OFILED . ,v STATE OF CALIFORNIA, . XAVIER BECERRA . . . MEDICAL BOARD-0F CALIFORNIA Attorney General of Ca11forn1a SACRAMENTO 20 JUDITH T. ALVARADO . BY I ?3 [2 l2 ANALYST Supervising Deputy Attorney General CHRISTINE R. FRIAR Deputy Attorney General State Bar No. 228421 California Department of Justice 300 South Spring Street, Suite 1702 Los Angeles, California 90013 Telephone: (213) 269-6472 Facsimile: (213) 897-9395 Attorneys for Complainant . BEFORE THE . BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE CALIFORNIA In the Matter cf the Accusation Against: 7 Case No. 800-2017-038106 MAHYAR OKHOVAT29525 CanWood Street, Suite 109 Agoura Hills, California 9130.1 Physician's and Surgeon's Certi?cate NO. A 85646, 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). I 2. On January 9, 2004, the Board issued Physician's and Surgeon's Certi?cate Number - A 85646 to Mahyar Okhovat, M.D. (Respondent). That license yvas in full force and effect at all 1 (MAHYAR OKHOVAT, MD.) ACCUSATION NO. 800-2017-038106 times relevant to the charges brought herein and will expire on September 30, 2019, unless renewed. JURISDICTION 3. This Accusation is brought before the Board, under the authority of the'following laws." All section references are to the Business and Professions Code 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, or such other . action taken in relation to discipline as the Board deems proper. 5. Section 2234 of the Code states, in pertinent part: ?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: I. Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. 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 departurefrom the applicable standard-of care shall constitute repeated negligent acts. An initial negligent diagnosis followed byan 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? 59 6. Section 2266 of the Code states: 2 . (MAHYAR OKHOVAT, M.D.) ACCUSATION NO. 800?2017-038 106 x'ioxum 2.8 ?The failure of a physician and surgeon to maintain adequate and acourate records relating to the provision of services to their patients constitutes unprofessional .conduct.?_ FIRST CAUSE FOR DISCIPLINE (Repeated Negligent Aets) I 7. Respondent is subject to disciplinary action under Code section 2234, subdivision (0), in that he committed repeated negligent acts in his care. and treatment of Patient A. 1" The circumstances are as follows: 8. During the relevant time period, Respondent was the primary neurologist and pain specialist at the Pain Management Injury Relief Medical Center (PMIR) located in Santa Monica and Thousand Oaks, California. A 9. October 14, 2008, Patient A, a 37-year-old female, presented to PMIR for pain i management of chronic lower back and bilateral lower extremity pain. Nine years prior, Patient A had gastric bypass surgery and four months prior, she had thigh surgery. Patient A also had been diagnosed with chronic anxiety, depression and severe sleep disorders. 10. At PMIR, Patient A was treated by Respondent who managed her pain medication and Patient A was concurrently being prescribed medications for her anxiety, depression and insomnia by other providers. 11. In December 2008, Patient A was hospitalized at Simi Valley Hospital after overdosing on Ambien (a Schedule sleep medication). I 12. From the time she ?rst'presented to PMIR through-March 2009,.Respondent acted as Patient A?s pain management specialist. During that time period, he prescribed her both oral and 1 In this Accusation, the patient is referred to as ?Patient to protect her right of privacy. The patient?s ?ill name was disclosed to Respondent during the course of Board Investigation No. ?800- 2017- 038106 and will be disclosed to Respondent again when discovery 1s provided pursuant to Government Code section 11507. 6. 3 . I (MAHYAR ACCUSATION NO. 800?2017-038106 topical pain medication. The medications Respondent prescribed to Patient A included Perco'cet? and Lyrica.3 i I 13. . Respondent did not see Patient A between March 2009 through November 2009, at which point she was referred back to Respondent. During this time period, another treating - 9 physician had prescribe-d her Fentanyl4 50 meg/hr patch and Norco5 10/325. Patient A had also reportedly had a reversal of her gastric bypass. 14. Between NoVember 2009 and October 2011, Respondent managed Patient A?s pain medication and '15. In February 2011, Patient A had lost a signi?cant amount of. weight and her pain was stable on her current medication regime. Respondent?s plan was/to wean her off of Fentanyl. Respondent started her on SaVella (a selective serotonin and norepinephrine inhibitor for her ?bromyalgia and depression. 16. In May 2011, Patient A reported severe pain in her lower extremities. Respondent restarted her on Fentanyl 25 meg/hr. 17. In July 2011, Patient A reported abdominal including nausea and A vomiting. Respondent referred Patient A to her bariatric surgeon. Respondent also re?lled her Fentanyl and Norco prescriptions, among others. 18. In September 2011, Patient A planned-to have another gastric surgery. Respondent recommended discontinuing Fentanyl prior to her surgery and because she was experiencing nausea and vomiting. 19. In October 2011, Patient A?s gastric surgery was reportedly postponed. Respondent restarted her on Fentanyl. 2 Percocet 15 the brand name for Oxycodone with acetaminophen, a Schedule II opiate narcotic 3 Lyrica, a Schedule medication, is used to treat chronic pain, such as that associated with ?bromyalgia. . 4 Fentanyl is a Schedule II opiate narcotic, typically prescribed in patch form. 5 Norco IS a brand name for hydrocodone and acetaminophen, a Schedule II opiate narcotic. - 4 . (MAHYAR OKHOVAT, MD.) ACCUSATION NO. 800-2017-038106 \lONU'l-hw 20. In November 2011, Respondent again planned to decrease her Fentanyl dosage prior to her gastric Surgery. . 21. In December 2011, Patient A was post abdominal'surgery. While her abdominal pain had improved, she continued to complain of severe bilateral lower extremity pain and new onset neck pain that Was myofaScial. Respondent gave Patient A trigger point injections in the of?ce, increased her Fentanyl dosage and re?lled her prescriptions. This was the last time Respondent, saw Patient A. '22. Patient A died on June 2, 2013. 23. During the relevant time period, the applicable standard of care in the medical community required that a medical history'and physical examination be conducted of a patient that includes an assessment of the pain, physical and function; a substance abuse history; history of prior pain treatment; an assessment of underlying or coexisting diseases or conditions; and documentation of the presence of a recognized medical indication for the use of a controlled substance. 24. During the relevant time period, the applicable standard of care. in the medical community required that a treatment plan, informed consent, periodic review and consultations be re?ected in a patient?s medical record. 25. During the course of Respondent?s care and treatment of Patient A, information pertaining to Patient A?s treatment plans and objectives and evidence of informed consent, periodic review and consultations are either frequently, or entirely, missing from her medical record. These de?ciencies in Patient A?s medical record on the part of Respondent constitute simple departures from the standard of "care. i '26. I The applicable standard of care in the medical community requires that a medical provider?s notes in a patient?s medical record be legible. 27. Respondent?s handwritten medical notes detailing Patient A?s examinations are consistently illegible. This constitutes a simple departure from the Standard of care. 5 (MAHYAR OKHOVAT, MD.) ACCUSATION NO. 800-2017-038106 28. During the relevant time period, the applicable standard of care in the medical community required that when a patient is suspected of having made a-suicide attempt that evidence. of appropriate medication use is required. I Urine testing is the standard method. . I 29. During the course of Respondent?s care and treatment of Patient A, there is no - evidence that Patient A was ever drug tested, including but not limited to through urine analysis, even though she had-overdosed on Ambien in December 2008. Respondent?s failure to drug-test Patient A to ensure that she was taking her medications as prescribed and not abusing other substances is a simple departure from the standard of care. I i 30. Respondent?s acts and/or omissions as set forth in paragraphs 9 through 28, inclusive above, whether proven individually, jointly, or in any cOmbination thereof, constitute repeated - negligent acts in violation of section 2234, subdivision of the Code. As such, cause for discipline exists. SECOND CAUSE FOR DISCIPLINE (Inadequate Record Keeping) 31. Respondent is subject to disciplinary action under Code sections 2234, subdivision and 2266, in that he failed to maintain adequate and accurate records for Patient A. 'Ihe circumstances are as follows: i 32. Paragraphs 8 through 29 are incorporated by reference and reralleged as if fully set forth herein. I 33. Respondent?s acts and/or omissions as set forth in paragraphs 8 through 29 and 32, - above, whether proven individually, jointly, or in any combination thereof, constitute the failure . to maintain adequate and accurate records pursuant to section 22.66 of the Code. As such, cause for discipline exists. 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: I I Revoking or suspending Physician's and Surgeon's Certi?cate Number A 85646, 7 issued to Mahyar Okhovat, 6 (MAHYAR OKHOVAT, MD.) ACCUSATION NO. 800-2017-038106 Revoking, suSpending or denying approval of Mahyar Okhovat, M.D.'s authority to supervise physician assistants and advanced practice nurses; 3. I If placed on probation, ordering Mahyar Okhovat, MD. to pay the Board the costs of probation monitoring; and 4. Taking such other and further action as deemed necessary and proper. DATED: OCtober 11: 2018 BE KI Executive ctor a Medical Bo dofC' form'a - Department Co umer Affairs State of California Complainant 7 1 (MAHYAR OKHOVAT, MD.) ACCUSATION N0. 800-2017-038106