XAVIER BECERRA Attorney ,General of California STEVEN D. MUNI Supervising Deputy Attorney General DEMOND L. PHILSON Deputy Attorney General State Bar No. 220220 1300 I Street, Suite 125 PO. Box 944255 Sacramento, CA 94244-2550 Telephone: (916) 210-7548 Facsimile: (916) 327-2247 Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: John Courtney Dozier, M.D. PO. Box 1726 Susanville, CA 96130 Physician?s and Surgeon?s Certi?cate No. 46031, . Respondent. Case No. 800-2017-033164 A A I A Complainant alleges; PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this Accusati'on 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 September 16, 1981, the Medical Board issued Physician?s and Surgeon?s Certi?cate Number 46031 to John Courtney Dozier, M.D. (Respondent). The Physician?s and Surgeon?s Certi?cate was in full force and effect at all times relevant to the charges brought herein and will expire on May 31, 2019, unless renewed. 1 (JOHN COURTNEY DOZIER, M.D.) ACCUSATION NO. 800-201-7-033164 10JURISDICTION 3. This Accusation is brought before the Board, under the authority of the following laws. All section references are to the Business and Professions Code unless otherwise indiCated. 1 4. Section 2227 of the Code states: A licensee whose matter has been heard by an administrative law judge of the Medical Quality Hearing Panel as-designated in Section 11371 of the Government Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in accordance with the provisions of this chapter: I 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 cf probation monitoring upon order of the board. Be publicly reprimanded by the board. The public reprimand may inc1ude a requirement that the licensee complete relevant educational courses approved by the board. 1 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 except for warning letters, medical review or advisory conferences, professional competency examinations, continuing education activities, and cost reimbursementassociated 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 (JOHN COURTNEY DOZIER, MD.) ACCUSATION NO. 800-2017-033164 Section 2234 of the Code, states: I ?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: Violating or. attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. Gross negligence. I 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: i 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 changeIin the diagnosis, act, or A 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. Incompetence. The commission of any act involving dishonesty or corruption which is substantially related to the quali?cations, functions, or duties of a physician and surgeon. Any action or conduct which would have Warranted the denial of a certificate. The practice of medicine from this state into another state or country without meeting the legal requirements of that state or country for the practice of medicine. Section 2314 shall not apply to this subdivision.? This subdivision shall 3 (JOHN COURTNEY DOZIER, M.D.) ACCUSATION NO. 800-2017-033164 ?214th0become operative upon the implementation of the proposed registration program described in Section 2052.5. The repeated failure'by a certificate holder, in the absence of good cause, to attend and participate in an interview by the board. This subdivision shall only apply to a certi?cate holder who is the subject of aninvestigation by the board.? 6. Section 2241 ofthe Code states: A physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict under his or her treatment for a purpose other than maintenance on, or detoxi?cation from, prescription drugs or controlled substances. A physician and surgeon may prescribe, dispense, or administer prescription drugs or prescription controlled substances to an addict for purposes of maintenance on, or detoxi?cation from, prescription drugs or controlled substances only as set forth in subdivision (0) or in Sections 11215, 11217, 11217.5, 11218, 11219, and 11220 of the Health and Safety Code. Nothing in this subdivision shall authorize a physician and surgeon to prescribe, dispense, or administer dangerous i drugs or controlled substances to a person he or she knows or reasonably believes is using or will use the drugs or substances for a nonmedical purpose. Notwithstanding subdivision prescription drugs or controlled substances may also be administered or applied by a physician and surgeon, or by a registered nurse acting under his or her instruction and supervision, under the following circumstances: - Emergency treatment of a patient whose addiction is complicated by the presence of incurable disease, acute accident, illness, or injury, orthe in?rmities attendant upon age. Treatment of addicts in state-licensed institutions where thelpatient is kept under restraint and control, or in city or county jails or state prisons. 4 (JOHN COURTNEY-DOZIER, M.D.) ACCUSATION NO. 800-2017-033164 \Treatment of addicts as provided for by Section 11217.5 of the Health and Safety Code. For purposes of this section and Section 2241.5, ?addict? means a . person whose actions are characterized by craving incombination with one or more of the following: I Impaired control over drug use. Cdmpulsive uSe. Continued use despite harm. Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not an addict within the meaning of this section or Section 2241.5.? 7., Section 2242 of the 'Code statesf Prescribing, dispensing, or furnishing dangerous drugs as de?ned in Section 4022 without an appropriate prior examination and a medical indication, constitutes unprofessional conduct. - No licensee, shall be found to have committed unprofessional conduct within the meaning of this section'if, at the time the drugs were prescribed, dispensed, I or furnished, any of the following applies: The licensee was a designated physician and surgeon or podiatrist serving in the absence of the! patient?s physician and surgeon or podiatrist, as the case. may be, and if the. drugs were prescribed, dispensed, or furnished only as necessary to maintain the. patient until the return of his or her practitioner, but in any case no longer than 72 hours. The licensee transmitted the order for the drugs to a registered nurse or to a licensed vocational nurse in an inpatient facility, and if both of the following conditions exist: I I The practitioner had consulted with the registered nurse or licensed vocational nurse who had reviewed the patient?s records. 5 (JOHN COURTNEY ACCUSATION NO. 800-2017-033 164 - - .28 9-D.) The practitioner was designated as the practitioner to serve in the absence of the patient?s physician and surgeon or podiatrist, asthe case may be. A The licensee was a designated practitioner serving in the absence of the "patient?s physician and surgeon or podiatrist, as the case may be, and was in possession of or had utilized the patient?s records and ordered the renewal of a medically indicated prescription for an amount not exceeding the original prescription in strength or amount or for more than one re?ll. I The licensee was acting in accordance with Section 120582 of the Health, and Safety Code.? I 8, Section 2266 of the Code states: ?The failure of a physician and surgeon to maintain adequate and accurate recOrds relating to the provision of services to their patients constitutes unprofessional conduct.? FIRST CAUSE FOR DISCIPLINE (Gross Negligence) 9. Respondent is subject to disciplinary action under sections 2227 and 2234, as de?ned {by section 2234, subdivision of the Code, in that respondent committed. gross negligence in his care and treatment of Patient A1. The circumstances are as follows: 10. On or about March, 2017, the Medical Board of California (Board) reviewed the prescribing practices of Respondent to deceased patient A. Patient A?died of an overdose on June 17, 2012, as a result of Oxycodone intoxication. The Board learned Respondent had prescribed controlled medications, including Oxycodonez, to patient A leading up to her death. A Coroner?s Report from the Lassen County Sheriff?s Of?ce indicated that Patient A?s death was diie to oxycodone intoxication. Morbid obesity and hypertensive and atherosclerotic cardiovascular disease Vvere other signi?cant conditions. 1 The patient in the Accusation will be referred to as patient A. The identi?cation of the patient A will be disclosed to the Respondent during discovery. 2 Oxycodone, brand name OxyContin, is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, and a dangerous drug pursuant to Business and Professions Code section 4022. 6 (JOHN COURTNEY DOZIER, MD.) ACCUSATION NO. 800?20 17-033 164 Auto 11. Patient A was a 54-year-old female at the time that she started treating with Respondent. At that initial visit she was diagnosed as having hypertension, hypothyroidism, diabetes mellitus type II, depression, morbid obesity'and severe degenerative joint disease of the knees. She was taking multiple medications including Metformin3, Cozaars, Atenolol6, hydrochlorothiazide7, Halciong, Paxilg, Celebrexlo?, alprazolam11 1 mg per day and Norco12 10 mg 5 per day. Patient A was also on methadonel3 which was not noted on the initial visit of February 16, 2006?, but later was noted on her second visit of March 22, 2006. At that second visit it was noted that Patient A was on ?methadone tapering off?. 12. On December 8, 2008, Respondent noted in Patient A?s medical record that she had completed a ?rehabilitation program for prescription'drug addiction.? RespOndent also noted, Patient A was seeing a Dr.- B. in Reno and a counselor Dr. in Susanville. At that 3 Metformin is used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. 4 (levothyroxine) treats hypothyroidism (low thyroid hormone) and different types of g'oiters (enlarged thyroid gland). 5 Cozaar(losartan) is used to treat high blood pressure (hypertension) and to help protect the kidneys from damage due to diabetes 1 6 Atenolol, is a medication of the beta blockers type, primarily used to treat high blood pressure and angina. 7 Hydrochlorothiazide is used to treat ?uid retention (edema) that is caused by congestive heart failure, severe liver disease (cirrhosis), kidney disease, or treatment with a steroid or hormone medicine. 8 Halcion is a fast?acting benzodiazepine commonly prescribed for acute insomnia. .9 Paxil (paroxetine) is an antidepressant belonging to a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Paroxetine affects chemicals in the brain that may be unbalanced in people with depression, anxiety, or other disorders 10 Celebrex is a nonsteroidal anti-in?ammatory drug used to treat pain or in?ammation. ?1 Alprazolam is a benzodiazepine. Alprazolam affects chemicals in the brain that may be unbalanced in peeple with anxiety. Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression. Alprazolam 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. ?2 Norco (acetaminophen and hydrocodone) is used to relieve moderate to severe?pain. Norco (hydrocodone) 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. ,13 Methadone is a Schedule II controlled substance pursuantto Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. 14 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. 7 (JOHN COURTNEY DOZIER, M.D.) ACCUSATION NO. 800-2017-033164 point the PatientA was only taking Tylenol for pain. Respondent did not list substance abuse as a problem in his problem list. 13. On January 12, 2010, Patient A was ?worked in early?- for"?increasing pain with cold, damp weather?. Patient A had been using ibuprofen with inadequate pain control. The medical note states ?she has had trouble in the past with minor tranquilizers in combination with opiates but she states that her problems were actually more with the minor The medical note stated Patient A did tolerate Oxycodone reasonably well in the past. The medical note stated Patient A?s pain was in the shoulders, low back, hands and the big toes. It also stated, Patient A?s ?knees are doing relatively well but she has had bilateral knee replacements.? Respondent?s treatment plan indicated that he would start her back on opiates and ?monitor her closely?. Respondent reminded Patient A that ?since she had only a single kidney that .she should avoid nonsteroidal as much as possible.? Respondent gave her Tramadol 50 mg every 4 hours as needed for pain. Respondent also gave her Oxycodone 5/325 oneevery 6 hours as needed for pain not controlled by the Tramadol?. Respondent indicated he would be checking laboratory studies. 14. On February 17,2010, Respondent discontinued Patient A?s Tramadol and placed her on Oxchdone 5mg, two inithe morning and two at night. No laboratory'results were documented. 15. on March 19, 2010, no labs were documented and there was no discussion of the opiate treatment in Respondent?s medical note. 16. On September 21, 2010, no labs were documented but Respondent performed a back examination. Patient A was started on Alprazolam once again without mention of the prior problems she had with Alprazolam abuse previously noted in 2008 in Respondent?s records. The oxycodonewas increased to 5 mg or 2 every 6 hours. 7 i 17. On February 1, 2011, the patient was seen but there was no back or knee examination. Patient A was given a prescription for 30 days worth of alprazolam and OxyContini?. Respondent 15 Tramadol is a narcotic-like pain reliever. Tramadol is used to treat moderate to severe pain. . . 16 Oxycodone, brand name OxyContin, 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. 8 . (JOHN COURTNEY DOZIER, MD.) ACCUSATION NO. 800-2017?033 164 oo q?ox28' also gave Patient A 90 days of the same medications via mail order pharmacy. She was to return- for re-evaluatiOn in four months. 18. June 7, 2011, Respondent noted Patient A?s pain was ?controlled?. There was no back examination and no mention of the continuation of the pain medications. Respondent increased I Patient A?s prescription for Alprazolam due to stress from a numbero'f ?family. issues? mainly related to her son. 19. on July 7, 2011, Respondent saw Patient A-for follow up of spine pain and Chronic pain Patient A was taking Oxycontin 5 milligrams to be ID. The AlpraZolam was . decreased to 0.5 mg q6h. 20. On September 15, 2011, Respondent saw Patient A in follow-up for hospitalization for dehydration and acute renal failure. Respondent indicated in his medical note that the review of systems was positive for ?back pain and joint pain?. The musculoskeletal examination was normal without pain. Patient A?s examination demonstrated appropriate mood and affect. Respondent made a comment regarding the ?history of chronic pain due to multiple musculoskeletal problems?. In Respondent?s treatment plan he did not mention the chronic pain issues or musculoskeletal condition. For the anxiety state Respondent indicated the patient was A worse and that he would ?change directions for one month.? Respondent encouraged restarting of counseling. AlpraZolam and Oxycodone continued to belisted on the medication list. 21'. November 9, 201 1,.Respondent treated Patient A for chronic conditions including chronic pain. Respondent noted Patient A was reported to be functional on present analgesic . regimen without adverse effects or non-compliance or diversion. Respondent indicated he would no longer give 30-day bridging prescriptions. Medications were listed multiple times (Alprazolam X3 oxycodone X4). Respondent indicated Patient A was being Weaned off of opiates by the Respondent indicated that Patent A?s daughter was managing her regimen. I 22. On March 27, 2012, Respondent saw Patient for follow up of chronic conditions. Respondent noted that Patient A was being weaned off her benzodiazepines and she was being followed by Dr. B. in Reno, and she admitted to overuse of benzodiazepines, which led to a 9 . (J OI-DI COURTNEY DOZIER, M.D.) ACCUSATION NO. 800-2017-033164 family intervention four weeks before. Respondent also noted that Patient A was being'weaned off her oxycodone by her and she admits to overuse of prescription opiates. 23. On June 17, 2012, Patient A died. The coroner?s report ?ndings stated that the death of Patient A was due to oxycodone intoxication. Morbid obesity and hypertensive and atherosclerotic cardiovascular disease were other signi?cant conditions. 24. Respondent committed gross negligence in his care and treatment of Patient A, which included, but are not limited to, the following: Respondent departed from the standard of care by failing to coordinate Patient A?s care with the or a pain specialist; and, i Respondent departed from the standard of care by failing to closely monitor - Patient A with a known history of substance abuse with Alprazolam and oxycodone; and. (0) Respondent departed from the standard of care by failing to keep organized accurate and legible-medical records and his lacking of reference to his own medical records; and - Respondent departed from the standard of care by trusting Patient A with 960 5 mg oxycodone in one month due to her known history of substance abuse; and Respondent departed from the standard of care by restarting the prescription of Patient A?s alprazolam without consulting a or reviewing the prior medical records regarding the prior overuse of alprazolam. 25. Respondent?s conduct, as described above, constitutes gross negligence in the practice of medicine'in violation of section 2234(b) of the Code and thereby provides cause to discipline Respondent?s I SECOND CAUSE FOR (Repeated Acts of Negligence) 26. Respondent is subject 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. 27. Paragraphs 10 through 22 as more particularly alleged above, are hereby incorporated by reference. and realleged as if fully set forth herein. . 10 . (JOHN COURTNEY DOZIER, M.D.) ACCUSATION NO. 800-2017-033164 4kg; \1028. Respondent committed acts of repeated negligence in his care and treatment of patient A, which included, but are not limited to, the following: Respondent departed from the standard of care by failing to conduct a complete initial medical history and physical; and Respondent departed from the standard of care by failing to discuss the risks and benefits of treatment of pain with opiates as demonstrated by the lack of documentation of informed consent; and i (0) Respondent departed from the standard of care by poorly monitoring and record keeping to account for the actual amounts of Alprazolam the patient was taking. 29. Respondent?s conduct, as described above, constitutes repeated acts of negligence in the practice of medicine in violation of section the Code and thereby provides cause to discipline RespOndent?s license. I THIRD CAUSE FOR DISCIPLINE (Furnishing Drugs to an Addict) 30. Respondent'is subject to disciplinary action under sections 2227 and 2234, as de?ned I by section 2241, of the Code; in that respondent prescribed controlled substances and dangerous drugs to patient A, whom he .knew or reasonably should have known was using or would be using. the controlled substances and dangerous drugs for a nonmedical purpose, as more particularly alleged in paragraphs 10 through 22 above, which are hereby incorporated by reference and realleged as if fully set forth herein. FOURTH CAUSE FOR. DISCIPLINE - (Prescribing Controlled Substances Without Prior Examination) I 31. Respondent is subject to disciplinary action under sections 2227 and 2234, as de?ned by section 2242, of the Code, in that respondent prescribed controlled substances without an I prior examination and a medical indication in his care and treatment of patient A, as more particularly alleged in paragraphs 10 through 22 above, which are hereby incorporated by reference and realleged as if fully set forth herein. 1 1 . (JOHN COURTNEY DOZIER, M.D.) ACCUSATION NO. 800-2017-033164 FIFTH CAUSE FOR DISCIPLINE (Failure to Maintain Complete and Accurate Medical Records) - 32. Respondent is subject to disciplinary action under sections 2227 and 2234, as defined 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 10 through 22 above, which are hereby incorporated by reference and realleged as if fully set forth herein. I I 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 46031, issued to John Courtney Dozier, 2. Revoking, suspending or denying approval of John Courtney Dozier, authority to supervise physician assistants and advanced practice nurSes; Ordering John Courtney Dozier, M.D., ?if placed on probation, to pay the Board the costs of probation monitoring; and 4. Taking such other and further action as deemed necessary and proper. November 1, 2018 . Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant SA201830267S 33593567.docx 12 (JOHN COURTNEY DOZIER, MD.) ACCUSATION NO. 800-2017-033164