BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: RAMON FAWZI FAKHOURY, MD. 3 Case No. 09-2011-216645 Physician's and Surgeon's 3 Certi?cate No. A 98772 Respondent. DECISION AND ORDER The attached Stipulated Settlement and Disciplinary Order is hereby adopted by the Medical Board of California, Department of Consumer Affairs, State of California, as its Decision in this matter. This Decision shall become effective at 5:00 pm. on September 15, 2016. IT IS SO ORDERED August 16, 2016. MEDICAL BOARD OF CALIFORNIA By: QT Jamie Wright, J.D., Chair Panel A KAMALA D. HARRIS Attorney General of California ALEXANDRA M. ALVAREZ Supervising Deputy Attorney General TESSA L. Deputy Attorney General State Bar No. 241559 600 West Broadway, Suite 1800 San Diego, CA 92101 PO. Box 85266 San Diego, CA 92186?5266 Telephone: (619) 645-2074 Facsimile: (619) 645-2061 Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA RAMON F. FAKHOURY, M.D. In the Matter of the Accusation Against: Case No. 09-2011-216645 PO Box 579 OAH No. 2015050011 Norco, CA 92860 STIPULATED SETTLEMENT AND Physician?s and Surgeon?s Certi?cate DISCIPLINARY ORDER No. A 98772 Respondent. IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above- entitled proceedings that the following matters are true: PARTIES l. Kimberly Kirchmeyer (?complainant?) is the Executive Director of the Medical - Board of California, Department ofConsumer Affairs (?Board?). She brought this action solely in her of?cial capacity and is represented in this matter by Kamala D. Harris, Attorney General of the State ofCalifornia, by Tessa L. Heunis, Deputy Attorney General. 2. Respondent Ramon F. Fakhoury, M.D. (?respondent?) is represented in this proceeding by attorney Courtney Pilchman, Esq., whose address is: Courtney Pilchman, Esq, Pilchman and Kay, 2030 Main St. #1300, Irvine, CA 92614. 1 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-201 1-216645) about February 1, 2007, the Board issued Physician?s and Surgeon?s Certi?cate No. A 98772 to respondent. The Physician?s and Surgeon?s Certi?cate was in full force and effect at all times relevant to the charges and allegations brought in Accusation No. 09-201 1- 216645 and will expire on June 30, 2016, unless renewed. JURISDICTION 4. On October 5, 2011, Accusation No. 09-2011?216645 was ?led before the Board and is currently pending against respondent. A true and correct copy of Accusation No. 09?201 1- 216645 and all other statutorily required documents were properly served on respondent on October 5, 2015. Respondent timely ?led his Notice of Defense contesting the Accusation. A true and correct copy of Accusation No. 09-201 1-216645 is attached hereto as Exhibit A and incorporated herein by this reference as if fully set forth herein. ADVISEMENT AND WAIVERS 5. Respondent has carefully read, fully discussed with counsel, and fully understands the charges and allegations in Accusation No. 09-201 1-216645. Respondent has also carefully read, fully discussed with counsel, and fully understands the effects ofthis Stipulated Settlement and Disciplinary Order. 6. Respondent is fully aware of his legal rights in this matter, including the right to a hearing on the charges and allegations in the 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 1 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. 7. Respondent voluntarily, knowingly, and intelligently waives and gives up each and every right set forth above. CULPABILITY 8. Respondent understands and agrees that the charges and allegations contained in Accusation No. 09-2011-216645, if proven at a hearing, constitute cause for imposing discipline upon his Physician?s and Surgeon?s Certi?cate No. A 98772. 2 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09?20l1-216645) For the purpose of resolving the Accusation without the expense and uncertainty of further proceedings, and without making any admissions to the allegations contained in Accusation No. 09?2011-216645, respondent hereby gives up his right to contest those charges. 10. Respondent agrees that his Physician?s and Surgeon?s Certificate No. A 98772 is subject to discipline and he agrees to be bound by the Board?s probationary terms as set forth in the Disciplinary Order below. 1 1. Respondent agrees that if he ever petitions for early termination of probation or modification of probation, or if the Board ever petitionsfor revocation of probation, he will not contest any ofthe charges and allegations contained in Accusation No. 09-201 1?216645 for purposes of any such proceeding or any other licensing proceeding involving respondent in the State of California. RESERVATION 12. The Stipulated Settlement and Disciplinary Order entered into by respondent herein is only for the purposes of this proceeding, or any other proceedings in which the Board or other professional licensing agency is involved, and shall not be admissible in any other criminal or civil proceeding. CONTINGENCY 13. This Stipulated Settlement and Disciplinary Order shall be subject to approval of the Board. The parties agree that this Stipulated Settlement and Disciplinary Order shall be submitted to the Board for its consideration in the above-entitled matter and, further, that the Board shall have a reasonable period oftime in which to consider and act on this Stipulated Settlement and Disciplinary Order after receiving it. By signing this stipulation, respondent fully understands and agrees that he may not withdraw his agreement or seek to rescind this stipulation prior to the time the Board considers and acts upon it. 14. The parties agree that this Stipulated Settlement and Disciplinary Order shall be null and void and not binding upon the parties unless approved and adopted by the Board, except for this paragraph, which shall remain in full force and effect. Respondent fully understands and agrees that in deciding whether or not to approve and adopt this Stipulated Settlement and Disciplinary Order, the 3 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-201 1?216645) Board may receive oral and written communications from its staff and/or the Attorney General?s Of?ce. Communications pursuant to this paragraph shall not disqualify the Board, any member thereof, and/or any other person from future participation in this or any other matter affecting or involving respondent. In the event that the Board does not, in its discretion, approve and adopt this Stipulated Settlement and Disciplinary Order, with the exception ofthis paragraph, it shall not become effective, shall be of no evidentiary value whatsoever, and shall not be relied upon or introduced in any disciplinary action by either party hereto. Respondent further agrees that should this Stipulated Settlement and Disciplinary Order be rejected for any reason by the Board, I respondent will assert no claim that the Board, or any member thereof, was prejudiced by its/his/her review, discussion and/or consideration ofthis Stipulated Settlement and Disciplinary Order or of any matter or matters related hereto. ADDITIONAL PROVISIONS IS. This Stipulated Settlement and Disciplinary Order is intended by the parties herein to be an integrated writing representing the complete, final and exclusive embodiment of the agreements of the parties in the above?entitled matter. 16. The parties agree that copies of this Stipulated Settlement and Disciplinary Order, including copies ofthe signatures of the parties, may be used in lieu of original documents and . signatures and, further, that such copies shall have the same force and effect as originals. 17. In consideration ofthe foregoing stipulations, the parties agree the Board may, without further notice to or opportunity to be heard by respondent, issue and enter the following Disciplinary Order: DISCIPLINARY ORDER IT IS HEREBY ORDERED that Physician?s and Surgeon?s Certificate No. A 98772 issued to Respondent RAMON F. FAKHOURY, M.D. (Respondent) is revoked. However, the revocation is stayed and respondent is placed on probation for thirty?five (35) months from the effective date ofthe Board?s Decision in this matter on the following terms and conditions. I. MEDICAL RECORD KEEPING COURSE. Within 60 calendar days ofthe effective date ofthis Decision, respondent shall enroll in a course in medical record keeping equivalent to 4 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09?2011-216645) the Medical Record Keeping Course offered by the Physician Assessment and Clinical Education Program, University of California, San Diego School of Medicine (Program), approved in advance by the Board or its designee. Respondent shall provide the program with any information and documents that the Program may deem pertinent. Respondent shall participate in and successfully complete the classroom component of the course not later than six (6) months after respondent?s initial enrollment. Respondent shall successfully complete any other component of the course within one (1) year of enrollment. The medical record keeping course shall be at 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 Accusation, but prior to the effective date ofthe Decision may, in the sole discretion of the Board or its designee, be accepted towards the ful?llment 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. 1 Respondent shall submit a certi?cation 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 ofthe Decision, whichever is later. 2. PROFESSIONALISM PROGRAM (ETHICS COURSE). Within 60 calendar days of the effective date of this Decision, respondent shall enroll in a professionalism program, that meets the requirements of Title 16, California Code of Regulations (CCR) section 1358. Respondent shall participate in and successfully complete that program. Respondent shall provide any information and documents that the program may deem pertinent. Respondent shall successfully complete the classroom component ofthe program not later than six (6) months after respondent?s initial enrollment, and the longitudinal component of the program not later than the time speci?ed by the program, but no later than one (1) year after attending the classroom component. The professionalism program shall be at respondent?s expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure. A professionalism program taken after the acts that gave rise to the charges in the 5 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-201 1-216645) 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 ful?llment of this condition ifthe program would have been approved by the Board or its designee had the program been taken after the effective date of this Decision. Respondent shall submit a certification of successful completion to the Board or its designee not later than 15 calendar days after successfully completing the program or not later than 15 calendar days after the effective date of the Decision, whichever is later. 3. PROFESSIONAL BOUNDARIES PROGRAM. Within 60 calendar days from the effective date of this Decision, respondent shall enroll in a professional boundaries program equivalent to the Professional Boundaries Program offered by the Physician Assessment and Clinical Education Program at the University of California, San Diego School of Medicine (?Program?). Respondent, at the Program?s discretion, shall undergo and complete the Program?s assessment of respondent?s competency, mental health and/or performance, and at minimum, a 24 hour program of interactive education and training in the area of boundaries, which takes into account data obtained from the assessment and from the Decision(s), Accusation(s) and any other information that the Board or its designee deems relevant. The Program shall evaluate respondent at the end of the training and the Program shall provide any data from the assessment and training as well as the results of the evaluation to the Board or its designee. Failure to complete the entire Program not later than six (6) months after respondent?s initial enrollment shall constitute a violation of probation unless the Board or its designee agrees in writing to a later time for completion. Based on respondent?s performance in and evaluations from the assessment, education, and training, the Program shall advise the Board or its designee of its recommendation(s) for additional education, training, and other measures necessary to ensure that respondent can practice medicine safely. Respondent shall comply with Program recommendations. At the completion ofthe Program, respondent shall submit to a final evaluation. The Program shall provide the results ofthe evaluation to the Board or its designee. The professional boundaries program shall be at respondent?s expense and shall be in addition to 6 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-2011-216645) the Continuing Medical Education (CME) requirements for renewal of licensure. The Program has the authority to determine whether or not respondent successfully completed the Program. A professional boundaries course taken after the acts that gave rise to the charges in the 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 ful?llment ofthis 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. lf respondent fails to complete the Program within the designated time period, respondent shall cease the practice of medicine within three (3) calendar days after being notified by the Board or its designee that respondent failed to complete the Program. 4. COMMUNICATION COURSE. Within 60 calendar days of the effective date of this Decision, respondent shall enroll in a clinician-patient communication course equivalent to the Clinician-Patient Communication Course offered by the Physician Assessment and Clinical Education Program, University of California, San Diego School of Medicine (Program), approved in advance by the Board or its designee. Respondent shall provide the Program with any information and documents that the Program may deem pertinent. Respondent shall participate in and successfully complete the course not later than six (6) months after respondent?s initial enrollment. The clinician?patient communication course shall be at respondent?s expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure. A clinician?patient communication course taken after the acts that gave rise to the charges in the 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 ful?llment ofthis condition if the course would have been approved by the Board or its designee had the course been taken after the effective date ofthis Decision. 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 7 SETTLEMENT AND DISCIPLINARY ORDER (09-201 1-216645) calendar days after the effective date of the Decision, whichever is later. 5. THIRD PARTY CHAPERONE. During probation, respondent shall have a third party chaperone present while consulting, examining or treating female patients. Respondent shall, within 30 calendar days of the effective date of the Decision, submit to the Board or its designee for prior approval name(s) of persons who will act as the third party chaperone. lf respondent fails to obtain approval of a third party chaperone within 60 calendar days of the effective date ofthis Decision, respondent shall receive a notification from the Board or its designee to cease the practice of medicine within three (3) calendar days after being so notified. Respondent shall cease the practice of medicine until a chaperone is approved to provide monitoring responsibility. Each third party chaperone shall sign (in ink or electronically) and date each patient medical record at the time the chaperone?s services are provided. Each third party chaperone shall read the Decision(s) and the Accusation(s), and fully understand the role ofthe third party chaperone. Respondent shall maintain a log of all patients seen for whom a third party chaperone is required. The log shall contain the: 1) patient initials, address and telephone number; 2) medical record number; and 3) date of service. Respondent shall keep this log in a separate file or ledger, in chronological order, shall make the log available for immediate inspection and copying on the premises at all times during business hours by the Board or its designee, and shall retain the log for the entire term of probation. Respondent is prohibited from terminating employment ofa Board-approved third party chaperone solely because that person provided information as required to the Board or its designee. Ifthe third party chaperone resigns or is no longer available, respondent shall, within 5 calendar days of such resignation or unavailability, submit to the Board or its designee, for prior approval, the name ofthe person(s) who will act as the third party chaperone. 1f respondent fails to obtain approval of a replacement chaperone within 60 calendar days of the resignation or unavailability of the chaperone, respondent shall receive a notification from the Board or its 8 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-2011-216645) designee to cease the practice of medicine within three (3) calendar days after being so noti?ed. Respondent shall cease the practice of medicine until a replacement chaperone is approved and assumes monitoring responsibility. 6. NOTIFICATION. Within seven (7) days of the effective date of this Decision, respondent shall provide a true copy of this Decision and Accusation to the Chief of Staff or the Chief Executive Officer at every hospital where privileges or membership are extended to respondent, at any other facility where respondent engages in the practice of medicine, including all physician and locum tenens registries or other similar agencies, and to the Chief Executive Officer at every insurance carrier which extends malpractice insurance coverage to respondent. Respondent shall submit proof of compliance to the Board or its designee within 15 calendar days. This condition shall apply to any change(s) in hospitals, other facilities or insurance carrier. 7. OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules governing the practice ofmedicine in California and remain in full compliance with any court ordered criminal probation, payments, and other orders. 8. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations under penalty of perjury on forms provided by the Board, stating whether there has been compliance with all the conditions of probation. Respondent shall submit quarterly declarations not later than 10 calendar days after the end of the preceding quarter. 9. GENERAL PROBATION REQUIREMENTS. Compliance with Probation Unit Respondent shall comply with the Board?s probation unit and all terms and conditions of this Decision. Address Changes Respondent shall, at all times, keep the Board informed of respondent?s business and residence addresses, email address (if available), and telephone number. Changes of such addresses shall be immediately communicated in writing to the Board or its designee. Under no 9 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-201 1?216645) circumstances shall a post office box serve as an address of record, except as allowed by Business and Professions Code section 2021(b). Place of Practice Respondent shall not engage in the practice of medicine in respondent?s or patient?s place of residence, unless the patient resides in a skilled nursing facility or other similar licensed facility. License Renewal Respondent shall maintain a current and renewed California physician?s and surgeon?s license. Travel or Residence Outside California Respondent shall immediately inform the Board or its designee, in writing, of travel to any areas outside the jurisdiction of California which lasts, or is contemplated to last, more than thirty (30) calendar days. In the event respondent should leave the State of California to reside or to practice, respondent shall notify the Board or its designee in writing 30 calendar days prior to the dates of departure and return. 10. INTERVIEW WITH THE BOARD OR ITS DESIGNEE. Respondent shall be available in person upon request for interviews either at respondent?s place of business or at the probation unit office, with or without prior notice throughout the term of probation. 1 l. WHILE ON PROBATION. Respondent shall notify the Board or its designee in Writing within 15 calendar days of any periods of non?practice lasting more than 30 calendar days and within 15 calendar days of respondent?s return to practice. Non-practice is defined as any period oftime respondent is not practicing medicine in California as defined in Business and Professions Code sections 2051 and 2052 for at least 40 hours in a calendar month in direct patient care, clinical activity or teaching, or other activity as approved by the Board. All time spent in an intensive training program which has been approved by the Board or its designee shall not be considered non-practice. Practicing medicine in another state of the United States or Federal jurisdiction while on probation with the medical licensing authority of that state or 10 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09-2011-216645) jurisdiction shall not be considered non-practice. A Board-ordered suspension of practice shall not be considered as a period of non?practice. In the event respondent?s period of non?practice while on probation exceeds 18 calendar months, respondent shall successfully complete a clinical training program that meets the criteria of Condition 18 of the current version ofthe Board?s ?Manual of Model Disciplinary Orders and Disciplinary Guidelines? prior to resuming the practice ofmedicine. Respondent?s period of non-practice while on probation shall not exceed two (2) years. Periods of non-practice will not apply to the reduction of the probationary term. Periods of non-practice will relieve respondent of the responsibility to comply with the probationary terms and conditions with the exception of this condition and the following terms and conditions of probation: Obey All Laws; and General Probation Requirements. 12. COMPLETION OF PROBATION. Respondent shall comply with all financial A obligations restitution, probation costs) not later than 120 calendar days prior to the completion of probation. Upon successful completion of probation, respondent?s certificate shall be fully restored. l3. VIOLATION OF PROBATION. Failure to fully comply with any term or condition of probation is a violation of probation. If respondent violates probation in any respect, the Board, after giving respondent notice and the opportunity to be heard, may revoke probation and carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke Probation, or an Interim Suspension Order is filed against respondent during probation, the Board shall have continuingjurisdiction until the matter is final, and the period of probation shall be extended until the matter is final. 14. LICENSE SURRENDER. Following the effective date ofthis Decision, if respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy the terms and conditions of probation, respondent may request to surrender his or her license. The Board reserves the right to evaluate respondent?s request and to exercise its discretion in determining whether or not to grant the request, or to take any other action deemed appropriate and reasonable under the circumstances. Upon formal acceptance ofthe surrender, respondent 11 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (09?201 1-216645) n1 melh 30 Izm mum-J Hum rm; aim? within l3 oulmulm' slnyu \?mllol um! In Um ?mud or Ila \lmluuw mu! mamuuleul Ilu itmw? [Irnmluu mmllulno. will nu In; nubjwl Ilw mum and ll?rmupuudnnl alums?: "Jr a mmliml Hm 3:th l-n Imuml m: ponuun I'm? ul'n unrll?cuw. H. l?liLth?'lUN ulmn my the com Uh nmullmlug mum mul (wary your orpruhmlun. un by ljumd, which um ho tullunlml uu nu ?mum! hnalm Such 0mm hhull hn puyuhlu In tho Board and to 1hr: Dunn! [w uu law? January 11 ufnnuh ycur. have road the Stlpulnlmi and Order and have fully abandon it wilh my nllunmy. (L?nmluuy l?llohmuu. Euq I fully uudct?hlund (31 and 1h: Mfmel i! on my l?lwalmnu's null Hurguou'a Cerll?unlu A I an inm Ihlu \?puinlml mul Unlnr voluntarily. and agree Urdcl Lil MULUOHI by? -- erML cab 1 In W. ?(and and ?My dlsuusuml with RAMON I7. FAKI-IOURY. MD. the (arms and mullunua mu! olhm' Innuors lu Hm above Simulated and Urdu. 1 H3 fonn uncl comm: mum: 3h! [lbw nguilg? if (g 9m MW mMm? . - mummy fer Respondent SETTLEMENT AND 01mm (09-2011-216645) 2' ENDORSEMENT The tin-gigging Siipulatcd and Disciplimry Order is respectfully Submitted for consideration by Medical 01?Cfaiili:rniu. Dated: 3! My 2% chpectl?uliy Ki-mmgx If). HARRES .z?Xt'zomcy 01" Calitmrzizi ALEXANDRA M. ALVAMZ Supervising Deputy Attorney Genera} 'I'r?szsix L. Haumg Deputy Attorney Genm?ai C'unzlz'zlairzczi-zf 33 m0 ORDER cam?2i): l-Z 1662,43; Exhibit A Accusation N0. 09?2011?216645 KAMALA D. HARRIS Attorney General of California FELED THOMAS S. LAZAR STATE OF CAUFDRMA Supervising Deputy Attorney General MEDECAL aoann 0F - TESSA L. Heums (Dea??eam 5; A?g? Deputy Attorney General We cl!? State Bar No. 241559 110 West Street, Suite 1100 San Diego, CA 92101 13.0. Box 85266 San Diego. CA 92186?5266 Telephone: (619) 645?2074 Facsimile: (619,) 645?2061 Complainant . BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Aecusation Against: Case No. 09-20] 1316645 RAMON F. MD. 1780 Town and Country D11. Ste. 103 Noreo,CA92860 ACCUSATION Physician's and Surgeon's Certi?cate No. A 98772 Respondent. Complainant alleges: PARTIES . Linda K. Whitney (Complainant) brings this Accusation solely in her of?cial capacity as the Executive Director of the Medical Board of Calilbrnia, Department of Consumer Affairs. 2. On or about February la 2007, the Medical Board of California issued Physician?s and Surgeon?s Certi?cate Number A 98772 to lU?xM ON F. FAKHOURY, MD. (Respondent). 'l?he Physician?s and Surgeon's Certificate was in full force and effect at all times relevant to the charges brought herein and will expire on lune 30, 2012, unless renewed. Accusation JURISDICTION 3. This Accusation is brought before the Medical Board of California, Department of Consumer Affairs (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 ofthe Code states: A licensee whose matter has been heard by an administrative law judge of the Medical Quality Hearing Panel as designated in Section 1 1371 of the Government Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinaiy action with the division, 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. 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. . 5. Section 2234 of the Code states: ?The Division of Medical Qualityl 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: California Business and Professions Code section 2002, as amended and effective January 1, 2008, provides that, unless otherwise expressly provided, the term ?board? as used in the State Medical Practice Act (Bus. Prof. Code, 2000, et seq.) means the ?Medical Board of California,? and references to the ?Division of Medical Quality? and ?Division of Licensing? in the Act or any other provision oflaw shall be deemed to refer to the Board. 2 Accusation Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter [Chapter 5, the Medical Practice Act]. 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. LC Any action or conduct which would have warranted the denial of a certi?cate. 6. Section 726 of the Code states: ?The commission of any act of sexual abuse, misconduct, or relations with a patient, client, or customer constitutes unprofessional conduct and grounds for disciplinary action for any person licensed under this division,[2] under any initiative act referred to in this division and under Chapter 17 (commencing with Section 9000) of Division 3. CC 5? 2 Section 726 is located within Division 2 ofthe Business and Professions Code. Accusation Section 2266 ofthe 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.? 8. Unprofessional conduct under California Business and Professions Code section 2234 is conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming a member in good standing of the medical profession, and which demonstrates an unfitness to practice medicine. (Shea v. Board Qf?MedicaZ Examiners (1978) 81 Cal. App.3d 564, 575.) FIRST CAUSE FOR DISCIPLINE (Sexual Abuse and/or Misconduct with Patient) 9. Respondent is subject to disciplinary action under section 726 of the Code in that he committed an act or acts of sexual abuse, misconduct or relations with patients R.K., C.G., TE. and MC.3 The circumstances are as follows: 10. Between on or about June 11, 2011 and on or about July 9, 2011, respondent was employed by the Lorna Linda University Faculty Medical Group and working as a physician in the Urgent Care clinic on the East Campus (?Urgent Care?). 1 11. Patient R.K. A. On or about June 1 l, 201 1, patient R.K. injured her leg and went to Urgent Care to have her severely swollen, bruised left leg X?rayed and treated. B. After getting undressed and having X?rays taken, patient R.K. waited in her curtained?off cubicle for the doctor to arrive. She was dressed in a hospital gown and panties. C. Respondent arrived and started examining her injured leg. According to patient estimate, the obviously injured area stretched from roughly ten inches below patient R.Kis left knee to about one foot above it, along the outside of the leg. Respondent ran his hands up and down the injured area, pressing with his thumbs, apparently checking muscles and ligaments (and other soft tissue) for possible injury. 3 In order to protect their privacy, patients are identified in this Accusation by their initials only. Respondent is aware oftheir true identities. Accusation Respondent also had patient R.K. stand up and continued his thumb?pressing motions on patient neck and shoulders. Respondent would press hard with his thumbs and then release the pressure, which relieved some of the pain and tension R.K. was feeling in those areas. Patient R.K. sat down again and respondent continued his examination. Throughout the examination, respondent would ask patient R.K. questions like, ?how does this feel?? and ?does this hurt?? . E. During the course of the examination, respondent repeatedly moved his hands to patient crotch. He pressed on her pubic bone and all around her vaginal area, as close to her vaginal opening as he could get without touching or penetrating it. At the same time, respondent would ask questions, like ?how does this feel?? and ?does it hurt here?? F. The ?rst time respondent put his hands in her crotch, patient R.K. told him that it did not hurt there, and respondent moved his hands away of his own accord. After that, respondent repeatedly and intermittently returned to feel and press on patient vaginal area, ignoring her repeated insistence that it did not hurt there. Patient R.K. repeatedly took respondent?s hands away from her crotch and placed them on an area where she was actually feeling pain. Soon, respondent would quickly move his hands back to patient crotch again. Patient R.K. estimates that this happened approximately a dozen times, and states that she admonished respondent in a progressively louder voice. G. After the examination was concluded, respondent discharged patient R.K. with a prescription for pain medication and reported no ?ndings of any fractures. H. Soon after patient R.K. had left Urgent Care, respondent called patient R.K. on her cell phone and told her that, on further re?ection, it seemed she had a fracture of her ?bula. Respondent asked patient R.K. whether she would be willing to return inside for a cast, to which she agreed. Patient R.K. went back into the Urgent Care and was fitted with a cast by one of the other Urgent Care employees. I. In patient medical records for this visit, the section marked ?genitalia? makes no mention of any examination or other inspection and/or ?ndings by respondent, and respondent?s notes and/or ?ndings in those medical records are otherwise partly illegible. 5 Accusation 12. Patient C.G. A. Patient C.G. suffers from diabetes, which makes her somewhat susceptible to urinary tract infections On or about June 30, 201 1, patient C.G. felt and recognized the familiar of a and went to Urgent Care for diagnosis and treatment. Her four year - old granddaughter was with her. B. After checking in and being triaged, patient C.G. was shown into a room where she and her granddaughter waited for the doctor to arrive. Patient C.G. remained fully clothed and there was no female chaperone present. C. After a while, respondent arrived and asked patient .G. what her complaint was. Patient CG. informed reSpondent that she had a suspected UTI. D. Respondent stood directly in front of patient CG. and told her to stand up. When she was standing in front of him, he stretched out his hand, cupping her crotch. Respondent asked, ?does it hurt here?? Patient C.G. replied that it did not. B. Respondent then pushed his hand further between patient legs and, with one or more ?ngers bent upwards, pushed his hand up so that his ?nger(s) penetrated patient vaginal opening through her clothes. He asked, ?does this hurt?? Patient C.G. replied that it did, since respondent was hurting her. F. Respondent removed his hand and pushed it further backwards, towards patient rectum. Respondent again pushed his hand up as though he was pushing his ?nger(s) into her rectum. Respondent asked patient C.G. whether it hurt where he was pressing, and patient C.G. told him he was too far back. Respondent brought his hand forward and again pushed his hand and ?nger(s) up into patient vagina. Throughout this period that respondent was touching patient crotch and rectal area, he repeatedly asked patient CG. whether it hurt where he was touching. G. Respondent also reached up and squeezed patient breasts. He asked, ?does this hurt?? and she answered, ?no, but what does this have to do with a Respondent told her to let him do his job. Accusation After the physical examination, patient CG. was asked to produce a urine sample, which she did. After testing, it was confirmed that patient CG. had a for which respondent prescribed medication and advised the patient to increase her ?uids. 1. In patient medical records for this visit, the section marked ?genitalia? makes no mention of any examination or other inspection and/or ?ndings by respondent, and respondent?s notes and/or ?ndings on those medical records are otherwise partly illegible. 13. Patient T.E. A. Patient TE. reported to Urgent Care on or around the evening of July 8, 201 1, with an in?amed gallbladder. Recent prior treatment and ultrasound examinations had revealed the presence of gallstones, which were once again causing patient T.E. distress. B. After being initially triaged, patient T.E. was shown to an examination cubicle. At the nurse?s instructions, she undressed her upper body, put on the gown which had been provided to her and waited for the doctor to come see her. Respondent then arrived. C. After asking initial questions and ordering certain tests, respondent told patient TE. to remove her pants and underwear so he could perform a rectal examination. Patient TE. duly undressed while respondent remained standing at her side, facing her. D. Respondent instructed patient TE. to lie on her side, with her one knee bent and the other leg extended, which she did. E. Respondent then spread patient labia before inserting his finger or fingers into her vagina and then into her rectum. While respondent?s finger was in her rectum, patient T.E. felt his other fingers lying across her labia. F. Patient chart for this visit shows that respondent?s assessments included abdominal pain with a history of cholelithiasis,4 cough and hypothyrodisim. His plans included providing patient TE. with Emergency Room precautions, a nebulizer treatment and a follow up with her primary care physician in 3 days. 4 Gallstones. Accusation Respondent failed to document in patient medical records that he performed a genitalia examination on patient TE. on July 8, 201 1. 14. Patient MC. A. Patient MC. had abscesses on her upper inner thighs which were incised and drained at Urgent Care, for the first time, on or about July 5, 2011. She was told to return to Urgent Care for wound treatment every 48 hours, until the wounds had healed. B. On or about July 9, 2011, patient MC. returned to Urgent Care for wound treatment and was seen by respondent. When respondent arrived at the examination room, he instructed patient MC. to lie on her back with her legs raised and bent at the knees, and told her not to remove her panties. C. Patient husband, GC., was present in the room, seated on a chair at the head of the bed. No female chaperone was in attendance. D. Patient medical records for this visit indicate that respondent?s assessments of her condition included right and left thigh abscesses. His plans included irrigating and repacking a wound and requesting that patient MC. continue her Bactrirn (antibiotic), and return to her primary care physician for wound care. E. During the course of his treatment of patient M.C., respondent pulled her panties to one side, spread her labia and informed her she had a vaginal yeast infection. Respondent showed patient exposed vaginal area to GC. Respondent then touched and played with patient vagina and labia as if deliberately trying to sexually stimulate her to the point of an orgasm. F. In patient medical records for this visit, the section marked ?genitalia? makes no mention of any examination or other inspection and/or ?ndings by respondent, and respondent?s notes and/or ?ndings in those medical records are otherwise partly illegible. Accusation SECOND CAUSE FOR DISCIPLINE (Gross Negligence) 15. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by section 2234, subdivision of the Code, in that he committed an act or acts of gross negligence in his care and treatment of patients R.K., C.G., TE. and MC. The circumstances are set forth in paragraphs 10 through 14, above, which are hereby incorporated by reference as if fully set forth herein. 16. On or about June 11, 2011, respondent was grossly negligent in his care and treatment of patient R.K., which included, but was not limited to, the following: A. Respondent performed a genitalia examination on patient R.K. without the presence of a female chaperone. B. Respondent performed a genitalia examination on patient R.K. not medically indicated by her history or physical examination ?ndings, and/ or without diagnostic bene?t. 17. On or about June 30, 2011, respondent was grossly negligent in his care and treatment of patient C.G., which included, but was not limited to, the following: A. Respondent performed a breast and/or genitalia examination on patient C.G. without the presence of a female chaperone. B. Respondent performed a genitalia examination on patient C.G. not medically indicated by her history or physical examination ?ndings, and/ or without diagnostic bene?t. C. Respondent touched, squeezed and/or otherwise handled patient breasts in a manner which was neither medically indicated by her history and physical examination ?ndings, nor did it have diagnostic bene?t. 18. On or about July 8, 201 1, respondent was grossly negligent in his care and treatment of patient T.E., which included, but was not limited to, the following: A. Respondent performed a genitalia examination on patient TE. not medically indicated by her history or physical examination findings and/or without diagnostic bene?t. 19. On or about July 9, 2011, respondent was grossly negligent in his care and treatment of patient M.C., which included, but was not limited to, the following: 9 Accusation Respondent performed a genitalia examination on patient MC. without the presence of a female chaperone. B. Respondent performed a genitalia examination on patient MC. not medically indicated by her history or physical examination ?ndings, and/or without diagnostic bene?t. THIRD CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 20. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by sections 2234(0), of the Code, in that he committed repeated negligent acts in his care and treatment of patients R.K., C.G., TE. and MC. The circumstances are set forth in Paragraphs 10'through 19, above, which are hereby incorporated by reference as if fully set forth herein. 21. Respondent committed repeated negligent acts in his care and treatment of patients R.K., C.G., TE. and MC., which include, but are not limited to, the following: A. Respondent performed a genitalia examination on patient R.K. without the presence of a female chaperone. B. Respondent performed a genitalia examination on patient R.K. not medically indicated by her history or physical examination ?ndings, and/or without diagnostic bene?t. C. Respondent failed to ask patient R.K. for her permission to perform the genitalia examination. D. Respondent performed a breast and genitalia examination on patient C.G. without the presence ofa female chaperone. E. Respondent performed a genitalia examination on patient C.G. not medically indicated by her history or physical examination ?ndings, and/ or without diagnostic bene?t. F. Respondent touched, squeezed and/or otherwise handled patient breasts in a manner which was neither medically indicated by her history and physical examination ?ndings, nor did it have diagnostic bene?t. G. Respondent failed to ask Patient C.G. for her permission to perform the genitalia and/or breast ?examination?. 10 Accusation Respondent performed a genitalia examination on patient T.E. not medically indicated by her history or physical examination findings and/or without diagnostic bene?t. 1. Respondent failed to ask patient TE. for her permission to perform the genitalia examination. .1. Respondent performed a genitalia examination on patient MC. without the presence of a female chaperone. K. Respondent performed a genitalia examination on patient MC. not medically indicated by her history or physical examination findings, and/ or without diagnostic benefit. L. Respondent failed to ask patient MC. for her permission to perform the genitalia examination. M. Respondent failed to document in patient medical records that he performed a genitalia examination on patient R.K. on June 11, 2011. N. Respondent?s notes and/or ?ndings as recorded by him in patient medical records for June 11, 2011 are illegible in part. 0. Respondent failed to document in patient medical records that he performed a genitalia and/or breast examination on patient CG. on June 30, 2011. P. Respondent?s notes and/or findings as recorded by him in patient medical records for June 30, 201 are illegible in part. Q. Respondent failed to document in patient medical records that he performed a genitalia examination on patient T.E. on July 8, 201 l. R. Respondent failed to document in patient C.?s medical records that he performed a genitalia examination on patient MC. on July 9, 2011. S. Respondent?s notes and/or findings as recorded by him in patient medical records for July 9, 2011 are illegible in part. ii Accusation FOURTH CAUSE FOR DISCIPLINE (Failure to Maintain Adequate and Accurate Medical Records) 22. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by sections 2266, of the Code, in that he failed to maintain adequate and accurate records relating to the provision of services to his patients. The circumstances are set forth below. 23. Paragraphs 10 through 14, above, are hereby incorporated by reference as if fully set forth herein. 24. Respondent failed to document in patient medical records that he performed a genitalia examination on patient R.K. on June 1 1, 201 1. 25. Respondent?s notes and/or ?ndings as recorded by him in patient medical records for June 11, 2011 are illegible in part. 26. Respondent failed to document in patient medical records that he performed a genitalia and/or breast examination on patient CG. on June 30, 201 1. 27. Respondent?s notes and/or ?ndings as recorded by him in patient medical records for June 30, 2011 are illegible in part. 28. Respondent failed to document in patient medical records that he performed a genitalia examination on patient TE. on July 8, 2011. 29. Respondent failed to document in patient medical records that he performed a genitalia examination on patient M.C. on July 9, 2011. 30. Respondent?s notes and/or ?ndings as recorded by him in patient medical records for July 9, 2011 are illegible in part. FIFTH CAUSE FOR DISCIPLINE (General Unprofessional Conduct) 31. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by section 2234, in that he has engaged in conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming of a member in good standing of the medical profession, and which demonstrate an un?tness to practice medicine, as more 12 ., Accusation particularly alleged in paragraphs 10 through 30, above, which are hereby incorporated by reference 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 Certi?cate Number A 98772, issued to respondent RAMON F. FAKHOURY, 2. Revoking, suspending or denying approval of respondent RAMON F. FAKHOURY, M.D.'s authority to supervise physician's assistants, pursuant to section 3527 of the Code; 2. Ordering respondent RAMON F. AKHOURY, M.D., if placed on probation, to pay the Medical Board of California the costs of probation monitoring; and 3. Taking such other and further action as deemed necessary and proper. DATED: Oddbu' 5) 2011 {Lav LINDA K. WHITNEY Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant SD2011801148 80552830.doe l3 Accusation