'XAVIER BECERRA . Attorney General of California MATTHEW M. DAVIS . . FILED Supervising Deputy Attorney General - STATE OF JASON J. AHN some gr cauzon Deputy Attorney General FAWENTO (g MW 2515 State Bar No. 253172 BY- ANALYST 600 West Broadway, Suite 1800 l/ . San Diego, CA 92101 PO. Box 85266 San Diego, CA 92186?5266 Telephone: (619) 738-9433 Facsimile: (619) 645-2061 Attorneys for Complainant BEFORE THE . MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATEOF CALIFORNIA In the Matter of the Accusation Against: Case No. 800-2017-035816 Wayne Stewart True, M.D. . A A I 8881 FLETCHER PKWY STE 105 LA MESA CA 91942-3132 Physician?s and Surgeon?s Certi?cate No. 62330, . Respondent. Complainant alleges: PARTIES 1. Kimberly (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). 2. On or about February 16, 1988, the Medical Board issued Physician?s and Surgeon?s . Certi?cate No. 62330 to Wayne Stewart True, MD. (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 June 30,. 2019, unless renewed. (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800?2017-035816 --"Jam-busts.) JURISDICTION 3. This Accusation is brought before the Board, under the authority of the followmg laws. All section references are to the Business and Professions code (Code) unless otherwise indicated. 4. A 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 Iof the Government Code, or whose default has been entered, and Who isfound 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. I 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. Any matter heard pursuant to subdivision (21), 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 803.1.? 2 (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800?2017-035 816 Seetion 2234 of the Code, states: ?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: - 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. 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 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. 6. Section 2266 of the Code states: ?The failure of a physician and surgeon to maintain adequate and accurate records relating I to the provision of services to their patients constitutes unprofessional conduct.? 7. Unprofessional conduct under Business and Professions Code section 2234 is conduct which breaches the rules or ethical code of the medical profession, or conduct which 13 unbecoming a member 1n good standing of the medical profession, and which demonstrates an un?tness to practice medicine. (Shea v. Board of Medzcal Examiners (1978) 81 Cal. App. 3d 564, 575.) . 3 (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800-2017-0358 16 . . FIRST CAUSE FOR DISCIPLINE '(Gross Negligence) 8. Respondent has subjected his Physician?s and Surgeon?s Certi?cate No. (362330 to disciplinary action under sections 2227 and 2234, as de?ned by section 2234, subdivision of- the Code, in that he committed gross negligence in his care and treatment of Patient as more particularly alleged hereinafterz' I 9. Respondent was Patient A?s primary care physician between 1992 until'February 2012.2 Patient A had a history of systemic lupus erythematosus severe asthma, peripheral neuropathy?, chronic back pain, anxiety, depression and Post-traumatic stress disorder (PTSD). 10. Between on or about September 9, 2011 to on or about February 23, 2012, Respondent prescribed the following controlled substances to Patient A. Filled I Drug Name Quantity Prescriber 09-09-1 1 Diazepam5 10 mg . 90 Respondent . 6 . 094 3_1 1 APAP/Hydrocodone 325/10 . 240 Respondent 1 References to ?Patient are used to protect patient privacy. 2 Conduct occurring more than seven (7) years from the ?ling date of this Accusation 1s for infOrmational purposes only and 15 not alleged as a basis for disciplinary action. . 3 Systemic Lupus Erythematosus (SLE) 1s an autoimmune disease, meaning that the immune system of the body mistakenly attacks healthy tissue. 4 Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord ?om and to the rest of the body are damaged or diseased. . 5 Diazepam is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subsection and a dangerous drug pursuant to Business and Professions ?Code section 4022. When properly prescribed and indicated, Diazepam IS generally used to treat anxiety disorders, alcohol withdrawal or muscle spasms. 6 APAP, also known as Acetaminophen, is a less potent pain reliever that mcreases the effects of hydrocodone. Hydrocodone1s 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. APAP Hydrocodone (V icod1n? Lortab? and Norco?) IS a hydrocodone combination of hydrocodone bitartrate and Acetaminophen which was formerly a Schedule controlled substance pursuant to Health and Safety Code section 11056, subdivision (continued. . .) 4 (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800-2017-035816 10 ll ,12Filled - Drug Name Quantity Prescriber 09?13-11 Morphine Sulfate7 30 mg 60 Respondent 10-28-11 AMP/Hydromdone 325710 240 Respondent 10-29-11 Diazep am 10 mg '90 Respondent 11_9_11 Morphine Sulfate 30 mg 60 Respondent 1 1-14?11 Morphine Sulfate 30 mg 60 Respondent 12_15_11 APAP/HydrocodOne 325/10 240 Respondent 12-15-11 Morphine 3111f? 30 mg 60 Respondent 12-22-11 Morphine sums 30 mg 60 Respondent 12-30-1 1 Diazep am 10 mg 90 Respondent 01_17_12 APAP/Hydrocodone 325/ 10 240- Respondent . 01-18?12 Diazepam 10 mg 90 Respondent 01-20-12 Morphine sulfate 30 mg 60 Respondent 02_23_12 APAP/Hydrocodone 325/10 240 Respondent 02-23-12 Morphine sulfate 30 mg 60 Respondent (.. .continued) - and a dangerous drug pursuant to Business and Professions Code section 4022. On August 22 2014, the DEA published a ?nal rule rescheduling hydrocodone combination products s) to schedule II of the Controlled Substances Act, which became effective October 6, 2014. Schedule II controlled substances are substances that have a currently accepted medical . use in the United States, but also have a high potential for abuse, and the abuse of Which may lead to severe or physical dependence. When properly prescribed and indicated, are used for the treatment of moderate to severe pain. In addition to the potential for and physical dependence there 13 also the risk of acute liver failure which has resulted in a black box warning being issued by the Federal Drug Administration (FDA). The FDA black box warning provides that? ?[a]cetaminophen has been associated with cases of acute liver failure, at times resulting 1n liver transplant and death. Most of the cases of liver 1nj ury are - associated with use of the acetaminbphen at doses that exceed 4000 milligrams per day, and Often - involve more than one acetaminophen containing product.? 7 Morphine Sulfate extended release (MS Contin?) is a strong prescription pain medication and 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. _5 (WAYNE STEWART TRUE, M.D.) ACCUSATION NO. 800-2017?0358 1 6 7Pabout August 8, 2011, Patient A was seen in the emergency department at - Sharp Grossmont Hospital for ?slurred speech? reported by Patient A?s wife. After the evaluation, it was concluded that Patient A may have had. a speech alteration from a ?possible medication effect.? 12. Respondent prescribed the above controlled substances without regular physician reassessment of Patient A. i A 13. Respondent failed to have and/or failed to document having an established treatment plan with stated goals and objectives for Patient A?s long-term opiate use. 14. Without regular reassessment of suicide risk, Respondent augmented prescribed opiates and simultaneously prescribed benzodiazepines to Patient, A, a patient with anxiety and major depression. 0 i 15. - Respondent failed to conduct a periodic review of the pain treatment plan and failed to conduct regular monitoring to detect possible substance abuse and/ or drug diversion. 16..- For management of Patient A?s asthma, without regular clinic visits, Respondent authorized injections of Depo?testosterone8 to Patient A on or about August 24, 201 1, September 8, 2011, September 23, 2011, October 7, 2011, October 21, 2011, November 4, 2011, December 23, 2011, and January 20, 2012. Respondent utilized chronic oral corticosteroids9 without use of inhaled corticosteroids, long-acting beta-agonistslo, anticholinergicllyinhalers, or a leukotriene receptor antagonist.12 8 Depo Testosterone is a drug used to support normal male development such as muscle growth, facial hair, and deep voice. 9 Corticosteroids are used to provide relief for in?amed areas of the body. ?0 Beta Agonists are medications that relax muscles of the airways, which widen the airways and result in easier breathing. ?1 Anticholinergics are medications that prevent the muscle bands around the airways from tightening. - 12 Leukotriene receptor antagonists are among the most prescribed?drugs for the management of asthma, used both for treatment and prevention of acute asthmatic attacks. 6 . (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800?2017-035816 17. Respondent committed gross negligence in his care and treatment of Patient A, which included, but was not limited to, the following: A Without regular reassessment of suicide risk, Respondent augmented prescribed opiates and simultaneously prescribed benzodiazepines to Patient A, a patient with, anxiety and major depression. A SECOND CAUSE FOR DISCIPLINE . (Repeated'Negligent Acts) 18. ?Respondent has ?1rther subjected his Physician?s and Surgeon?s Certi?cate No. G6233O to disciplinary action under sections 2227 and 2234, as de?ned by section 2234, subdivision of the Code, in that he committed repeated negligent acts in his care and treatment of Patient A, as more particularly alleged herein. Paragraphs 8 through 17, above, are hereby?inCorporated by reference and realleged as if fully set forth herein. Respondent committed repeatednegligent acts which included, but were not limited to, the following: (0) Respondent prescribed above controlled substances without regular physician reassessment of Patient Respondent failed to have and/or failed to document having an established treatment plan with stated goals and objectives for Patient'A? long?term opiate use; i Without regular reassessment of suicide risk, Respondent augmented prescribed opiates and simultaneously prescribed benzodiazepines to Patient A, a patient with anxiety and major depression; Respondent failed to conduct a periodic review of the pain treatment plan and failed to conduct regular monitoring to detect possible substance abuse and/or drug diversion; and l- 7 (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800-2017-035816 .2128' For management of PatientA?s asthma, Respondent utilized chronic oral corticosteroids? without use of inhaled corticosteroids, long-acting beta-agonists?, anticholinergic15 inhalers, or a leukotriene receptor antagonist.16 THIRD CAUSE FOR DISCIPLINE (Failure-t0 Maintain Adequate and Accurate Records) 19. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. G6233O to disciplinary action under sections 2227 and 2234, as de?ned by section 2266, of the Code, in that respondent failed to maintain adequate and accurate records regarding his care and treatment of Patient A, as more particularly alleged in paragraphs 8 through 18, above, which are' hereby incorporated. by reference and realleged as if fully set forth herein. FOURTH CAUSE FOR DISCIPLINE (General Unprofessional Conduct) 20. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. G62330 to disciplinary action under sections 2227 and 2234 of the Code, in that he 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 unfitness to practice medicine, as more particularly alleged in paragraphs 8 through 19, above, which are hereby incorporated by reference as if fully set forth herein. 13 Corticosteroids are used to provide relief for in?amed areas of the body. 14. Beta Agonists are medications: that relax muscles of the airways, which widen the airways and result in easier breathing. 15 Anticholinergics are medications that prevent the muscle bands around the airways from tightening. . - 16 Leukotriene receptor antagonists are among the most prescribed drugs for the management of asthma, used both for treatment and prevention of acute asthmatic attacks. 8 (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800-2017-035 816 PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and thatfollowing the'hearing, the Medical Board of California issue a decision: 1. Revoking or suspending Physician?s and Surgeon?s Certi?cate Number 62330, issued to-Wayne Stewart True, - 2. Revoking, suspending or denying approval of Wayne Stewart True, authority - to supervise physician assistants and advanced practice nurses; 3. Ordering Wayne Stewart True, M.D., if placed on probation, to pay the 'Board the costs of probation monitoring; and 4. Taking such other and ?irther action as deemed necessary and proper. KIMBERLY Executive rector Medical Board of California Department of Consumer Affairs State of California Complainant 9 (WAYNE STEWART TRUE, MD.) ACCUSATION NO. 800-2017-035816