OO-JON 10 11 12 13 14 15 ~16-28 XAVIER BECERRA FILED Attorney General of California STATE CALIFORNIA MARY CAIN-SIMON . CALIFOH Supervising Deputy Attorney General 1 . WU . . 8 JOSHUA M. TEMPLET m" Jilly! ANALYST 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 E-mail: shua.Templet@doj .ca. gov Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STAT-E OF CALIFORNIA In the Matter of the Accusation Against: Case No. 800-2017-032335 Raymond Paul Freitas, MD. A A I 4816 Westminster Pl. Santa Rosa, CA 95405 Physician's and-Surgeon's Certi?cate No. 55595, Respondent. - Complainant alleges: PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her?of?cial capacity as the Executive Director of the Medical Board of California, Department of Consumer Affairs (Board). I . I 2. On August 5, 1985, the Board issued Physician's and Surgeon's Certi?cate Number 55595 to Raymond Paul Freitas, M.D. (Respondent). The certi?cate was in full force and effect at all times relevant to the charges brought herein and will expire on July 31, 2019, unless renewed. 1 (RAYMOND PAUL FREITAS, M.D.) ACCUSATION NO. 800?2017-03233f laws. All section references are to the Business and Professions Code unless otherwise indicated. of the disciplinary and criminal provisions of the Medical Practice Act. has been found guilty under the MedicalvPractice Act by revoking his or her license, suspending the license for a period not to exceed one year, placing the license on probation and requiring payment of costs of probation monitoring, or taking such other action as the Board deems proper. 3. This Accusation is brought before the Board, under the authority of the following 4. Section 2004 provides that the Board shall have the responsibility for the enforcement JURISDICTION 5. Section 2227 of the Code authorizes the Board to take action against a licensee who 6. Section 2234 of the Code states, in relevant part: The board shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following: I Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. (0) Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts. (1) An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act. (2) When the standard of care requires a change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph (1), including, but not-limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care. 2 (RAYMOND PAUL FREITAS, MD.) ACCUSATION NO. 300?2011032335 ?could be better if his compliance with Lasix were better,? and noted that P-l ?5 use of Lasix was Lasix for the treatment of IIH and did not order Lasix for P-l. 7. At all times relevant to this matter, Respondent was licensed and practicing medicine in California. Respondent?s Treatment of Patient P-l?s Chronic Headaches, from July 2008 until March 2013. 8. Respondent was the primary care physician for Patient P-l1 from July 2008 until March 2013. P-l suffered from elevated pressure inSide his skull, a condition known as idiopathic intracranial hypertension (IIH) or, alternatively, pseudotumor cerebri. IIH is associated with headaches originating behind the eyes that may cause swelling of the optic nerve and result in vision loss. During the time that Respondent treated P-l, an ophthalmologist also followed P-l for IIH. 9. P-l had been diagnosed with IIH and headaches related to IIH prior to his treatment by Respondent. had previously undergone a procedure to address his IIH, but he still required- ongoing diuretic treatment. P-l had reported side effects from the preferred agent for treating IIH, . Diamox, and his ophthalmologist prescribed an alternative, Lasix. P-l ?s ophthalmology treatment notes re?ect his non-adherence to using Lasix and observe that IIH could be treated more effectively-if P-l were compliant. For example, during a visit with his ophthalmologist on September 16, 2011, the ophthalmologist documented that-P-l ?s IIH was ?moderately controlled, ?managed by [Respondent].? 10. Throughout his treatment by Respondent, P?l stated that he had headaches everyday. Respondent believed P-l ?s headaches were related to his prior diagnosis of IIH, and Respondent was aware of P-l ?s inconsistent use of Lasix. Respondent did not advise or encourage P-1 to take 11.. Respondent also treated P?l for chronic headaches by continuing P-l on the headache regimen he was previously on when Respondent took over the patient?s care, including daily 1 The patient is designated in this document as Patient P-l to protect his privacy. Respondent knows the names of the patient and can con?rm his identity through discovery. 3 (RAYMOND PAUL FREITAS, M.D.) ACCUSATION NO. 800?2017-032335 'improvement in P-l ?s of depression and anxiety, Respondent did not refer P-l to a doses of butalbital, a barbiturate, codeine, an opioid, and acetaminophen, an analgesic. Respondent occasionally asked P-l about the effectiveness of this medication, and, on his last visit, documented P?l ?3 interest in reducing the medication in the future. Respondent never reported any improvement in P-l ?s headaches. Respondent?s Management of Patient P-l?s Depression and Anxiety 12. P-l had long?standing diagnoses of depressive and anxiety disorders that pre?dated Respondent?s treatment of him. R-l regularly complained to Respondent of being depressed and presented with of depression and anxiety. At P-l ?5 request, Respondent and other physicians prescribed him citalopram, a selective serotonin reuptake inhibitor used to treat depression, and diazepam, a benzodiazepine used to treat anxiety. l3. P-l "3 history of mental illness and his identity as a transgender individual placed him at an increased risk of suicide. Transgender individuals have higher rates of suicidal ideation and more of anxiety and depression. 14. 'In his documentation of P-l ?3 treatment visits, Respondent noted no improvement of P-l?s of depression or anxiety. Despite P-l ?s heightened risk of suicide and the lack of behavioral health specialist to address the reasons for P-lfs depression or anxiety. Nor did Respondent ask P?l if he would be interested in seeing a behavioral health specialist or participating in cognitive-behavioral therapy. FIRST CAUSE FOR DISCIPLINE I (Repeated Negligence: Improper Management of Chronic Headaches) 15. Respondent is guilty of unprofessional conduct and subject to disciplinary action against his license under section 2234, subdivision (0) (repeated negligence) of the Code, in that, in conjunction with the conduct described in the Second Cause for Discipline, he committed repeated negligence in the practice of medicine by engaging in the conduct described above, including but not limited to: A. Respondent did not advise or encourage P-l to take Lasix for the treatment of 11H and did not order Lasix for P-l. 4 (RAYMOND PAUL FREITAS, MD.) ACCUSATION NO. 800-2017?032335 Respondent did not consider options for the treatment of P-l ?5 chronic headaches apart from the patient?s pre-existing medication regimen of butalbital and codeine? medications with a known side effect of causing headaches. C. Respondent did not consider an alternative diagnosis for P-l, such as tension? type headache, migraine headache, or medication?overuse headache. 16. Respondent?s de?cient treatment of P-lj constitutes a departure from the standard of care. i SECOND CAUSE FOR DISCIPLINE (Repeated Negligence: Improper Management of Depressive and Anxiety Disorders) 17. Respondent is guilty of unprofessional conduct and subject to disciplinary action against his license under section 2234, subdivision (0) (repeated negligence) of the Code, in that, in conjunction with the conduCt described in the First Cause for 'Discipline, he committed repeated negligence in the practice of medicine by engaging in the conduct described above, including but not limited to failing to refer P-l to a behavioral health specialist or for co gnitive- behavioral therapy to address the reasons for P-l ?s depression and anxiety. _1 8. iReSpondent?s de?cient treatment of P-l constitutes a departure from .the standard of care. DISCIPLINARY HISTORY 19. On March 30, 2018, the Board publicly reprimanded Respondent-f Physician?s and Surgeon?s Certificate in Case No. 8002014007418 as a result of the following conduct during his treatment of a patient from approximately 2003? or 2004 until approximately 2014:. The Respondent failed to follow-up on his patient?s abnormal lab test results and imaging results. The Respondent also failed to correctly interpret his patient?s lab test results as indicating malignant conditions and did not formulate appropriate differential diagnoses. PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Board issue a decision: 5 (RAYMOND PAUL FREITAS, M.D.) NO. 800-2017-032335 Revoking or suspending Physician's and Surgeon's Certi?cate Number 55595 issued to: Respondent; 2. Revoking, suspending or denying approval of Respondent?s authority to supervise physician assistants and advanced practice nurses; 3. Ordering Respondent, 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 proper. mm KIMBERLY RCHME Executive Di ctor Medical Board of California Department of Consumer Affairs DATED: June 5, 2018 State of California Complainant SF2018200302 21121695.docx 6 (RAYMOND PAUL FREITAS, MD.) ACCUSATION N0. 800-2017-032335