San Diego, California 92108 XAVIER BECERRA Attorney General of California FILED ALEXANDRA M. ALVAREZ STATE OF CALIFORNIA SuperViSing Depu?fy Attorney General MEDICAL BOARD CALIFORNIA JOSEPH F. MCKENNA SACRAMENTO Mm I 0-37 20 lg Deputy Attorney General . _StateBarNo. 231195 - 1m ANALYST 600 West Broadway, Suite 1800 San Diego, CA 92101 PO. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 738?9417 Facsimile: (619) 645?2061 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. 800-2015-013651 David James Smith, MD. A A I 3703 Camino Del Rio South, Suite '210 Physician?s and Surgeon?s License No. G66777, 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, and not otherwise. I 2. On or ahout August 21, 1989, the Medical Beard iss'ued Physician?s and Surgeon?s Certi?cate No. G66777 to David James Smith, MD. (Respondentl. The Physician?s and Surgeon?s Certi?cate was in full force and effect at all times relevant to the charges and allegations brought herein and will expire on January 31, 2019, unless renewed. 1 (DAVID JAMES SNIITH, ACCUSATION NO. 800-2015-013651 .JURISDICTION 3. This Accusation is brought before the Medical Board of California (Board), Department of Consumer Affairs, 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 provides that a licensee who is found guilty under the Medical Practice Act may have his or her license revoked, suspended for a period not'to exceed one year, placed on probation and required to pay the costs of probation monitoring, be publicly reprimanded which may include a requirement that the licensee complete relevant educational courses, or have such'other action taken in relation to discipline as the Board deems proper. 5. Section 2234 of the Code states: ?The board shall take action against any licensee who is charged with I unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following: Violating or attemptingto 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 followed by a - separate and distinCt departure from the applicable standard of care shall constitute repeated negligent acts. Incompetence; 6. Unprofessional conduct under section 2234 of the Code is conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical profession, and which demonstrates an un?tness to practice medicine. (Shea v. Board of Medical Examiners.(l978) 81 Cal.App.3d 564, 575.). 2 (DAVID JAMES SMITH, M.D.) ACCUSATION N0. 800-2015-013651 000Section 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 unpn?bs?onalconduct? 8. Section 725 of the Code states: Repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering of drugs or treatment,?repeated acts of clearly excessive use of diagnostic procedures, or repeated acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of the community of licensees is unprofessional conduct for a physician and surgeon, dentist, podiatrist, physical therapist, chiropractor, optometrist, speech-language. pathologist, or audiologist. Any person who engages in repeated acts of clearly excessive prescribing or administering of drugs or treatment is guilty of a misdemeanor and shall be punished by a ?ne of not less than one hundred dollars ($100) nor more than six hundred dollars or by imprisonment for a term of not less than 60 days nor more than 180 days, or by both that ?ne and imprisonment. - A practitioner who has a medical basis for prescribing, furnishing, dispensing, or administering dangerous drugs or prescription controlled substances shall not be subject to disciplinary action or prosecution under this section. No physician and surgeon shall be subject to disciplinary action pursuant to this section for treating intractable pain in compliance with Section 2241.5.? 9. Section 4022 of the Code states: - ??Dangerous drug? or ?dangerous device? means any drug or device unsafe for self?use in humans or animals, and includes the following: Any drug that bears the legend: ?Caution: federal law prohibits dispensing without prescription,? ?Rx only,? or words of similar import. NH 3 (DAVID JAMES SMITH, MD.) 800-2015-013651 Any device that bears the statement: ?Caution: federal law restricts this device to sale'by or on the order of a ?Rx only,? or words of similar import, the blank to be ?lled in with the designation of the practitioner licensed to use or order use of the device. Any other drug or device that by federal or state law can be lawfully dispenSed only on prescription or furnished pursuant to Section 4006.? FIRST CAUSE FOR DISCIPLINE (Gross Negligence)- 10. Respondent has subjected his Physician?s and Surgeon?s Certi?cate No. G66777 to disciplinary action under sections 2227 and 2234, as de?ned in section 2234, subdivision of the Code, in that Respondent committed gross negligence in his care and treatment of patients A, B, and C1, as more particularly alleged hereinafter: 11. Patient A Since at least 2010, Patient A treated with Respondent for pain management due to chronic pain in herback, leg, knee, and shoulder.2 In or around that time, Patient A already had an intrathecal pump3 implanted. In or around 2012 and 2013, Respondent implanted multiple new- intrathecal pUmps in Patient A due to various medical issues. I From in or around 2011 to in or around 2017, Respondent managed Patient A?s pain medication through intrathecal drug therapy and high dose 1 Letters A, B, and are used for the purposes of maintaining patient con?dentiality. 2 Conduct occurring more than seven (7) years from the ?ling date of this Accusation is for informational purposes only and is not alleged as a basis for disciplinary action. 3 An intrathecal pump is a medical device used to deliver medication directly into the space between the spinal cord and the protective sheath surrounding the spinal cord for targeted drug delivery. An intrathecal pump delivers medicine directly into the Cerebrospinal ?uid and requires a signi?cantly smaller amount of medication compared to systemically taken (orally) medication due to bypassing the systemic path that oral medication must travel in the body. An intrathecal pump is programmable and it stores the information about medication in its memory. An intrathecal pump is programmed to slowly release medication over a period of time and can - be programmed to release different amounts of medication at different times of the day. When the intrathecal pump?s reservoir is empty, the medication is re?lled by insertion of a needle through the skin and into the ?ll port on top of the pump?s reservoir. 4 . (DAVID JAMES SMITH, MD.) ACCUSATION NO. 800-2015-013651 ()1me systemic (oral) opioid?drug therapy. During this same time frame, ReSpondent routinely ?lled Patient A?s intrathecal pump with massive doses of controlled pain medication and routinely prescribed excessive doses of oral opioids and other controlled substances. Signi?cantly, the potent and highly addictive medications from the combined drug therapies (intrathecal and systemic/oral) were being taken by Patient A atthe same time, as prescribed by Respondent. Inifact, Respondent, notwithstanding Patient A?s intrathecal drug therapy, routinely preseribed excessive amounts'of oral opioid medication that often exceeded well more than three hundred (300) morphine milligram equivalents (MME) 1n a day. Respondent prescribed these massive oral doses of opioids to Patient A on multiple dates including, but not limited to, October 2, 2017; July 25, 2016; September 4, 2013; and November 7,2012. I . I On'or about October 2, 2012, Respondent replaced Patient A?s existing intrathecal pump with a newer model.4 On or about October 9, 2012, Respondent ?lled Patient A?s newly installed pump with medication but failed to clearly and accurately document the concentration of initial medication that was used to?ll the pump. According to the chart note for this outpatient visit, Respondent initiated the pump?s medication with an extremely high amount of fentanyl.5 Patient A?s initiating fentanyl dose was documented ata concentration of 25 milligrams (mg) per milliliter with a starting dose of 2.499? mg of fentanyl per day. The chart note for this visit also documented-?lling the pump with Marcaine 5 mg/mL. The chart note further 4 A pump implant operative note indicated that Respondent implanted the Medtronic II. 1 5 Fentanyl-is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivisidn and a dangerous drug pursuant to Business and Professions Code section 4022. Fentanyl 15 a potent opioid drug used as an analgesic and anesthetic. Fentanyl 15 ?approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. (Drugs of Abuse, Drug Enforcement Administration (DEA) Resource Guide (2017 Edition), at p. 40.) 5 (DAVID JAMES SNIITH, MD.) ACCUSATION NO. 800?2015-013651 43bdocumented that Patient A was continuing to orally take Methadone6 and Roxicodone7- for pain. Respondent, notwithstanding the amount of controlled pain medications Patient A was getting through combined intrathecal and systemic drug therapies, also gave verbal orders for an intramuscular injection of Dilaudid8 4 mg for Patient A at this visit. Signi?cantly, there was no observation period of Patient A following the pump?s medication re?ll at this visit. . Following a pump pocket ?ll of Patient A?s intrathecal pump, Respondent sent her home after only one dose of Naloxone.9 Signi?cantly, Respondent failed to observe Patient A after this single dose and evaluate potential'side-effects including, but not limited to, opioid over-dosage. 7 In or around June 2015, Patient A was admitted for a prolonged admission to a hospital at the University of California San Diego (UCSD). During her admission, Patient A?s intrathecal pump had to be ?lled with medication. . UCSD physician treating Patient A identi?ed that the concentration of medication in her pump was ?extremely high?? and that the pump?s internal computer listed the concentration of drugs in ?milligrams,? and not micrograms (mcg), even though is the standard measurement of concentration of medication used in an intrathecal pump. RespOndent personally veri?ed the accuracy of the listed concentrations and infusion doses directly to the UCSD physician. A ?formula I sheet? containing a list of medication concentration was also faxed from 6 Methadone is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. 7 Roxicodone 1s a brand name for oxycodone, a Schedule II controlled substance pursuant to Health and- Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. 8 Dilaudid is a_brand name for hydromorphone, is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. 9 Naloxone is a medication designed to rapidly reverse opioid overdose. 6 (DAVID JAMES SMITH, MD.) ACCUSATION NO. 800-2015-013651 Respondent?s clinic to UCSD to again verify concentrations and dosages that the Respondent ?lls in Patient A?s pump. The ?formula sheet? clearly indicated that major discrepancies existed between its listed concentrations and dosages and the ?nal concentrations actually contained in Patient A?s pump. Respondent routinely issued prescriptions to Patient A for the concomitant use of addictive controlled pain medications including, but not limited to, MS Contin,10 Roxicodone, benzodiazepines,11 Soma,12 and phentermine.13 Prescriptions for this dangerous drug combination were issued to Patient A on multiple dates including, but not limited to, January 23, 2017; February 21, 2017; March 6, 2017 April 28, 2017; June 1, 2017; August 7, 2017; and October 2, 2017. Respondent failed to document his clinical judgment behind prescribing a controlled medication combination with potentially lethal consequences, which occurred every time?he prescribed the concOmitant use of these drugs to Patient A. From in or around 2011 to in or around 2017, Respondent, notwithstanding his knowledge of Patient A?s documented history of drug and alcohol abuse and ?drug seeking? behavior, continued to prescribe massive amounts of addictive controlled pain medication even after inconsistencies were discovered 10 MS Contin IS a brand name for morphine, a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. . 1? Benzodiazepines are Schedule IV controlled substances pursuant to Health and Safety Code section 11057, subdivision and are a dangerous drug pursuant to Business and Professions Code section 4022. Concomitant use of benzodiazepines with opioids may result in profound sedation, respiratory depressiOn, coma, and/or death. The DEA has identi?ed benzodiazepines as a drug of abuse. (Drugs of Abuse, DEA Resource Guide (2017 Edition), at p. 59.) 12 Soma is a brand name for carisoprodol, which is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. The DEA has identi?ed Soma as a drug of abuse. (Drugs of Abuse DEA Resource Guide (2017 Edition), at p. 27.) 13 Phentermine IS a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. The DEA has identi?ed phentermine as a drug of abuse. (Drugs of Abuse, DEA Resource Guide (2017 Edition), at p. 50.) 7 (DAVID JAMES SNIITI-I, MD.) ACCUSATION NO. 800-2015-013651 in. her urine drug screens and Controlled SubstanceUtiliz?ation Review and reports indicating she had received controlled prescriptions from other physicians. The chart notes during this time frame fail to adequately do?cument any discussion with Patient A about the reasons and/or explanations for these inconsistencies. 12. Respondent committed gross negligence in his care and treatment of patient A including, but not limited to,- the following: Respondent, after initiation of intrathecal drug therapy, failed to reduce and/or eliminate Patient A?s continued use of systemic opioid drug I therapy; On or about October 9,2012, Respondent initiated an excessive dose of fentanyl at an intended concentration of 25 mg/mL and a starting dose of 2.499 mg per day, in Patient A?s intrathecal pump; (0) On or about October 9, 2012, Respondent failed to initiate intrathecal therapy in an inpatient setting to observe whether Patient A had a safe response to the medication; I On or about October 9, 2012, Respondent failed to initiate intrathecal therapy in an outpatient setting to, observe whether Patient A had a safe response to the medication; 1 On or about October 9, 2012, Respondent gave verbal orders for an intramuscular injection of Dilaudid 4 mg for Patient A despite the - 14 The Controlled Substance Utilization Review and Evaluation System (CURES) is a program operated by-the California Department of Justice (DOJ) to assist health care practitioners in their efforts to ensure appropriate prescribing of controlled substances, and law enforcement and regulatory agencies in their efforts to control diversion and abuse of controlled substances. (Health Saf. Code, 11165.) California law requires dispensing pharmacies to report to the DOJ the dispensing of Schedule II, and IV controlled substances as soon asnreasonably possible after the prescriptions are ?lled. (Health Saf. COde, 11165, subd. It is important to note that the history of controlled substances dispensed to a speci?c patient based on the data contained in CURES is available to a health care practitioner who is treating that patient. (Health Saf. Code, 11165.1, subd. 8 (DAVID JAMES. SIVHTH, MD.) ACCUSATION NO. 800-2015-013651 (1) amount 0f controlled pain medications Patient A was already receiving through combined intrathecal drug therapy and systemic drug therapy; Respondent performed a pump pocket ?ll of Patient A?s intrathecal pump, and, after administering a single dose of Naloxone, he failed to observe and evaluate the patient for potential side?effects of opioid over- dosage; I Respondent failed to maintain adequate and accurate records by failing to accurately record information about medication used in Patient A?s intrathecal pump, including, but not limited to, starting concentration of A medication, ?nal concentration of medication, starting and ?nal concentration of medication after other medication was added, drug calculations, and other reported values of concentration and doses; Respondent failed toproperly program medication information into Patient A?s intrathecal pump, including, but not limited to, starting concentration of medication, ?nal concentration of medication, starting and ?nal concentration of medication after other medication was added; and otherreported valuesof concentration and doses; Respondent repeatedly and clearly excessively prescribed, furnished, dispensed, and/or administered opioids to patient Respondent routinely prescribed dangerous drug combinations and doses to Patient At including, but not limited to, MS Contin, Roxicodone, benzodiazepines, Soma, and phentermine; Respondent failed to document his clinical judgment behind prescribing a controlled medication combination for concomitant use by Patient A i with potentially lethal consequences; and Respondent, with knowledge of Patient A?s documented drug seeking behavior, failed to provide appropriate treatment in that he, among other things, repeatedly prescribed excessive amounts of addictive pain 9 . - (DAVID JANIES SMITH, MD.) ACCUSATION NO. 800-2015-013651l medication to Patient A over an extended period of time, while failing to respond to objective signs of aberrant drug behavior. 13. Patient Between in or around 2004 and in or around November 2013, Patient treated with Respondent for pain management due to a number of medical issues including, degenerative disc disease and chronic low back pain.15 'On or about April 19, 2015, Patient '3 died of a drug overdose. The medical examiner?s autopsy report determined his cause of death was from ?mixed medication intoxication (fentanyl, oxyCodone, oxymorphone, and diazepam).? Between in or around 2011 and in or around 2013, Respondent - prescribed Patient 3 escalating doses of opioids in combination with'other controlled drugs, including, but not limited to, benzodiazepines, antidepressants, muscle relaxants, and testosterone. 'In fact, Respondent prescribed excessive amounts of opioids including, but not limited to, on or about October 1, 2013, issuing a prescription for Roxicodone (3 0mg) (#140) amounting to approximately ten (10) tablets daily. Signi?cantly, this prescription alone equaled an incredibly high four hundred ?fty (450) MME. From in or around 2011 to in or around 2013, Respondent, notwithstanding his knowledge cf Patient B?s documented history of opioid dependence, alcohol and drug abuse, depression, and other aberrant drug behaviors, continued prescribing large amounts of addictive medication even a?er numerous inconsistencies were discovered in Patient B?s urine drug screens and reports, including, but not limited to, June 23, 2011- (inconsistent for Vicodin and Valium); March 14, 2013 (misused prescription); April 16, 2013 (misused prescription); and August 14, 2013 The chart notes during - this time frame fail to adequately document any discussion with Patient about 28? 15 Conduct occurring more than seven (7) years from the ?ling date of this AccuSation is for informational purposes only and is not alleged'as a basis for disciplinary action. 10 (DAVID M.D.) ACCUSATION NO. 800-2015-013651 the reasons and/or explanations for these inconsistencies. Although Patient B?s medications were discontinued on occasion due to non-compliance, the prescriptions were later continued with similar dosing strength and?frequency. Signi?cantly, Respondent failed to document any discussion with Patient regarding a referral to addictionology or a rehabilitation facility despite multiple ?red ?ags? involving drug abuse and depression. - In a chart note dated November 29, 2012, it was documented that- Patient requested a different dosage of medication in order to help with his depression. At the next charted visit, on or about January 15, 2013, there is no documentation of a follow up on Patient B?s request for a different dosage. However, it is documented that he has been experiencing increased anxiety but with no further comment or follow up charted in the note. There are missing chart notes for July, August, and September 2013. However, Patient ?lled controlled prescriptions issued by Respondent during this time frame. In addition, there are chart notes documenting con?icting information regarding what medication was being prescribed and taken. 14. Respondent committed gross negligence in his care and treatment of Patient including, but not limited to, the following: Respondent prescribed excessive amounts of opioids including, but not "limited to, on Or about October 1, 2013, issuing a prescription for Roxicodone (30mg) (#140) amounting to approximately ten (10) tablets daily; Respondent failed to effectively monitor and manage Patient B?s drug use by continuing to prescribe addictive controlled medication after years of inconsistent drug tests, positive test result for cocaine, and/or repeated misuse of controlled prescriptions; (0) Respondent failed to refer Patient to addictionology or rehabilitation facility after repeated ?red ?ags? of aberrant drug behavior; 11 (DAVID JAMES SMITH, MD.) ACCUSATION NO. 800-2015-013651 There are missing chart notes for July, August, and September 2013 and; There are multiple inaccurate chart notes documenting con?icting information regarding what medication was being prescribed and taken. 15. Patient Between in or around 2008 and in Or around 2012, Patient treated with Respondent for pain management due to chronic pain from a work related injury.16 On or about July 22, 2012, Patient died ofa drug overdose. The medical examiner?s autopsy report determined her cause of death was from ?acute oxycodone, carisoprodol, and diazepam intoxication.? Between in or around 2011 and in or around 2012, Respondent managed . Patient on many different medication classes for her drug therapy including, but not limited to, opioids (long acting and short acting), multiple benzodiazepines, neuropathic pain medication, multiple muscle relaxants at same time, and antiemetics. In fact, Respondent prescribed an excessive number of drugs that performed same or similar mechanisms of action to treat Patient C. (0) Patient C?s medical charts failedto include a review'of systems, failed to consistently include a well-de?ned chief complaint, and failed to accurately record information regarding prescribed medication. In addition, there were no. CURES reports contained in Patient C?s medical records nor any mention in her charts of checking CURES for patient compliance. - 16. Respondent committed gross negligence in his care and? treatment of patient including, but not limited to, the following: I I Respondent prescribed an excessive number of controlled drugs, - including, but not limited to, opioids (long acting and short acting), benzodiazepines, muscle relaxers, and antiemetics to treat Patient C. ?5 Conduct occurring more than seven (7) years from the ?ling date of this Accusation is for informational purposes only and is not alleged as a basis for disciplinary action. 12 - (DAVID JAMES SMITH, M.D.) ACCUSATION NO. 800-2015-013651 SECOND CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 7 17. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. G66777 to disciplinary action under sections 2227 and 2234, as de?ned in isection 2234, subdivision (0), of the Code, in that Respondent committed repeated negligent acts in his care and treatment of patients A, B, and C, as more particularly alleged hereinafter: 18. Patient A I I Paragraphs 11 and 12, above, are 'hereby incorporated by reference and realleged as if fully set forth herein. 19. Patient Paragraphs 13 and 14, above, are hereby incorporated by reference and realleged as if fully set forth herein. 20. Patient .- Paragraphs 15 and 16, above, are hereby incorporated by reference . and realleged as if fully set forth herein; There are no CURES reports in Patient C?s medical records nor any mention of checking CURES for patient compliance; In 2012, Respondent prescribed two (2) muscle relaxants at same time to Patient and I i Patient C?s medical charts failed to include a review of systems; failed to consistently include a well-de?ned chief complaint; and failed to accurately record information regarding prescribed medication. THIRD CAUSE FOR DISCIPLINE . (Incompetence) 21. Respondent has further subjected his Physician?s and ,Surgeon?s Certi?cate No. G66777 to disciplinary action under sections 2227 and 2234, as de?ned in section 2234, subdivision of the Code, in that Respondent demonstrated incompetence in his care and treatment of patient A, as more particularly alleged hereinafter: .13 (DAVID JAMES SMITH, MD.) ACCUSATION N0. 800-2015-0 1'3 651 \o oo \J'22. Patient A Paragraphs 11 and 12, above, are hereby incorporated by reference and realleged as if fully set forth herein. FOURTH CAUSE FOR DISCIPLINE (Repeated Acts of Clearly Excessive Prescribing) 23. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. G66777 to disciplinary action under sections 2227 and 2234, as de?ned in section 725, of the Code, in that Respondent has committed repeated acts of clearly excessive prescribing drugs or treatment to patients A, B, and C, as determined by the standard of the community of physicians and surgeons, as more particularly alleged hereinafter: I 24. Patient A I Paragraphs 11' and 12, above, are hereby incorporated by reference and realleged as if fully set forth herein. I i 25. Patient Paragraphs 13 and 14, above, are hereby incorporated by reference and realleged as if fully set forth herein. 26. Patient Paragraphs 15 and 16, above, are hereby incorporated by reference and realleged as if fully set forth herein. FIFTH CAUSE FOR DISCIPLINE I (Failure to Maintain Adequate and Accurate Medical Records) 27. Respondent has further subjected his Physician?s and Surgeon? 5 Certificate No. G66777 to disciplinary action under sections 2227 and 2234, as ?de?ned 1n section 2266, of the Code, in that Respondentfailed to maintain adequate and accurate records in' connection with his care and treatment of patients A, B, and C, as more particularly alleged hereinafter: 28. Patient A I Paragraphs 11 and 12, above, are hereby incorporated by reference and realleged as if set forth herein. 1'4 (DAVID JAMES SMITH, MD.) ACCUSATION NO. 800-2015-013651' 29. Patient Paragraphs 13 and 14, above, are hereby incorporated by reference and realleged as if fully set forth herein. 30. Patient Paragraphs 15 and 20, above, are hereby incorporated by reference and realleged as if fully set forth herein. SIXTH CAUSE FOR DISCIPLINE (Unprofessional Conduct) 31. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. to disciplinary action under sections 2227 and 2234 of the Code, in that Respondent has engaged in conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical ?profeSSion, and which demonstrates an un?tness to practice medicine, as more particularly alleged in paragraphs 10 through 30, above, 1 which are hereby incorporated by reference and realleged as if fully set forth herein. 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 License No. G66777, issued to Respondent David James Smith, 2. Revoking, suspending or denying approval of Respondent David James Smith, authority to supervise physician assistants and/or advanced practice nurses; 3. Ordering Respondent David James Smith, M.D., to pay the Medical Board of . California the costs of probation monitoring, if placed on probation; and 4. Taking such other and further actij/m as deemed necessary and proper. DATED: Aprf/ )2 21/29 .911ng - Executive Director Medical Board of California Department of Consumer Affairs State of California Doc.No.7l443842 Complainant 15 (DAVID SMITH, M.D.) ACCUSATION NO. SOD-20154013651