XAVIER BECERRA Attorney General of California ALEXANDRA M. ALVAREZ Supervising-Deputy Attorney General JOSEPH F. MCKENNA HI Deputy Attorney General State Bar No. 231 195 600 West Broadway, Suite 1800 San Diego, California 92101 PO. Box 85266 San Diego, California 92186-5266 Telephone: (619) 73 8-9417 Facsimile: (619) 645-2061 Attorneys for Complainant ?mm a 20 ANALYST BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 800-2017-033914 Jose Rosendo Cesena, MD. A A I 1421 Burris Drive El Cajon, California 92019 Physician?s and Surgeo?n?s Certi?cate . No. G78761, Respondent. Complainant alleges: PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her of?cial capacity as the Executive Director of the Medical Board of California, Department of Consumer Affairs. 2. On or about May 4, 1994, the Medical Board issued Physician?s and Surgeon?s Certi?cate No. to Jose Rosendo Cesena, 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 September 30, 2019, unless renewed; . 1 (JOSE ROSENDO CESENA, MD.) ACCUSATION NO. 800-2017-033914 JURISDICTION 3. This Accusation is brought before the Medical Board of California (Board), Department of Consumer Affairs, under the authority of the following laws. All section references are to the Business and Professions Code (Code) unless otherwise indicated. 4. Section 2227 of the Code provides that a licensee who is found guilty under the Medical Practice Act may have his or her license revoked, suspended for a period not to exceed one year, placed on probation and required to pay. the costs of probation monitoring, be publicly reprimanded which may include a requirement that the licensee complete relevant educational courses, or have such other action taken in relation to discipline as the Board deems proper. 5. Section 2234 of the Code states, in relevant part: ?The board shall take action againstany 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. 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. 6. Unprofessional conduct under section 2234 of the Code is conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical profession, and which demonstrates an un?tness to practice medicine. (Shea v. Board of Medical Examiners (1978) 81 Cal.App.3d 564, 575.). 7. 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.? 2 (JOSE ROSENDO CESENA, MD.) ACCUSATION NO. FIRST CAUSE FOR DISCIPLINE (Repeated Negligent Acts) . 8. Respondent has subjected his Physician?s and Surgeon?s Certi?cate No. G78761 to disciplinary action under sections 2227 and 2234, as de?ned in section 2234, subdivision (0), of the Code, in that Respondent committed repeated negligent acts-in his care and treatment of patient A, as more particularly alleged hereinafter: 9. Patient A established care with Respondent in 2006.1 Patient A had a history of multiple medical conditions including, but not limited to, active drug seeking behavior, opiate dependency, alcohol dependency, chronic pain, anxiety, major depression, personality disorder, hypertension, and asthma. 10. Between in or around January 2009 through December 2012, a review of the Controlled Substance Utilization Review'and Evaluation System2 (CURES) report Contained in patient A?s medical record documented that she had consistently ?lled prescriptions issued by Respondent for multiple controlled substances including, but not limited to, opioids and benzodiazepines. 11.. On or. about April 26, 2012, Respondent saw patient A due to complaints of post-? operative pain and dif?culty ambulating. Patient A reported to Respondent that she had been using twelve (12) Percocet tablets a day.3 Respondent, despite advising patient to reduce her 1 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. ,2 The Controlled Substance UtiliZation Review and Evaluation System (CURES) is a program operated by the California Department of Justice (DOJ) to assist health care practitioners in their efforts to ensure appropriate prescribing of controlled substances, and law enforcement and regulatory agencies in their efforts to control diVersion and abuse of controlled substances. (Health Saf. Code, 11165.) California law requires dispensing pharmacies to report to the DOJ the dispensing of Schedule II, and IV controlled substances as soon as reasonably possible after the prescriptions are ?lled. (Health Saf. Code, 11165, subd. It is important to note that the history of controlled substances dispensed to a speci?c patient based on the data contained in CURES is available to a health care practitioner who is treating that patient. . (Health Saf. Code, 11165.1, subd. 3 Percocet is a brand name for the drug combination of oxycodone-acetaminophen, which is an opioid commonly prescribed under the generic name of Oxycodo'ne HCL?Acetaminophen, and 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. 3 (JOSE ROSENDO CESENA, MD.) ACCUSATION NO. 800-2017-033914 45-935Percocet use, issued another large prescription for Oxycodone HCLjAcetaminophen (325 MG) Respondent also issued'several other prescriptions for controlled substances at this visit including, but not limited-to, morphine, clonazepam, and alprazolam. - 12. On or about May 22, 2012, patient A was evaluated by Dr_. 8.8., an orthopedic surgeon, for complaints of pain.4 Dr. S.S. noted that the patient had good range of motion, no crepitus, mild tenderness to palpation, and there was no orthopedic explanation for patient?s self? reported pain. Dr. 8.8. also documented that patient had slurred speech during the visit and recommended that she be ?vigorously? weaned off of pain medication due to no orthopedic explanation forthe pain. . 13. In May-2012, Respondent, despite recently. warning patient A to reduce her use of opioids, issued two (2) prescriptions in a single month for Oxycodone HCL?Acetaminophen (32.5 MG-IO MG) totaling ?ve hundred (#500) tablets. In addition, during this same month, Respondent, despite the existence of documented red ?ags of aberrant drug behaviors including, but not limited to, drug seeking behavior, chemical dependence, and evidence of opioid tolerance,- reissued several more prescriptions for otherlcontrolled substances including, hy'drocodOne, clonazaepam, alprazolam, and morphine. 14. In fact, on or about May 23, 2012, only one day after Dr. S. S. saw patient A and had documented no medical explanation existed for her reported pain, Respondent still issued additional prescriptions to Patient A for Percocet morphine clonazepam and alprazolam . 15. Between in or around January 2009 through December 2012, Respondent did not - properly and thoroughly document pertinent information in the chart notes for Patient A?s clinical visits including, but not limited to, pain assessment, functional status, detailed examination continued: When properly prescribed and indicated, Oxycodone IS used for the treatment of moderate to moderately severe pain. The Drug Enforcement Administration (DEA) has identi?ed opioids, such as Oxycodone, as a drug of abuse. (Drugs of Abuse, DEA Resource Guide (2015 Edition), at p. 43. 4 Patient A?s medical record indicates that prior to this visit, she was last seen by a pain management physician 1n 2009. 4 . (JOSE ROSENDO CESENA, MD.) ACCUSATION NO. 800-2017-033914 .ooqm,m 16' ?ndings in the areas of reported pain, previous diagnostic evaluations, and prior treatment. In addition, Respondent did not document in the patient?s medical record that he had discussed 'with her the risks and bene?ts of the concurrent use of opioids and benzodiazepines. 16. Respondent committed repeated negligent acts in his care and treatment of . Patient A including, but not limited to, the following: I Respondehtp'rescribed high dose narcotics without clear bene?t to Patient A, who was a high risk patient exhibiting multiple red ?ags of aberrant drug behaviors; Respondent failed to properly and thoroughly document the medical record with information pertinent to the pain management treatment Patient A was receiving from Respondent; and (0) Respondent failed to document in the mediCal record that he had discussed with Patient A about the risks and bene?ts of concurrent use of opioids and benzodiazepines. SECONI) CAUSE Eon DISCIPLINE (Failure to Maintain Adequate and Accurate Medical Records) .17. Respondent has further subjected his PhySician?s and Surgeon?s Certi?cate 7 No. G78761 to disciplinary action under sections 2227 and 2234, as de?ned in section 2266, of the Code, in that Respondent failed to maintainadequate and accurate records in connection with his care and treatment of patient A, as more particularly alleged in paragraphs 8 through 16, above, which are hereby incorporated by reference and realleged as if fully setforth herein. THIRD CAUSE FOR DISCIPLINE (Unprofessional Conduct)_ 18. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. G78761 to disciplinary action under sections 2227 and 2234 of the'Code, in that Respondent has engaged in conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical profession, and which demonstrates an un?tness to practice medicine, as more particularly alleged in paragraphs 8 through 17, above, which are hereby incorporated by reference and realleged as if fully set forth herein. 5 . (JOSE ROSENDO CESENA, MD.) ACCUSATION NO. 800-2017-033914 4; 1'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 No. G78761, issued to Respondent Jose Rosendo Cesena, 2. Revoking, suspending or denying approval of Respondent Jose Rosendo Cesena, authority to supervise physician assistants pursuant to section 3527 of the Code, and' advanced practice nurses; 3. Ordering Respondent Jose Rosendo Cesena, M.D., to. pay the Medical Board the costs of probation monitoring, if placed on probation; and 4. Taking such other and further action as deemed necessary and proper. October 30, 2018 KIMBERLWKIRCHMEYER Executive Dlrector Medical Board of California Department of Consumer Affairs State of California Complainant SD2017802115 Doc.No.71634742 6 (JOSE CESENA, MD.) ACCUSATION NO. 800-2017-033914