau of Adjudication, Hedley Park Place, 5th Floor, 433 River Street, Troy, New York (518-402-0748), 12180, upon notice to the attorney for the Department of Health whose name appears below, and at least five days prior to the scheduled hearing date. Adjournment requests are not routinely granted as scheduled dates are considered dates certain. Claims of court engagement will require detailed, Affidavits of Actual Engagement Claims of illness will require medical documentation. Pursuant to the provisions of N.Y. Pub Health Law Section 230(10) (c) you shall file a written answer to each of the Charges and Allegations in the Statement of Charges no later than ten days prior to the date of the hearing. Ar?y Charge and Allegation not so answered shall be deemed admitted. the advice of counsel prior to filing You may wish to seek such answer. The answer shall be filed with the Bureau of Adjudication, at the address indicated above, and a copy shall be forwarded to the attorney for the Department of Health whose name appears below. Pursuant to Section 301(5) of the State Administrative Procedure Act, the Department, upon reasonable notice, will provide at no charge a qualified interpreter of the deaf to interpret the proceedings to, and the testimony of, any deaf person. At the conclusion of the hearing, the 2 committee shall make findings of fact, in the event any of the charges dismissed, and, the charges sustained conclusions concerning or are sustained, a determination of the penalty to be imposed or appropriate action to be taken. Such determination may be reviewed by the administrative review board for professional medical conduct. THESE PROCEEDINGS MAY RESULT IN A DETERMINATION THAT YOUR LICENSE TO PRACTICE AS A PHYSICIAN IN NEW YORK STATE BE REVOKED OR SUSPENDED, AND/OR THAT YOU BE FINED OR SUBJECT TO THE OTHER SANCTIONS SET OUT IN NEW YORK PUBLIC HEALTH LAW SECTION 230-a. YOU ARE URGED TO OBTAIN AN ATTORNEY TO REPRESENT YOU IN THIS MATTER. DATED: PETER D. VAN BUREN Deputy Counsel Inquiries should be directed to: MICHAEL A. HISER Associate Counsel Division of Legal Affairs Bureau of Professional Medical Conduct Corning Tower Building Room 2509 Empire State Plaza Albany, New York 12237-0032 (518) 473-4282 STATE OF NE'W YORK DEPARTMENT OF HEALTH : STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT ____~________________~~~~~~~--~~~~~~~~~~~~- X IN THE MATTER OF : STATEMENT : CHARLES M. MOMAH, M.D. : OF CHARGES CHARLES M. MOMAH, M.D., the Respondent, was authorized to practice medicine in New York State on August 7, 1987 by the issuance of license number 171684 by the New York State Education Department. The Respondent is not currently registered for the practice of medicine. He was last registered for the practice of medicine for the period January 1, 1995 through June 30, 1997 with an office address of P.O. Box 5178, Massena, New York A. 13662. Respondent provided medical care to Patient A (patients are identified in the Appendix), a female patient 24 year old when first treated, from on or about July 23, 1992 through on or about March 1993, at Respondent's office at 180 East Orvis Street, Massena, New York 13662 (hereinafter, "the office"). Respondent provided prenatal obstetric care to Patient A. Respondent's care of Patient A did not meet minimum standards of care, in that: 1. Respondent continued to provide prenatal obstetric services to Patient A after December 31, 1992, when Respondent no longer had admitting privileges at any health care facility with appropriate obstetric services. 2. Respondent, with knowledge that he had no admitting privileges at any facility with obstetric services misrepresented to Patient A that he was in the prokess of getting privileges at Canton-Potsdam Hospital in Potsdam, New York, and that he would have privileges "any day". 3. Respondent, with knowledge that he had no admitting privileges at any facility capable of providing obstetric services, contacted Patient A on numerous occasions and offered to deliver Patient A's baby at her home, or at Respondent's office. B. Respondent treated Patient B from on or about December 14, 1992 through on or about February 16, 1993, at Respondent's office. Respondent provided prenatal obstetric care to Patient B. Respondent's care of Patient B did not meet minimum standards of care, in that: 1. Respondent continued to provide prenatal obstetric services to Patient B after December 31, 1992, when Respondent no longer had admitting privilegesat any health care facility with appropriate obstetric services. 2. Respondent, with knowledge that he had no admitting privileges at any facility with obstetric services, misrepresented to Patient B that he had privileges at Canton-Potsdam Hospital in Potsdam, New York. C. Respondent provided medical care to Patient C, a 20 year old female, from on or about April 4, 1991 through on or about April 10, 1991, at Respondent's office. Patient C presented with what Respondent diagnosed as "extensive vaginal 2 and vulva condyloma". Respondent's care of Patient C did not meet minimum standards of care, in that: 1. Respondent applied excessive trichloroacetic acid to Patient's C cervix, vagina and vulva, thereby causing severe and extensive burns of the patient's perineal and buttocks region, as well as on the patient's knee. 2. Respondent failed to provide Patient C with adequate instructions for perineal care following the trichloracetic treatment. D. Respondent provided medical care to Patient D, a female patient 48 years old, on or about February 23, 1990 at Masse&a Memorial Hospital. Patient D was admitted to the hospital with a complaint of severe right lower quadrant abdominal pain of sudden onset, 12 hour duration. The patient underwent a diagnostic laparoscopy and laparotomy. Respondent's care of Patient D did not meet minimum standards of care, in tha?s 1. Respondent performed a primary closure of the surgical wound, despite having identified that the patient had severe peritonitis and a pelvic abscess, which was contraindicated in light of the extreme contamination of the operative site. E. Respondent treated Patient E from on or about May 6, 1991 through on or about December 29, 1991 at Respondent's office and at other health care facilities, including Massena Memorial Hospital, Massena, New York. Respondent provided prenatal and obstetric care for Patient E. Respondent's care of Patient E did not meet minimum standards of care, in that: 3 1. Respondent inappropriately stopped the administration of oxytocin to Patient E on December 24 1991, despite diagnosing the patient as having pregnancy induced hypertension, decreased fetal movements, bilateral pedal edema, and an inducible cervix. 2. Respondent, despite the presence of thick meconium after artificial rupture of membranes at approximately 1:45 p.m. on December 29, 1991, failed to discontinue the administration of intravenous oxytocin. 3. Respondent, despite evidence of tetanic contractions during the patient's course of labor from approximately 10:00 a.m. to approximately 4:25 p.m., failed to discontinue the administration of intravenous oxytocin. F. Respondent provided medical care to Patient F, a female patient 25 years old when first seen, 15, from on or about February 1990 through March 1990 at Respondent's office and at Massena Memorial Hospital. Patient F received prenatal and obstetric care from Respondent. Respondent's care of Patient F did not meet minimum standards of care, in that: . . 1. Respondent failed to adequately respond to and/or manage the patient's elevated serum glucose levels present at her initial evaluation in mid-February, 1990. 2. Respondent, despite having administered or ordered the administration of 300 mcg of Rhogam on or about March 15, 1990, and having diagnosed Patient F as having "RH inappropriately administered, negative sensitization", or ordered the administration of a second 300 mcg dose of Rhogam, which was not medically indicated. 3. Respondent failed to request a maternal fetal medicine consultation, despite the nature of the patient's symptoms. G. Respondent provided medical care to Patient G, a female 4 I. patient 25 years old when first seen, from on or about February 15, 1990 through March 1990 at Respondent's office and at Massena Memorial Hospital. Patient G, care from Respondent, on November 6, who received prenatal obstetric presented to the Massena Memorial Hospital 1989 with a chief complaint of left lower quadrant pain, abrupt onset 3 days before admission. Respondent's care of Patient G did not meet minimum standards of care, in that: 1. Respondent failed to perform and/or record the performance of an adequate history and physical of Patient G upon admission to the hospital, including references to the patient's two past caesarean section deliveries and the performance of a tubal ligation. 2. Respondent failed to adequately assess, and/or recprd the performance of an adequate assessment, of the etiology of the patient's complaints in his discharge summary. H. Respondent, on or about October 2, 1992 falsely answered "No" to question l(c) on his New York State Education Department registration application, which stated: "Since you last registered, has any hospital or 1icensLd facility restricted or terminated your professional training, employment, or privileges conduct, ... due to professional misconduct, unprofessional incompetence or negligence?" In fact, Massena Memorial Hospital had suspended Respondent's privileges to practice medicine at that facility on or about February 13, 1992 for failure to provide timely coverage of obstetrical services to the emergency department. . SPECIFICATIONS OF MZSCONDUCT Respondent is charged with committing professional nisconduct as defined by New York Education Law §6530(2 (McKinney Supp. 1997) by practicing the profession of medicine fraudulently as alleged in the facts of the following: 1. The facts in Paragraphs A and A.2. 2. The facts in Paragraphs B and B.2. 3. The facts in Paragraph H. UGH SZXTH SPEB UNFW Respondent is charged with committing professional misconduct as defined in N.Y. Educ. Law $6530(20) (McKinney Supp. 1997) by conduct in the practice of medic&e which evidences moral unfitness to practice medicine, as alleged in the facts of: 4. The facts in Paragraphs A and A-2. 5. The facts in Paragraphs B and B.2. 6. The facts in Paragraph H. 6 . Respondent is charged with committing professional misconduct as defined by New York Education Law $6530(4) (McKinney Supp. 1997) by practicing the profession of medicine with gross negligence as alleged in the facts of the following: 7. The facts in Paragraphs A and A.3. 8. The facts in Paragraphs C and C.l. 9. The facts in Paragraphs D and D.l. THROUGH TWELFTH SPECIFICATIONS OSS xOMP_ \ . Respondent is charged with committing professional misconduct as defined by New York Education Law $6530(6) (McKinney Supp. 1997) by practicing the profession of medicine with gross incompetence as alleged in the facts of the following: 10. The facts in Paragraphs A and A.3. 11. The facts in Paragraphs C and C.l. 12. The facts in Paragraphs D and D.l. 7 I ; .. Respondent is charged with committing professional misconduct as defined by New York Education Law $6530(3) (McKinney Supp. 1997) by practicing the profession of medicine with negligence on more than one occasion as alleged in the facts of two or more of the following: 13. The facts in Paragraphs A and A.l, A and A.3 B and B.l, C and C.l, C and C.2, D and D.l, E and E.1, E and E.2, E and E.3, F and F.l, F and F.2, F and F-3, G and G.l, and/or G and G.2. Respondent is charged with committing professional misconduct as defined by New York Educatiok Law $6530(S) (McKinney Supp. 1997) by practicing the profession of medicine with incompetence on more than one occasion as alleged in the facts of two or more of the following: 14. The facts in Paragraphs A and A-1, A and A.3, B and B.l, C and C.l, C and C.2, D and D-1, E and E-1, E and E.2, E and E-3, F and F.l, F and F.2, F and F.3, G and G.l, and/or G and G.2. , CIFIW A PA&SE REPORT Respondent is charged with committing professional misconduct as defined by New York Education Law !$6530(21) (McKinney Supp. 1997) by wilfully making or filing a false report required by law by the department of health or the education department, as alleged in the facts of the following: 15. The facts in Paragraph H. DATED: Aprilas, 1998 Albany, New York PETER D. VAN BUREN Deputy Counsel Bureau of Professional' Medic& Conduct . If NEW YORK ?b stat: department of NiravR. Shah,M.D.. MPH. Sue Kelly Commissioner Executive Deputy Commissioner May 31, 201 1 CERTIFIED MAIL - RETURN RECEIPT REQUESTED Jude B. Mulvey, Esq. Robert H. Iseman, Esq. NYS Department of Health Iseman, Cunningham, Riester Hyde, LLP ESP-Corning Tower?Room 2512 9 Terrace Albany, New York 12237 Albany, New York 12203 David B. Zuckennan, Esq. Charles Momah, MD. l300 Hoge Building DOC #388910 705 Second Avenue Coyote Ridge Corrections Center Seattle, Washington 98104-1705 1301 North Ephrata Avenue Connell, Washington 99326 RE: In the Matter of Charles L. Momah, MJ). Dear Parties: Enclosed please find the Determination and Order (No. 11?135) of the Hearing Committee in the above referenced matter. This Determination and Order shall be deemed effective upon the receipt or seven days after mailing by certi?ed mail as per the provisions of ?230. subdivision 10, paragraph (11) of the New York State Public Health Law. Five days after receipt of this Order, you will be required to deliver to the Board of" Professional Medical Conduct your license to practice medicine together with the registration certi?cate. Delivery shall be by either certi?ed mail or in person to: Of?ce of Professional Medical Conduct New York State Department of Health Hedley Park Place 433 River Street - Fourth Floor Troy, New York 12180 If your license or registration certi?cate is lost, misplaced or its whereabouts is otherwise unknown, you shall submit an affidavit to that effect. If subsequently you locate the requested items, they must then be delivered to the Of?ce of Professional Medical Conduct in the manner noted above. EALTH. NYLGOV Facebook.cern?HY5DOH minimum As prescribed by the New York State Public Health Law ?230, subdivision 10, paragraph (McKinney Supp. 2007) and ?230-c subdivisions 1 through 5, (McKinney Supp. 2007), "the determination of a committee on professional medical conduct may be reviewed by the Administrative Review Board for professional medical conduct. Either the licensee or the Department may seek a review of a committee determination. Request for review of the Committee's determination by the Administrative Review Board stays penalties other than susgension or revocation until ?nal determination by that Board. Summary orders are not stayed by Administrative Review Board reviews. All notices of review must be served, by certi?ed mail, upon the Administrative Review Board and the adverse party within fourteen (14) days of service and receipt of the enclosed Determination and Order. The notice of review served on the Administrative Review Board should be forWarded to: James F. Horan, Esq, Administrative Law Judge New York State Department of Health Bureau of Adjudication Hedley Park Place 433 River Street, Fifth Floor Troy, New York 12180 The parties shall have 30 days from the notice of appeal in which to ?le their briefs to the Administrative Review Board. Six cepies of all papers must also be sent to the attention of Mr. Horan at the above address and one copy to the other party. The stipulated record in this matter shall consist of the of?cial hearing transcript(s) and all documents in evidence. Parties will be noti?ed by mail of the Administrative Review Board's Determination and Order. Sincerely, F. Horan, Acting Ulrector ur of Adjudication .TFiizcah Enclosure STATE OF NEW YORK DEPARTHEHT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT . . . . . . . . . . . . . . . . . . . . . . . IN THE MATTER DETERMINATION OF AND CHARLES L. MOMAH, M.D. A Notice of Referral Proceeding and Statement of Charges, ORDER both dated July 20, 2006, were served upon the Respondent, Charles L. Momah, M.D. REVINDER MAMTANI, M.D. (Chair), JOHN D. THOMAS II, M.D., and THOMAS W. KING, JR., M.P.A., P.E., duly designated members of the State Board for Professional Medical Conduct, served as the Hearing Committee in this matter pursuant to Section 230(l?ltej of the Public Health Law. LARRY G. ESQ., ADMINISTRATIVE LAW JUDGE, served as the Administrative Officer. The Department of Health appeared by Jude B. Mulvey, Esq., Associate. The Respondent failed to appear in person or by counsel. A hearing was held on May 18, 2011. Evidence was received and witnesses sworn and heard and transcripts of these proceedings were made. After consideration of the entire record, the Hearing Committee issues this Determination and Order. STATEMENT OF CASE This case was brought pursuant to Public Health Law Section The statute provides for an expedited hearing where a licensee is charged solely with a violation of Education Law ?6530{9}. In such cases, a licensee is charged with misconduct based upon a prior criminal conviction in New York or another jurisdiction, or upon a prior administrative adjudication regarding conduct which would amount to professional misconduct, if committed in New York. The scope of an expedited hearing is limited to a determination of the nature and severity of the penalty to be imposed upon the licensee. In the instant case. Respondent is charged with Ilprofessional misconduct pursuant to Education Law in that Respondent was found guilty of a Crime I under the law of another jurisdiction and which, if committed in this state, would have constituted a crime under New York state law. In additionJr Respondent is charged with professional misconduct pursuant to Education Law by virtue of Ilhaving been found guilty of improper professional practice by a duly authorized professional disciplinary agency of the State of IIWashington, where the conduct resulting in the disciplinary action would constitute professional misconduct under New York state law; as well as professional misconduct pursuant to Education Law ?6530(9)(d) by having his license to practice 2 medicine revoked by the duly authorized disciplinary agency of the State of Washington. A copy of the Statement of Charges is Iattached to this Determination and Order in Appendix I. II FINDINGS OF FACT The following Findings of Fact were made after a review of the entire'record in this matter. Numbers in parentheses refer to transcript page numbers or exhibits. These citations represent evidence found persuasive by the Hearing Committee in arriving at a particular finding. Conflicting evidence, if any, was considered and rejected in favor of the cited evidence. 1. Charles L. Momah, M.D.(hereinafter, "Respondent"), was authorized to practice medicine in New York State on August 7, 1987 by the issuance of license number 171684 by the New York State Education Department. (Ex. 2. On or about November 16, 2005, in the Superior Court llfor King County, State of Washington, Respondent was found guilty Iof one (1) count of Rape in the Third Degree, two (2) counts of Indecent Liberties, and one count of Rape in the Second Degree. On February 6, 2005, Respondent was sentenced to sixty {60} months confinement for Rape in the Third Degree, twelve {12) months confinement for each count of Indecent Liberties, and two hundred forty-five (245) months to life imprisonment for Rape in the Second Degree, $500 restitution and Community Custody 3 "conditions. (Exhibit 3. On or about June 19, 2006, the State of Washington, Department of Health, Medical Quality Assurance Commission "(hereinafter ?Washington Board"), by a Stipulated Findings of Fact, Conclusions of Law and Agreed Order (?Washington Order"), revoked Respondent's license to practice medicine, based on providing knowingly false information on a healthcare providers network re?credentialing form; prescribing Percocet and Xanax to a patient with a drug addiction problem whom he had referred to an inpatient drug treatment program; having sex with a patient in his office during the course of a physical examination; threatening the patient not to report the sexual encounter to the I'police; performing a hysteroscopy on a patient when a hysteroscopy was contraindicated; performing a hysterectomy on a "patient when a hysterectomy was contraindicated; inaccurate recordkeeping; abandoning or neglecting a patient under and in need of immediate professional care without making reasonable arrangements for the continuation of such care; performing unnecessary ultrasounds on a patient; performing seven laparoscopies and two laparotomies on a patient, all of which were medically unnecessary and not for the benefit of the patient; sexualized touching a patient?s clitoris and vagina, asking a patient, during a physical examination for permission to insert his penis in her, sexually caressing her breasts, kissing 4 her, calling her for dates, and offering to exchange narcotic drugs for sexual contact; and the criminal conviction set forth in paragraph 2, above. (Exhibit 4. Respondent?s criminal conviction was subsequently upheld by the Washington Court of Appeals (Exhibit as well as by the Washington Supreme Court. (Exhibit Respondent's petition for a writ of certiorari was denied by the United States Supreme Court on October 14, 2010. (Mbmah v. washington, 131 160 {2010)}. CONCLUSIONS OF MN The following conclusions were made pursuant to the Findings of Fact listed above. All conclusions resulted from a unanimous vote of the Hearing Committee unless noted otherwise. The evidence amply established that Respondent stands convicted of multiple counts of rape and other sexual misconduct, including second degree rape. He is currently serving a sentence of 20+ years life for his crimes. Moreover, he has exhausted his appellate remedies through both the State and Federal courts. Therefore, we conclude that Respondent was convicted of crimes under Washington law that would, if committed in New York, would have constituted crimes under New York State law. Thus he is guilty of professional misconduct pursuant to Education Law Accordingly, we sustain the First Specification of professional misconduct set forth in the Statement of Charges. In addition, the record demonstrated that the Washington Board revoked Respondent's Washington medical license based upon stipulated findings of fact and conclusions of law. The findings against Respondent involved misconduct in the care of nineteen "patients. Respondent was found guilty of especially egregious sexual misconduct with multiple patients, as well as multiple acts of gross negligence, gross incompetence, moral unfitness, willfully harassing, abusing intimidating patients, and abandonment of patients, among other violations. Thus, Respondent was found guilty of numerous acts of improper professional conduct which, if committed in New York, would constitute professional misconduct as set forth in paragraph of the Statement of Charges. Accordingly, the Hearing Committee sustained the Second and Third Specifications of professional misconduct. DETERMINRTION AS TO PENALTY The Hearing Committee, pursuant to the Findings of Fact and Conclusions of Law set forth above, unanimously determined that Respondent's license to practice medicine in the State of New York should be revoked. This determination was reached upon due consideration of the full spectrum of penalties available pursuant to statute, including revocation, suspension and/or probation, censure and reprimand, and the imposition of monetary penalties. Respondent abused his position of trust as a physician in order to take sexual advantage of his patients. There can be no mitigation for such actions. The crimes of rape and indecent liberties virtually mandate revocation. In addition, the record established that Respondent lacked the skills and judgment Inecessary to practice the profession. In the absence of any mitigating evidence, the misconduct found by the Washington hoard independently warrants revocation. Based upon the foregoing, IT IS HEREBY ORDERED THAT: 1. The Specifications of professional misconduct, as set forth in the Statement of Charges (Exhibit 5} are 2. Respondent's license to practice medicine in New York State shall be and hereby is 3. This Determination and Order shall be effective upon service. Service shall be either by certified mail upon ReSpondent at Respondent's last known address and such service shall be effective upon receipt or seven days after mailing by certified mail, whichever is earlier, or by personal service and such service shall be effective upon receipt. DATED: Hopewell Junction, NEW York I 2011 REDACTED no. (CHAIR) JOHN D. THOMAS II, M.D. THOMAS W. M.P.A., P.E. TO: Jude E. Mulvey, Esq. Associate Counsel New York State Department of Health Corning Tower, Room 2512 Albany, New York 12237 Robert H. Iseman, Esq. Iseman, Cunningham, Riester Hyde, LLP 9 Thurlow Terrace Albany, New York 12203 David B. Zuokerman, Esq. 1300 Hoge Building 705 Second Avenue Seattle, Washington 98104-1705 Charles Momah, M.D. DOC #888910 Coyote Ridge Corrections Center 1301 North Ephrata Avenue Connell, Washington 99326 APPENDIX I STATE OF NEW YORK DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER STATEMENT OF OF CHARLES M. MDMAH, Mp. CHARGES 00-03-094449-A CHARLES L. MOMAH. M.D.. Respondent. was authorized to practice medicine in New York state on August 193?. by the issuance of license number 1?1684 by the New York State Education Department. FACTUAL ALLEGATIDNS A. On or about November 16. 2005. in the Superior Court of Washington for King County, State of Washington. Respondent was found guilty of one count of Rape in the Third Degree. two (2) counts of Indecent Liberties. and one (1) count of Rape in the Second Degree. and on February 6. 2006. was sentenced to sixty (60) months con?nement for Rape in the Third Degree. twelve (12) months con?nement for each count of the Indecent Liberties, and two hundred forty?live (245) months to life con?nement for Rape in the Second Degree. $500 restitution. and Community Custody conditions. A On or about June 19. 2006. the State of Washington. Department of Health. Medical Quality Assurance Commission. {hereinafter ?Washington Board"). by a Stipulated Findings of Fact. Conclusions of Law and Agreed Order. (hereinafter ?Washington Order"), REVOKED Respondent's license to practice medicine. based on. inter alia. providing knowingly false information on a healthcare providers network re-credentialing application form in May 2001; prescribing Percocet and Xanax to a patient with a drug addiction problem whom he had referred to an inpatient program for drug addiction; having sex with a patient in his of?ce during the course of a physical examination: threatening a patient not to report the sexual encounter to the police; performing a hysteroscopy on a patient when a hysteroscopy was contraindicated; performing a hysterectomy on a patient when a hysterectomy was contraindicated; inaccurate recordkeeping; abandoning or neglecting a patient under and in need of immediate professional care without making reasonable arrangements for the continuation of such care: performing unnecessary ultrasounds on a patient: performing seven (7) laparoscopies and ttvo (2) Iaparotomies on a patient all of which were medically unnecessary and not for the benefit of the patient; sexualized touching of a patient's clitoris and vagina; asking a patient. during a physical examination. for permission to insert his penis in her. sexually caressing her breasts. kissing her. calling her for dates. and offering to exchange narcotic drugs for sexual contact; and the criminal conviction set forth in paragraph A. above. C. The conduct resulting in the Washington Board disciplinary action against ReSpondent would constitute misconduct under the iaws of New York State. pursuant to the following sections of New York State law: 1 New York Education Law ?6530(3) (negligence on more than one occasion): 2 New York Education Law ?6530(4} (gross negligence); 3. New York Education Law (incompetence on more than one occasion); 4 New York Education Law (gross incompetence); 5. New York Education Law (being convicted of committing an act constituting a crime under state law); 6. New York Education Law ?6530(1?} (exercising undue in?uence on a patient); New York Education Law ?6530(20) (moral unfitness): 8. New York Education Law ?8530(30) (abandoning or neglecting a patient under and in the need of immediate professional care. without making reasonable arrangements for the continuation of such care); 9. New York Education Law ?6530(31) (willfully harassing. abusing or intimidating a patient); andior 10. New York Education Law ?6530(32) (failing to maintain a record for each patient which accurately reflects the evaluation and treatment of the patient). FIRST SPECIFICATION Respondent violated New York Education Law by being convicted of committing a crime under the law of another jurisdiction and which, if committed within this state. would have constituted a crime under New York state law. in that Petitioner charges: 1. The facts in Paragraph A. SECOND SPECIFICATION Respondent violated New York Education Law by having been found guilty of improper professional practice or professional misconduct by a duly authorized professional disciplinary agency of another state. where the conduct resulting in the disciplinary action would constitute professional misconduct under the laws New York state. in that Petitioner charges: 2. The facts in Paragraphs A. B. andfor C. THIRD SPECIFICATION Respondent violated New York Education Law ?6530(9)(d) by having his license to practice medicine revoked or having other disciplinary action taken by a duly authorized professional disciplinary agency of another state. where the conduct resulting in the revocation or other disciplinary action would. if committed in New York state. constitute professional misconduct under the laws of New York state. in that Petitioner charges: 3. The facts in Paragraphs A. B. andfor C. DATED: 2006 REDACTED Albany. is York PETER o. VAN BUREN Deputy Counsel Bureau of Professional Medical Conduct APPENDIX I STATE OF NEW YORK DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT THE MATTER STATEMENT OF OF CHARLES M. MOMAH. M.o. CHARGES CHARLES L. MOMAH. M.D.. Respondent. was authorized to practice medicine in New York state on August 1987. by the issuance of license number 1?1884 by the New York State Education Department. FACTUAL ALLEGATIONS A. On or about November 16. 2005. in the Superior Court of Washington for King County. State of Washington. Respondent was found guilty of one count of Rape in the Third Degree. two (2) counts of Indecent Liberties. and one (1) count of Rape in the Second Degree. and on February 6. 2006. was sentenced to sixty (60) months con?nement for Rape in the Third Degree. twelve (12) months con?nement for each count of the indecent Liberties. and two hundred forty-?ve (245) months to life con?nement for Rape in the Second Degree. $500 restitution. and Community Custody conditions. A On or about June 19. 2006. the State of Washington. Department of Health. Medical Quality Assurance Commission. (hereinafter "Washington Board?), by a Stipulated Findings of Fact. Conclusions of Law and Agreed Order. (hereinafter ?Washington Order?). REVOKED Respondent's license to practice medicine. based on. inter alia. providing knowingly false information on a healthcare providers network re-credentiallng application form in May 2001; prescribing Percocet and Xanax to a patient with a drug addiction problem whom he had referred to an inpatient program for drug addiction: having sex with a patient in his office during the course of a physical examination: threatening a patient not to report the sexual encounter to the police; performing a hysteroscopy on a patient when a hysteroscopy was contraindicated: performing a hysterectomy on a patient when a hysterectomy was contraindicated: inaccurate recordkeeping; abandoning or neglecting a patient under and in need of immediate professional care without making reasonable arrangements for the continuation of such care; performing unnecessary ultrasounds on a patient; performing seven (7) iaparoscopies and two (2) Iaparotomies on a patient all of which were medicain unnecessary and not for the bene?t of the patient; sexuaiized touching of a patient's clitoris and vagina; asking a patient, during a physical examination. for permission to insert his penis in her. sexually caressing her breasts, kissing her. calling her for dates. and offering to exchange narcotic drugs for sexual contact: and the criminal conviction set forth in paragraph A. above. C. The conduct resulting in the Washington Board disciplinary action against Respondent would constitute misconduct under the laws of New York State. pursuant to the following sections of New York State law: New York Education Law ?6530(3) (negligence on more than one occasion): New York Education Law ?6530(4) (gross negligence); New York Education Law ?6540(5) (incompetence on more than one occasion); New York Education Law (gross incompetence); 5. New York Education Law (being convicted of committing an act constituting a crime under state law); 6. New York Education Law ?6530(1?) (exercising undue in?uence on a patient); T. New York Education Law ?6530(20) {moral un?tness): 8. New York Education Law ?6530(30) (abandoning or neglecting a patient under and In the need of immediate professional care. without making reasonable arrangements for the continuation of such care); 9. New York Education Law ?8530(31) (willfully harassing. abusing or intimidating a patient); andior 10. New York Education Law ?8530(32) (failing to maintain a record for each patient which accurately re?ects the evaluation and treatment of the patient). SPECIFICATIONS FIRST SPECIFICATION Respondent violated New York Education Law by being convicted of committing a crime under the law of anotharjurisdiction and which. if committed within this state. would have constituted a crime under New York state law. in that Petitioner charges: 1. The facts In Paragraph A. seems) SPECIFICATION Reapondent viotated New York Education Law by having been found guilt};r of improper professional practice or professional misconduct by a duly authorized professional disciplinary agency of another state, where the conduct resulting in the disciplinary action would constitute professional misconduct under the laws New York state. in that Petitioner charges: 2. The facts In Paragraphs A. B, andlor C. THIRD SPECIFICATKE Respondent violated New York Education Law ?6530(9}(d) by having his license to practice medicine revoked or having other disciplinary action taken by a duly authorized professional disciplinary agency of another state. where the conduct resulting in the revocation or other disciplinary action would. if committed in New York state, constitute professional misconduct under the laws of New York state. in that Petitioner charges: 3. The facts in Paragraphs A. B. andior C. REDACT ED DATED: ?20. 2006 - Albany. York PETER D. VAN BUREN Deputy Counsel Bureau of Professional Medical Conduct STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles Momah, MD Docket No.: 03-01-A-1015MD Document: Final Order Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION in the Matter of the License to Practice Docket No. 03-01-A-1015MD as a Physician and Surgeon of STIPULATED FINDINGS OF CHARLES MOMAH. MD FACT, CONCLUSIONS OF LAW License No. MD00030669 AND AGREED ORDER The Medical Quality Assurance Commission (?Commission?), by and through Michael L. Farrell, Department of Health Staff Attorney, and Respondent, Charles Momah, MD, represented by counsel, John C- Versnel, Ill. stipulate and agree to the following: Section 1: PROCEDURAL STIPULATIONS 1.1 Respondent is licensed to practice as a physician and surgeon in the state of Washington. 1.2 On June 17, 2003, the Commission issued the original Statement of Charges in Docket No. The charges have been amended, and on August 1 3, 2004 the Commission issued the 4th Amended Statement of Charges against Respondent. The Order on Summary Suspension dated September 1 0, 2003 summarily suspended Respondent's license to practice medicine and Respondent did not contest the summary suspension. 1.3 In the Statement of Charges, the Commission alleges that Respondent violated RCW 1.4 Respondent understands that the State is prepared to proceed to a hearing on the allegations in the Statement of Charges. 1.5 Respondent understands that if the allegations are proven at a hearing, the Commission has the authority to impose sanctions pursuant to RCW 18.130.160. 1.8 Respondent has the right to defend against the allegations in the Statement of Charges by presenting evidence at a hearing. STIPULATED FINDINGS OF FACT, PAGE 1 Of 15 CONCLUSIONS OF LAW AND AGREED ORDER DOCKEI: NO. no REV mes 1.7 Respondent waives the opportunity for a hearing on the Statement of Charges provided that the Commission accepts this Agreed Order. 1-8 The parties agree to resolve this matter by means of this Stipulated Findings of Fact, Conciusions of Law, and Agreed Order (Agreed Order). 1.9 Respondent understands that this Agreed Order is not binding unless and until it is signed and accepted by theCommission. 1.10 if the Commission accepts this Agreed Order, it is subject to the federal reporting requirements pursuant to Section 1128E of the Social Security Act and 45 CFR Part 61, RCW 18.130.110 and any other applicable interstate/national reporting requirements. It is a public document and will be available on the Department of Health web site. 1.11 if the Commission rejects this Agreed Order, Respondent waives any objection to the participation at hearing of any Commission members who heard the Agreed Order presentation. Section 2: FINDINGS OF FACT Vi?thout admitting the allegations herein, and speci?cally denying any criminal conduct, the Respondent acknowledges the following allegations and, for the purposes of this proceeding only, does not dispute them. 2.1 Charles Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. Respondent?s license is currently active and suspended . subject to the Order on Summary Suspension dated September 10, 2003- 2.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. 2.3 On or about May 2001, Respondent saw Patient One, a 21 -?year-old female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One's primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the Respondent and by September of 2002. STIPULATED FINDINGS OF FACT, PAGE 2 of i5? OF LAW AND AGREED ORDER Docket NO. no .nEv. 10-011 owed him Over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 2.4 In July of 2002, Respondent noted Patient One was pregnant- Patient One delivered that infant in November of 2002. 2.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent's records state that he was discussing her "drug addiction problem? with her but continued to prescribe Percocet and Xanax. 2.6 In April of 2003, Respondent's progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However. Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 2-7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 2.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior." The note also indicates that Respondent told Patient One to seek another provider. 2.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Peroocet. 2.10 August ?121 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet. Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Reapondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. FINDINGS OF FACT, PAGE 3 0f 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket No. 9.0? REV. torn 2.11 Respondent pulled down his pants and undemear and got on top of Patient One. He placed his penis inside her- When Patient One asked Respondent what he was doing, he said. ?You know you want it." Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 2.12 Patient One wiped off Respondent's semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 2.13 in April 2001, Respondent evaluated Patient Two, age 36, for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section (ts-section). During the pregnancy. cervical cerclage was performed to prevent prematurity. After delivery, there were complications of endometritis and abdominal wound cellulitis. I 2-14 On April 23, 2001, Respondent performed surgery for a diagnostic Iaparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient's prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patients pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c-section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 2.15 On May 17, 200i, Respondent scheduled a Iaparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c?section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section. postpartum endometritis. abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide sufficient information for this patient to form an informed consent to the surgery Respondent proposed. STIPULATED FINDINGS OF FACT. PAGE 4 of 15 CONCLUSIONS OF LAW AND AGREED ORDER DOCKBI NO- inns Lam-.- ?msn- .. m- 2.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two's complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period- Later, shock from blood loss developed. Hospital staff initiated lifeusaving emergency measures during a period when the Respondent could not be reached. Respondent's actions delayed the Patents return to surgery and needlessly exposed her to the risk of exsanguination. 2.17 Pathology results failed to con?rm Respondent's justi?cation for the hysterectomy on Patient Two. which showed the patient's uterus was not enlarged. Respondent did not dictate his operative report for ?ve days, and did not dictate his discharge summary for twenty-one days- Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 2.18 Patient Three was a 46-yearold woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy. lysis of adhesions, and bi?laterai salpingo?oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13. 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent's basis for diagnosing this patient with an enlarged uterus. 2.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post- operative follow-up care to attend the wound for several weeks. 2.20 Patient Four was a 23-year-old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of adhesions, and on'or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. STIPULATED FINDINGS OF FACT, PAGE 5 Of15 CONCLUSIONS OF LAW AND AGREED ORDER ND. no-rn??v was 2.21 Patient Four arrived at the hospital at 0555 hours on April. 2001 for delivery of her baby for a possible vaginal birth after cesarean (V BAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in imminent labor. In the absence of GBS test results before the patient's due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 2-22 In July 2001 Patient Four returned to the hospital for a Iaparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not ruie out other patholOgy including malignancy, pelvic infection, organic disease, complications from her two 0? sections, or other causes. The time interval between the patient's pregnancy and her complaints was too short to justify surgical evaluation. 2.23 Patient Five, age 23 was the Respondent's patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000._Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent's efforts to treat the patient?s condition medically were inadequate. 2.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrheic. 2.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the Operating room to stop bleeding and to receive four units STIPULATED FINDINGS OF FACT, PAGE 6 of '15 CONCLUSIONS OF LAW AND AGREED ORDER Docket No. lilo?rim mos of blood replacement. No evidence of end ometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy. but there is no record of this meeting in the chart- 2.26 Patient Six, age 22, was diagnosed with a twin pregnancy in October 2000. She had been seeing Reapondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor. ultrasound noted the twin pregnancy to be monoamniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 2.27' On February .2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre-tenn labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 000 hours February'2001. Respondent should have referred her to a tertiary care center for specialized management. 2.28 Patient Seven, age 24, was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain- The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was little. if any, indication for a Iaparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 2-29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncertified of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 2.30 Patient Eight. age 19, began medical care with Respondent at age 16, in December 2000 for contraceptives. She was only four months post-partum. Respondent STIPULATED FINDINGS OF PAGE 7 of 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket No. AO-REV.1IJO5 prescribed 150 mg Depo?Provera. which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient, only seven months post-partum and only sixteen years old. 2.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 2.32 Patient Nine, age 30. sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds 0n the patient that did not benefit the patient. 2.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He attempted to engage her in a social relationship by calling her withOut medical basis and asking her to join him for lunch- 2.34 Patient Ten, age 40, began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, ali of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary. 2.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patients clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient- He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patients exams was demonstrated by his sexual comments during the exam, sexually caressing the patient's breasts, kissing her, calls to the patient?s home between visits for dates. and offering to exchange narcotic drugs for sexual contact. STIPULATED FINDINGS OF FACT, PAGE 8 Of 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket NO. no REV ro-os 2.36 Patient Eleven, age 46, ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven _ontinued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed iaparoscopies in November of 2000 and March of 2001. The March 2001 Iaparoscopy was not medically indicated so soon after the one Respondent had performed in November 2000. 2.37 Respondent failed to take necessary diagnostic steps for Patient Eleven's headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient's condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels- 2.33 In 1998, Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, Respondent asked Patient Eleven to? Remnants" sent the -employees home. Respondent called Patient Eleven into his of?ce. He grabbed her arm and said. ?You know you wanted it and I can make you feel good. Nobody needs to know about this-? Respondent eXposed his penis and pushed Patient Eleven's head down trying to get her to perform oral sex. Respondent pushed his penis into her mouth and after some minutes ejaculated. Respondent then told Patient Eleven to go into the operating room. Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. Respondent told Patient Eleven he had written in her patient chart that she was a ?drug seeker? and that no one would believe her. 2.39 Patient Twelve, age 32, began seeing Respondent in 1998 for routine gynecological care. Reapondent performed medically unnecessary laparoscopies, ultrasou nds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a STIPULATED FINDINGS OF FACT, PAGE 9 of 15 OF LAW AND AGREED ORDER Docket No. AD-REV. 10-05 left oophorectomy performed in Respondent?s unceni?ed of?ce operating room in July 2003- Respondent did not have hospital privileges at the time, therefore Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent's operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. 2-40 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers. Respondent continued to presoribe narcotics for the patient. 2.41 Patient Thirteen, age 39, began seeing Respondent for fertility treatments and gynecological care- Respondent performed ultrasounds while she was pregnant that were not medically necessary. Respondent performed a laparoscopy in January 2003, that was not medically necessary. 2.42 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 2.43 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 2.44 Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. Respondent did not put her on prenatal vitamins. 2.45 Patient Fourteen, age 29, began seeing Respondent in approximately June 2001 for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds. Respondent performed an emergency Iaparoscopy in February 2003 in his uncertitied of?ce operating room. This procedure was not medically necessary, and performing the procedure in his office operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm- - 2.46 Patient Fifteen, age 23, began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically steamer; FINDINGS OF FACT, PAGE 10 of 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket No. loos unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003. for tubal reversal. Respondent did not have hospital privileges. and he performed this open procedure at his uncerti?ed of?ce operating reom without appropriate facilities or equipment. 2.4T Respondent dictated two different operative reports for the March 30, 2003, surgery on Patient Fifteen- One operative report re?ects the tubal repair with a laparoscopy. and the other does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 2.48 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 23,2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent's lack of hospital admitting privileges and his inadequate operating room, this procedure put the patient in danger because there was a significant risk of bleeding, and the Respondent had no ability to give the patient blood. 2.49 Patient Sixteen. age 26. began visiting Respondent in April 2002 for treatment of irregular menstrual cycles- The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons- After several visits, Respondent began probing the patient's personal life, asking questions about her past sexual activity. and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 2.50 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen. he used the instrument in a manner she felt was intended to sexually stimulate FINDINGS OF FACT, - . PAGE 11 of 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket NO. her. in May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he c0uld not feel her cervix through the glove. I 2.51 Patient Seventeen. age 36, began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and she believed she needed for her ?bromyalgia- The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil. and Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 2.52 Patient Eighteen, age 35, began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, ReSpondent began flirting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 2.53 Patient Nineteen, age 25, visited Respondent November 15, 2002, to consider whether to establish pro-natal care during her pregnanCy. Respondent told her that she needed to see him instead of a midwife. Respondent told her he had no hospital privileges to deliver a baby, but that he would by the time she delivered. After informing STIPULATED FINDINGS OF FACT, PAGE 12 of 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket No. no the patient he would not do an exam because his nurse was not in the of?ce, Respondent had Patient Nineteen disrobe and he performed a vaginal ultrasound, abdominal ultrasound, breast exam, and manual exam- The patient w0uld have required a chaperone if she understood the extent of the exam the Respondent was going to do, but she understood a chaperone was not available. 2.54 Respondent told Patient Nineteen he could not con?rm her pregnancy. She was requested to have a pregnancy test at a iocal hospital. Respondent called the patient's home and left a message on her answering machine with hertest results. and requesting that she return to his of?ce. A family member picked up the message off the answering machine. She had not yet informed her family that she was pregnant. 2.55 Patient Nineteen called Respondent's of?ce soon after the ?rst visit and informed them that she had decided not to obtain further care from Respondent. Six months later Respondent sent the patient a bill for the visit and exams. Patient Nineteen asked for a cepy of her chart. Respondent's of?ce staff informed her of his policy that charts would not be released until the bill was paid. After attempting to dispute the bill, the patient eventually paid it. Respondent's staff continued to contact the patient to schedule appointments despite her request not to do so. 2.56 The Commission conducted a practice review of the Respondent's of?ces, exam rooms. and practice procedures. Findings from the in-person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. 2.57 On or about November 16. 2005, Respondent was convicted of Rape in the Third Degree, two counts of Indecent liberties, and Rape in the Second Degree after a jury trial in King County Superior Court, Docket No. 04-1-05925-KNT. All four victims were, at the time of the criminal acts, Respondent's patients. Respondent was sentenced to twenty years in prison. STIPULATED FINDINGS OF FACT, 13 of CONCLUSIONS OF LAW AND AGREED ORDER Docket No. Section 3: CONCLUSIONS OF LAW The State and Respondent agree to the entry of the following Conclusions of Law: 3.1 The Commission has jurisdiction over Respondent and over the subject matter of this proceeding. 3.2 Respondent has committed unprofessional conduct in violation of 3.3 The above violations provide grounds for imposing sanctions under RCW18.130.160. Section 4: AGREED ORDER Based on the Findings of Fact and Conclusions of Law, Respondent agrees to entry of the following Agreed Order: 4.1 Respondent. Charles .Mornah, MD. agrees that his license to practice medicine in the state of Washington is REVOKED. Respondent has no right to petition for reinstatement, to reapply for a license, or to practice pursuant to an exemption in ROW 18-71 .030- Respondent further agrees that he will not return to practice or apply for a license to practice medicine in any other state or province. Respondent agrees to immediately return to the Department all copies of current credentials, if he has not already done so. 4.2 Respondent is responsible for all costs of complying with this Agreed Order. Section 5: ACCEPTANCE I, Charles Momah. MD. Respondent. have read, understand, and agree to this Agreed Order. This Agreed Order may be presented to the Commission without my appearance. I understand that i will receive a signed copy if the Commission accepts this Agreed Order. CHMLES MOMAH. MD Respondent she/or; Date! STIPULATED FINDINGS OF FACT, PAGE 14 of 15 CONCLUSIONS OF LAW AND AGREED ORDER Docket No. no REV. 10-05 Versnol. Ill. wsamu Attorney for Respondnt Gr 1c. ?06 Date Section 7: ORDER The Commission accepts and enters this Stipulath Finding: of Fact. Conclusions of Law and Agreed Ordar. DATED: pg?/ .2003 STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION Wwas?eg; e2 PANEL-CHAIR cwskaA 9w Michael Fan?fwsaA #13022 DEPARTMENT OF HEALTH STAFF ATTORNEY Date FDR INTERNAL us: ONLY: PROGRAM no. o1-1o-oozsmn. 02-12-551 5' 03?11-0910M?r mauo. 03-01 4037MB. mmeamn. oa-ea-uoumn. 03-1 ammo. tum-ammo. 03-09- own-noun: 03-10-0100MD. STIPULATED FINDINGS OF FACT. PAGE 15 of 15 CONCLUSIONS or LAW AND AGREED ORDER Docket No. an- mw 1ch STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: Document: Modification Order Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: NONE If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice Docket No. as a Physician and Surgeon of: Docket No. O33MD CHARLES M. MOMAH, M.D.. PREHEARING ORDER NO. 14: License No. MD00030669, ORDER EXTENDING THE STAY AND SETTING STATUS CONFERENCE Respondent. A status conference was held on September 12, 2005 regarding the status of the criminal trail. Prehearing Order No. 11 stayed the above entitled proceedings until October 31, 2005 or upon the completion of the criminal trial, whichever occurs ?rst. The criminal trial is scheduled to commence on October 10, 2005. The parties estimate that the criminal trial Will be at least a month long. Pursuant to the analysis in Prehearing Order No. 11, the stay is extended to the completion of the criminal trial or until December 1, 2005 whichever first occurs. A status conference shall be held on December 12, 2005 at 10:00 am. The Respondent shall file and serve a status report no later than November 29, 2005 regarding the criminal trial date and any motionsimatters that may change the date of the criminal trial. - - Dated this Eygday of September, 2005. ZIMrlliE CANER, Health Law Judge Presiding Officer PREHEARING ORDER NO. 14: ORDER EXTENDING THE STAY AND SETTING STATUS CONFERENCE Page 1 of 2 Docket Nos. DECLARATION OF SERVICE BY MAIL I declare that today I served a copy of this documenI upon the following parties of record: JOHN VERSNEL. ATTORNEY AT LAW AND KIM M6 by maiIing a copy properly addressed with postage prepaid. OF SEPTEMBER. 2005. DATED AT OLYMPIA. WASHINGTON THIS Farm Lu arm-L, Adjudicative Service Unit' oc: LISA NOONAN - MICHAEL WEISMAN FOR INTERNAL USE ONLY: (Internal tracking numbers) - Program Nos. 00-11-0001, 01-10-0029, 02-12-0018, 02-11-0019, 02?12-0063, 03-01?0067, 03?03?002 03-09-0066, 03-09-0044, 03-09-0120, 03-10-0044; 03-09-0045, 03-09-0018, 03-09-0067, 03?09-0080, 03-09-0081. 03-09-0096, 03-10-0106 PREHEARING ORDER NO. 14: ORDER EXTENDING THE STAY AND SETTING STATUS CONFERENCE Page 2 of 2 Docket Nos. 03-01-A-1015MD 8: 03-09-A-1033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01-A-1015MD Document: Pre-hearing Order No. 11: Stay of Proceedings Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: NONE If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice Docket No. O3-01-A-1015MD as a Physician and Surgeon of: Docket No. 03-09-A-1033MD CHARLES M. MOMAH, M.D., PREHEARING ORDER NO. 11: License No. MD00030699, STAY OF PROCEEDINGS Respondent. INTRODUCTION On May 3, 2004, John Versnel, Ill, Attorney at Law on behalf of Charles Momah, MD. (the Respondent) filed a motion for a stay of the proceedings. Kim O?Neal, Assistant Attorney General representing the Department of Health (the Department) filed a response on May 16, 2005. The Respondent filed a supplemental brief on May 19, 2005 and declaration on May 21, 2005. The Department does not oppose the motion for a stay, as long as the criminal proceedings are not extended for a period beyond the October 3, 2005 trial date. Stay granted. PROCEDURAL BACKGROUND The original Statement of Charges (SOC) (03-01-A-1015MD) regarding five patients was filed in June 2003. In September 2003 a second SOC (03-090A-1033MD) regarding the alleged rape of one patient was filed with an Ex Parte Motion for Summary Suspension. The Medical Quality Assurance Commission (the Commission) summarily suspended the Respondent's license on September 10, 2003. In November 2003 these cases were consolidated. From January 2004 through August 2004 the SOC was amended several times adding charges related to 14 additional patients. Five of the 19 patients encompassed in the SOC relate to alleged unprofessional conduct under RCW 18.130.180(24) (patient abuse or sexual contact with a patient). Seventeen of the 19 patients encompass charges related to quality of care and other allegations of unprofessional conduct unrelated to the pending criminal charges. In September 2004, criminal charges were filed against the Respondent in King County Superior Court. Five of the patients encompassed in this disciplinary matter are alleged victims in the pending criminal case. The criminal trial was set to commence on May 9, 2005, and on March 10, 2005 the trial date was continued to October 3, 2005 for discovery reasons. The criminal trial may be several weeks in length. The disciplinary hearing in the case at hand is set for the latter two weeks in July 2005. The PREHEARING ORDER NO. 11: STAY OF PROCEEDINGS Page 1 of 4 Docket Nos. 8: 03-09-A-1033MD Respondent has requested that the disciplinary matter be stayed until the criminal trial is completed. In December 2004, the Presiding Officer stayed this proceeding until May 31, 2005, and held that the stay would not be extended if the trail date is continued because the Department was concerned with the risk of failed memories or lost witnesses. At this time, the Department agrees with the need for a limited stay, and that such a stay will not prejudice the Department. ISSUE Should the entire case or the non?criminal portion of the case be stayed pending the outcome of the criminal proceeding? DISCUSSION The existence of pending charges or criminal investigation does not bar proceeding with civil litigation arising out of the same factual allegations. King v. Olympic Pipe Line 00., 104 Wn. App. 338 (2002). review denied, 143 Wn.2d 290 (2001 The Fifth Amendment is one of seven factors balanced by the court in determining whether a stay or protective order is warranted when parallel criminal investigation/charges exits. Id. In civil cases, negative inferences may be drawn when a witness invokes the privilege against self-incrimination. lkeda v. Curtis, 43 Wn.2d 449 (1953). The King factors apply to the case at hand as follows: 1. Degree of overlap. The extent to which a party?s Fifth Amendment rights are implicated is a key factor. Five of nineteen patients of this disciplinary action are encompassed in the criminal charges. 2. Trial schedule. On March 10, 2005, the criminal trial was continued to October 3, 2005 and this disciplinary case is set for a two week hearing starting July 18, 2005. There is not a direct overlap, but there is significant overlap between the preparation for the criminal case and the hearing in the case at hand. 3. Respondent?s interest. The Respondent is concerned that he may not defend himself without providing incriminating information that may be used against him in a potential criminal proceeding. If he chooses to invoke his Fifth Amendment privilege, negative inferences may be drawn. He is also concerned with defending himself on two fronts at the same time possibly compromising the defense in this case and in the criminal case. 4. Departments interest. The Department does not object to a stay. The Department considers a stay the prudent course considering the nearness of the new criminal trial date and the probability of a partial or full settlement resulting from a possible criminal conviction. This would conserve judicial resources. The Department PREHEARING ORDER NO. 11: STAY OF PROCEEDINGS Page 2 of 4 Docket NOS. 03-01-A-1015MD 03-09-A-1033MD is interested in proceeding expeditiously, but at this time is not concerned that a second limited stay would result in prejudice caused by failed memories and/or lost witnesses. 5. Third party interest. The alleged victims of sexual misconduct would probably want to avoid the stress and embarrassment of testifying more than one time. 6. Public interest. The Respondent's license was summarily suspended in 2003, and the Department has no evidence that he is practicing without a license. Therefore, the public is safe from that potential harm. The SOC was amended several times; the last amendment filed in August 2004. The Department is not concerned that a second stay will result in failed memories and/or lost witnesses, or erode public con?dence in the system. The Department is not concerned with the loss of public confidence because criminal trial is set in the near future. 7. Judicial economy is a significant factor considering the potential resolution of the sexual misconduct allegation in the case at hand by the criminal proceeding. in addition, the Department states that a criminal conviction may also result in a full settlement of this disciplinary case. In light of these factors, a limited stay is appropriate. Bifurcating the case and ordering that the hearing proceed as scheduled on the non sexual misconduct allegations may result in the waste of valuable Commission time and resources. A criminal trial verdict may result in a settlement of the case at hand. The public is adequately protected by the summary suspension of Respondent's license. Public confidence in the system should not erode when the case is stayed so the criminal trial may proceed. This case has attracted public press and attention; therefore the public will probably be informed of the progress of the criminal trial through the media. The public should understand that the wheels of justice are moving forward in a logical, judicial and timely manner; that one case is proceeding first before the other to protect all interests involved including public interests. ORDER The above entitled case is STAYED until October 31, 2005 or upon the- completion of the criminal trial, whichever occurs ?rst. The prehearing and hearing dates are stricken. The motion and discovery deadlines passed (Prehearing Order No. 7), therefore no new deadlines will be set. PREHEARING ORDER NO. 1 1: STAY OF PROCEEDINGS Page 3 of 4 Docket Nos. Regular status conferences shall be held to monitor the pending criminal case. On July 6, 2005 at 10:00 a.m. a telephone status conference shall be held. At least two working days before each status conference, the Respondent shall ?le and serve a status report regarding the criminal trial date and any motions and/or matters that may change the date of the criminal trial. Dated thi?fday of May, 2005. ?Za/ ZIMMIE CANER, Health Law Judge Presiding Of?cer DECLARATION OF SERVICE BY MAIL I declare that today I served a copy of this document upon the following parties of record: JOHN VERSNEL Ill. ATTORNEY AT LAW AND KIM M6 by mailing a copy properly addressed with postage prepaid. DATED AT OLYMPIA. WASHINGTON THIS OF MAY, 2005. bat-mt Quota. Adjudicative Service Unit cc: LISA NOONAN FOR INTERNAL USE ONLY: (Internat tracking numbers) Program Nos. 00-11-0001, 01-10-0029, 02-12-0018, 02-11-0019, 02?12-0063, 03-01-0067, 03-05-0025, 03-09-0066, 03-09-0044, 03-09-0073, 03-09-0120, 03-10-0044, 03-09-0045, 03-09-0018, 03-09-0067, 03?09~0080, 03-09-0096 03-10-0106 PREHEARING ORDER NO. 11: STAY OF PROCEEDINGS . Page 4 of 4 Docket NOS. 03-01-A-1015MD 03-09-A-1033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01-A-1015MD Document: Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH FD MEDICAL QUALITY ASSURANCE COMMISSION ass I 2004 In the Matter Of the License to Practice Adjudicaiive (Jig-K W. As a Physician and Surgeon of: Docket NOS. 03-01-A-1015MD ice CHARLES M. MOMAH, MD License NO. MD00030669, FOURTH AMENDED STATEMENT OF CHARGES Respondent (Revised as of 08?12?04) The Program Manager of the Medical Quality Assurance Commission (?Cormnission?), on I designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(S) NO 00-11-0001MD, 01-10-0029MD, 02-12-001 SMD, 02-11? 0019MD, 03-01-0067MD, 03-09-0066MD, O3- 10-0044MD, 03-09-0018MD, 03-09-0081MD, 03-09-0096MD, Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington on March 16, 1993. 1.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status Of the actions against him in the state Of New York. 1.3 On or about May 2001, Respondent saw Patient One, a - female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the FOURTH AMENDED STATEMENT OF CHARGES (Revised as of08?12w04) Charles M. Momah, MD Docket No. 0 I I PAGE 1 OF 14 Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. I 1.7 Respondent saw Patient One on une 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that ReSpondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.1 1 Respondent pulled down his pants and underwear and got on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-09-A-1033MD PAGE 2 OF 14 he said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 In April 2001, Respondent evaluated Patient Two, age I for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section (c?section). During the pregnancy, cervical cerclage was performed to prevent prematurity. A?er delivery, there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c-section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001 Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charles M. Momah, MD Docket No. PAGE 3 OF 14 Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.17 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was a Iyear?old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a'year-old woman who had a c-section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed alaparoscopy,1ysis of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April I 2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charles M. Momah, MD Docket No. SMD 03-09-A-1033MD PAGE 4 OF 14 imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.22 In July 2001 Patient Four returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, age .vas the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age I was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscan'iages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08?12?04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 5 OF 14 monochon'onic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.27 On February .2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre-terrn labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.28 Patient Seven, age. was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially both a laparoscopy and a hysterOSCOpy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clornid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. ReSpondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age .began medical care with Respondent at age 1. in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo-Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient, only seven months post-partum and only -years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. PAGE physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age I sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age I began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age I ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven also ?Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March 2001 laparoscopy was not medically indicated so soon after the one Respondent had performed in November 2000. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 7 OF 14 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. ApprOpriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. 1.39 In 1998, Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, Respondent asked Patient Eleven to stay late - Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. Respondent pushed his penis into her mouth and after some minutes ejaculated. Respondent then told Patient Eleven to go into the operating room. Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. Respondent told Patient Eleven he had written in her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age I began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a left oopherectomy performed in Respondent?s uncerti?ed of?ce operating room in July 2003. Respondent did not have hospital privileges at the time, therefore Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent? operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-01-A-1015MD PAGE 8 OF 14 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain ?om at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age I began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medically necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003, that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hOSpita] privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age .began seeing Respondent in approximately June 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncerti?ed of?ce operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age .began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003, for tubal reversal. Respondent did not have hOSpital privileges, and he performed this open procedure at his uncerti?ed of?ce operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different Operative reports for the March 30, 2003, surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03?01-A-l01 SMD 03-09-A-1033MD PAGE 9 0F 14 does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.50 Patient Sixteen, age began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.5] During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age .began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08?12?04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 10 OF 14 Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 1.53 Patient Eighteen, age I began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 Patient Nineteen, age I visited Respondent November 15, 2002, to consider whether to establish pro-natal care during her pregnancy. Respondent told her that she needed to see him instead of a midwife. Respondent told her he had no hospital privileges to deliver a baby, but that he would by the time she delivered. After informing the patient he would not do an exam because his nurse was not in the of?ce, Respondent had Patient Nineteen disrobe and he performed a vaginal ultrasound, abdominal ultrasound, breast exam, and manual exam. The patient would have required a chaperone if she understood the extent of the exam the Respondent was going to do, but she understood a chaperone was not available. 1.55 Respondent told Patient Nineteen he could not con?rm her pregnancy. She was requested to have a pregnancy test at a local hospital. Respondent called the patient?s home and left a message on her answering machine with her test results, and requesting that she return to his of?ce. A family member picked up the message off the answering machine. Respondent?s action breached the patient?s con?dentiality. She had not yet informed her family that she was pregnant. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charies M. Momah, MD Docket No. PAGE 1 1 OF I4 1.56 Patient Nineteen called Respondent?s of?ce soon after the ?rst visit and informed them that she had decided not to obtain ?irther care from Respondent. Six months later Respondent sent the patient a bill for the visit and exams. Patient Nineteen asked for a copy of her chart. Respondent?s of?ce staff informed her of his policy that charts would not be released until the bill was paid. After attempting to dispute the bill, the patient eventually paid it. Respondent?s staff continued to contact the patient to schedule appointments despite her request not to do so. 1.57 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings ?om the in?person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.44, 1.48, and 1.56 constitute unprofessional conduct in violation of RCW 18.130.180(1) and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of - the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.3 through 1.9, 1.13, through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49, 1.54 and 1.57 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. PAGE 12 OF 14 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, 1.39 and 1.50 through 1.53 constitute unprofessional conduct in violation of RCW and -. 80(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . and Abuse of a client or patient or sexual contact with a client or patient.? 2.5 The facts alleged in paragraph 1.33 constitute unprofessional conduct, in violation of RCW 18.130.180(l) and .180(4), which provides in part; The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be and 2.6 The facts alleged in paragraph 1.55 constitute unprofessional conduct, in violation of RCW which provides in part: The willful betrayal of a practitioner-patient privilege as recognized by law.? ll FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. PAGE 13 OF 14 Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. DATED this 35 ii" day of uni Ural? 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION f" If 2; l. .45 did- mower-?em- Lisa Noonan Program Manager L/l ff) . Kim O?Neal, WSBA 129339 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-11-0001MD, 02- 03-01-0067MD, 03-09-0066MD, 03-09-0044MD, 03-09-0120MD, 03-10-0044MD, 03-09-004SMD, 03-09- ODISMD, 03-09-0067MD, 03-09-008thD2 03-09-0096MD, 03-10-0106MD FOURTH AMENDED STATEMENT OF CHARGES (Revised as of08?12-04) Charles M. Momah, MD Docket No. 03-Ol-A-10l SMD 03-09-A-1033MD PAGE 14 OF 14 AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-09-A-1033MD Program Case File No(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 02-11-0019MD, 02-12- 0063MD, 03-01-0067MD, 03-08-0025MD, 03-09-0066MD, 03-09-0044MD, 03-10-0044MD, 03-09-0045MD, 03-09- 0018MD, 03-09-0081MD, 03-09-0067MD, 03-09-0096MD, 03-09-0120MD, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient One: Patient Two: Patient Three: Patient Four: Patient Five: Patient Six: Patient Seven: Patient Eight: Patient Nine: Patient Ten: Patient Eleven: Patient Twelve: Patient Thirteen: Patient Fourteen: Patient Fifteen: Patient Sixteen: Patient Seventeen: AMENDED CONFIDENTIAL SCHEDULE PAGE OF 2 Docket Nos. 0 I AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-01-A-1015MD, Program Case File No(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 0242?00131? D, 02-12- 0063MB, 03-01-0067MD, 03-08-0025MD, 03-09-0044MD, 03-10-0044MD, 03-09-0045M 1), 03-09- 0018MB, 03-09-0081MD, 03-09-0080MD, 03-09-0096MD, 03419-01201? I), 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient Eighteen: Patient Nineteen: AMENDED CONFIDENTIAL SCHEDULE - PAGE 2 OF 2 Docket Nos. 03-01 -A- 10 SMD, 03-09-A1033 MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01-A-1015MD Document: Corrected Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON 3:1 LED DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION JAN 2 9 2004 Adgudica?tive Clerk Office (Corrected version as of 1-27-04) In the Matter of the License to Practice As a Physician and Surgeon of: Docket Nos. 03-09-A-1033MD CHARLES M. MOMAH, MD License NO. MD00030669, THIRD AMENDED STATEMENT OF CHARGES 1 The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) NO 01-10-0029MD, 02-12-0018MD, 02-11- 0019MD, 03-01-0067MD, 03-09-0066MD, 03-09-0044MD, 03- 10-0044MD, 03-09-0045MD, 03-09-0081MD, 03-09-0096MD, 03-10-0106MD. Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. This is a corrected version of the Third Amended Statement Of Charges served on January 21, 2004. This version corrects errors caused by a defective software program. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. 1.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state of New York. 1.3 On or about May 2001, Respondent saw Patient One, a. ?year-old female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27~04) Docket NO. U3-01-A-1015MD PAGE 10F 13 episodic health insurance coverage (mostly Medicaid) during her treatment time with the Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. I 1.11 Respondent pulled down his pants and underwear and go on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1427-04) Docket No. 03-01-A-1015MD PAGE 2 OF I3 he Said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 Ill-April 2001, Respondent evaluated Patient Two, age I for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section. During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, I there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c-section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001, Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, post partum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. Respondent was negligent in failing to respond to the Patient?s of internal THIRD AMENDED STATEMENT OF CHARGES (Corrected Version b27404) Docket No. 03-01-A-1015MD PAGE 3 OF 13 bleeding. Later, shock from blood loss developed. Hospital statiC initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.17 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was a .year?old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes ?om the March procedure noted a left ovarian cyst, but his notes ?om the May procedure puts the 0n the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. ReSpondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a Iyear?old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lys-is of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April 27, 2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1?27-04) Docket No- PAGE 4 OF 13 1.22 In July 2001 Patient Four returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications ?om her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, age .was the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age .was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.27 On February 3, 2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre?terrn labor and complaining of chest tightness. Respondent should have attended THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. 03-01-A-1015MD PAGE 5 OF 13 this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.28 Patient Seven, age I was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hystero scopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age I began medical care with Respondent in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo- Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient only seven months post-partum and only - years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age I sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 6 OF 13 did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for final delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age .began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age I ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven also ?and continued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds ReSpondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March, 2001, laparoscopy was not medically indicated so soon after the one ReSpondent had performed in November, 2000. 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent-did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27?04) Docket No. U3-01-A-1015MD PAGE 7 OF 13 1.39 In 1998 Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems, he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, he asked Patient Eleven to stay late The Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. The Respondent pushed his penis into her mouth and after some minutes ejaculated. The Respondent then told Patient Eleven to go into the operating room. The Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, the Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. The Respondent told Patient Eleven he had put into her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age .began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a loft oopherectomy performed in Respondent?s uncerti?ed of?ce operating room in July 2003. The Respondent did not have hospital privileges at the time, therefore the Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age. began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medical necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003 that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1?27-04) Docket No. PAGE 8 0F 13 status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 The Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. The Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age I began seeing Respondent in approximately June, 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncerti?ed of?ce operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age legan seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003 for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his uncerti?ed of?ce operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different operative reports for the March 30, 2003 surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed office operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate THIRD AMENDED STATEMENT OF CHARGES (Corrected 'Version [-27-04) Docket No. 03-01-A-1015MD - PAGE 9 OF 13 operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.50 Patient Sixteen, age. began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.51 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age .began seeing Respondent in December 1999 for treatment of ?brornyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe these drugs. In April 2000, the patient discussed weight control issues with Respondent. The Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. The Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and the Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. I 1.53 Patient Eighteen, age .began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during THIRD AMENDED STATEMENT OF CHARGES (Corrected Version l?27?04) Docket No. 03-01-A-1015MD PAGE 10 OF 13 exams that seemed to the patient to be longer than necessary. The Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed the Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings from the inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.44, and 1.48 constitute unprofessional conduct in violation of RCW 18130.1 80( 1) and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.3 through 1.9, 1.13, through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49 and 1.54 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be hanned. . THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 11 0F 13 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, 1.39, and 1.50 through 1.53 constitute unprofessional conduct in violation of RCW -. 1 80(4), and ?.180(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . and Abuse of a client or patient or sexual contact with a client or patient.? 2.5 The facts alleged in paragraph 1.33 constitute unprofessional conduct, in violation of RCW 18.130.180(1) and .180(4), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. . and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be banned. . and Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27?04) Docket No. PAGE 12 OF 13 Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. ?7 . 1 5/9? DATED this day of 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION Lisa Noonan Program Manager Kim O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-110001MD, 02- 12-0063MD, 03-01-0067MD, 03-05-0025MD, 03-10-0044MD, 03?09- 00le, 03-09-0067MD, 03-09-0080MD, 03-10-0106MD THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 13 OF 13 AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket No. 03-01-A-1015MD Program Case File N0(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 02-12-0018MD, 02-11-0019MD, 02.12- 0063MB, 03-01-0067MD, 03-03-00st1), 03-09-0066M o, 03-09-0044M n, 03-10-0044MD, 03-09-0045MD, 03-09-0067MD, D, 03-09-0096MD, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW One - Two - Three - Four Five Six - Seven Eight Nine Ten - Eleven Twelve?- Thirteen- Fourteen- Fifteen- Sixteen? Seventeen- Eighteen~ AMENDED CONFIDENTIAL SCHEDULE - PAGE 1 OF 1 Docket No. SUMMARY OF CHANGES and CORRECTIONS in the THIRD AMENDED STATEMENT OF CHARGES (Corrected Version) DATED 1-27-04 CHARLES M. MOMAH, MD Consolidated Case Nos. Caption: added Docket numbers of the two consolidated cases. Footer: each page is identi?ed as being of the ?corrected version?. Para. 1.30: the number .is replaced with Para. 2.2: should read, ?The facts alleged in paragraphs 1.2, 1.44, and 1.48 constitute unprofessional conduct in violation of RCW 18.130.180(1) and -. 180(13), which provide in part: ,3 Para. 2.3: should read, ?The facts alleged in paragraphs 1.3 through 1.9, 1.13 through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49 and 1.54 constitute unprofessional conduct in violation of RCW which provides in part: . . Para. 2.4: should read, ?The facts alleged in paragraphs 1.10 through 1.12, 1.35, 1.39, and 1.50 through 1.53 constitute unprofessional conduct in violation of RCW ?180(4), and which provide in part: .. FILED JAN 2 9 2004 Adiudicative Clerk Of?ce STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01-A-1015MD Document: Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON FILED DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION AUG 0 5 2304 Adludicar?we Clerk Ottlce In the Matter of the License to Practice As a Physician and Surgeon of: Docket Nos. CHARLES M. MOMAH, MD License NO. MD00030669, FOURTH AMENDED STATEMENT OF CHARGES Respondent. The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) No 00-1 1-0001 MD, 01 -10-0029MD, 02-12-0018MD, 02-1 1- 0019MD, 02-12-0063MD, 03-01-0067MD, 03- 10-0044MD, 03-09-0045MD, 03-09-0018MD, 03 -09-008 1 MD, 03-09-0067MD, 03 -09-0073MD, 03-09-0096MD, 03-09-0120MD, 03-10-0106MD. Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington on March 16, 1993. 1.2 In May 2001, Respondent ?lled out a re?credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state Of New York. 1 .3 On or about May 2001, Respondent saw Patient One, al?year-Old female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket NO. PAGE 1 OF 14 MOBIPINAMLW l_ Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.4 in July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.1 1 Respondent pulled down his pants and underwear and got on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-01-A-1015MD PAGE 2 OF 14 he said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 In April 2001, Respondent evaluated Patient Two, age I for treatment of irregular and pain?il menses. Patient Two delivered her feurth baby in February 2001 by cesarean section (c-section). During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c-section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001 Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide sufficient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001 Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immedi ate postoperative period. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 5M1) PAGE 3 OF 14 Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.17 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty?one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was a .year-old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a .year-old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed alaparoscopy,1ysis of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April .2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-09-A-1033MD PAGE .?oH-imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.22 In July 2001 Patient Four returned to the hOSpital for a laparoscopy and hysteroscopy. Pathological results failed to confirm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c?sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, age .was the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age I Afterward, She complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient ?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age lvas diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 5 OF 14 monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.27 On February I2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre-term labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.28 Patient Seven, age .was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age I began medical care with Respondent at age-in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo-Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass._ The laparoscopy was also not indicated in this patient, only seven months post-partum and only -years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-0] -A-lOl SMD PAGE 6 OF 14 physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age I sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by - calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age I began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotornies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age .?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven continued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March 2001 laparoscopy was not medically indicated so soon after the one Respondent had performed in November 2000. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-OI-A-IOISMD PAGE 7 OF 14 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. 1.39 In 1998, Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, Respondent asked Patient Eleven to stay late - Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. Respondent pushed his penis into her mouth and after some minutes ejaculated. Respondent then told Patient Eleven to go into the operating room. Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. Respondent told Patient Eleven he had written in her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age .began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a left oopherectomy performed in Respondent?s uncerti?ed of?ce operating room in July 2003. Respondent did not have hospital privileges at the time, therefore Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 3 OF 14 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age I began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medically necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003, that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or - continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age I began seeing Respondent in approximately June 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncertified office operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age I began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003, for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his uncerti?ed office operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different operative reports for the March 30, 2003, surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-09-A-1033MD PAGE 9 OF 14 does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fi?een that her insurance would not cover. The patient paid 1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant a?er the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with ReSpondent?s lack of hospital admitting privileges and his inadequate - operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.50 Patient Sixteen, age .began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.51 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age .began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-09-A-IO33MD PAGE 10 OF l4 Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 1.53 Patient Eighteen, age .began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He - asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 Patient Nineteen, age .visited Respondent November 15, 2002, to consider whether to establish pro-natal care during her pregnancy. Respondent told her that she needed to see him instead of a midwife. Respondent told her he had no hospital privileges to deliver a baby, but that he would by the time she delivered. After informing the patient he would not do an exam because his nurse was not in the of?ce, Respondent had Patient Nineteen disrobe and he performed a vaginal ultrasound, abdominal ultrasound, breast exam, and manual exam. The patient would have required a chaperone if she understood the extent of the exam the Respondent was going to do, but she understood a chaperone was not available. 1.55 Respondent told Patient Nineteen he could not con?rm her pregnancy. She was requested to have a pregnancy test at a local hospital. Respondent called the patient?s home and left a message on her answering machine with her test results, and requesting that she return to his of?ce. A family member picked up the message off the answering machine. Respondent?s action breached the patient?s con?dentiality. She had not yet informed her family that she was pregnant. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket N0. -OI-A-1015MD PAGE 1 1 OF '4 1.56 Patient Nineteen called Respondent?s office soon after the ?rst visit and informed them that she had decided not to obtain further care from Respondent. Six months later Respondent sent the patient a bill for the visit and exams. Patient Nineteen asked for a copy of her chart. Respondent?s of?ce staff informed her of his policy that charts would not be released until the bill was paid. After attempting to dispute the bill, the patient eventually paid it. Respondent ?3 staff continued to contact the patient to schedule appointments despite her request not to do so. 1.57 The Commission conducted a practice review of the Respondent?s offices, exam rooms, and practice procedures. Findings from the in?person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.44, 1.48, and 1.56 constitute unprofessional conduct in violation of RCW 18.130.180(1) and 180(13), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.3 through 1.9, 1.13, through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49, 1.54 and 1.57 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-01-A-1015MD PAGE 12 OF 14 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, and 1.50 through 1.53, and 1.57 constitute unprofessional conduct in Violation of RCW and - .180(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. . and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be and Abuse of a client or patient or sexual contact with a client or patient.? 2.5 The facts alleged in paragraph 1.33 constitute unprofessional conduct, in violation of RCW l8.130.180(1) and .180(4), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be and 2.6 The facts alleged in paragraph 1.55 constitute unprofessional conduct, in violation of RCW which provides in part: The willful betrayal of a practitioner-patient privilege as recognized by law.? FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 13 OF 14 Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 1 8.130.160. DATED this SW day of 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION ?aw-am- Lisa Noonan Program Manager Kim 'O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-1 01-10-0029MD, 02-12-0018MD, 02-11-0019MD, 02- 12-0063MD, 03-01-0067MD, 03-05-0025MD, 03-08-0025MD, 03-09-0066MD, 03-09-0044MD, 03-09-0073MD, 03-09-0120MD, 03-10- oo441vn), 03.09.0045MD, 03-09-0018NID, 03.094303: MD, osmooswm, oamoosomo, osmooasmn, 03-10-0106MD FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-O9-A-1033MD PAGE 14 OF 14 AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-01-A-1015MD, 03-09-A-1033MD Program Case File No(s). Program Nos. 00-11-0001MD, 02-12-0018M o, 02-11-0019MD, 02-12- 0063M 1), 03-08-0025MD, 93-01-0067M D, 03-09-0066MD, 03-09-0044MD, 03? 09-0073MD, 03-10-0044MD, 03-09-0045M n, 03-09-0081MD, 03-99-0067!? D, 03-09-0080MD, 03-09-0096MD, D, 0340. 0106MB This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient One: Patient Two: I Patient ThIee: Patient Four: Patient Five: Patient Six: Patient Seven: Patient Eight: Patient Nine: Patient Ten: Patient Eleven: Patient Twelve: Patient Thirteen: Patient Fourteen: Patient Fifteen: Patient Sixteen: Patient Seventeen: AMENDED CONFIDENTIAL SCHEDULE - PAGE i OF 2 Docket NosAMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-09-A-1033MD Program Case File No(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 02-12-0018MD, 02-11-0019MD, 02-12- 0063M D, 03-01-0067MD, 03-01-0067M D, 0339-0066!? D, 03- 09-00731? D, 03-10-0044M D, 03419?00131? I), 03-09-0067MD, 03-09-0080MD, 03-D9-0096M 1), 03?09?11 120M 0, 03-10- 0106MB This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient Eighteen: Patient Nineteen: AMENDED CONFIDENTIAL SCHEDULE PAGE 2 OF 2 Docket Nos. 03-01-A-1015MD, 03-09-A1033MD .. . I .. w. . .4 nan?~- a . vomm. .-. . ?mm?"n - . -- STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice Docket No. as a Physician and Surgeon of: Docket No. 03-09-A-1033MD CHARLES M. MOMAH, M.D., PREHEARING ORDER NO. 8: License No. STAY OF PROCEEDINGS . Respondent. INTRODUCTION On November 24, 2004. John Versnel, lli, Attorney at Law on behalf Of- Charles Momah, MD. (the Respondent) ?led a motion for a stay of the proceedings. Kim O'Neal, Assistant Attorney General representing the Department of Health (the Department) ?led a motion for a four day extension of time to file a response. An extension was granted, and the Department filed its response on December 9, 2004. The Department does not Oppose the motion for a stay, as long as the criminal trial is not continued. During a December 17, 2004 status conference Respondent?s counsel stated that the criminal trial is set to commence on May 9, 2005 rather than in April 2005. Department's counsel stated that it still supports a stay as long as the criminal trial is not continued. PROCEDURAL BACKGROUD The original Statement of Charges (SOC), Docket No. 03-01-A-1015MD, encompassing five patients was ?led in June 2003. In September 2003 a second SOC (03-090A-1033MD) regarding the alleged rape of one patient was ?led with an ex parte motion for summary suspension. The MedicalQuality Assurance Commission (the Commission) summarily suspended the Respondent's license on September 10, 2003. In November 2003 these cases were consolidated. On January 12, 2004 the Amended SOC was filed under these docket numbers adding charges related to 11 additional patients. On January 16, 2004 the Second Amended 800 was filed adding charges related to one additional patient. In August 2004 the Fourth Amended SOC was filed adding one more patient to the charges, totaling 19 patients. Five of theSe 19 patients encompass charges related to alleged unprofessional conduct under RCW 18.130.180(24) (patient abuse or'sexual contact with a patient). Seventeen Of the 19 patients encompass charges related to quality of care and other allegations of unprofessional conduct unrelated to the pending criminal charges. PREHEARING ORDER NO. 8.: STAY OF PROCEEDINGS . Page ?l of 4 Docket NOS. 03-O1-A-1015MD O3-09-A-1033MD On June 1, 2004 the Presiding Of?cer issued a protective order that prohibited the'disclosure of any information related to alleged sexual misconduct in the case at hand or any health care information obtained through discovery and/or contained in exhibits offered for admission at hearing. The protectiVe order prohibits the disclosure of this information to the public or to any individual who is not party to this action other than experts aiding the parties in preparation of their case in the above entitled matter (Prehearing Order No. 5). In September 2004, criminal charges were ?led against the ReSpondent in King County Superior Court. Only five of the patients encOmpassed in this disciplinary matter . are alleged victims in the pending criminal case. The criminal case is set to commence on May 9, 2005. The criminal trial may be several weeks in length. The disciplinary hearing in the case at hand is set for the weeks of January 10, 2005 and February 21, - 2005. The Respondent has requested that the disciplinary matter be stayed until the criminal trial is completed. The Department agrees with the need for a limited stay that should not be extended if the criminal trial is continued. ISSUE Therefore the issue is twofold. Should the entire case be stayed? If so, should the presiding of?cer stay the entire case or bifurcate the case; only staying the allegations related to the patients encompassed in both this matter and the pending criminal case? DISCUSSION The existence of pending charges or criminal investigation does not bar proceeding with civil litigation arising out of the same factual allegations. King v. Olympic Pipe Line 00., 104 Wn. App. 338 (2002), review denied, 143 Wn.2d 290 (2001 The Fifth Amendment is one of seven factors balanced by the court in determining whether a stay or protective order is warranted when parallel criminal investigation/charges exits. Id. In civil cases, negative inferences may be drawn when a witness invokes the privilege against self-incrimination. ikeda v. Curtis, 43 Wn.2d 449 (1953) I The King factors apply to the case at hand as'follows: 1. Degree of overlap. The extent to which a party?s Fifth Amendment rights are implicated is a key factor. Only ?ve of nineteen patients of this disciplinary action are encompassed in the criminal charges. . 2. Trial schedule. The criminal trial is set to commence May9, 2005 and this disciplinary case is set for hearing the weeks of January 10 and February 21, 2005. There is not a direct overlap, but there is an overlap between the preparation for the criminal case and the hearing in the case at hand. PREHEARING ORDER NO. 8: STAY OF PROCEEDINGS Page 2 of 4 Docket NOS. 81 3. Respondent's interest. The Respondent is concerned that he may not defend himself without providing incriminating information that may be used against him in a potential criminal-proceeding. If he chooses to invoke his Fifth Amendment privilege, negative inferences may be drawn. He is also concerned with defending himself on two fronts at the same time resulting in possible poor defense in'the case at hand and the criminal case. - 4. Department's interest. The Department also requested a stay because the results of the criminal trial may prompt a full or partial settlement of this disciplinary matte-r. This would conserve judicial resources. The Department is interested in proceeding expeditiously, but at this time is not concerned that a limited stay would result in prejudice caused by failed memories and/or lost witnesses. At the same time Department considers a stay the prudent course considering the nearness of the criminal trial date and the probability of a partial or full settlement resulting from a possible criminal conviction. 5. Third party interest. The alleged victims of sexual misconduct would probably want to avoid the stress and embarrassment of testifying more than one time. 6. - Public Interest. The Respondent?s license was summarily suspended in 2003, and Program has no evidence that he is practicing without a license. Therefore, the public is safe from that potential harm. On the other hand, this proceeding should be conducted in a timely manner before memories fail and/or witness lost, and to provide the public with closure and confidence in the system. The Department is not concerned with the loss of public con?dence because criminal trial is set so close to the present hearing dates. Only a limited stay is necessary. 7. Judicial economy and Convenience is a signi?cant factor considering the potential resolution of the sexual misconduct allegation in the case at hand by the criminal proceeding. In addition, the Department states that a criminal conviction may also result in a full settlement of this disciplinary case. - In light of these factors, a'limited stay is appropriate. Bifurcating the case and ordering that the hearing proceed as scheduied on the non sexual misconduct allegations may result in the waste of valuable Commission time and resources. As the Department argues, the criminal trial verdict may result in a settlement of the case at hand. The public is adequately protected by the summary suspension of Respondent?s license. Public confidence in the system should not erode when the case is stayed so the criminal trial may proceed. As the Respondent argues, this case has attracted public press and attention; therefore the public will probably be informed of the progress of the criminal trial through the media. The public should. understand that the wheels of justice are moving forward in a logical, judicial and timely manner; that one case is proceeding first before the other to. protect all interests involved including public interests. PREHEARING ORDER NO. 8: STAY OF PROCEEDINGS Page 3 of 4 Docket Nos. 5MD 03-09-A-1033MD ORDER The above entitled case is STAYED until May 31, 2005 or upon the completion of the criminal trial, whichever first occurs. - If the criminal trial is continued this stay will not be extended. status conferencesshall be held to monitor the pending criminal case. The ?rst telephone status conference shall be held on January 12, 2005 at 9:00 am. At least two working days before each status conference, the Respondent - shall ?le and serve a status report regarding the criminal trial date and any motions and/or matters that may change the date of the criminal trial. - The prehearing conference and hearing will soon be rescheduled consistent with- this stay and the Commission?s schedule. The motion and discovery deadlines passed in November 2004 (Prehearing Order No. 7), therefore no new deadlines will be set. Dated this EL day of December, 2004. I 5H 1..) ame- er MIE c.0039, Health Law Judge Presiding Officer DECLARATION OF SERVICE BY MAIL declare that today I served a copy of this document upon the following parties of record: JOHN VERSNEL. Ill. ATTORNEY AT AND KIM M6 by mailing a copy properly addressed with postage prepaid. DATED AT OLYMPIA. WASHINGTON OF DECEMBER. 2004. dJUdiC we Service Unit . cc: LISANOONAN FOR INTERNAL USE ONLY: (Internal tracking numbers} Program Nos. 00-11-0001, 01-10-0029, 02-12-0018, 02-11-0019, 02-12-0063, 03-01?0067, 03?05-0025, 03-08-0025, 03-09-0066, 03-09-0044, 03-09-0073, 03-09-0120, 03-10-0044, 03-09-0045, 03-09?0018, 0309?0067, 03-09-0080, 03-09-0096 03?10-0106 PREHEARING ORDER NO. 8: STAY OF PROCEEDINGS Page 4 of 4 Docket Nos. 03-01-A-1015MD 8: 03-09-A-1033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01-A-1015MD Document: Second Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Adjudicative Clerk Office PO. Box 47879 Olympia, WA 98504-7879 Phone: (360) 236-4677 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. FILED STATE OF WASHINGTON JAN 1 6 2004 DEPARTMENT OF HEALTH Adjudicative Clerk 0 . MEDICAL QUALITY ASSURANCE COMMISSION ?me In the Matter of the License to Practice As a Physician and Surgeon of: Docket No. CHARLES M. MOMAH, MD SECOND AMENDED License No. STATEMENT OF CHARGES Respondent. The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) NO 00-1 1-0001MD, 01-10-0029MD, 02-12-0018MD, 02-1 1- 0019MD, 02-12-0063MD, 03-08-0025MD, 03-01-0067MD, 03-09-0044MD, 03'- 10-0044MD, 03-09-0045MD, 03-09-0018MD, 03-09-0080MD, 03-09-0096MD, 03-10-0106MD. Patients referred to in this Statement of Charges are identi?ed in an. attached Con?dential Schedule.- Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. 1.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status Of the actions against him in the state of New York. 1.3 On or about May 2001, Respondent saw Patient One, a 21 ?year?old female, and in July 2001 performed a diagnostic laparoscOpy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined She had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. SECOND AMENDED STATEMENT OF CHARGES PAGE 1 OF 13 Docket NO. 03-01-A-1015MD l' 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.11 Respondent pulled down his pants and underwear and go on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, he said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. SECOND AMENDED STATEMENT OF CHARGES - PAGE 2 OF 13 Docket No. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 In April 2001, Respondent evaluated Patient Two, age 36, for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section. During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c?section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001, scheduled a laparo scopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records ?om her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum ,endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life?saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. SECOND AMENDED STATEMENT OF CHARGES PAGE 3 OF 13 Docket No. 03-01-A-1015MD 1.17 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was a 46-year-old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-iateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a 23-year?old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April 27, 2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.22 In July 2001 Patient Four returned to the hospital for a laparoscopy and hysteroseopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, SECOND AMENDED STATEMENT OF CHARGES - PAGE 4 OF 13 DocketNo. organic disease, complications ?om her two e-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, age 23 was the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was arnenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age 22, was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoarnniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level HI nursery. 1.27 On February 3, 2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre?term labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. SECOND AMENDED STATEMENT OF CHARGES - PAGE 5 0F 13 Docket No. 1.28 Patient Seven, age 24, was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent. initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age 19, began medical care with Respondent in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo- Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient only seven months post-partum and only sixteen years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age 30, sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. SECOND ANIENDED STATEMENT OF CHARGES PAGE 6 OF 13 Docket No. 03-01-A-1015MD 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age 40, began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age 46, ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven also began working in the Respondent?s of?ce and continued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March, 2001, laparoscopy was not medically indicated so soon after the one Respondent had performed in November, 2000. 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. 1.39 In 1998 Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems, he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, he asked Patient Eleven to stay late at work telling her SECOND AMENDED STATEMENT OF CHARGES - PAGE 7 OF 13 Docket No. there was un?nished work to do. The Respondent then sent the other employees home. The Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. The Respondent pushed his penis into her mouth and after some minutes ejaculated. The Respondent then told Patient Eleven to go into the operating room. The Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, the Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. The Respondent told Patient Eleven he had put into her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age 32, began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a left oopherectomy performed in Respondent?s uncerti?ed o?ice operating room in July 2003. The Respondent did not have hospital privileges at the time, therefore the Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent? 3 operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age 39, began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medical necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003 that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. SECOND AMENDED STATEMENT OF CHARGES PAGE 8 OF 13 Docket No. 03-01-A-1015MD 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 The Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. The Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age 29, began seeing Respondent in approximately June, 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncerti?ed of?ce operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age 28, began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 3 0, 2003 for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his uncerti?ed of?ce operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different operative reports for the March 30, 2003 surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. SECOND AMENDED STATEMENT OF CHARGES PAGE 9 0F 13 Docket No. 1.50 Patient Sixteen, age 26, began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.51 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age 36, began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her ?brornyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. The Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. The Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and the Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair With him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 1.53 Patient Eighteen, age 35, began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. The Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to SECOND AMENDED STATEMENT OF CHARGES PAGE 10 OF Docket No. 03-01-A- 101 SMD sexually stimulate the patient on several visits. Patient Eighteen believed the Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings from the in-person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18130180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2 through 1.11, 1.44, 1.45, and 1.48 constitute unprofessional, conduct in violation of RCW 18. 130. 180(1), and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person?s profession. and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.4 through 1.10, 1.13, through 1.32, 1.34, 1.36 through 143,146, 1.47, 1.49 and 1.54 constitute unprofessional conduct, in violation of RCW which provides in part: incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be 2.4 The facts alleged in paragraph 1.12 constitute unprofessional conduct in violation of RCW which provides: SECOND AMENDED STATEMENT OF CHARGES - PAGE 11 OF 13 Docket No. 03-01-A-1015MD Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative, or by the use of threats or harassment against any patient or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal action. The facts alleged in paragraphs 1.10, 1.11, 1.33 and 1.35, and 1.50 through 1.53 Constitute unprofessional conduct, in violation of RCW and ?.180(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person?s profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be banned. . and Abuse of a client or patient or sexual contact with a client or patient.? Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving f/ SECOND AMENDED STATEMENT OF CHARGES - PAGE 12 OF 13 Docket No. Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. DATED this {(5th day of? a? 2 1 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION 0249; 14mm? 151% Noonan Program Manager Kim O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 01-10-0029MD, 02-12-0018MD, 02-11-0019MD, 02- 12-0063MD, 03-01-0067 MD, 03-05-0025MD, 03-08-0025MD, 03-10-0044MD, 03-09-0045MD, 03-09- 0018MD, 03-09-0081 MD, 03-09-0067MD, 03-09-0096MI), 03-10-0106MD SECOND AMENDED STATEMENT OF CHARGES PAGE 13 OF 13 Docket No. OS-UI-A-IOISMD AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket No. 03-01-A-1015MD Program Case File No(s). Program Nos. 00-11-0001MD, 0140-0029011), 02-11-0019MD, 02-12- 0063MB, 03-01-0067MD, 03-08-0025MD, 03-09-0066MD, 03-09-0044MD, 03-10-0044MD, 03-09-0045MD, 03-09-0081MD, 03-09-006mn, 03-09-0080MD, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW 42.17 .310(1)(d) One - Two - Three Four Five Six Seven - Eight Nine I Ten - Eleven - Twelve- Thirteen- Fourteen? Fifteen- Sixteen- Seventeen- Eighteen- AMENDED CONFIDENTIAL SCHEDULE - PAGE 1 0F 1 Docket No. 03-01-A-1015MD ORIGINAL STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 033M Document: Modification Order Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: NONE If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice Docket No. as a Physician and Surgeon of: Docket No. O33MD CHARLES M. MOMAH, M.D.. PREHEARING ORDER NO. 14: License No. MD00030669, ORDER EXTENDING THE STAY AND SETTING STATUS CONFERENCE Respondent. A status conference was held on September 12, 2005 regarding the status of the criminal trail. Prehearing Order No. 11 stayed the above entitled proceedings until October 31, 2005 or upon the completion of the criminal trial, whichever occurs ?rst. The criminal trial is scheduled to commence on October 10, 2005. The parties estimate that the criminal trial Will be at least a month long. Pursuant to the analysis in Prehearing Order No. 11, the stay is extended to the completion of the criminal trial or until December 1, 2005 whichever first occurs. A status conference shall be held on December 12, 2005 at 10:00 am. The Respondent shall file and serve a status report no later than November 29, 2005 regarding the criminal trial date and any motionsimatters that may change the date of the criminal trial. - - Dated this Eygday of September, 2005. ZIMrlliE CANER, Health Law Judge Presiding Officer PREHEARING ORDER NO. 14: ORDER EXTENDING THE STAY AND SETTING STATUS CONFERENCE Page 1 of 2 Docket Nos. DECLARATION OF SERVICE BY MAIL I declare that today I served a copy of this documenI upon the following parties of record: JOHN VERSNEL. ATTORNEY AT LAW AND KIM M6 by maiIing a copy properly addressed with postage prepaid. OF SEPTEMBER. 2005. DATED AT OLYMPIA. WASHINGTON THIS Farm Lu arm-L, Adjudicative Service Unit' oc: LISA NOONAN - MICHAEL WEISMAN FOR INTERNAL USE ONLY: (Internal tracking numbers) - Program Nos. 00-11-0001, 01-10-0029, 02-12-0018, 02-11-0019, 02?12-0063, 03-01?0067, 03?03?002 03-09-0066, 03-09-0044, 03-09-0120, 03-10-0044; 03-09-0045, 03-09-0018, 03-09-0067, 03?09-0080, 03-09-0081. 03-09-0096, 03-10-0106 PREHEARING ORDER NO. 14: ORDER EXTENDING THE STAY AND SETTING STATUS CONFERENCE Page 2 of 2 Docket Nos. 03-01-A-1015MD 8: 03-09-A-1033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 033M Document: Pre-hearing Order No. 11: Stay of Proceedings Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: NONE If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice Docket No. O3-01-A-1015MD as a Physician and Surgeon of: Docket No. 03-09-A-1033MD CHARLES M. MOMAH, M.D., PREHEARING ORDER NO. 11: License No. MD00030699, STAY OF PROCEEDINGS Respondent. INTRODUCTION On May 3, 2004, John Versnel, Ill, Attorney at Law on behalf of Charles Momah, MD. (the Respondent) filed a motion for a stay of the proceedings. Kim O?Neal, Assistant Attorney General representing the Department of Health (the Department) filed a response on May 16, 2005. The Respondent filed a supplemental brief on May 19, 2005 and declaration on May 21, 2005. The Department does not oppose the motion for a stay, as long as the criminal proceedings are not extended for a period beyond the October 3, 2005 trial date. Stay granted. PROCEDURAL BACKGROUND The original Statement of Charges (SOC) (03-01-A-1015MD) regarding five patients was filed in June 2003. In September 2003 a second SOC (03-090A-1033MD) regarding the alleged rape of one patient was filed with an Ex Parte Motion for Summary Suspension. The Medical Quality Assurance Commission (the Commission) summarily suspended the Respondent's license on September 10, 2003. In November 2003 these cases were consolidated. From January 2004 through August 2004 the SOC was amended several times adding charges related to 14 additional patients. Five of the 19 patients encompassed in the SOC relate to alleged unprofessional conduct under RCW 18.130.180(24) (patient abuse or sexual contact with a patient). Seventeen of the 19 patients encompass charges related to quality of care and other allegations of unprofessional conduct unrelated to the pending criminal charges. In September 2004, criminal charges were filed against the Respondent in King County Superior Court. Five of the patients encompassed in this disciplinary matter are alleged victims in the pending criminal case. The criminal trial was set to commence on May 9, 2005, and on March 10, 2005 the trial date was continued to October 3, 2005 for discovery reasons. The criminal trial may be several weeks in length. The disciplinary hearing in the case at hand is set for the latter two weeks in July 2005. The PREHEARING ORDER NO. 11: STAY OF PROCEEDINGS Page 1 of 4 Docket Nos. 8: 03-09-A-1033MD Respondent has requested that the disciplinary matter be stayed until the criminal trial is completed. In December 2004, the Presiding Officer stayed this proceeding until May 31, 2005, and held that the stay would not be extended if the trail date is continued because the Department was concerned with the risk of failed memories or lost witnesses. At this time, the Department agrees with the need for a limited stay, and that such a stay will not prejudice the Department. ISSUE Should the entire case or the non?criminal portion of the case be stayed pending the outcome of the criminal proceeding? DISCUSSION The existence of pending charges or criminal investigation does not bar proceeding with civil litigation arising out of the same factual allegations. King v. Olympic Pipe Line 00., 104 Wn. App. 338 (2002). review denied, 143 Wn.2d 290 (2001 The Fifth Amendment is one of seven factors balanced by the court in determining whether a stay or protective order is warranted when parallel criminal investigation/charges exits. Id. In civil cases, negative inferences may be drawn when a witness invokes the privilege against self-incrimination. lkeda v. Curtis, 43 Wn.2d 449 (1953). The King factors apply to the case at hand as follows: 1. Degree of overlap. The extent to which a party?s Fifth Amendment rights are implicated is a key factor. Five of nineteen patients of this disciplinary action are encompassed in the criminal charges. 2. Trial schedule. On March 10, 2005, the criminal trial was continued to October 3, 2005 and this disciplinary case is set for a two week hearing starting July 18, 2005. There is not a direct overlap, but there is significant overlap between the preparation for the criminal case and the hearing in the case at hand. 3. Respondent?s interest. The Respondent is concerned that he may not defend himself without providing incriminating information that may be used against him in a potential criminal proceeding. If he chooses to invoke his Fifth Amendment privilege, negative inferences may be drawn. He is also concerned with defending himself on two fronts at the same time possibly compromising the defense in this case and in the criminal case. 4. Departments interest. The Department does not object to a stay. The Department considers a stay the prudent course considering the nearness of the new criminal trial date and the probability of a partial or full settlement resulting from a possible criminal conviction. This would conserve judicial resources. The Department PREHEARING ORDER NO. 11: STAY OF PROCEEDINGS Page 2 of 4 Docket NOS. 03-01-A-1015MD 03-09-A-1033MD is interested in proceeding expeditiously, but at this time is not concerned that a second limited stay would result in prejudice caused by failed memories and/or lost witnesses. 5. Third party interest. The alleged victims of sexual misconduct would probably want to avoid the stress and embarrassment of testifying more than one time. 6. Public interest. The Respondent's license was summarily suspended in 2003, and the Department has no evidence that he is practicing without a license. Therefore, the public is safe from that potential harm. The SOC was amended several times; the last amendment filed in August 2004. The Department is not concerned that a second stay will result in failed memories and/or lost witnesses, or erode public con?dence in the system. The Department is not concerned with the loss of public confidence because criminal trial is set in the near future. 7. Judicial economy is a significant factor considering the potential resolution of the sexual misconduct allegation in the case at hand by the criminal proceeding. in addition, the Department states that a criminal conviction may also result in a full settlement of this disciplinary case. In light of these factors, a limited stay is appropriate. Bifurcating the case and ordering that the hearing proceed as scheduled on the non sexual misconduct allegations may result in the waste of valuable Commission time and resources. A criminal trial verdict may result in a settlement of the case at hand. The public is adequately protected by the summary suspension of Respondent's license. Public confidence in the system should not erode when the case is stayed so the criminal trial may proceed. This case has attracted public press and attention; therefore the public will probably be informed of the progress of the criminal trial through the media. The public should understand that the wheels of justice are moving forward in a logical, judicial and timely manner; that one case is proceeding first before the other to protect all interests involved including public interests. ORDER The above entitled case is STAYED until October 31, 2005 or upon the- completion of the criminal trial, whichever occurs ?rst. The prehearing and hearing dates are stricken. The motion and discovery deadlines passed (Prehearing Order No. 7), therefore no new deadlines will be set. PREHEARING ORDER NO. 1 1: STAY OF PROCEEDINGS Page 3 of 4 Docket Nos. Regular status conferences shall be held to monitor the pending criminal case. On July 6, 2005 at 10:00 a.m. a telephone status conference shall be held. At least two working days before each status conference, the Respondent shall ?le and serve a status report regarding the criminal trial date and any motions and/or matters that may change the date of the criminal trial. Dated thi?fday of May, 2005. ?Za/ ZIMMIE CANER, Health Law Judge Presiding Of?cer DECLARATION OF SERVICE BY MAIL I declare that today I served a copy of this document upon the following parties of record: JOHN VERSNEL Ill. ATTORNEY AT LAW AND KIM M6 by mailing a copy properly addressed with postage prepaid. DATED AT OLYMPIA. WASHINGTON THIS OF MAY, 2005. bat-mt Quota. Adjudicative Service Unit cc: LISA NOONAN FOR INTERNAL USE ONLY: (Internat tracking numbers) Program Nos. 00-11-0001, 01-10-0029, 02-12-0018, 02-11-0019, 02?12-0063, 03-01-0067, 03-05-0025, 03-09-0066, 03-09-0044, 03-09-0073, 03-09-0120, 03-10-0044, 03-09-0045, 03-09-0018, 03-09-0067, 03?09~0080, 03-09-0096 03-10-0106 PREHEARING ORDER NO. 11: STAY OF PROCEEDINGS . Page 4 of 4 Docket NOS. 03-01-A-1015MD 03-09-A-1033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 033M Document: Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH FD MEDICAL QUALITY ASSURANCE COMMISSION ass I 2004 In the Matter Of the License to Practice Adjudicaiive (Jig-K W. As a Physician and Surgeon of: Docket NOS. 03-01-A-1015MD ice CHARLES M. MOMAH, MD License NO. MD00030669, FOURTH AMENDED STATEMENT OF CHARGES Respondent (Revised as of 08?12?04) The Program Manager of the Medical Quality Assurance Commission (?Cormnission?), on I designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(S) NO 00-11-0001MD, 01-10-0029MD, 02-12-001 SMD, 02-11? 0019MD, 03-01-0067MD, 03-09-0066MD, O3- 10-0044MD, 03-09-0018MD, 03-09-0081MD, 03-09-0096MD, Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington on March 16, 1993. 1.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state Of New York. 1.3 On or about May 2001, Respondent saw Patient One, a -female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the FOURTH AMENDED STATEMENT OF CHARGES (Revised as of08?12w04) Charles M. Momah, MD Docket No. 0 I I PAGE 1 OF 14 Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that ReSpondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 1 1. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.1 1 Respondent pulled down his pants and underwear and got on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 2 OF 14 he said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 In April 2001, Respondent evaluated Patient Two, age .for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section (c?section). During the pregnancy, cervical cerclage was performed to prevent prematurity. A?er delivery, there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c-section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001, Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenornyo sis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charles M. Mornah, MD Docket No. PAGE 3 OF 14 Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.17 Pathology results failed to confirm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was a .year?old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to resolve the in?ammatory process ?orn the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had po st?operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a lyear-old woman who had a c-section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April .2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon alter her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-1 2-04) Charles M. Momah, MD Docket No. SMD 03-09-A-IO33MD PAGE 4 OF 14 imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.22 In July 2001 Patient Four returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent ?illy informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, agelwas the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persi stent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. A?er the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometiiosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age .vas diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08?12-04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 5 OF 14 monochon'onic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.27 On February .2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre-term labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.28 Patient Seven, age .was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recormnended both a laparoscopy and a hysterOSCOpy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. ReSpondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age I began medical care with Respondent at age .in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo-Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient, only seven months post-partum and only -years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 6 OF 14 physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age I sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age .began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age I ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven also ?Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March 2001 laparoscopy was not medically indicated so soon after the one Respondent had performed in November 2000. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charles M. Momah, MD Docket No. 03-01-A-1015MD PAGE 7 OF 14 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. ApprOpriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. 1.39 In 1998, Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, Respondent asked Patient Eleven to stay late - Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. Respondent pushed his penis into her mouth and after some minutes ejaculated. Respondent then told Patient Eleven to go into the operating room. Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. Respondent told Patient Eleven he had written in her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age .began seeing Respondent in 1996 for routine gynaecological care. Respondent performed medically unnecessary laparascopi es, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a left oopherectomy performed in Respondent?s uncerti? ed of?ce operating room in July 2003. Respondent did not have hospital privileges at the time, therefore Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-01-A-1015MD PAGE 8 OF 14 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age .began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medically necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003, that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hOSpita] privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age .began seeing Respondent in approximately June 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncerti?ed office operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age I began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003, for tubal reversal. Respondent did not have hOSpital privileges, and he performed this open procedure at his uncerti?ed of?ce operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different Operative reports for the March 30, 2003, surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-09-A-1033MD PAGE 9 OF 14 does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparo scopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not benefit the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.50 Patient Sixteen, age .began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.5] During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age I began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her fibrornyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08?12?04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 10 OF 14 Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 1.53 Patient Eighteen, age I began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 Patient Nineteen, age I visited Respondent November 15, 2002, to consider whether to establish pro-natal care during her pregnancy. Respondent told her that she needed to see him instead of a midwife. Respondent told her he had no hospital privileges to deliver a baby, but that he would by the time she delivered. After informing the patient he would not do an exam because his nurse was not in the of?ce, Respondent had Patient Nineteen disrobe and he performed a vaginal ultrasound, abdominal ultrasound, breast exam, and manual exam. The patient would have required a chaperone if she understood the extent of the exam the Respondent was going to do, but she understood a chaperone was not available. 1.55 Respondent told Patient Nineteen he could not confirm her pregnancy. She was requested to have a pregnancy test at a local hospital. Respondent called the patient?s home and left a message on her answering machine with her test results, and requesting that she return to his of?ce. A family member picked up the message off the answering machine. Respondent?s action breached the patient?s con?dentiality. She had not yet informed her family that she was pregnant. FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12?04) Charles M. Momah, MD Docket No. PAGE 1 1 OF I4 1.56 Patient Nineteen called Respondent?s of?ce soon after the ?rst visit and informed them that she had decided not to obtain ?irther care from Respondent. Six months later Respondent sent the patient a bill for the visit and exams. Patient Nineteen asked for a copy of her chart. Respondent?s of?ce staff informed her of his policy that charts would not be released until the bill was paid. After attempting to dispute the bill, the patient eventually paid it. Respondent?s staff continued to contact the patient to schedule appointments despite her request not to do so. 1.57 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings ?om the in-person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.44, 1.48, and 1.56 constitute unprofessional conduct in violation of RCW 18.130.180(1) and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of - the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.3 through 1.9, 1.13, through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49, 1.54 and 1.57 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be FOURTH AMENDED STATEMENT OF CHARGES (Revised as of08-12-04) Charles M. Momah, MD Docket No. PAGE 12 OF 14 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, 1.39 and 1.50 through 1.53 constitute unprofessional conduct in violation of RCW and -.180(24) which provides in part: 1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . and Abuse of a client or patient or sexual contact with a client or patient.? 2.5 The facts alleged in paragraph 1.33 constitute unprofessional conduct, in violation of RCW 18.130.180(1) and .180(4), which provides in part; The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be and 2.6 The facts alleged in paragraph 1.55 constitute unprofessional conduct, in violation of RCW which provides in part: The willful betrayal of a practitioner-patient privilege as recognized by law.? ll FOURTH AMENDED STATEMENT OF CHARGES (Revised as of 08-12-04) Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 13 OF 14 Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. DATED this 5 to day of A mi as} 2004. STATE or WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION I 'er 2; 377147-me- Lisa Noonan Program Manager L/i if} 8) . Kim O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-11-0001MD, 01-10-0029MD, 02-12-0018MD, 02-11-0019MD, 02- 03-01-0067MD, 03-09-0066MD, 03-09-0044MD, 03-09-0120MD, 03-10-0044MD, 03-09-0045MD, 03-09- 0018MB, 03-09-0067MD, 03 -09-0096MD, 03-10-0106MD FOURTH AMENDED STATEMENT OF CHARGES (Revised as of08?12-04) Charles M. Momah, MD Docket No. SMD 03-09-A-1033MD PAGE 14 OF 14 AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-09-A-1033MD Program Case File No(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 02-11-0019MD, 02-12- 0063MD, 03-01-0067MD, 03-08-0025MD, 03-09-0066MD, 03-09-0044MD, 03-09-0045MD, 03-09- 00 ISMD, 03-09-0081MD, 03-09-0067MD, 03-09-0096MD, 03-09-0120MD, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient One: Patient Two: Patient Three: Patient Four: Patient Five: Patient Six: Patient Seven: Patient Eight: Patient Nine: Patient Ten: Patient Eleven: Patient Twelve: Patient Thirteen: Patient Fourteen: Patient Fifteen: Patient Sixteen: Patient Seventeen: AMENDED CONFIDENTIAL SCHEDULE PAGE 1 OF 2 I GINA AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. Program Case File No(s). Program Nos. 0041?0001341), 01-10-0029MD, 02-12-0018MD, 02-12- 0063M D, 03-01-0067MD, 03-08-0025MD, 03-09-0044MD, 03-10-0044MD, 03-09-0045M D, 03-09- 0018M D, 03-09-0081MD, 03-09-0080MD, 03-09-0096MD, 03-09-0120M n, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient Eighteen: Patient Nineteen: AMENDED CONFIDENTIAL SCHEDULE - PAGE 2 OF 2 Docket Nos. 03-09-A1033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 033M Document: Corrected Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON 3:1 LED DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION JAN 2 9 2004 Adgudica?tive Clerk Office (Corrected version as of 1-27-04) In the Matter of the License to Practice As a Physician and Surgeon of: Docket Nos. 03-09-A-1033MD CHARLES M. MOMAH, MD License NO. MD00030669, THIRD AMENDED STATEMENT OF CHARGES 1 The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) NO 01-10-0029MD, 02-12-0018MD, 02-11- 0019MD, 03-01-0067MD, 03-09-0066MD, 03-09-0044MD, 03- 10-0044MD, 03-09-0045MD, 03-09-0081MD, 03-09-0096MD, 03-10-0106MD. Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. This is a corrected version of the Third Amended Statement Of Charges served on January 21, 2004. This version corrects errors caused by a defective software program. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. 1.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state of New York. 1.3 On or about May 2001, Respondent saw Patient One, a 'year-old female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27~04) Docket NO. U3-01-A-1015MD PAGE 10F 13 episodic health insurance coverage (mostly Medicaid) during her treatment time with the Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. I 1.11 Respondent pulled down his pants and underwear and go on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1427-04) Docket No. 03-01-A-1015MD PAGE 2 OF 13 he Said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his office, and left the room. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his office. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 Ill-April 2001 Respondent evaluated Patient Two, age I for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section. During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, I there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c?section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001, Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenornyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, post partum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide sufficient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. Respondent was negligent in failing to respond to the Patient?s of internal THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 147-04) Docket No. 03-01-A-1015MD PAGE 3 OF 13 bleeding. Later, shock from blood loss developed. Hospital staf?f initiated life?saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.17 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102R 1.18 Patient Three was a lyear-old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes ?om the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. ReSpondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a lyear?old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lys-is of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April .2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have difficulty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Arnpicillin; Penicillin allergy was listed in the chart. THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 4 OF 13 1.22 In July 2001 Patient Four returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, age .was the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concentng the bleeding other than she was amenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age .was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.27 On February. 2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre?terrn labor and complaining of chest tightness. Respondent should have attended THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1?27?04) Docket No. 03-01-A-1015MD PAGE 5 OF 13 this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.28 Patient Seven, age .was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age I began medical care with Respondent in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depov Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient only seven months post-partum and only- years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age I sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 6 OF 13 did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age I began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age I ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven also and continued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds ReSpondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March, 2001, laparoscopy was not medically indicated so soon after the one ReSpondent had performed in November, 2000. 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent-did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 7 OF 13 1.39 In 1998 Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems, he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, he asked Patient Eleven to stay late Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. The Respondent pushed his penis into her mouth and after some minutes ejaculated. The Respondent then told Patient Eleven to go into the operating room. The Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, the Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. The Respondent told Patient Eleven he had put into her patient chait that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age .began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a left oopherectomy performed in Respondent?s uncerti?ed of?ce operating room in July 2003. The Respondent did not have hospital privileges at the time, therefore the Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age I began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medical necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003 that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1?27-04) Docket No. 03-0i-A-10l SMD PAGE 8 0F 13 status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 The Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. The Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age I began seeing Respondent in approximately June, 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncertified of?ce operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age .began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003 for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his uncerti?ed office operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different operative reports for the March 30, 2003 surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his unceiti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate THIRD AMENDED STATEMENT OF CHARGES (Corrected 'Version [-27-04) Docket No. 03-01-A-1015MD - PAGE 9 OF 13 operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.50 Patient Sixteen, age-began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.51 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age .began seeing Respondent in December 1999 for treatment of ?brornyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. The Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. The Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and the Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. I 1.53 Patient Eighteen, age I began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few Visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during THIRD AMENDED STATEMENT OF CHARGES (Corrected Version l?27-04) Docket No. O3-01-A-1015MD PAGE 10 OF 13 exams that seemed to the patient to be longer than necessary. The Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed the Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 The Commission conducted a practice review of the Respondent?s offices, exam rooms, and practice procedures. Findings from the in-person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the office; and does not have a certified or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.44, and 1.48 constitute unprofessional conduct in violation of RCW 18.130.180(1) and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession" 2.3 The facts alleged in paragraphs 1.3 through 1.9, 1.13, through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49 and 1.54 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. 03-01-A-1015MD PAGE 11 0F 13 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, 1.39, and 1.50 through 1.53 constitute unprofessional conduct in violation of RCW and ?.180(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . and Abuse of a client or patient or sexual contact with a client or patient.? 2.5 The facts alleged in paragraph 1.33 constitute unprofessional conduct, in violation of RCW 18.130.180(1) and .180(4), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. if the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. . and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . and Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 12 OF 13 Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. .v if - . DATED this day of all?? 2004. t, STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION Lisa Noonan Program Manager Kim O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-11-0001MD, 01-10-0029MD, 02- 12-0063011), 03-01-0067MD, 03-05-0025MD, 0349-0044041), 03?09- 0018MD, 03-09-0067MD, 03-09-0080MD, 03-09-0096MD, 03-10-0106MD THIRD AMENDED STATEMENT OF CHARGES (Corrected Version 1-27-04) Docket No. PAGE 13 OF 13 AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket No. 03-01-A-1015MD Program Case File No(s). Program 02?12- 0063MB, 03-01-0067MD, 03-03-00st1), 03-09-0066M o, 03.09-0044M n, 03-10-0044MD, 03-09-0045MD, 03-09-0067MD, 03?09430301? D, 03-09-0096MD, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW One - Two - Three - Four Five - Six - Seven Eight Nine Ten - Eleven a Twelve? Thirteen? Fourteen- Fifteen- Sixteen? Seventeen- Eighteen~ AMENDED CONFIDENTIAL SCHEDULE - PAGE 1 OF 1 Docket No. SUMMARY OF CHANGES and CORRECTIONS in the THIRD AMENDED STATEMENT OF CHARGES (Corrected Version) DATED 1-27-04 CHARLES M. MOMAH, MD Consolidated Case Nos. Caption: added Docket numbers of the two consolidated cases. Footer: each page is identi?ed as being of the ?corrected version?. Para. 1.30: the number .is replaced with Para. 2.2: should read, ?The facts alleged in paragraphs 1.2, 1.44, and 1.48 constitute unprofessional conduct in violation of RCW 18.130.180(1) and which provide in part: ,3 Para. 2.3: should read, ?The facts alleged in paragraphs 1.3 through 1.9, 1.13 through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49 and 1.54 constitute unprofessional conduct in violation of RCW which provides in parts. Para. 2.4: should read, ?The facts alleged in paragraphs 1.10 through 1.12, 1.35, 1.39, and 1.50 through 1.53 constitute unprofessional conduct in violation of RCW 18.130. 180(1), ?1 80(4), and which provide in partz.. FILED JAN 2 9 2004 Adiudicative Clerk Of?ce STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 033M Document: Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Customer Service Center PO. Box 47865 Olympia, WA 98504-7865 Phone: (360) 236-4700 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON FILED DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION AUG 0 5 2304 Adludicar?we Clerk Ottlce In the Matter of the License to Practice As a Physician and Surgeon of: Docket Nos. CHARLES M. MOMAH, MD License NO. MD00030669, FOURTH AMENDED STATEMENT OF CHARGES Respondent. The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) No 00-1 1-0001 MD, 01 -10-0029MD, 02-12-0018MD, 02-1 1- 0019MD, 02-12-0063MD, 03-01-0067MD, 03- 10-0044MD, 03-09-0045MD, 03-09-0018MD, 03 -09-008 1 MD, 03-09-0067MD, 03 -09-0073MD, 03-09-0096MD, 03-09-0120MD, 03-10-0106MD. Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington on March 16, 1993. 1.2 In May 2001, Respondent ?lled out a re?credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state Of New York. 1 .3 On or about May 2001, Respondent saw Patient One, a .year-Old female, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket NO. PAGE 1 OF 14 MOBIPINAMLW l_ Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.11 Respondent pulled down his pants and underwear and got on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 2 OF 14 he said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 In April 2001, Respondent evaluated Patient Two, age I for treatment of irregular and pain?il menses. Patient Two delivered her feurth baby in February 2001 by cesarean section (c?section). During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c-section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001 Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent faiied to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001 Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 3 OF 14 "mum-um mum-nnm- - - nut - - Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.17 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty?one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was 3 .year-old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the inflammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was a .year-old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of adhesions, hysteroscopy, and DSLC on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April .2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-09-A-1033MD PAGE nun-?imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.22 In July 2001 Patient Four returned to the hOSpital for a laparoscopy and hysteroscopy. Pathological results failed to confirm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.23 Patient Five, age .was the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age I Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six, age .was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 5 OF 14 monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.27 On February .2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre-term labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.28 Patient Seven, age .was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, age I began medical care with Respondent at age .in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo-Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient, only seven months post-partum and only - years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 6 OF 14 physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, age .sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by - calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, age legan medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching 0f the Patient?s Clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, age .?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven continued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March 2001 laparoscopy was not medically indicated so soon after the one Respondent had performed in November 2000. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-OI-A-1015MD PAGE 7 OF 14 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. 1.39 In 1998, Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, Respondent asked Patient Eleven to stay- Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. Respondent pushed his penis into her mouth and after some minutes ejaculated. Respondent then told Patient Eleven to go into the operating room. Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. Respondent told Patient Eleven he had written in her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, age .began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Twelve had a left oopherectorny performed in Respondent?s uncerti?ed of?ce operating room in July 2003. Respondent did not have hospital privileges at the time, therefore Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 3 OF 14 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, age .began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medically necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003, that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or - continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospitai. 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, age .began seeing Respondent in approximately June 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncerti?ed of?ce operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen, age .began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003, for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his unceiti?ed office operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different operative reports for the March 30, 2003, surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparoscopy, and the other FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-01-A-1015MD 03-09-A-1033MD PAGE 9 OF 14 does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fi?een that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent re?ned to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant a?er the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with ReSpondent?s lack of hospital admitting privileges and his inadequate - operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.50 Patient Sixteen, age .began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.51 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, age .began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentermine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 10 OF 14 Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her difficulties. She told Respondent she thought she should try Paxil, and Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 1.53 Patient Eighteen, age I began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He - asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Eighteen believed Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 Patient Nineteen, age I visited Respondent November 15, 2002, to consider whether to establish pro-natal care during her pregnancy. Respondent told her that she needed to see him instead of a midwife. Respondent told her he had no hospital privileges to deliver a baby, but that he would by the time she delivered. After informing the patient he would not do an exam because his nurse was not in the of?ce, Respondent had Patient Nineteen disrobe and he performed a vaginal ultrasound, abdominal ultrasound, breast exam, and manual exam. The patient would have required a chaperone if she understood the extent of the exam the Respondent was going to do, but she understood a chaperone was not available. 1.55 Respondent told Patient Nineteen he could not con?rm her pregnancy. She was requested to have a pregnancy test at a local hospital. Respondent called the patient?s home and left a message on her answering machine with her test results, and requesting that she return to his of?ce. A family member picked up the message off the answering machine. Respondent?s action breached the patient?s con?dentiality. She had not yet informed her family that she was pregnant. FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 1 1 OF '4 1.56 Patient Nineteen called Respondent?s of?ce soon after the ?rst visit and informed them that she had decided not to obtain further care from Respondent. Six months later Respondent sent the patient a bill for the visit and exams. Patient Nineteen asked for a copy of her chart. Respondent?s of?ce staff infonned her of his policy that charts would not be released until the bill was paid. After attempting to dispute the bill, the patient eventually paid it. Respondent?s staff continued to contact the patient to schedule appointments despite her request not to do so. 1.57 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings from the in-person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a ceiti?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.44, 1.48, and 1.56 constitute unprofessional conduct in violation of RCW 18.130.180(1) and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.3 through 1.9, 1.13, through 1.32, 1.34, 1.36 through 1.38, 1.40 through 1.43, 1.45 through 1.47, 1.49, 1.54 and 1.57 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-01-A-1015MD PAGE 12 OF 14 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, and 1.50 through 1.53, and 1.57 constitute unprofessional conduct in violation of RCW and - .180(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be and Abuse of a client or patient or sexual contact with a client or patient.? 2.5 The facts alleged in paragraph 1.33 constitute unprofessional conduct, in violation of RCW 18.130.180(l) and .180(4), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be and 2.6 The facts alleged in paragraph 1.55 constitute unprofessional conduct, in violation of RCW which provides in part: The willful betrayal of a practitioner?patient privilege as recognized by law.? l/ FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. PAGE 13 OF 14 Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to ROW 18. 130.180 and the imposition of sanctions under 18.130.160. DATED this Ste day of A on; 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION 14% Lisa Noonan Program Manager Kim 'O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-11-0001MD, 02-12-0018MD, 02-11-0019MI), 02- 12-0063MD, 03-01-0067MD, 03-05-0025MD, 03-08-0025 MD, 03-09-0066MD, 03-09mm, 03-09-0073MD, 03-09-0120MD, 03-10- 0044MD, 03-09-00451vm, 0349-0010519, 03-09-0031 MD, memes-mm, FOURTH AMENDED STATEMENT OF CHARGES Charles M. Momah, MD Docket No. 03-09-A-1033MD PAGE 14 OF 14 AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-01-A-1015MD, 03-09-A-1033MD Program Case File No(s). Program Nos. 00-11-0001MD, 0140-0029511), 02-12- 0063M 1), 03-08-0025MD, 03-01-0067M I), 03-09-0066MD, 03-09-0044MD, 03? 09-0073MD, 03-10-0044MD, D, 03-09-0081MD, 03-09-0067M D, 03-09-0080MD, 03-09-0096MD, 03419-01201? I), 0340. 0106MB This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient One: Patient Two: I Patient ThIee: Patient Four: Patient Five: Patient Six: Patient Seven: Patient Eight: Patient Nine: Patient Ten: Patient Eleven: Patient Twelve: Patient Thirteen: Patient Fourteen: Patient Fifteen: Patient Sixteen: Patient Seventeen: AMENDED CONFIDENTIAL SCHEDULE - PAGE 1 OF 2 Docket NosAMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket Nos. 03-01-A-1015MD, 03-09-A-1033MD Program Case File No(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 02-12-0018MD, 02-11-0019MD, 02-12- 0063M D, 03-01-0067M D, 03.09-0066MD, 03- 09-0073MD, 03-10-0044M D, osomosmn, 03-09-0067MD, 03-09-0080MD, 03-09-0120MD, 03-10- 0106MB This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW Patient Eighteen: Patient Nineteen: AMENDED CONFIDENTIAL SCHEDULE - PAGE 2 OF 2 Docket Nos. 03-01-A-1015MD, 03-09-A1033M STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles L. Momah, MD Docket No.: 033M Document: Summary Action Order Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: NONE If you have any questions or need additional information regarding the information that was withheld, please contact: Adjudicative Clerk Office PO. Box 47879 Olympia, WA 98504-7879 Phone: (360) 236-4677 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice as a Physician and Surgeon of: Docket No. CHARLES L. MOMAH, M.D., EX PARTE ORDER OF License No. SUMMARY ACTION Respondent. This matter came before the Medical Quality Assurance Commission (the Commission) on September 10, 2003 on an Ex Parte Motion for Order of Summary Action brought by the Department of Health (the Department) by and through its attorney, Kim O?Neal, Assistant Attorney General. The Presiding Officer for the Commission was Senior Health Law Judge Lyle 0. Hanson. The Commission members deciding the Ex Parte Motion for Order of Summary Action were: Julian Ansell, M.D., Panel Chair; Karl Forch, and Mike Snell, Public Member. The Commission, having reviewed the motion and the documents submitted in support of the motion, and having heard an oral presentation, hereby enters the following: I. ALLEGATIONS 1.1 Charles L. Momah, MD, the Respondent, was issued a license to practice as a physician by the State of Washington in March 1993. A Statement of Charges was issued in Docket No. on or about June 17, 2003. That case is pending at the present time. 1.2 Patient One was a regular patient of Respondent. On or about August 12, 2003 at approximately 6PM, Patient One called Respondent to ask for ?morning after? EX PARTE ORDER OF SUMMARY ACTION Page 1 of 4 Docket No. 03-09-A-1033MD contraception. The Respondent asked the patient to meet him at his office immediately. When Patient One arrived at Respondent's office, which was closed, Respondent let her in. No one else was in the of?ce. The Respondent wrote out prescriptions for Patient One for Percocet, Valium, and four birth control pills. The Respondent had the patient change into an exam gown and mount the exam table. The Respondent performed an ultrasound and manual pelvic exam. The patient felt Respondent's hands caressing her clitoris. The patient recognized that the pelvic exam was not proceeding normally. 1.3 The Respondent pulled down his pants and underwear and got on t0p of Patient One. He placed his penis inside her and raped her. Patient One asked Respondent to stop, and he responded, ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted 10 minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants and told her to come to his of?ce. After putting her clothes back on, she met with Respondent in his of?ce. The Respondent threatened Patient One that if she reported the event to the police he would reveal her history of narcotic dependence and her child would be taken away from her. ll. FINDINGS OF FACT 2.1 The Respondent, a physician licensed by the State of Washington at all times applicable to this matter, practicing in Federal Way, Washington. 2.2 The Commission issued a Statement of Charges alleging Respondent violated RCW and The Statement of Charges was accompanied by all other documents required by WAC 246-11-250. EX PARTE ORDER OF SUMMARY ACTION Page 2 of 4 Docket NO. 03-09-A-1033MD 2.3 The Commission ?nds there is imminent danger to the public health, safety and welfare requiring emergency action suspending Respondent?s license to practice medicine pending further proceedings due to the nature of the allegations as stated above and in the Statement of Charges. 2.4 The alleged conduct, as set forth in the Allegations above and as supported by the documents attached to the Ex Parte Motion for Order of Summary Action, is directly related to Respondent's ability to practice as a physician in the state of Washington. The Commission finds, based on the declarations and evidence submitted with the Ex Parte Motion for Order of Summary Action, that a summary suspension of Respondent?s license to practice as a physician is the least restrictive action necessary to prevent or avoid immediate danger to the public health, safety, or welfare. Ill. CONCLUSIONS OF LAW 3.1 The Commission has jurisdiction over Respondent?s license to practice as a physician. 3.2 The Commission has authority to take emergency adjudicative action to address an immediate danger to the public health, safety, or welfare. RCW RCW 34.05.479, RCW and WAC 246-1 1-300. 3.3 The above Findings of Fact and Allegations establish: The existence of an immediate danger to the publichealth, safety, or welfare; That the requested summary action adequately addresses the danger to the public health, safety, or welfare; and The requested summary action is necessary to address the danger to the public health, safety, or welfare. EX PARTE ORDER OF SUMMARY ACTION Page 3 of 4 Docket NO. 03-09-A-1033MD 3.4 The requested summery action is the least restrictive agency action justi?ed by the danger posed by Respondent?s continued practice as a physician. 3.5 The above Findings of Fact and legatione establish conduct which warrants summary action to protect the public alth. safety, or welfare. IV. on ER Based on the above Findings of Fact. AI atlone and Conclusions of Law, the Commission enters the foliowmg order: 4.1 IT IS HEREBY ORDERED that the license of Respondent be SUMMARILY SUSPENDED pending further disciplinary proo bedings by the Commission- 4.2 In addition. Reepondent is Ordered not to contact any current or former female patients by any means and for any purpose, effective immediately. Respondent shall arrange for coverage for all of his patientei. The Respondent will put a message on his answering service advising patients of the change of care and directing patients to the new provider. For continuity of care. Respondent will communicate directly with the provider. not the patients. Dated this 10 Way of September, 2003. MEDICAL QUALITY ASSURANCE COMMISSON 315R LI A SELLMD. Pa Cha 5 INTERNAL use ONLY. INTERNAL TRACKING NUMBERS: Program No. zoo?oe-omsmo EX PARTE ORDER OF SUMMARY ACTION Page 4 of 4 Docket No. 03-09-A4033MD STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles L. Momah, MD Docket No.: 033M Document: Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Adjudicative Clerk Office PO. Box 47879 Olympia, WA 98504-7879 Phone: (360) 236-4677 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice as a Physician and Surgeon of: Docket No. 03-09-A-1033MD CHARLES L. MOMAH, MD STATEMENT OF CHARGES License No. MD00030669 Respondent. The Disciplinary Manager of the Medical Quality Assurance Commission, (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in program case ?le no. Any patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles L. Momah, MD, Respondent, was issued a license to practice as a physician by the state of Washington in March 1993. A Statement of Charges with Docket No. 03-01-A-1015MD was issued on or about June 17, 2003. That case is pending at the present time. 1.2 Patient One was a 21?year?old female who ?rst saw Respondent on or about May of 2001 and in July performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with ReSpondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. 1.3 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.4 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured STATEMENT OF CHARGES - PAGE I OF 4 Docket No. ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percocet and Xanax. 1.5 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish Hospital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. 1.6 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.7 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.8 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Perco cet. 1.9 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.10 Respondent pulled down his pants and underwear and got on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, he said ?You know you want it.? Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. 1.11 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with Respondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. STATEMENT OF CHARGES - PAGE 2 OF 4 DOCket N0. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2 through 1.1 1 constitute unprofessional conduct in violation of RCW which provides in part: l) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary 2.3 The facts alleged in paragraphs 1.2 through 1.9 constitute unprofessional conduct in violation of RCW which provides in part: (4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. 2.4 The facts alleged in paragraphs 1.9 through 1.10 constitute unprofessional conduct in violation of RCW which provides: (24) Abuse of a client or patient or sexual contact with a client or patient. 2.5 The facts alleged in paragraph 1.1] constitute unprofessional conduct in violation of RCW which provides: (22) Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative, or by the use of threats or harassment against any patient or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal actlon. STATEMENT OF CHARGES - PAGE 3 OF 4 Docket No. Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Disciplinary Manager of the Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. DATED this as day of ?9 :I'L?mioer', 2003. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION Lisa Noonan Disciplinary Manager l. I) .- I a- - ICim {0 Neal WSBA ?ng ?3 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: Program No. STATEMENT OF CHARGES - PAGE 4 OF 4 Docket No. 03-09-A-l 033M CONFIDNETIAL SCHEDULE CASE NO. 2003-08-0025MD CHARLES L. MOMAH, MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW CONFIDENTIAL SCHEDULE PAGE 1 0F 1 Docket No. O33MD v-W?Hv? .. STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles Momah, MD Docket No.: 03-01-A-1015MD Document: Third Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Adjudicative Clerk Office PO. Box 47879 Olympia, WA 98504-7879 Phone: (360) 236-4677 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON FILED DEPARTMENT OF HEALTH JAN 2 I 2004 MEDICAL QUALITY ASSURANCE COMMISSION Adiudicat?we Gterk Office In the Matter of the License to Practice As a Physician and Surgeon of: Docket No. CHARLES M. MOMAH, MD THIRD AMENDED License No. MD00030669 STATEMENT OF CHARGES Respondent. The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) No 00?1 1-0001MD, 02-12-0018MD, 02-11- 0019MD, 02-12-0063MD, 03-08-0025MD, 03-01-0067MD, 03? 10-0044MD, 03-09-0045MD, 03-09-0018MD, 03-09-0081MD, 03-09-0067MD, 03-09-0080MD, 03 -09-0096MD, Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 . Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. 1.2 In May 2001, Respondent filled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent will?jlly misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state of New York. 1.3 On or about May 2001, Respondent saw Patient One, and in July 2001 performed a diagnostic laparoscopy and hysteroscopy for abnormal uterine bleeding. Patient One?s primary care provider had opined she had irritable bowel Patient One had episodic health insurance coverage (mostly Medicaid) during her treatment time with the Respondent and by September of 2002, owed him over eight thousand dollars. Respondent prescribed narcotics for Patient One during this time including morphine tablets. THIRD AMENDED STATEMENT OF CHARGES PAGE 1 OF 13 DocketNo. 0 1.4 In July of 2002, Respondent noted Patient One was pregnant. Patient One delivered that infant in November of 2002. 1.5 Patient One returned to Respondent?s care in February of 2003. Respondent performed seven transvaginal ultrasounds on Patient One from February 2, 2003 through July 30, 2003. Respondent prescribed Percocet and Xanax for her pelvic pain and indicated she had ruptured ovarian Respondent?s records state that he was discussing her ?drug addiction problem? with her but continued to prescribe Percoeet and Xanax. 1.6 In April of 2003, Respondent?s progress notes indicate that he referred Patient One to Swedish HOSpital for inpatient treatment of her addiction. However, Respondent continued to prescribe Percocet and Xanax. Respondent also provided Patient One with his cell phone number in case she needed him. I 1.7 Respondent saw Patient One on June 30, 2003, and again prescribed Percocet. 1.8 On July 7, 2003, Respondent saw Patient One and according to his progress notes engaged in a detailed discussion about her ?drug addiction and drug seeking behavior.? The note also indicates that Respondent told Patient One to seek another provider. 1.9 On July 30, 2003, Respondent saw Patient One again for pelvic pain, performed a transvaginal pelvic ultrasound and endometrial biopsy, and ordered blood work. He also gave her another prescription for Percocet. 1.10 August 12, 2003, Patient One called Respondent telling him that she was having more abdominal pain and needed contraception. He told her to come to the of?ce at 6 pm. When Patient One saw Respondent she told him she wanted emergency contraception because she had unprotected intercourse with her boyfriend on August 11. Respondent gave Patient One prescriptions for Percocet, Valium, and four birth control pills. He then had her change into an exam gown. Respondent did a transvaginal ultrasound and then began a manual exam. Patient One felt Respondent massage her clitoris and recognized that the pelvic exam was not proceeding normally. 1.1 1 Respondent pulled down his pants and underwear and go on top of Patient One. He placed his penis inside her and raped her. When Patient One asked Respondent what he was doing, he said ?You know you want it?. Patient One told Respondent to stop and get off. The assault lasted about ten minutes until Respondent ejaculated. Respondent then got off of Patient One, pulled up his pants, told her to come into his of?ce, and left the room. THIRD AMENDED STATEMENT OF CHARGES - PAGE 2 OF l3 Docket No. 03-01-A-1015MD 1.12 Patient One wiped off Respondent?s semen with her panties and got dressed. After putting her clothes back on, she met with ReSpondent in his of?ce. Respondent threatened Patient One that if she reported the event to the police, he would reveal her history of narcotic dependence and her child would be taken away from her. 1.13 In April 2001 Respondent evaluated Patient Two, - for treatment of irregular and painful menses. Patient Two delivered her fourth baby in February 2001 by cesarean section. During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, there were complications of endometritis and abdominal wound cellulitis. 1.14 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient Two. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient Two only two months after the patient had a c?section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.15 On May 17, 2001, Respondent scheduled a laparoscopy and hysterectomy on Patient Two for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal wound infection, and recent Uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.16 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient Two?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life?saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. THIRD AMENDED STATEMENT OF CHARGES - PAGE 3 OF 13 Docket No. 03-01-A-1015MD 1.17 Pathology results failed to confirm Respondent?s justi?cation for the hysterectomy on Patient Two, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient Two from the hospital while she still had a temperature of 102F. 1.18 Patient Three was ?with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Three on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.19 Patient Three visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. ReSpondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.20 Patient Four was _who had a c-section in 1997. Respondent had been her physician for several years when he saw Patient Four in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Four lacked clear indications for hysteroscopy based-only on ahistory of pelvic pain and irregular bleeding. 1.21 Patient Four arrived at the hospital at 0555 hours on April 27, 2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospitai while his patient was in imminent labor. in the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1 .22 In July 2001 Patient Four returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Four of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, THIRD AMENDED STATEMENT OF CHARGES - PAGE 4 OF I3 Docket No. 03-01-A-1015MD organic disease, complications from her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 123 Patient Five, .vas the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometn'osis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.24 Patient Five returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Five continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.25 Vaginal hysterectomy on Patient Five was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Five was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.26 Patient Six,- was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatolog'y service and Level nursery. 1.27 On February 3, 2001, Patient Six presented to Labor and Delivery at approximately 2000 hours in pre?tenn labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. THIRD AMENDED STATEMENT OF CHARGES PAGE 5 OF l3 Ducket No. 1.28 Patient Seven, -was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.29 Patient Seven went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Seven to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.30 Patient Eight, -began medical care with Respondent in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo- Provera, which most likely lead to irregular bleeding" and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient only seven months post-partum and only sixteen years old. 1.31 Patient Eight returned to see Respondent for prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care of this very young patient. Respondent did not have any formal or informal arrangement with a physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.32 Patient Nine, - sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. THIRD AMENDED STATEMENT OF CHARGES - PAGE 6 OF 13 Docket No. 03-01-A-1015MD 1.33 Respondent did not respect Patient Nine?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.34 Patient Ten, - began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the benefit of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.35 Respondent performed pelvic exams on Patient Ten that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.36 Patient Eleven, - ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. In 1998, Patient Eleven also began working in the Respondent?s of?ce and continued seeing him as a patient. Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds ReSpondent performed on Patient Eleven were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of2000 and March of 2001. The March, 2001, laparoscopy was not medically indicated so soon after the one Respondent had performed in November, 2000. 1.37 Respondent failed to take necessary diagnostic steps for Patient Eleven?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly- Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.38 Respondent prescribed narcotic pain medication for Patient Eleven for years without following through with appropriate treatment. 1.39 In 1998 Respondent started to make sexual comments to Patient Eleven. After hearing about her marital problems, he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, he asked Patient Eleven to stay late at work telling her THIRD AMENDED STATEMENT OF CHARGES PAGE 7 OF 13 Docket No. 03-01-A-1015MD there was un?nished work to do. The Respondent then sent the other employees home. The Respondent called Patient Eleven into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Eleven?s head down trying to get her to perform oral sex. The Respondent pushed his penis into her mouth and after some minutes ejaculated. The Respondent then told Patient Eleven to go into the operating room. The Respondent told Patient Eleven to take her clothes off and get onto the table. When Patient Eleven got onto the table, the Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. The Respondent told Patient Eleven he had put into her patient chart that she was a ?drug seeker? and that no one would believe her. 1.40 Patient Twelve, -began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, Iultrasounds, and hysteroscopies without any benefit to the patient. Patient Twelve had a left oopherectomy performed in Respondent?s uncerti?ed of?ce operating room in July 2003. The Respondent did not have hospital privileges at the time, therefore the Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Twelve safely. 1.41 Respondent prescribed narcotic pain medications for Patient Twelve?s pelvic pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.42 Patient Thirteen, - began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medical necessary and were not for the bene?t of the patient. Respondent performed a lapa?rascopy in? January 2003 that was not medically necessary. 1.43 Respondent provided obstetric and prenatal care to Patient Thirteen and did not inform Patient Thirteen that his hospital privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient deveIOp a complication or need to be admitted to the hospital. THIRD AMENDED STATEMENT OF CHARGES - PAGE 8 OF l3 Docket No. 03-01 -A- 0] SMD 1.44 Respondent billed insurance for an outpatient surgery on Patient Thirteen dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.45 The Respondent did prenatal blood tests on Patient Thirteen and the results indicated her iron level was low. The Respondent did not put her on prenatal vitamins. 1.46 Patient Fourteen, -began seeing Respondent in approximately June, 2001, for complaints relating to fertility and pelvic pain. ReSpondent performed medically unnecessary ultrasounds that did not benefit the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncertified of?ce operating room. This procedure was not medically necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.47 Patient Fifteen,- began seeing Respondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fifteen saw Respondent on March 30, 2003 for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his uncerti?ed of?ce operating room without appropriate facilities or equipment. 1.48 Respondent dictated two different operative reports for the March 30, 2003 surgery on Patient Fifteen. One operative report re?ects the tubal repair with a laparo scopy, and the other does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy procedure while also collecting $3,000 from the patient for the tubal repair which he told Patient Fifteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.49 Patient Fifteen became pregnant after the tubal reversal. Respondent performed medically unnecessary ultrasounds that did not benefit the patient. Respondent told Patient Fifteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncertified office operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. THIRD AMENDED STATEMENT OF CHARGES PAGE 9 OF 13 Docket No. 1.50 Patient Sixteen, - began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent becauSe he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Sixteen?s mobile phone repeatedly and asked Patient Sixteen out on dates, which she declined. 1.51 During one of many vaginal ultrasounds Respondent performed on Patient Sixteen, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, Respondent performed a pelvic exam on Patient Sixteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.52 Patient Seventeen, - began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Seventeen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentennine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. The Respondent did full pelvic examinations and vaginal ultrasound examinations at every visit. The Respondent never checked Patient Seventeen?s blood pressure during her visits. Patient Seventeen researched other drugs when she believed that Prozac was causing her dif?culties. She told Respondent she thought she should try Paxil, and the Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an atfair With him. She declined, and he called her at home three days later to ask if she reconsidered his offer. She declined again. 1.53 Patient Eighteen,-began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. The Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to THIRD AMENDED STATEMENT OF CHARGES - PAGE 10 OF 13 DocketNo. sexually stimulate the patient on several visits. Patient Eighteen believed the Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.54 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings from the in-person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the office; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS 2.1 The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18130180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2 through 1.11, 1.44, 1.45, and 1.48 constitute unprofessional, conduct in violation of RCW 18.130. 180(1), and which provides in part: The commission of any act involving moral turpitudc, dishonesty, or corruption relating to the practice of the person's and (l3) Misrepresentation or fraud in any aspect of the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.4 through 1.10, 1.13, through 1.32, 1.34, 1.36 through 1.43, 1.46, 1.47, 1.49 and 1.54 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be banned. . 2.4 The facts alleged in paragraphs 1.10, 1.11, 1.12, 1.35, and 1.50 through 1.53 constitute unprofessional conduct, in violation of RCW and -.180(24) which provides in part: THIRD AMENDED STATEMENT OF CHARGES - PAGE 11 OF 13 The commission of any act involving moral ,turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. . and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. and Abuse of a client or patient or sexual contact with a client or patient.? The facts alleged in paragraph 1.33 constitute unprofessional conduct, in. violation of RCW 18.130. 1 80(1) and .180(4), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person?s profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. and Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving THIRD AMENDED STATEMENT OF CHARGES PAGE 12 OF 13 Docket No. Respondent the Opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. DATED this 1.31? at: day of ?Ems max 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH . MEDICAL QUALITY ASSURANCE COMMISSION Lisa Noonan Program Manager Kim O?Neal, WSBA 12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. TRACKING NUMBERS: 00-11-0001MD, 01-] 0-0029MD, 02-1 2-0018MD, 02-11-0019MD, 02- 12-0063MD, 03-0l 03-05-0025MD, 03-08?00 25MB, 03-09-0066MD, 03-09-0044MD, 03-09-0045MD, 03-09? 0018MD, 03-09-0080MD, 03-09-0096NID, 03-10-0106MD THIRD AMENDED STATEMENT OF CHARGES - PAGE 13 OF [3 Docket No. AMENDED CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket No. Program Case File No(s). Program Nos. 00-11-0001MD, 01-10-0029MD, 02-12-0018MD, 02-12- 0063 MD, 03-01-0067MD, D, 03-09-0066MD, 03-09-0044MD, 03-10-0044MD, 03-09-0045M D, D, 03-09-0080M1), 03-09-0096M D, This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW One - Two - Three Four Five - Six - Seven - Eight I Nine - Ten - Eleven - Twelve- Thirteen- Founeen- Fifteen- Sixteen- Seventeen- Eighteen- AMENDED CONFIDENTIAL SCHEDULE - PAGE 1 OF I DocketNo. 0 I I STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01A-1015MD Document: Amended Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Adjudicative Clerk Office PO. Box 47879 Olympia, WA 98504-7879 Phone: (360) 236-4677 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. FILED JAN 1' 2 2004 STATE OF WASHINGTON ?Means Clerk of?ce DEPARTMENT OF HEALTH - MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice As a Physician and Surgeon of: Docket No. 03-01-A-1015MD CHARLES M. MOMAH, MD License No. MD00030669 AMENDED STATEMENT OF CHARGES Respondent. The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program 01-10-0029MD, 02-12-0018MD, 02-11- 0019MB, 02-12-0063MD, 03-09-0044MD, O9-OO45MD, 03-09-0018MD, 03-09-0081MD, 03-09-0080MD, 03 -09-0096MD, 03-10-0106MD. Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles M. Mornah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. 1.2 In May 2001, Respondent ?lled out a re?credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent will?rlly misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state of New York. I 1.3 In April 2001, Respondent evaluated Patient One, - for treatment of irregular and painful menses. Patient One delivered her fourth baby in February 2001 by cesarean section. During the pregnancy, cervical cerclage was performed to prevent prematurity. After delivery, there were complications of endometritis and abdominal wound cellulitist 1.4 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient One. Respondent did not obtain and review the patient?s prior medical records ?om her other providers. Respondent did not evaluate any other organ systems as a AMENDED STATEMENT OF CHARGES - PAGE 1 OF 1 possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient One only two months after the patient had a c?section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.5 On May 17, 2001, Respondent scheduled a laparoscopy and hysterectomy on Patient One for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c-section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal woundinfection, and recent uterine perforation by hysteroscopy. Respondent did not provide sufficient information for this patient to form an informed consent to the surgery Respondent proposed. 1.6 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient One?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.7 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient One, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient One from the hospital while she still had a temperature of 102F. 1.8 Patient Two was a .year-old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bi-lateral salpingo- oophorectomy on Patient Two on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to ?illy resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. AMENDED STATEMENT OF CHARGES - PAGE 2 OF 11 Docket No. 03-01-A-1015MD Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.9 Patient Two visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the wound, despite the fact that the patient had post-operative follow?up care to attend the wound for several weeks. 1.10 Patient Three was a [year-old woman who had a c-section in 1997. Respondent had been her physician for several years when he saw Patient Three in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of adhesions, hysteroscopy, and on or about July 21, 2000. Patient Three lacked clear .. indicatiossfor hrsteroscopy based. only on a maul? bleeding- 1.11 Patient Three arrived at the hospital at 0555 hours on April 27, 2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.12 In July 2001 Patient Three returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Three of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c-sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.13 Patient Four, -vas the Respondent?s patient for five years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age I Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometriosis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. AMENDED STATEMENT OF CHARGES - PAGE 3 OF ll Docket No. 03-01-A-1015MD 1.14 Patient Four returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure, Patient Four continued to have pain. Respondent recommended a hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.15 Vaginal hysterectomy on Patient Four was very difficult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Four was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record 1.16 Patient Five, - was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. I 1.17 On February 3, 2001, Patient Five presented to Labor and Delivery at approximately 2000 hours in preterm labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.18 Patient Six, - was Respondent?s patient beginning in 1999. She presented with of heavy menstrual bleeding and abdominal pain. The patient was started on Clomid at the very ?rst visit without clear documentation of the indication. Respondent initially recommended both a laparoscopy and a hysteroscopy. There was with little, if any, indication for a laparoscopy and none for a hysteroscopy. Respondent did not follow or monitor the patient while she was taking Clomid. 1.19 Patient Six went to Respondent?s of?ce in September 2002 for a scheduled laparoscopy and hysteroscopy. She became concerned about conditions in Respondent?s of?ce and declined to proceed with the procedures. The Respondent attempted to coerce Patient Six to have the surgery by telling her she could not get pregnant unless she had a laparoscopic procedure AMENDED STATEMENT OF CHARGES - PAGE 4 0F 11 Docket No. 03-01-A-1015MD performed. The patient left before the surgery was started. Respondent put the patient at risk of harm by attempting to carry out a laparoscopy and hysteroscopy in an uncerti?ed of?ce surgical facility with inadequate facilities and equipment and at a time when he did not have hospital privileges or a transfer agreement with a hospital. 1.20 Patient Seven, -began medical care with Respondent in December 2000 for contraceptives. She was only four months post-partum. Respondent prescribed 150 mg Depo- Provera, which most likely lead to irregular bleeding and some pain. In March 2001 Respondent performed a and hysteroscopy without any indication of an intrauterine mass. The laparoscopy was also not indicated in this patient only seven months post-parturn and only- years old. 1-21 Patient Seven remnant? Respo?ertt?t Prenatal care with her second pregnancy. Respondent did not have hospital privileges and did not arrange for continuity of care- of this very young patient. Respondent did not have any formal 0r informal arrangement with a physician or midwife to perform the hospital care. There was no coordination of the patient?s care or transfer of records. 1.22 Patient Eight,- sought care with Respondent for pregnancy and delivery. The patient believed her pregnancy was high risk. Respondent put this patient at risk because he did not have hospital privileges or an arrangement with a practitioner to perform the delivery. Respondent did not inform the patient that he could not take care of her in the case of complications requiring hospitalization or for ?nal delivery. Respondent performed medically unnecessary ultrasounds on the patient that did not bene?t the patient. 1.23 Respondent did not respect Patient Eight?s privacy when she was dressing. He violated the physician-patient relationship by attempting to engage her in a social relationship by calling her without an appropriate medical reason and asking her to join him for lunch. 1.24 Patient Nine, I began medical care with Respondent in 1994 for pelvic pain and fertility treatment. Over the period 1996 to 2003, Respondent performed seven laparoscopies and two laparotomies, all of them medically unnecessary and not for the bene?t of the patient. Respondent performed ultrasounds that were medically unnecessary and not for the bene?t of the patient. 1.25 Respondent performed pelvic exams on Patient Nine that included sexualized touching of the Patient?s clitoris and vagina. Respondent used a transvaginal ultrasound to sexually AMENDED STATEMENT OF CHARGES - PAGE 5 OF 1 1 Docket No. 03-01-A-1015MD stimulate the patient. He asked the patient permission to insert his penis in her during the course of a medical exam. Respondent?s intent to sexualize the patient?s exams was demonstrated by his sexual comments during the exam, sexually caressing the patient?s breasts, kissing her, calls to the patient?s home between visits for dates, and offering to exchange narcotic drugs for sexual contact. 1.26 Patient Ten,- ?rst saw Respondent in 1997 for pregnancy and delivery and later for pelvic pain. _Although Respondent diagnosed the patient with ovarian the repetitive ultrasounds Respondent performed on Patient Ten were medically unnecessary to monitor or treat this condition. Respondent performed laparoscopies in November of 2000 and March of 2001. The March, 2001, laparoscopy was not medically indicated so soon after the one Performed 1.27 Respondent failed to take necessary diagnostic steps for Patient Ten?s headaches and visual disturbances. Appropriate diagnostic steps would include an MRI or CT scan to ascertain the cause of the patient?s condition and treat it correctly. Respondent did not record evidence that he counseled the patient about the side effects of bromocriptine medication that he prescribed for her elevated pituitary hormone levels. 1.28 Respondent prescribed narcotic pain medication for Patient Ten for years without following through with appropriate treatment. 1.29 In 1998 Respondent started to make sexual comments to Patient Ten. After hearing about her marital problems, he told her, ?We can do it,? (meaning we can have sex) and, can make you feel good.? On one occasion, he asked Patient Ten to stay late _?The Respondent then sent _ome. The Respondent called patient Ten into his of?ce. He grabbed her arm and said, ?You know you wanted it and I can make you feel good. Nobody needs to know about this.? Respondent exposed his penis and pushed Patient Ten?s head down trying to get her to perform oral sex. The Respondent pushed his penis into her mouth and after some minutes ejaculated. The Respondent then told Patient Ten to go into the operating room. The Respondent told Patient Ten to take her clothes off and get onto the table. When Patient Ten got onto the table, the Respondent had intercourse with her. Respondent told her that if she told anyone he would see that her child would be taken away, and that no one would believe her because she was receiving prescription narcotics. The Respondent AMENDED STATEMENT OF CHARGES - PAGE 6 OF 11 Docket No. 03-01-A-1015MD told Patient Ten he had put into her patient chart that she was a ?drug seeker? and that no one would believe her. 1.30 Patient Eleven, - began seeing Respondent in 1996 for routine gynecological care. Respondent performed medically unnecessary laparascopies, ultrasounds, and hysteroscopies without any bene?t to the patient. Patient Eleven had a left oopherectomy performed in Respondent?s uncerti?ed office operating room in July 2003. The Respondent did not have hospital privileges at the time, therefore the Respondent could not admit this patient or provide continuity of care if there were complications in surgery or later during the recovery period. Respondent?s operating room lacked the facilities and equipment required to perform the surgical procedures he performed on Patient Eleven safely. 1-31 .Bsquadsnt prescribed narcotic Pain medications for Pati??lef?n?s Pelvic Pain from at least 1998. After learning the patient was obtaining narcotics from other providers, Respondent continued to prescribe narcotics for the patient. 1.32 Patient Twelve, - began seeing Respondent for fertility treatments and gynecological care. Respondent performed ultrasounds while she was pregnant that were not medical necessary and were not for the bene?t of the patient. Respondent performed a laparascopy in January 2003 that was not medically necessary. 1.33 Respondent provided obstetric and prenatal care to Patient Twelve and did not inform Patient Twelve that his hospital privileges were revoked; instead, he misrepresented his status to her. This misrepresentation put the patient at risk because he had no transfer of records or continuity of care protocol in place should the patient develop a complication or need to be admitted to the hospital. 1.34 Respondent billed insurance for an outpatient surgery on Patient Twelve dated July 17, 2003. The patient did not have a surgery on that date, Respondent was paid for the surgery, and Respondent did not return the money paid to him. 1.35 The Respondent did prenatal blood tests on Patient Twelve and the results indicated her iron level was low. The Respondent did not put her on prenatal vitamins. 1.36 Patient Thirteen, - began seeing Respondent in approximately June, 2001, for complaints relating to fertility and pelvic pain. Respondent performed medically unnecessary ultrasounds that did not bene?t the patient. Respondent performed an emergency laparoscopy in February 2003 in his uncerti?ed of?ce operating room. This procedure was not medically AMENDED STATEMENT OF CHARGES - PAGE 7 OF 1] Docket No. necessary, and performing the procedure in his of?ce operating room without adequate facilities, equipment or hospital privileges put the patient at risk of harm. 1.37 Patient Fourteen, -began seeing ReSpondent in February 2003 for pelvic pain and reversal of her tubal ligation. Respondent performed medically unnecessary laparoscopy surgeries in February and March 2003. Patient Fourteen saw Respondent on March 30, 2003 for tubal reversal. Respondent did not have hospital privileges, and he performed this open procedure at his uncerti?ed office operating room without appropriate facilities or equipment. 1.38 Respondent dictated two different operative reports for the March 30, 2003 surgery on Patient Fourteen. One operative report re?ects the tubal repair with a laparoscopy, and the other does not mention the tubal repair. Respondent used the second operative report to obtain insurance payment for the laparoscopy proc?urewhile also collecting $3,000from the patient for the repair which he told Patient Fourteen that her insurance would not cover. The patient paid $1000 and agreed to make payments. While the patient was in recovery, Respondent refused to allow her husband to see her until he had paid an additional $500 that was paid to the anesthetist. 1.39 Patient Fourteen became pregnant after the tubal reversal. Respondent performed medically umecessary ultrasounds that did not bene?t the patient. Respondent told Patient Fourteen she might have an ectopic pregnancy. On August 28, 2003, Respondent performed open surgery in his uncerti?ed of?ce operating room to remove the patient?s ectopic pregnancy. In addition to the risks associated with Respondent?s lack of hospital admitting privileges and his inadequate operating room, this procedure put the patient in danger because there was a signi?cant risk of bleeding, and the Respondent had no ability to give the patient blood. 1.40 Patient Fifteen, - began visiting Respondent in April 2002 for treatment of irregular menstrual cycles. The patient had not been able to become pregnant and she was also seeking fertility treatment. She chose the Respondent because he was the only physician she could ?nd who would accept her medical coupons. After several visits, Respondent began probing the patient?s personal life, asking questions about her past sexual activity, and preferred sexual positions. Respondent told her he was attracted to her sexually, made unwanted comments about her private parts, and touched her breasts. Respondent called Patient Fifteen?s mobile phone repeatedly and asked Patient Fifteen out on dates, which she declined. 1.41 During one of many vaginal ultrasounds Respondent performed on Patient Fi?een, he used the instrument in a manner she felt was intended to sexually stimulate her. In May 2003, AMENDED STATEMENT OF CHARGES - PAGE 8 OF 1] Docket No. 03-01-A-1015MD Respondent performed a pelvic exam on Patient ifteen without a latex barrier glove, because he said he could not feel her cervix through the glove. 1.42 Patient Sixteen, - began seeing Respondent in December 1999 for treatment of ?bromyalgia, chronic fatigue and ovarian and ?broids which caused pain and irregular bleeding. Patient Sixteen sought out Respondent because she wanted to ?nd a physician who would prescribe the Prozac and Phentennine she believed she needed for her ?bromyalgia. The Respondent wrote those prescriptions for her at her ?rst visit and continued to prescribe those drugs. In April 2000, the patient discussed weight control issues with Respondent. The Respondent did ?ill pelvic examinations and vaginal ultrasound examinations at every visit. The Respondent never checked Patient Sixteen?s blood pressure during her visits. Patient Sixteen _re_se_arched other drugs when she believed that Prozaiwagcausinglier dif?culties.? She told Respondent she thought she should try Paxil, and the Respondent wrote her a prescription for it. Respondent asked the patient intimate and irrelevant questions about her sex life and insisted that women her age must have an active sex life to avoid medical consequences. Respondent asked her to have an affair with him. She declined, and he called her at home three days later to ask if she reconsidered his o?er. She declined again. I 1.43 Patient Seventeen, - began seeing Respondent in April 2002 for treatment of irregular menses and infertility. After a few visits, Respondent began ?irting with the patient. He asked her to have sex with him and began unwanted fondling of her genitals and breasts during exams that seemed to the patient to be longer than necessary. The Respondent required these examinations and vaginal ultrasounds at every visit. Respondent used an ultrasound instrument to sexually stimulate the patient on several visits. Patient Seventeen believed the Respondent did this sexual stimulation intentionally. Respondent removed his latex barrier gloves during a pelvic exam; when the patient noticed this Respondent said, ?this will only take a few minutes.? 1.44 The Commission conducted a practice review of the Respondent?s o?ices, exam rooms, and practice procedures. Findings from the in?person inspection of his practice indicate that Respondent does not have staff trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. AMENDED STATEMENT OF CHARGES - PAGE 9 OF 1] Docket No. 03-01-A-1015MD Section 2: ALLEGED VIOLATIONS 2.1 The Violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. 2.2 The facts alleged in paragraphs 1.2, 1.34, 1.35, and 1.38 constitute unprofessional, conduct in violation of RCW and which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession? 2.3 The facts alleged in paragraphs 1.3 through 1.22, 1.24, 1.26 through 1.33, 1.36, 1.37, 1.39, and 1.44 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. 2.4 The facts alleged in paragraphs 1.23 and 1.25, and 1.40 through 1.43 constitute unprofessional conduct, in violation of RCW and -.180(24) which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession, whether the act constitutes a crime or not- If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary and Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be banned. . and Abuse of a client or patient or sexual contact with a client or patient.? AMENDED STATEMENT OF CHARGES - PAGE 10 OF 1 DocketNo. Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. DATED this or? day of 2004. STATE OF WASHINGTON DEPARTMENT OF HEALTH . . MEDICAL QUALITY ASSURANCE COMMISSION Lisa Noonan Program Manager m, 54?? ig?a Kim b?Neal, WSBA ?12939 Assistant Attorney General Prosecutor FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-11-0001MD, 01-10-0029MD, 02- 12-0063NID, 03-01-0067m, 03-09-0066MD, 03-09-0018MD, 03-09- 0067IVID, 03-09-0080MD, AMENDED STATEMENT OF CHARGES - PAGE 11 OF 11 Docket No. 03-01-A-1015h?3 CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket No. 03-01-A-1015MD Program Case File Program Nos. 00-11-0001MD, oossmo, 03-01-0067MD, 03-09-0066MD, 03-09-0044MD, 03-10-0044MD, 03-09.004 5MB, 03-09-0013M D, 03-09-0031 MD, 03-09-0080MD, 03-09-0096MD, 03-10-0106MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW One - Two - Four - Five - Six - Seven - Eight - Nine - Ten - Eleven - Twelve- Thirteen Fourteen Fi?een Sixteen Seventeen CONFIDENTIAL SCHEDULE PAGE 1 OF 1 Docket No. SMD ORIGINAL STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 RE: Charles M. Momah, MD Docket No.: 03-01-A-1015MD Document: Statement of Charges Regarding your request for information about the above-named practitioner, certain information may have been withheld pursuant to Washington state laws. While those laws require that most records be disclosed on request, they also state that certain information should not be disclosed. The following information has been withheld: The identity of the complainant if the person is a consumer, health care provider, or employee, pursuant to RCW 43.70.075 (Identity of Whistleblower Protected) and/or the identity of a patient, pursuant to RCW 70.02.020 (Medical Records - Health Care Information Access and Disclosure) If you have any questions or need additional information regarding the information that was withheld, please contact: Adjudicative Clerk Office PO. Box 47879 Olympia, WA 98504-7879 Phone: (360) 236-4677 Fax: (360) 586-2171 You may appeal the decision to withhold any information by writing to the Deputy Secretary, Department of Health, PO. Box 47890, Olympia, WA 98504-7890. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION In the Matter of the License to Practice As a Physician and Surgeon of: Docket No. 03-01-A-1015MD CHARLES M. MOMAH, MD STATEMENT OF CHARGES License No. MD00030669 Respondent. The Program Manager of the Medical Quality Assurance Commission (?Commission?), on designation by the Commission, makes the allegations below, which are supported by evidence contained in Program Case File(s) No 00-1 1-0001 MD, 01-10-0029MD, and 03- Patients referred to in this Statement of Charges are identi?ed in an attached Con?dential Schedule. Section 1: ALLEGED FACTS 1.1 Charles M. Momah, MD, Respondent, was issued a license to practice as a physician and surgeon by the state of Washington in March 1993. 1.2 In May 2001, Respondent ?lled out a re-credentialing application form with a healthcare provider network. The form contained an attestation clause signed by Respondent, certifying all of the answers on the application are complete, accurate and current. The application contained information that was knowingly false. Respondent willfully misrepresented facts in his application, including, among others, whether he had privileges or actions against him, and the status of the actions against him in the state of New York. STATEMENT OF CHARGES PAGE 1 OF 7 ORIGINAL 1.3 In April 2001, Respondent evaluated Patient One, age I, for treatment of irregular and painful menses. Patient One delivered her fourth baby in February 2001 by cesarean section. During the pregnancy cervical cerclage was performed to prevent prematurity. After delivery there were complications of endometritis and abdominal wound cellulitis. 1.4 On April 23, 2001, Respondent performed surgery for a diagnostic laparoscopy and hysteroscopy on Patient One. Respondent did not obtain and review the patient?s prior medical records from her other providers. Respondent did not evaluate any other organ systems as a possible source of the patient?s pain. Complications of the surgery were uterine perforation treated by placement of Surgicil. Other complications were increased vaginal bleeding and pelvic pain. Respondent performed surgery on Patient One only two months a?er the patient had a c?section, which also entailed excessive bleeding. There were no acceptable indications for hysteroscopy presented; on the contrary, hysteroscopy was contraindicated in this patient. No certi?ed ultrasound examinations were recorded. 1.5 On May 17, 2001 Respondent scheduled a laparoscopy and hysterectomy on Patient One for indications of enlarged uterus and adenomyosis. Respondent failed to prepare for the surgery by reviewing the patient?s records from her c?section. Vaginal hysterectomy for this patient was contraindicated because of the combination of recent cesarean section, postpartum endometritis, abdominal wound infection, and recent uterine perforation by hysteroscopy. Respondent did not provide suf?cient information for this patient to form an informed consent to the surgery Respondent proposed. 1.6 During the last surgery on May 17, 2001, Respondent failed to identify the source of Patient One?s complicating excessive bleeding and did not effectively stop it prior to the end of the operation. Blood replacement was inadequate during the immediate postoperative period. STATEMENT OF CHARGES - PAGE 2 OF 7 Docket No. 03-01-A-1015MD Respondent was negligent in failing to respond to the Patient?s of internal bleeding. Later, shock from blood loss developed. Hospital staff initiated life-saving emergency measures during a period when the Respondent could not be reached. Respondent?s actions delayed the Patient?s return to surgery and needlessly exposed her to the risk of exsanguination. 1.7 Pathology results failed to con?rm Respondent?s justi?cation for the hysterectomy on Patient One, which showed the patient?s uterus was not enlarged. Respondent delayed dictating his operative report for ?ve days, and delayed dictating his discharge summary for twenty-one days. Respondent discharged Patient One from the hospital while she still had a temperature of 102F. 1.8 Patient Two was a-year-old woman with complaints of abdominal pain. Respondent performed a total abdominal hysterectomy, lysis of adhesions, and bilateral salpingo- oophorectomy on Patient Two on May 19, 2001, only two months after she had her ruptured appendix removed on March 13, 2001. The patient had not had time to fully resolve the in?ammatory process from the ruptured appendix. Respondent?s notes from the March procedure noted a left ovarian cyst, but his notes from the May procedure puts the on the right side. Pathological results did not con?rm Respondent?s basis for diagnosing this patient with an enlarged uterus. 1.9 Patient Two visited the emergency room soon after her surgery because she developed wound infection and super?cial dehiscence. Respondent did not acknowledge the seriousness of the w0und, despite the fact that the patient had post-operative follow-up care to attend the wound for several weeks. 1.10 Patient Three was alyear-old woman who had a c?section in 1997. Respondent had been her physician for several years when he saw Patient Three in July 2000 for complaints of abdominal pain and bleeding. Respondent recommended and performed a laparoscopy, lysis of STATEMENT OF CHARGES - PAGE 3 OF 7 Docket No. 03-0 I -A- 101 SMD adhesions, hysteroscopy, and on or about July 21, 2000. Patient Three lacked clear indications for hysteroscopy based only on a history of pelvic pain and irregular bleeding. 1.11 Patient Three arrived at the hospital at 0555 hours on April 27, 2001 for delivery of her baby for a possible vaginal birth after cesarean (VBAC). The patient began to have dif?culty soon after her arrival. Respondent was called and paged, but he did not arrive at the hospital to attend the patient until 1204 hours. Respondent then left the hospital while his patient was in imminent labor. In the absence of GBS test results before the patient?s due date, Respondent ordered Ampicillin; Penicillin allergy was listed in the chart. 1.12 I In July 2001 Patient Three returned to the hospital for a laparoscopy and hysteroscopy. Pathological results failed to con?rm Respondent?s indications for these procedures. There is no record that Respondent fully informed Patient Three of the possible complications of the procedure. Respondent did not rule out other pathology including malignancy, pelvic infection, organic disease, complications from her two c?sections, or other causes. The time interval between the patient?s pregnancy and her complaints was too short to justify surgical evaluation. 1.13 Patient Four, age .was the Respondent?s patient for ?ve years, beginning in 1997. Her two cesarean sections were in 1997 and 1999, with a bilateral tubal ligation in February 1999 at age 21. Afterward, she complained of persistent right lower abdominal pain. Respondent listed endometrio sis as the cause of her pelvic pain. Endometrial biopsy was normal. In August 2000, Respondent diagnosed her with an enlarged uterus and recommended a laparoscopy and hysteroscopy. There was no indication for a diagnostic hysteroscopy; the Respondent?s efforts to treat the patient?s condition medically were inadequate. 1.14 Patient Four returned on September 28, 2000 for a hysteroscopy and laparoscopy. After the procedure Patient Four continued to have pain. Respondent recommended a STATEMENT OF CHARGES - PAGE 4 OF 7 Docket No. 03-01-A-1015MD hysterectomy, despite a lack of evidence to support the recommendation. Respondent?s diagnosis was pelvic pain and abnormal uterine bleeding, but there was little history concerning the bleeding other than she was amenorrhic. 1.15 Vaginal hysterectomy on Patient Four was very dif?cult. This could have been predicted on the basis of the risk factors listed. During the ?rst night in hospital, Patent Four was returned to the operating room to stop bleeding and to receive four units of blood replacement. No evidence of endometriosis was found and the uterus was not as large as suspected. Respondent stated that he met with the patient and her husband to discuss a hysterectomy, but there is no record of this meeting in the chart. 1.16 Patient Five, - was diagnosed with a twin pregnancy in October 2000. She had been seeing Respondent for fertility treatment. She had a history of miscarriages. During one of her admissions for preterm labor, ultrasound noted the twin pregnancy to be monoamniotic and monochorionic. This ?nding classi?ed her as high risk. Respondent should have referred this patient to a hospital with a perinatology service and Level nursery. 1.17 On February 3, 2001, Patient Five presented to Labor and Delivery at approximately 2000 hours in pre-term labor and complaining of chest tightness. Respondent should have attended this patient as soon as it was apparent she was in labor. Respondent delayed his one visit until 1000 hours February 4, 2001. Respondent should have referred her to a tertiary care center for specialized management. 1.18 The Commission conducted a practice review of the Respondent?s of?ces, exam rooms, and practice procedures. Findings from the inspection of his practice indicate that Respondent does not have stafiC trained to clean and sterilize instruments; does not have any backup or call coverage; does not have hospital admitting privileges at any facility; does not have quali?ed STATEMENT OF CHARGES PAGE 5 OF 7 Decket No. 03-01-A-1015MD nursing staff attending to patients in the of?ce; and does not have a certi?ed or otherwise quali?ed ambulatory surgical center to conduct outpatient surgeries. Section 2: ALLEGED VIOLATIONS The violations alleged in this section constitute grounds for disciplinary action, pursuant to RCW 18.130.180 and the imposition of sanctions under 18.130.160. The facts alleged in paragraph 1.2 constitute unprofessional, conduct in violation 18.130.180(1) and -.1 80(13), which provides in part: The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person's profession. . and (13) Misrepresentation or fraud in any aspect of the conduct of the business or profession? The facts alleged in paragraphs 1.3 through 1.18 constitute unprofessional conduct, in violation of RCW which provides in part: Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. . STATEMENT OF CHARGES PAGE 6 OF 7 Docket No. U3-01-A-10E5MD Section 3: NOTICE TO RESPONDENT The charges in this document affect the public health, safety and welfare and constitute a probability of death or bodily harm. The Program Manager of the Medical Quality Assurance Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline, pursuant to 18.130.180 and the imposition of sanctions under 18.130.160. DATED this a: day of IOQWJ 2003. STATE OF WASHINGTON DEPARTMENT OF HEALTH MEDICAL QUALITY ASSURANCE COMMISSION Program Manager "a Kim o?Neal, WSBA 12939 Assistant Attorney General Prosecutor I FOR INTERNAL USE ONLY. INTERNAL TRACKING NUMBERS: 00-1 1400011?th2 01-10-0029MD, 8; I STATEMENT OF CHARGES PAGE 7 OF 7 Docket No. CONFIDENTIAL SCHEDULE CHARLES M. MOMAH, MD Docket No. Program Case File No(s). 2000-11-0001 MD, and 2002-12-0018MD This information is con?dential and is NOT to be released without the consent of the individual or individuals named herein. RCW One Two - Three Four Five CONFIDENTIAL SCHEDULE PAGE 1 OF 1 DocketNo. 0 I I