- BEFORE TEE I MEDICAL QUALITY HEARING PANEL . OF THE OFFICE OF ADMINISTRATIVE HEARINGS STATE OF CALIFORNIA -. . In the Matter of the Petition for Interim Suspension Order Against: . - Case No. 12-2007-187981 EDWARD MANOUGIAN, M.D. - - OAH No. 2011030643 - . Physician and Surgeon?s Certificate N0. - C17929, . - - Respondent. . . an- DECISION I I I Administrative Law Judge Ruth S. Astle, State_of California, Office of Administrative . - Hearings, heard this matter in Oakland, Califomia, on April 5, 2011. . `Brenda P. Reyes and Lynne IC. Dombrowslci, Deputies Attomey General, represented petitioner. . . . Respondent was presentand represented by Geoffrey A. Mires, Attomeylat Law. Thematter was submitted on April 5, 2011. I l- AND ISSUES An Accusation was filed on May 8, 2009 against Edward Manougian, M.D.. (respondent) alleging that he engaged in gross negligence, repeated negligent acts, incompetence (Business and Professions Code section 2234, subdivisions and - and excessive prescribing (Businessand Professions Code section 725). This Accusation concems respondent's care and treatment of two patients. The Accusati on alleges, among other things, that respondent prescribed potentially lethal doses of acetaminophen, and . excessively prescribed unconventional combinations of controlled substances at high doses. . I In August and December 2008, the Board received two separate complaints _from pharmacists expressing concem that respondent was prescribing excessive amounts of . controlled substances to patients. Medical records for nine patients were obtained by the Board, including records for three patients who died while under respondent's care} Autopsies confirmed that two of the patieiit's died of drug related complications from - - medications prescribed by respondent. The third patient died and no autopsy wasnperformed. An Interim Order was entered on the record and signed April 5, 2011, suspending respondent's license and staying the suspension on the condition that respondent not possess, - prescribe, dispense, furnish, administer _or otherwise distributeany controlled substance or any dangerous drug; and not possess or hold any and all controlled substance prescription forms and regular prescription_ blanks, DEA Drug Order Formspermits, which documents shall be surrendered by respondent to the Medical Board for - safekeeping, upon demand, pending .further order in this matter .-The petition raises the_ - follow_ing issuesthere areasonable probability that-petitioner will prevail in the underlying action;and . . . . 2. . Is t.he likelihood. of injury to the public in not issuing the order outweighed by I the likelihood of injury to -t.he licensee in issuing the order? - . FACTUAL FINDINGS - - . . 1. At all times material to this matter, respondent, Edward Manougian, M.D., has held Physician and Surgeon's Certificate No. 17929, which was issued to him by the Medical Board of California (Board) on August 16, 1956. Unless renewed, this certificate will expire on April 30, 2013. -Respondent_presently has an Accusation pending. No action has been taken to date on the pending AccusationMarch 30, 2010, and April 27, 2010, respondent was interviewed by . District Medical Consultant Mardia Snider, M.D. The matter was reviewed by Kurt - - Miller, M.D., a physician who i_s Board Certified in both neurology and in pain- management. . . Dr. Miller found that respondent has*engaged in multiple extreme `departures from the . standard of practice in` his care and treatment _of each of the nine patients; that respondent has repeatedly exposed his patients to serious and even potentially fatal risks with his prescribing - . _practices and lack of medical management; and, that respondent is the ?proximal cause of - death-to at least two of his patients. Dr. Miller concludes that respondent's "practice - . endangers the public health, safety and welfare . Overall, Dr.`Manougian represents a clear - and present danger to his patients and to the public through his medical practice, particularly in his prescribing of controlled substances? . 3. Respondent presented `a declaration of Bemard R. Wilcosky, M.D. While Dr. Wilcosky does not agree with Dr. Miller, his declaration is not persuasive. Dr. Wilcosky does not appear to consider the negative consequences of respondent's prescribing practices. - LEGAL CONCLUSIONS - 1. Under Government Code section 11529, an interim order suspending or restricting a physician's license may be issued when the evidence shows that the licensee has engaged in acts constituting a violation of the Medical Practice Act and that permitting the licensee to continue to engage in the profession will endanger the public health, safety, or welfare (Gov. Code, 1529, subd. and where the administrative law judge, in the exercise of discretion, concludes that there is a reasonable probability that the petitioner wi_ll prevail in the underlying action, and that the likelihood of injtuy to the public in not issuing . the order outweighs the likelihood of injury to the licensee in issuing the order (Gov. Code, . 11529, subd. The standard of proof is a preponderance of the evidence. - - 2. There is a reasonable probability that petitioner will prevail in the underlying . action. The petitioner needs to show that respondent's conduct constitutes gross negligence, . - repeated negligent acts, incompetence (Business and Professions Code section 2234, subdivisions and and/or excessive prescribing (Business and Professions Code . section 725). Petitioner is likely to prevail against respondent with disciplinary action pursuant to one or more of these Business and Professions Code sections. 3. Pennitting respondent to continue to possess, prescribe, dispense, fumish, administer or otherwise distribute any controlled substance or any dangerous drugs endangers the public health, safety and welfare. Of course, respondent is harmed by not . being allowed to prescribe controlled substances and dangerous drugs, but the safety ofthe public must be paramount. . . . ORDER - Physician and Surgeon's Certificate No. 17929 issued to Edward Manougian, M.D., . is suspended. However, the suspension is stayed on the, condition that respondent not possess,-prescribe, dispense, furnish, administer or otherwise distribute any controlled - substance or any dangerous drug; and not possess or holdanyand all controlled substance - prescription forms and regular prescription blanks, DEA Drug Order Forms, and any and all DEA permits, which documents shall be surrendered by respondent to. the Medical Board for . safekeeping, upon demand, pending further order in this matter This order shallremain in effect until the hearing and final decision on the Accusation filed] by the complainant. He must comply with the interim order of suspension signed on April 5 2011. - - The accusation must.be filed and served pursuant to Government Cod_e sections .11503 and 11505 within 15 days ofMay 18, 2009. . . 3 I DATED: Lou - - - - RUTH S.ASTLE . Administrative Law ludge . Office of Administrative Hearings