LII ?XAVIER BECERRA . . STATE OF CALIFORNIA ?cam?? . MEDICAL BOARD OF CALIFORNIA Supervising Deputy Attorney General 20 CINDY M. LOPEZ BY MK. #2737491 ANALYST Deputy Attorney General . . m_m Telephone:. (213) 897-7373 \o'oosl'cx FILED State Bar No. 119988 California Department of Justice 300 So. Spring Street, Suite 1702 Los Angeles, CA 90013 Facsimile: (213) 897-9395 Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Amended Accusation Case No. 800-2014-005199 Against: - AMENDED ACCUSATION ASHMEAD ALI, - 9300 North Loop Blvd., Suite A California City, CA 93505 Physician's and Surgeon's Certi?cate Consumer Affairs (Board). expire on March 31, 2020, unless renewed. On March 17, 2011 ,Respondent was publicly No. 78625, I Respondent. Complainant alleges: I PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this Amended Accusation solely in her official capacity as the Executive Director of the Medical Board of California, Department of 2. on or about April 13, 1994, the Medical Board issued Physician's and Surgeon? 3 Certificate Number 78625 to Ashmead Ali, M.D. (Respondent). The Physician? and Surgeon's Certi?cate was in full force and effect at all times relevant to the charges brought herein and will reprimanded In case No. 05- 2007- 188544. 1 (ASHMEAD ALI, MD.) Amended Accusation NO. 800-2014-005199 -21action taken in relation to discipline as the Board deems proper. conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not JURISDICTION 3. This Accusation is brought before the Board, under the authority of the following laws. A11 section, references are to the Business and Professions Code unless otherwise indicated. 4. A 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 5. Section 2234 of the Code, states: 2 ?The board shall take action against any licensee who is charged with unprofessional limited to, the followingzy Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. . a 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. 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 certi?cate. 2 (ASHMEADQALI, M.D.) Amended Accusation NO. 800-2014-005195 The practice of medicine fromthis 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 become operative?upon the implementation of the proposed registration program described in Section 2052.5. The repeated failure by a certi?cate 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 an investigation by the board.? 6. 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 DISCIPLINE 7. Respondent is subject to disciplinary action under section 2234, subdivision in that he was grossly negligent in his care and treatment of two patients. The circumstances are as follows: . Factual Allegations Regarding Patient . A. Patient #1 was treated by RespOndent from March 2005 to May 2013, until she overdosed on controlled substances that were prescribed by Respondent. The Coroner's report indicated that death occurred on May 31, 2013, from methadone toxicity. B. Patient #1 was morbidly obese whose weight ?uctuated between 23.0 and 400 pounds. She had constant pain in her hips, knees and feet. She signed a contract for pain management on May 2, 2005. According to Respondent, he counseled her on' the dangers of narcotics medications and not to abuse them. Respondent kept her on methadone becauSe her medical conditions became increasingly complicated throughout her' eight years of treatment. CURES showed 94 prescriptions for methadone, Soma, Valium, and Ambien. I Allegations of Gross Negligence: There was an absence of exams, objective data, assessments, medications, prescriptions, treatment goals and plans; 3 (ASHMEAD ALI, MD.) Amended Accusation NO. 800-2014-005199 controlled substances were not in the best interests of the patient, and-if they were not bene?tting her health,.functions, quality of life and alleviation of pain, then they must be adjusted or discontinued. Respondent failed to adjust the prescriptions. . Respondent did not take the required precautions to ensure patient safety and ensure proper use of controlled substances. He did not change the' plan of Care and improperly prescribed opioids. . Respondent did not refer this patient to a or pain management expert, or use peer to peer consultations. . The records were incomplete to support the prescriptions. Factual Allegations Regarding Patient . Patient #2 saw Respondent starting August 2011, and continued to see him through I February 2015. She had a variety of medical conditions including a ruptured disc, hernia, and several back surgeries. Originally she was given prescriptions for OxyContin, Soma, and Ambien. Respondent also prescribed Percocet, Flexeril, and Dilaudid. - According to Respondent, he did refer this patient to a pain management doctor. In'_2014, due to non compliance with instructions to go to pain management, Respondent determined -the patient was high risk. The CURES report showed that for a year from November 2013 to November 2014,. 31 prescriptions were written for hydrocodone, oxycodone, tramadol, soma, and'Arnbien. CURES showed that from May 2013 to May 2014, Re3pondent prescribed Flexeril, Tramadol, Ambien, Norco, Oxycodone, Soma, Dilaudid, Percocet, 'Xanax and Vicodin. Allegations of Gross Neglig_nce: An appropriate dismissal of a patient includes a warning, a reasonable cause for discharge, time to remedy the situation and a dismissal letter. Respondent did not . appropriately Sever the doctor-patient relationship. 4 (ASHMEAD ALI, M.D.) Amended Accusation N0. 800-2014-005195 Respondent failed to determine the need for controlled substances. He did not inquire why ?the patient needed these medications, he did not review lab studies, or obtain a CURES report. i A L. Respondent Was aware of the patient's drug seeking behavior. He had questions with regards to what she was doing with themedications but did not recall if he confronted - her, and did not document any such encounter. He was aware of her possible diversion and misuse of controlled substances. SECOND FIRST CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 8. . Respondent is subject to disciplinary action under section 2234, subdivision in that he was negligent when he treated four patients. The circumstances are as follows: A A. Complainant incorporates by reference the allegations contained in paragraph 7, A through L. B. Regarding patient informed consent is required?before initiating and dispensing - controlled substances and the records contain no such consent. C. The patient's progress, medicationuse and treatinent response were not described in the 7 records. D. Regarding patient informedconsent is required before dispensing controlled substances. There is no record that the patient received appropriate informed consent. E. There are no periodic reviews of controlled substances, informed consent, treatment plan, and there are incomplete records to support prescriptions and medical care. Patient I F. Patient #3 was approximately 41 years old when she started treating with Respondent. She was initially evaluated on June 23, 2009. Her complaints included back pain, hypertension, morbid obesity, depression and headaches. G. She was taking Vicodin and Phenergan with Codeine at the time. 5 (ASHMEAD ALI, MD.) Amended Accusation NO. 800-2014-005199 00 1'0 11 12 C13for anxiety disorder, with no documentation as to why other drugs were not considered ?rst. I H. She. signed an agreement on August 26, 2010, on the use of chronic Opioid medications. I I. On May 21, 2013, Patient #3 saw Respondent for a chronic pain consult. He treated her with S'oma and Phenergan syrup. In June 2013, she saw him for right foot pain and she ?was -. prescribed Dilaudid; The next month she saw Respondent for chronic pain and was diagnosed with a lumbar spine condition. J. This'patient was seen approximately on a basis up through February 2016. She was diagnosed with several conditions including anxiety, UTI, degenerative disc disease, COPD, carpal tunnel chronic cough, chronic pain, left knee pain. K. Throttghout the patient's treatment, she was prescribed a variety of medications, oftentimes at the same time. Respondent prescribed 'Soma, :Xanax, Phenergan, Dilaudid, Vicodin, and Ambien. . I L. Respondent's notes, although illegible, failed'to document the patient's response to the pain medications, history of previous pain treatment, appropriateness of continued use of opioid treatment, and consideration for non-opioid treatments. It was unclear from the records why, for' instance, Respondent treated the patient With Dilaudid for her foot sprain, knowing she was already taking Xanax and. Soma. I M. Patient #3 was treated with Sdma chronically, even though it is a controlled substance that Ishould be used for 2-3_Weeks, rather. than months and months; Respondent did not document why he did not choose other muscle relaxants. The patient was treated with Xanax chronically N. Respondent was negligent in his record keeping and prescribing multiple controlled substances without trying alternative treatment options. . - Patient #4 0. Patient #4 began seeing Respondent in June of 2009 for seizure disorder, chronic renal failure, right knee injury and spinal stenosis. P. He signed a contract for chronic opioid medication on March 26, 2010. 6 (ASHMEAD ALI, M.D.) Amended Accusation NO. 800-2014-005195 JAWN \Jmm depressants in a patient with an underlying discrder. Q. Patient #4 was seen in May 2013 for chronic pain and was prescribed Soma, Xanax, Phenergan DM and Percocet. He was seen only a week later and was diagnosed with lumbar disc - disease. I R. Patient #4 saw Respondent approximately On a basis through April 2016. He was diagnosed with several conditions in addition to chronic pain and lumbar disease including seizure disorder, left knee issues, anxiety disorder, bipolar disorder, pneumonia, and a hernia. S. Throughout the patient's treatment,he was prescribed a variety of medications, oftentimes at the same time. Respondent prescribed Soma, Xanax, Phenergan, Dilantin, Norco, and Toradol. T. During the several years of treatment, Respondent recommended several consults including neurology, mental health, and pain management. U. His notes, although illegible, failed to document thepatient?s response to the pain medications, history of previous pain treatment, and the appropriateness of continued use of opioid treatment for back or knee pain. i V. Thelrecords do not document the rationale for repeatedly prescribing large amounts of Phenergan (aka Promethazine) for cough, which has multiple drug interactions and'may enhance the central nervous system'depressant effects of opioids and Benzodiazepines. W. The records do indicate that patient #4 had underlying issues, and-was suspected of being bipolar, howeVer he was repeatedly prescribed Xanax. X. The patient was treated with Soma and Hydrocodone at the same time,?but there is no indication in the records why other non habit forming muscle relaxants were not used ?rst. Y. Respondent was negligent in his record keeping and for prescribing multiple central CAUSE FOR DISCIPLINE (Inadequate Record Keeping) 9. Respondent is subject to disciplinary action under section 2266 in that he failed to maintain adequate records. The circumstances are as follows: 7. (ASHMEAD ALI, M.D.) Amended Accusation NO. 800-2014-005199 '21The facts and circumstances as alleged in paragraph 7, sub paragraphs A through L, and paragraph 8, s'ubparagraphs through Y, are incorporated here as if ?illy set forth herein. DISCIPLINARY CONSIDERATIONS 10. To determine the degree 'of discipline, if any, to be impbsed? on Respondent Ashmead. Ali, M.D., Complainant alleges that on or about March 17, 2011, in a prior disciplinary action entitled, In the Matter of the Accusation Against Ashmeaal Ali, MD, before the Medical Board of I California, in Case Number 05-2007-188544, Respondent's license was reprimanded for inadequate record keeping. That decision is-now ?nal and is 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 78625, a issued to Ashrnead Ali, I 2. Revoking, suspending or denying approval of Ashmead authority to supervise physician assistants, pursuant to section 3527 of the Code, and advanced'practice nurses; 3. Ordering Ashmead Ali, 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. DATED: November 1,1 2018 KIMBERLY Executive Difj ctor Medical Board of California Department of Consumer Affairs State of California Complainant LA20 175 05490 53 102923 .docx _8 (ASHMEAD ALI, MD.) Amended Accusation NO.. 800-2014-00519