FILED ?311ng 1350131111111 fc 1'1 STATEOFCALIFORNIA 151? 11331111131- 111 13111 Att JAJIglirS?gileriN myANALYST Deputy Attorney General State Bar No. 237826 1300 I Street, Suite 125 PO. Box 944255 Sacramento, CA 94244-2550 Telephone: (916) 210-7549 Facsimile: (916) 327-2247 Attorneys for Complainant BEFORE THE 1 MEDICAL BOARD OF CALIFORNIA . DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: CaSe No. 800-2017-031094. PAUL JONATHAN A A I M.D. 1335 S. Fairmont Lodi, CA 95240 Physician?s and Surgeon?s Certi?cate No. 79026, Respondent. Complainant alleges: PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her of?cial I capacity as the Executive Director of the Medical Board of California, Department of Consumer Affairs (Board). 2. On or about June 1, 1994, the Medical Board issued Physician?s and Surgeon?s Certificate No. 79026 to Paul Jonathan 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 June 30, 2020, unless renewed. 1 (PAUL JONATHAN MD.) ACCUSATION NO. 800-20117-031094 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 states: A licensee whose matter has been heard by an administrative lawjudge 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 intoa stipulation for disciplinary action with the board, 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. The public reprimand may include'a requirement that the licensee complete relevant educational courses approved 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 maydeem proper. Any matter heard pursuant to subdivision except for warning letters, medical review or advisory conferences, professional competency examinations, continuing education activities, and cost reimbursement associated 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.? 5. Section 2234 of the Code, states: ?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: LC 2 (PAUL JONATHAN SACKSCI-IEWSKY, MD.) ACCUSATION NO. 800-2017-031094 (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. I 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.? 7-. Unprofessional conduct under Businessand 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 un?tness to practice medicine. (Shea v. Board of Medical Examiners (1978) 81 Cal.App.3d 564, 575.) A 7 FIRST CAUSE FOR DISCIPLINE (Gross Negligence) 8. Respondent has subjected his Physician?s and Surgeon?s Certi?cate No. 79026 to disciplinary action under sections 2227 and 2234, as de?ned by section 2234, subdivision of the Code, in that he committed gross negligence in his care and treatment of Patient as more particularly alleged hereinafter: 1 References to ?Patient are used to protect patient privacy. The identity of Patient A is disclosed in the discovery. 3 . (PAUL JONATHAN MD.) ACCUSATION NO. 800?2017-031094 Patient A?s medical diagnoses included, but were not limited to, bipolar 1 disorder,2 anxiety, depression, chronic pain, hypertension,3 and chronic opiate and benzodiazepine4 dependence. On or about September 18, 2013, Patient A was seen by her primary care physician, Dr. and?requested a prescription for Methadone.5 On that day, Patient A was diagnosed with . atrial flutter,6 which resulted in a referral to the Emergency Room (ER), and a deferral of prescription for Methadone. - 10. Following her discharge from the ER, Patient A?requested an appointment with Respondent, demanding a prescription for Methadone. Apparently, Patient A was unwilling to wait for an appointment with Dr. K, who was unavailable until September 23, 2013. 11. On or about September 20, 2013', Patient A visited Respondent. Without identifying or documenting identi?cation of any new or acute medical issues, Respondent prescribed to Patient A, Methadone at 30 mg, per day, to be titrated up7, instead of deferring to Patient A?s primary care physician. Respondent did not order a cardiovascular examination in order to reassess Patient A?s atrial ?utter. Respondent did not refer Patient A to a cardiologist for further investigation and/or assessment and/or evaluation of Patient A?s atrial ?utter. Respondent failed to consider and/or failed to document consideration of Patient A?s need for anticoagulation. 2 Bipolar disorder, formerly called manic depression, is a mental health condition that causes dramatic shifts in a person?s mood, energy, and ability to think clearly. .3 Hypertension is another name for high blood pressuref 4 Benzodiazepine 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. When properly prescribed and indicated, it is used for the management of anxiety disorders. Concomitantuse of benzodiazepines, such as Xanax?, with opioids ?may result in profound sedation, respiratory depression, coma, and death.? The Drug Enforcement Administration (DEA) has identi?ed benzodiazepines, such as Xanax?, as a drug of abuse. (Drugs of-Abuse, DEA Resource Guide (2011 Edition), at p. 53.) 5 Methadone is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subsection and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, Methadone is generally used. to treat moderate to severe pain. 6 Atrial flutter is an abnormality in the beating of the heart. 7 Titrate means to continuously measure and adjust the balance of a physiological function or drug dosage. 4 (PAUL JONATHAN MD.) ACCUSATION NO. 800-2017-031094 .0.00 Despite Patient?s A?s bipolar 1 disorder diagnosis, Respondent did-not take steps to adequately assess and/or address additional risks associated with a poorly managed bipolar disorder, before prescribing Methadone to her. Respondent failed to document details of Patient A?s any physical examinations administered, or any plan for follow-up or referrals to specialists, if any. Respondent failed to adequately document assessment of pertinent co?existing. Conditions that may impact management of Patient A. 12. On or about September 21, 2013, Patient A expired. 13. Respondent committed gross negligence in his care and treatment of Patient A, which included, but was not limited to, the following: i Respondent failed to adequately reassess Patient A?s atrial ?utter after she was 7 diagnosed with it; and Respondent failed to adequately document his care and treatment of PatientlA. I SECOND CAUSE FQR DISCIPLINE (Repeated Negligent Acts) . 14. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. 79026 to disciplinary action under sections 2227 and 2234, as defined by section 2234, - subdivision (0), of the Code, in that he committed repeated negligent acts in his care and treatment of. Patient A, as more particularly alleged herein: - . Paragraphs 8 through 13, above, are hereby incorporated by reference and realleged as if fully set forth herein; '7 1 Respondent failed to adequately reassess Patient A?s atrial ?utter after she was diagnosed with it; (0) Respondent failed to adequately document his care and treatment of Patient Despite Patient?s'A?s bipolar disorder diagnosis, Respondent did not adequately assess and/or address additional risks associated with a poorly managed bipolar disorder, before prescribing Methadone to her; and 5 (PAUL JONATHAN MD.) ACCUSATION NO. 800-2017-031094 Without identifying or documenting identi?cation of any new or acute medical issues, Respondent prescribed Methadone to Patient A, instead of deferring to her primary care physician. THIRD CAUSE FOR DISCIPLINE (Failure to Maintain. Adequate and Accurate Records) 15. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. 79026 to disciplinary action under sections 2227 and 2234, as de?ned 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 8 through 14, above, which are hereby incorporated by reference and realleged as if fully set forth herein. . FOURTH CAUSE FOR DISCIPLINE (General Unprofessional Conduct) 16. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. . 79026 to disciplinary action under sections 2227 and 2234 of the'Code, in that he 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 15, above, which are hereby incorporated by reference as if fully set forth here. PRAYER I 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. 79026, issued to Paul Jonathan 2. v-Revok-i'ng, suspending or denying approval of Paul Jonathan authority to supervise physician assistants and advanced practice nurses; . 3. Ordering Paul Jonathan M.D., if placed on probation, to pay the Board the costs of probationmonitoring; and I IN 6 (PAUL JONATHAN MD.) ACCUSATION NO. 800-2017?031094 Taking such other and further action as deemed nec? ssar and proper. DATED: January 9, 2019 SA2019300020 71703819.docx LMBERL Executive irector Medical Board of California Department of Consumer Affairs State of California Complainant 7 (PAUL JONATHAN MD.) ACCUSATION NO. 800-2017?031094