BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Second Amended Accusation Against: MOSHE MILLER LEWIS, M.D. Case NO. '80072014-007325 Physician's and Surgeon's Certi?cate NO. A90204 Respondent DECISION The, attached Stiplilated Settlement and Disciplinary Order for Public Reprimand is hereby adopted as the Decision and Order of the Medical Board Of California, Department Of Consumer Affairs, State of California. This Decision shall become effective at 5:00 p.m. on Ma); 18: 2018. IT IS SO 19, 2018. MEDICAL BOARD OF CALIFORNIA 133:5 ??onam Lew .,Cjiair Panel A XAVIER BECERRA Attorney General of California MARY Supervising Deputy Attorney General JOSHUA M. TEMPLET Deputy Attorney General State Bar No. 267098 455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 510-3533 Facsimile: (415) 703?5480 Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Second Amended Case No. 800-2014?007325 Accusation Against: OAH No. 2017070937 MOSHE MILLER LEWIS, M.D. . STIPULATED SETTLEMENT AND 1580 Valencm Street #703 DISCIPLINARY ORDER FOR PUBLIC San Francisco, CA 94110 REPRIMAND Physician?s and Surgeon's Certificate No. A90204 Respondent. IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above? entitled proceedings that the following matters are true: PARTIES 1. Kimberly Kirchmeyer (Complainant) is the Executive Director of the Medical Board of California (Board). She brought this action solely in her official capacity and is represented in this matter by Xavier Becerra, Attorney General of the State of California, Via Joshua M. Templet, Deputy Attorney General. 2. Respondent Moshe Miller Lewis, M.D. (Respondent) is represented in this proceeding; by attorney David A. Depolo, 201 North Civic Drive, Ste. 239, Walnut Creek, CA 94596. STIPULATED SETTLEMENT (800?2014-007325) February 18, 2005, the Board issued Physician's and Surgeon's Certificate No. A90204 to the Respondent. The Physician's and Surgeon's Certificate was in full forceand effect at all times relevant to the charges brought in Second Amended Accusation No. 800?2014- 007325, and will expire on June 30, 2018, unless renewed. JURISDICTION 4. Accusation No. 800?2014?007325 was filed before the Board, and is currently pending against the-ReSpondent. The Accusation and all other statutorily required documents were properly served on ReSpondent on June 5, 2017. Respondent timely filed hisNotice of Defense contesting the Accusation. On November 1, 2017, First Amended Accusation No. 800? 2014?007325 was filed before the Board and was properly served on the Respondent with all other statutorily required documents. On February 28, 2018, Second Amended Accusation No. 800-2014?007325 (Second Amended Accusation) was filed before the Board and was pr0perly served on the Respondent with all other statutorily required documents. 5. A copy of the Second Amended Accusation is attached as Exhibit A and incorporated herein by reference. ADVISEMENT AND WAIVERS 6. The Respondent has carefully read, fully discussed with counsel, and understands the charges and allegations in the Second Amended Accusation. The Respondent has also carefully read, fully discussed with counsel, and understands the effects of this Stipulated Settlement and Disciplinary Order for Public Reprimand. 7. The Respondent is fully aware of his legal rights in this matter, including the right to a hearing on the charges and allegations in the Second Amended Accusation; the right to confront and cross-examine the witnesses against him; the right to present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel the attendance of witnesses and the production of documents; the right to reconsideration and court review of an adverse decision; and all other rights accorded by the California Administrative Procedure Act and other applicable laws. STIPULATED SETTLEMENT (800?2014-007325) The Respondent voluntarily, knowingly, and intelligently waives and gives up each and every right set forth above. 9. The Respondent understands and agrees that the charges and allegations in the Second Amended Accusation, if proven at a hearing, constitute cause for imposing discipline upon his Physician's and Surgeon's Certificate. 10. For the purpose of resolving the Second Amended Accusation without the expense and uncertainty of further proceedings, the Respondent agrees that, at a hearing, Complainant could establish a factual basis for the charges in the Second Amended Accusation, and that the Respondent hereby gives up his right to contest those charges. 11. The Respondent agrees that his Physician's and Surgeon's Certificate is subject to discipline and he agrees to be bound by the Board's probationary terms as set forth in the Disciplinary Order below. CONTINGENCY 12. This stipulation shall be subject to approval by the Board. The Respondent understands and agrees that counsel for the Complainant and the staff of the Medical Board of California may communicate directly with the Board regarding this stipulation and settlement, without notice to or participation by the ReSpondent or his counsel. By signing the stipulation, the Respondent understands and agrees that he may not withdraw his agreement or seek to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary Order for Public Reprimand shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal action between the parties, and the Board shall not be disqualified from further action by having considered this matter. 13. The parties understand and agree that Portable Document Format (PDF) and facsimile copies of this Stipulated Settlement and Disciplinary Order for Public Reprimand, including PDF and facsimile signatures thereto, shall have the same force and effect as the originals. STIPULATED SETTLEMENT (800-2014-007325) 14. In consideration of the foregoing admissions and stipulations, the parties agree that the Board may, without further notice or formal proceeding, issue and enter the following Disciplinary Order: DISCIPLINARY ORDER A. PUBLIC REPRIMAND IT IS HEREBY ORDERED that the Respondent, Moshe Miller Lewis, M.D., Physician's and Surgeon's Certificate No. A90204, shall be and hereby is publicly reprimanded pursuant to California Business and Professions Code, section 2227, subdivision This public reprimand is issued in connection with allegations of negligent prescribing and inadequate recordkeeping regarding the Respondent?s treatment of three patients between 2013 and 2017, as set forth in Second Amended Accusation No. 800?2014?007325. 1. PRESCRIBING PRACTICES COURSE. Within 60 calendar days of the effective date of this Decision, the Respondent shall enroll in a course in prescribing practices approved in advance by the Board or its designee. The Respondent shall provide the approved course provider with any information and documents that the approved course provider may deem pertinent. The Respondent shall participate in and successfully complete the classroom component of the course not later than six (6) months after Respondent?s initial enrollmentThe Respondent shall successfully complete any other component of the course within one (1) year of enrollment. The prescribing practices course shall be at Respondent?s expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure. A prescribing practices course taken after the acts that gave rise to the charges in the Second Amended Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board or its designee, be accepted towards the'fulfillment of this condition if the course would have been approved by the Board or its designee had the course been taken after the effective date of this Decision. The Respondent shall submit a certification of successful completion to the Board or its designee not later than 15 calendar days after successfully completing the course, or not later than 15 calendar days after the effective date of the Decision, whichever is later. 4 STIPULATED SETTLEMENT (800-2014?007325) ~MEDICAL RECORD KEEPING COURSE. Within 60 calendar days of the effective date of this Decision, the Respondent shall enroll in a course in medical record keeping approved in advance by the Board or its designee. The Respondent shall provide the approved course provider with any information and documents that the approved course provider may deem pertinent. The Respondent shall participate in and successfully complete the classroom component of the course not later than six (6) months after the Respondent?s initial enrollment. The Respondent shall successfully complete any other component of the course within one (1) year of enrollment. The medical record keeping course shall be at the Respondent?s expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure. - A medical record keeping course taken after the acts that gave rise to the charges in the Second Amended Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board or its designee, be accepted towards the fulfillment of this condition if the course would have been approved by the Board or its designee had the course been taken after the effective date of this Decision. The Respondent shall submit a certification of successful completion to the Board or its designee not later than 15 calendar days after successfully completing the course, or not later than 15 calendar days after the effective date of the Decision, whichever is later. ACCEPTANCE I have carefully read the above Stipulated Settlement and Disciplinary Order for Public Reprimand and have fully discussed it with my attorney, David A. Depolo. I understand the stipulation and the effect it will have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Settlement and Disciplinary Order for Public Reprimand voluntarily, knowingly, and intelligently, and agree to be bound by the Decision and Order of the Medical Board of California. DATED: ?/Lo 8/ Mag LL MOSHE MILLER LEWIS, M.D. Respondent 5 STIPULATED SETTLEMENT (800-2014?007325) have read and fully discussed with Respondent Moshe Miller Lewis, MD. the terms and conditions and other matters contained in the above t' ula ed Se t1 ent and Disciplinary Order for Public Reprimand. I approve its form and co tent. DATED: 20\ ?g DAVID A. Attorney for Respon ent ENDORSEMENT The foregoing Stipulated Settlement and Disciplinary Order for Public Reprimand is hereby respectfully submitted for consideration by the Medical Board of California. Dated: .9 a! Olg/ Respectfully submitted, XAVIER BECERRA Attorney General of California JANE ZACK Supew7Wy General JOSHUA M. TEMPLET Deputy Attorney General Attorneys for Complainant SF2016200668 Stipulationrtf STIPULATED SETTLEMENT (800-2014-007325) Exhibit A Second Amended Accusation N0. 800-2014-007325 10'1-8 1.9 20 21 22 .23. :24. 25 I 26 27 28 XAVIER BECERRA - Attorney General of California ZACK SIMON $1ng Supervising Deputy Attorney General STAT RF CAUFGRNEA JOSHUA M. TEMPLET . REDTCAL RQARD 0F RMA Deputy Attorney Gene; a1 State Ba] No 267098 . In the Matterof the Second Amended Case No. 3800-2014-007325 June 30, 2018, unless renewed. 455 Golden Gate Avenue; Suite 1.1000 San Ei-aneisoo,-CA. 94102-7004 Telephone: (415) 703-5529 Facsimile: (415)703-5418 0 A t?tqrnejas for Complainant' BEFORE THE . MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA Accusation Against: SEC-0ND AMENDED ACCUSATION MOSHE MILLER LEWIS, MD. 1213 Eaton Ave, Ste. 6 . San Caries, CA 94070- 5233 Physician? and Surgeon "5 Certificate No. A90204, Respondent. I Complainant alleges! PARTIES Kimberly Kirchmeyer (Complainant) brings this Second Amended Accasation solely in her of?cial capacity as the Executive Director of ?theJMedical Board of California, Departrhent of Consumer Affairs (Board)= 2.9 OngFebruary 18,2005, the Medical Board. issued Physician?s and Surgeon?s Certificate Number A90204 to Moshe Miller Lewis, MD. (Respondent). The certi?cate?was in full force and effect at'al'l?times relevant to the charges brought herein and will expire on 1 (MOSHE- SECOND AMENDED 800-20 144107-32: ggmmawmwlocmummamwv?o one year, placed on probation and required to pay the costs. of probation monitoring, or such other limited to, the following: JURISDICTION I 3. . This Second Amended Accdsation is brought before the Board, under the authority of the following; laws. All seetion references are to the Business and Professions Code unless otherwise indicated, 4. Seetion 2004 of the Code states, in "relevant part: ?The board shall have the responsibility for the following: The?enforcement of the disciplinary and criminal provisions of the Medical Practice) Act. The administration and hearing of disciplinary actions." Carrying out of disciplinary actions appropriate to ?ndings made by a panel cran administrative lawjudge. I . . Suspending, revoking, or otherwise limiting-certi?cates after the .conclusion of disciplinary actions. I Reviewing the quality of mediCal practices carried out by physician and surgeon certi?cate holders under the jurisdiction of the boar Section2227 of the Code provides that a licensee who is found guilty tinder the Medical Practice Act may have his or her license for a period not to exceed action taken in relation to discipline as the Board deems proper. - 6. Section 2234 of "the Code. states, in relevant part: ?The board shall take action against any licensee who is charged with unprofessional In addition to other, provisions of this article, unprofessional includes, but isnot Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. I 2 (MOSHE MILLER LEWIS, MD.) SECOND AMENDED ACCUSATIONNO. 800-2014007321 r?l co on 01.4:- applicable standard ofcare, each departure constitutes a separate anddistinct breach of the . 17, 2013. She Was.'seen by Respondent?s physician l'P?l complained of painfin her Gross negligence. Repeated negligent acts. To be repeated, there must .be two for more negligent aets or omissions. An initial negligent act or omission followed by aseparate and distinct departure. fr-Om the applicable standard of care shall constitute, repeated negligent. acts, An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute 'a single negligent act. - When the standard of care requires a change in the diagnosis; act, or orniSsien that constitutes. the negligent act described in paragraph (71), including, but not limited to, a I reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the standard of care.? 7. Section 2266'of the Code states: ?The failure of a. physician-and surgeon-to maintain adequate and accurate records relating to the provision of? services to their patients constitutes unprofessiOnal ctmduct.?? I FACTS 8. At all times relevant to this matter, Respondent was licensed and practicing medicine in California. a PATIENT Pad1 9. Patient P-?l was 41. years old. when she ?rst presented at Respondent?s of?ce on- May low back, right-hand, and both knees. __She was being treated for chronic pain with Thepatients are designated in this document-as Patient P-l through P-3 toprotect?their privacy. Respondent knows-the names of the patients and? can con?rm their identities through discover-y. '2 Norcoi a trade ?name for hydrocodone bitartrate with aCetaminOPhen, is an opioid analgesic. It "is etn'rently'aISchedulc II controlled substance?it'was resCheduled from a Schedule to' a Schedule II controlled substance onAugust 22, 2014?and is a dangerousndrug as de?ned in section4022a Hydrocodonecan produce drug dependence and,.theref0re, has the potential for being "abused; It has a CNS depressant effect.- 'Norco has 10 111g of-hydrocodone and 3-25 mg of acetaminophen. At high levels, acetaminophen can cause liverftoxicity and even death. The maximum 24?hour dosage of acetaminophen should not exceed-4000 mg. 3 (MOSHE MILLER LEWIS, MD.) SECOND AMENDED ACCUSATION No. 800-201-4-00732: . fentanyl3 patch, Flector Patch?, and lidocaine5 ointment and, for attention de?cit hyperactivity Respondent himself who also documented a thorough history and physical. Theglanguage I describing the physiCal examination is identical to the language Contained in the May 17th period; The CURES report-re?ected thatP-l had received multiple Classes of controlled . Flector Patchis, indicated for the topical treatment of acute pain due to minor strains, sprains, and,? disorder (ADHD), Adderall?. 10. The physician assistant tooka thorough history and performed a thorough physical examination during P-l ?5 initial encounter on May 17, 2013 and diagnosed P-l Wit-h scoliosis, right carpal tunnel and left chondromalacia patella. "She noted P-l ?s prior?non- medication treatments as physical therapy, joint inj actionsa knee bracing, acupuncture,- chiropractic, massage therapy, and TENS. A baseline urine drug screen was performed at the visit?which was positive for opiates, benzodiazepines, amphetamines, and oxy?codone?and P-l signed a pain medicatiOn agreement. P-l is next visit to Respondent?s of?ce was June 6, 2013. This, timejshe was Seen by chart notes. He obtained signed releases from P-l for her medical records from her prior physician and her and documented that-he had reviewed a Controlled. Substance Utilization Review and, Evaluation System report for P-l for the previous one-year" substances: (opi-oids, benzodiazepines, and. stimulants) from three different pharmacies. over-the] course. of that'year. Despite; the absence in the CURES Reportof any prescriptions-- for oxycodone, Respondent notedthat the results of P-l ?s urine drug screen, which was positive for 3 Fentanyl (is an opioid analgesic and a Schedule II contrOlle?d substance anddangerous drug as defined in section 4022. Fentanyl?sprinmry' effects are anesthesia and sedation. When patients are using a fentanylpatch, the dosage of central nervous system depressant drugs should be reduced atleast 50%. entanyl can produce drugdependence similar to that prodUced by morphine and. has the potential for abuse. It and addictive. 4 FlectorPatch is a patch containingdiclofenac epolamine, ainonsteroidal anti- in?ammatory drug. Diclofenac epolaminc'is adange?rous drug as de?ned in section 4022.. contusions. 5 Lidocaine ointment is a local anesthetic. It prevents pain by blocking .the'signals at the nerve endings in the skin. Lidocaine is a dangerous drug 'as de?ned in section 4022. - 5 Adderall Contains a combination of amphetamine and dextroamphetamine, central nervous system stimulants that affect chemicals in the brain and nerves that contribute to hyperactivity andimpulsc control. It is a SChedule II controlled substance and ajdangerous drug as de?ned in section 4022. Adderall is used to treat narcolepsy and attention de?cithyperactivityr disorder (ADHD). - 4 (MOSHE MILLER LEWIS, MD.) SECOND AMENDED ACCUSATION NO. 800-2014-007?325 i?l \o?eo'qoxmomro U1, 45-? .0 oxycodone, were ?consistent with CU RES report and prescriptions from other providers.? section .2266 (inadequate records) of the Code in that Respondent was grossly negligent and/or, in Without discussion of P-l ?s addiction risk, including possible referral. to an addiction specialist, Respondent prescribed Fentanyl patches, 25 mcg, a new patch to be applied every 72 hours; oxycodOne, 15 mg, one tablet tvvice a day; and Norco 10/325, 2tablets twice a day. 1.2.. Respondent noted on June 20, 2013, that P-l was; in the process of relocating to HaWaii. He. had six more encounters with her through February 4, 2014, four in person (June 27,? 2013, August .19, 2013, October 25, 2013, and December512, 2013) and two byv-teiephone (July. - 18, 2.01.3 andFebrua1y4, 2014). In the chart notes for each of the-fourineperson visits and the February 4, 2014 telephonic visit, a physical examination is documented in the e'Xact same. language as that used in the notes fer her ?rst two visits. . i 13'. Respondent did not document clear functional goals or progress toward goals in any of his chart notes for P-l. During the period Re'spOndent was treating P-l, she ?lled a prescription for hydrocodone'from her previous provider and re?lled it three times in violation of her pain medication agreement; she admitted to Respondent on July 18, 2013 that she was ?running through too much Norco?; and she used different pharmacies to ?ll prescriptions for multiple controlled substances. Despite these aberrant, behaviors, Respondent didnot perform . another urine drug screen or check P-l ?s CURES reports after his initial review-on May 20,2013. l4. Respondent made little attempt to establish a multidisciplinary treatment plan for P- 217?s chronic pain, instead concentrating on medication management. I i FIRST CAUSE FOR DISCIPLINE . (Gross Negligence, Repeated Negligent Acts, Failure to Maintain Adequate Records) - i 15. . Respondent is guilty of unprofessional conduct-and Subject to disciplinary action under section-2234, subdivisions (gross negligence) and/or (repeated negligent acts), and Conjunction with the conduct described in the Second and Third Causes for Discipline, conunitted repeated negligent acts and failed to maintain adequate records in the practice of medicine. by engaging in the conduct described above including, but not limited to, the following: A. ReSpondent failed to. suf?ciently asseSs Patient 1?5 addictionzrisk. - 5 (MOSHE LEWIS, MD.) SECOND AMENDED BOO-201400732: . p?"a in. the chart notes for each of his ineperson visits with and ?evenin one of his telephonic visits, raising serious concerns about the accuracy of his records. its attendant complications from approXimately November 27, 20,13 to March 23, 2017, During oxycodone among-the medications listed in the Current Medication list, The notes for the second B. Respondent failed to document clear ?anctional goals or utilize appropriate tools to monitor Patient P-l"s controlled substance use. C. Respondent?s documentation of P-l ?3 physical examination was repeated, verbatim, D. Respondent failed to establish a multidisciplinary treatment plan for 13-1 ?5 chronic pain. PATIENT P-3 16. Respondent treated Patient 13-3 for pain associated with chronic Crohn?s Disease and this period, the?_primary medications he prescribed for'P-3 weremethadone and oxycodone. 'l From as early as Respondent?s ?rst visit with P-3, he documented ?Depression or anxiety problems: Yes? in P?3?s chart notes. Respondent did not- do?cument any attempt to address P?-3?s functioning until March 17, 2016. 18. The chart notes for Respondent?s ?rst visit with P-.3 include both'methadone and visitd?o not include methadone, in the Current MedicatiOn list although they do, re?ect that Respondent was still prescribing" it for In the subsequent chart-notes for 3-3 prepared by both Respondent and another physician inthe practice, the Current Medication lists sometimes list methadOHe and, Sometimes do not, although the records do. always re?ect that'methadone?is being. prescribed. I SECOND CAUSE FOR DISCIPLINE (Repeated Negligent Acts, Failure to? Maintain Adequate Records) Respondent is guilty of unprofesSional conduct,.and subject to disciplinary action under section 22-73 4, subdivision (0) (repeated negligent; acts), and section .2266 (inadeQuate records) of the Code in that, in conjunction with the conduct described in the First and Third Causes for Discipline, Respondent committed repeated negligent acts and failed to maintain 6 (MOSHE MILLER. LEWIS, MD.) SECOND AMENDED ACCUSATIONNO. 800-2014LOO7321 notes for P13 .9. adequate records; in the practice of medicine by engaging in the conduct desoribed above including, but not limited to, the following: I A. Despite documenting that had-depression or anxiety problems as early 'as November 27, 2013; Respondent. did not document any attemptto address P-3-?s functioning until March 17, 20.16. i i B. Respondent failed to maintain an accurate list of current. medications in his chart PATIENT 4 20. Respondent treated Patient 4 for chronic neck pain from January ZOE-November 2013. P-4 had previously participated in physical therapy and underwent a variety of . interventional precedure.sth10ugh previous providers. The. Respondent?s treatment of P4 involved predominately opioid therapy, and he did not document that. he? considered or discussed alternatiVe treatment modalities with her, such as cognitive behavior therapy, non-opioid - medications, of complementary therapies. - THIRD CAUSE FOR DISCIPLINE (Repeated Negligent Acts, Failure to Maintain Adequate Records) 21 -. Respondent is guilty of unprofessional conduct and-subject to disciplinary action. under section. 2234, SubditriSion (repeatednegli gent acts), and section 2266 (inadequate records) of the Code in that, in?conjunction with the conduct described in the First and Second Causes for Discipline, Respondent committed repeated negligent acts and failed to maintain adequate .reCords in the practice of medicine by engaging in the conduct "described'abOVe. PRAYER I WHEREPORE, Complainant requests that a hearing be held on the matters herein alleged, and that fellowi?ng the hearing, the Medical Board of California. issue a decision: 1. Revoking or suspending Physician's and Surgeon's certi?cate NumberA90204, issued to Moshe Miller Lewis, M. 2.. Revoking, suspending. or denying approval of Moshe. Miller Lewis, M. authority? to supervise physician assistants and advanced practice nu1 ses, 7 . (MOSHE MILLER LEWIS, MD.) SECOND AMENDED ACCUSAT ION. NO. 800420.145007325 3. Ordering Meshe' Miller Lewis, if placed on probation, to pay the Board'the costs of probation monitoring; and 4. Taking such other-and further action as. deemed necessary and ptoper? DATED: 41754585-ddcx "February 28 201-8 KIMBERLY Executive ectm Medical Board of Califcl?nia Department 'of Consumet?Affairs State of California Complainmzt' 8 (MOSHE MILLER LEWIS, MD.) SECOND AMENDED ACCUSATION