mite FILED MEDISRELEOOF CALIFORNIA . . ARD-OF CALIFORNIA XAVIER BECERRA . Attorney General of California - SA RAMENTO ?ung - 20 L9 STEVEN D. MUNI BYJ ?lm ANALYST Supervising Deputy Attorney General MICHAEL C. BRUMMEL Deputy Attorney General State Bar No. 236116 Department of Justice 2550 Mariposa Mall, Room 5090 Fresno, CA 93721 Telephone: (559) 705-2307 Facsimile: (559) 445-5106 E-mail: Michael.Brummel@doi.ca.gov Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 800-201 7-03 6209 Tahir Yaqub, MD. A A I 0 1775 Third Street Atwater, CA 95301 Physician?s and SurgeOn?s Certi?cate No. A 96088, Respondent. Complainant alleges: PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her o?icial capacity as the Executive Directorgof the Medical Board of California, Department of Consumer - Affairs (Board). I I I On or about June 21, 2006, the Medical Board issued Physician?s and Surgeon?s License No. A 96088 to Tahir Yaqub, M.D. (Respondent). The Physician?s and Surgeon?s Certi?cate was in full force and effect at all times relevant to the charges brought herein and Will expire on December 31, 2019, unless renewed. 1 (TAHIR YAQUB, MD.) ACCUSATION NO. 800?2017-036209 JURISDICTION 3. This Accusation is brought before the Board, under the- authority of the following laws. All section references: are to the Business and Professions code (Code) unless otherwise indicated. 4. Section 2227 of the Code states: A licensee whose matter has been heard by an administrative law judge of the Medical- Quality Hearing Panel as designated in Section 11371 of the Government Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in accordance with the provisions of this chapter: Have his or her license revoked upon order of the board. Have his or her right to practice suspended for a period not to exceed one year upon order of the board. Be placed on probation and be required to pay the costs of probation monitoring upon . order of the board. Be publicly reprimanded by the board. The public reprimand may include a requirement that the licensee complete relevant educational courses approved by the board. Have any other action taken in relation to discipline as part of an order of probation, as' the board or an administrative law judge may deem proper. I Any matter heard pursuant to subdivisiOn except for warning letters, medical review or advisory conferences, professional competency examinations, continuing education activities, and cost reimbursement associated therewith that are agreed to with. the board and successfully completed by the licensee, or other matters made con?dential or privileged by existing law, is deemed public, and shall be made available to the public by the board pursuant to Section 2803.1.? - 5. Section 2234 of the Code. states: i ?The board shall take actionagainst 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: 2 YAQUB, MD.) ACCUSATION NO. 800-2017?036209' LII Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. Gross negligence. Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission follovved by a separate and. distinct departure from the applicable standard of care shall constitute repeated negligent acts. An initial negligent diagnosis followed by an act or omission medically appropriatefor 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 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. I 6. 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 conduct.? . FIRST CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 7. Respondent has subjected his Physician?s and Surgeon?s License No. A 96088 to disciplinary action under section 2227, as de?ned by section 2234, subdivision (0), of the Code, in that he committed. repeated negligent acts in the care and treatment of Patient A, as more particularly alleged hereafter: PATIENT Al . 8. On or about June 27, 2011, Patient A presented to Respondent for treatmentfor the ?rst time. Patient A had previously received treatment ?om another physician at Respondent?s 1 To protect the privacy of patients, individual names are not identi?ed in this Accusation. 3 (TAHIR YAQUB, MD.) ACCUSATION NO. 800-2017-036209 practice since 2008. Patient A was receiving treatment for a number of medical conditions including lower back pain, osteoarthritis, bilateral knee andhip pain, depression, peripheral neuropathy, ?bromyalgia, rheumatoid arthritis, osteoporosis, asthma, vitamin de?ciency, and gastritis. Respondent typically documented a very brief encounter with Patient A that included minimal handwritten notes, no documented physical examination or treatment plan. Respondent documented providing informed consent to Patient A relating to the use of controlled substances and required her to sign a controlled substances agreement. Respondent prescribed controlled . substances to Patient A at almost every patient encounter. While Patient A was receiving treatment ?om Respondent, a number of other health care providers also prescribed her controlled substances. EH 9. On or about July 10, 2011, Patient A sought treatment from Respondent for her continued back pain. Respondent did not document any information at all related to a review of systems, physical examination or history of Patient A?s back pain. 10. On or about August 23, 2011, Patient A sought treatment from Respondent for her continued back pain. Respondent previously referred Patient A to a pain management clinic for . evaluation. The medical records contain a handwritten note indicating that Patient A was failing to set up an appointment with the pain management clinic. 1 11. On or about October 11, 2011, Patient A signed a pain contract with Respondent. Per the terms of the contract, Patient A agreed that she would not seek early re?lls, and that she would not obtain controlled substances ?om any other doctors. Patient A was required to ?bring pain medications tolevery of?ce ,12_ On 0r about October 18, 2011, Patient A returned to Respondent reporting that she had recently passed out when getting up ?rom a toilet seat. Patient A explained that she had injured both of her legs and was treated at the hospital for a possible fracture to her right femur. Respondent admitted to investigators that Patient A, an elderly patient passing out at home, was a red ?ag for possible opiate abuse. 4. (TAI-IIR YAQUB, MD.) ACCUSATION NO. 800-2017?036209 OOKION about November 29, 2011, Patient A returned to Respondent for treatment of her pain. Respondent wrote in the medical records that she was non-compliant because she did not bring her medications to the visit. Respondent told investigators from the Board that he believes that someone else brought the bottles to the o?ice later on behalf of Patient A, although it is not documented in the medical records. Despite the note that Patient A was non?compliant and in violation of the pain contract, Respondent provided her with re?lls for her controlled substances. 14. Respondent provided treatment to Patient A approximately 9 times in 2011. According to the CURES report for Patient A, during the period of on or about July 1, 2011, through on or about December 2, 2011, Patient A ?lled the following prescriptions for controlled substances: Date Filled Drug Name Drug Strength 2 Qty Prescriber Name 7/1/2011 METHADONE HCL 10 MG 168 RESPONDENT 7/5/2011 ZOLPIDEM TARTRATE 10 MG 30 MC, MD. 7/12/2011 METHADONE HCL 10 MG 126 RESPONDENT 7/14/2011 DIAZEPAM 5 MG 90 N.C., M.D. 7/19/2011 TEMAZEPAM 15 MG 30 M.C., M.D. 7/21/2011 METHADONE HCL 10 MG 270 RESPONDENT 8/3/2011 TEMAZEPAM 30 MG 5 M.C., M.D. 8/16/2011 5 MG 90 NC, MB. 8/23/2011 METHADONE HCL 240 RESPONDENT 9/6/2011 TEMAZEPAM 30 MG 30 MC, MB. 9/6/2011 CLONAZEPAM .5 MG 60 M.C., M.D. 9/21/2011. METHADONE HCL 10 MG 240 RESPONDENT 10/3/2011 DIAZEPAM 5 MG 90 W.C., M.D. 10/5/2011 ALPRAZOLAM 1 MG 60 MC, MD. HYDROCODONE BITARTRATE 10/26/2011 ACETAMINOPHEN 750 MG 7.5 MG 1 10 W.R., M.D. HYDROCODONE BITARTRATE 1 10/27/2011 ACETAMINOPHEN 325 MG 10 MG 40 S.T., M.D. 11/3/2011 METHADONE HCL 10 MG 240 RESPONDENT 11/3/2011 METHADONE HCL 10 MG 90 RESPONDENT 11/30/2011 METHADONE HCL 10 MG 240 RESPONDENT HYDROCODONE BITARTRATE 12/1/2011 ACETAMINOPHEN 325 MG 10 MG 40 S.T., M.D. 12/2/2011 METHADONE HCL 10 MG I 30 RESPONDENT 5 (TAHIR MD.) ACCUSATION NO. 800?2017-036209 01-2012 15. On or about January 24, 2012, Patient A presented to ReSpondent complaining of pain ?om a fall approximately one week earlier. 16. On 0r about February 22, 2012, Patient A returned to Respondent seeking early re?lls of controlled substances in violation of the pain contract. 17. On or about March 20, 2012, Patient A returned to Respondent seeking early re?lls of controlled substances in Violation of the pain contract. 18. Respondent provided treatment to Patient A approximately 7 times in 2012. According to the CURES report for Patient A, during the period of on" or about January 5, 2012, through on or about April 11, 2012, Patient A ?lled the following prescriptions for controlled substances: Date Filled Drug Name Drug Strength Qty Prescriber Name 1/5/2012 DIAZEPAM 5 MG . 60 RESPONDENT 1/5/2012 METHADONE HCL 10 MG 240 RESPONDENT 1/5/2012 METHADONE HCL 10 MG 30 RESPONDENT HYDROCODONE BITARTRATE 1/16/2012 ACETAMINOPHEN 325 MG 10 MG 30 S.T., MB. 1/30/2012 DIAZEPAM 5 MG 30 RESPONDENT 1/30/2012 METHADONE HCL 10 MG I 240 RESPONDENT 1/30/2012 METHADONE HCL 10 MG 30 RESPONDENT HYDROCODONE BITARTRATE 1/31/2012 ACETAMINOPHEN 325 MG 10 MG 30 S.T., M.D. . 2/22/2012 METHADONE HCL 10 MG 7 30 RESPONDENT 2/23/2012 ALPRAZOLAM 1 MG 30 MC, MB. 2/25/2012 DIAZEPAM 5 MG 30 RESPONDENT 2/25/2012 METHADONE HCL 10 MG 240 RESPONDENT 3/20/2012 METHADONE HCL 10 MG 30 RESPONDENT 3/21/2012 DIAZEPAM 5 MG 30 RESPONDENT 3/21/2012 METHADONE HCL 10 MG 240 RESPONDENT 4/9/2012 METHADONE HCL 10 MG 30 RESPONDENT 4/10/2012 CLONAZEPAM 1 MG 30 MC, MB. 4/10/2012 ALPRAZOLAM 1 MG 30 MC, MB. 4/11/2012 DIAZEPAM 5 MG 30 RESPONDENT 4/11/2012 METHADONE HCL 10 MG 240 RESPONDENT 6 (TAHIR YAQUB, MD.) ACCUSATION NO. 800-2017-036209 19. Respondent failed to document an adequate history and physical for Patient A. Respondent documented that Patient A?s history included drug and alcohol use, but failedito - document any supporting information regarding the nature, duration, frequency, or prior treatments, if any. Respondent did not document the etiology, location, radiation, or intensity of Patient A?s pain. Respondent did not document any factors that aggravated or relieved Patient A?s pain, or the impact of the pain on her quality of life. Respondent did not document any speci?c concerns about the large amounts iof controlled substances prescribed to Patient Respondent did not document any concern regarding Patient A?s violation of her pain contract by obtaining controlled substances from other health care professionals and seeking early re?lls. Respondent failed to document a musculoskeletal examination or a focused examination of Patient A?s lumbar spine. I 20. Respondent failed to document an adequate treatment plan for Patient A, despite more than 10 months of treating Patient A and prescribing controlled substances. Respondent did not document any objectives for the treatment of Patient A. Respondent did not pursue any diagnostic evaluations or refer Patient A to rehabilitation or physical therapy for her pain. Respondent failed to d0cument attempts to obtain and review prior treatment records including prior diagnostic 2 Studies related to Patient A?s pain. 21. Respondent failed to document a periodic review of Patient A?s pain management during the time he was prescribing controlled substances. Respondent failed to review and/or document review of the CURES reports related to Patient A. A periodic review of Patient A?s CURES report and pain management treatment at appropriate intervals would have revealed patterns of abuse including early re?lls, and obtaining controlled substances ?om multiple health care professionals concurrently. 22. Respondent failed to maintain adequate and accurate medical records in the care and treatment of Patient A. Respondent?s medical records for Patient A were on template forms with checkboxes for and conditions. Respondent failed to document adequate infonnation related to the physical examination, evaluations, consultations, treatment plans, objectives, informed consent, prescribing and periodic reviewrelated to the care and treatment of Patient A. 7 (TAHIR YAQUB, MD.) ACCUSATION NO. 800?2017-036209 4303M LII Respondent?s documentation of the assessment and plan at each visit was cursory at best. Respondent?s medical records for Patient A primarily documented what medication Respondent prescribed at each visit. - 23. Respondent committed repeated negligent acts in the care and treatment of Patient A, which included, but was not limited to the following: i A. Paragraphs 8 through 2,2 are hereby incorporated by reference as if fully set forth herein; B. Respondent failed to appropriately manage Patient A?s chronic pain with controlled substances, which constitutes a departure from the standard of care; C. Respondent failed to perform and/or document an adequate history and physical examination of Patient A, which constitutes a departure from the standard of care; D. Respondent failed to develop and record an adequate treatment plan for Patient A, which constitutes a departure from the standard of care; i I ReSpondent failed to perform adequate periodic reviews of Patient A?s pain, treatment and status while prescribing controlled substances, which constitutes a departure from the standard of care; and F. Respondent failed to keep accurate, complete?and legible medical records for Patient A while prescribing controlled substances, which constitutes a departure ?om the standard of care. . I SECOND CAUSE FOR DISCIPLINE (Failure to Maintain Adequate and Accurate Medical Records) 24. Respondent has subjected his Physician?s and Surgeon?s License No. A 96088 to disciplinary action under section 2227, as de?ned by section 2266, of the Code, in that he failed to maintain adequate and accurate records in connection with his care and treatment of Patient A, as more particularly alleged in paragraphs 8 through 22, which are hereby incorporated by reference and realleged as if fully set forth herein. 8 (TAHIR YAQUB, MD.) ACCUSATION NO. 800-2017-036209 hulk'27 28_ PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,? and that following the hearing, the Medical Board of California issue a decision: 1. Revoking or suspending Physician?s and Surgeon?s Certi?cate No, A 96088, issued to . Tahir Yaqub, 2. Revoking, suspending or denying approval of Tahir Yaqub, authority to supervise physician assistants and advanced practice nurses; 3. Ordering Tahir Yaqub, M.D., if placed on probation, to pay the Board the costs of probationmonitoring; and I 4. Taking such other and further action as deeined necessary and proper. August .22 2018 AM RCHMEY 'Executive Di ector Medical Board of California Department of Consumer Affairs State of California Complainant FR2017306187 95276102.doc 9? (TAHIR YAQUB, MD.) ACCUSATION NO. 800?2017-036209