XAVIER BECERRA Attorney General of California MARY CAIN-SIMON - FILED Supervising Deputy Attorney General STATE OF LYNNE K. DOMBROWSKI - MEDICAL .-. mac or Deputy Attorney General ..- . State Bar No. 128080 - 455 Golden .Gate Avenue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 510-3439 Facsimile: (415) 703-5480 - Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Aeousation Against: Case No. 800-2017-0343 84 Richard Andrew Lannon, M.350 Parnassus -Ave., Ste. 909 - San Francisco, CA 94117 Physician's and Surgeon's Certi?cate No. A 23592, Respondent. Complainant alleges: PARTIES 7 l. - Kimberly Kirchmeyer (Complainant) brings this AccusatiOn solely in her of?cial .7 capacity as the Executive Director of the Medical Board of California, Department of Consumer Affairs (Boardabout November 21, 1969, the Medical Board issued Physician's and Surgeon's Certi?cate Number A 23592 to Richard Andrew Lannon, M. D. (Respondent). The Physician' and Surgeon' 3 Certi?cate was in full force and effect at all times relevant to the charges brought herein and will expire on October 31, 2019, unless renewed. 1 . (RICHARD ANDREW LANNON, MD.) ACCUSATION NO. 800-2017-0343 84 - . ooqox JURISDICTION 3. This Accusation? is brought before the Board, under the authority of the following I laWs. All section references are to the Business and Professions Code unless otherwise indicated. 4. Section 2001.1 of the Code provides that the Board?s highest priority shall be public? protection. I 5. I 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 topay the costs of probation monitoring, or such other action taken in relation to discipline as the Board deems proper. i 6. Section 2234 of the code, states: .cThe board shall take action against any licensee who-is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, butis not limited to, the following: A 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 change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph 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-4 standard of care. i a. Incompetence. 2 ANDREW LANNON, MD.) ACCUSATION N0. 800-20 17-0343 84 AWN 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. 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 become operative upon the implementation of the proposed registration program described in Section 2052.5. 1 I 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.? I 1 7. Section 2242 of the Code states: Prescribing, dispensing, or furnishing dangerous drugs as de?ned in Section 4022 without an appropriate prior examination and a medical indication, constitutes unprofessibnal 00nduCt. I 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, 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: The practitiOner had consulted with the registered nurse or licensed vocatiOnal nurse - who had reviewed the patient? 5 records. The practitioner was designated as the practitioner to serve in the absen?e of the patient?s physician and surgeon or podiatrist, as'the case may be. 3 (RICHARD ANDREW LANNON, MD.) ACCUSATION NO. 800-2017-0343 84 ?00 U1.-28? The licensee was a deSignated practitioner serving in the absence of the patient?s physician and surgeon or podiatrist, as thecase may be, and was in possession of or had Utilized - the patient?s records and ordered the renewal of a medically indicated prescription for anamount not exceeding the original prescription in strength or amount or for more than one re?ll. A The licensee was acting in accordance with Section 120582 of the Health and Safety Code.? 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 servicesto their patients constitutes unprofessional conduct.? - 9. . All of the incidents alleged herein occurred in California. 10. Alprazolam, also known by-the trade name Xanax, is a triazolo analogue of the 1,4 benzodiazepine class of central nervous system-active compounds. Xanax is used for the management of anxiety disorders or for the short-term relief of the of anxiety. It is a dangerous drug as de?ned in section 4022 and a scheduleIIV controlled Substance and narcotic as de?ned by section 11057, subdivision of the Health and Safety Code: Xanax has a central nervous System depressant effect and patients should be cautioned about the simultaneous ingestion of alcohol and other CNS depressant drugs during treatment with Xanax. Addiction- prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving alprazolam because of the predisposition of suCh patients to habituation and dependence. The usual starting dose of Xanax is 0.25 to 0.5jmg. three times per day; 11. Benzodiazepines (ben?zoe-dye-AZ?e?peens) belong to the group of medicines called - Central nervous system (CNS) depressants (medicines that slow down the nervous system). Some benzodiazepines are used to relieve anxiety. HoWever, benzodiazepines should not be used to relieve nervousness or tension caused by the stress of everyday life. Some benzodiazepines are used'to treat insomnia (trouble in sleeping). However, if used regularly (for example, every day) for insomnia, they usually are not effective for more than a few. weeks. 4 2. . (RICHARD ANDREW LANNON, MD.) ACCUSATION NO. 800-2017-034384 .?OO-JON 12. Diazepam (Valium) is a drug for the management of anxiety disorders or for the short-term relief of the of anxiety. It is a dangerous drug as de?ned in section 4022 and a Schedule IV controlled substance as de?ned by section 11057 of the Health and Safety Code. Diaiepam can produce and physical dependence and it should be prescribed with caution particularly. to addiction?prone individuals (Such as drug addicts and alcoholics), because of the predisposition of such patients to habituation and dependence. Valium. is available in 5 mg. and 10 mg. tablets. The recommended dosage times daily. 13. Methadone hydrochloride is a narcotic analgesic with multiple actions Quantitatively similar to those of morphine. It also goes by the trade names Methadose and Dolophine. It is a dangerous drug as de?ned in section 4022 and a schedule 11 controlled substance and narcotic as de?ned by section 11055, subdivision (0) of the Health and Safety Code. Methadone can produce drug dependence of the morphine type'and, therefore, has the potential for being abused. dependence, physical dependence, and tolerance may develop upon repeated administration of methadone, and it should be prescribed and administered with the same degree of caution appropriate to the use of morphine. Methadone should be used with caution and in reduced dosage in patients who are concurrently receiving other narcotic analgesics. The usual adult dosage is 2.5 mg. to 10 mg. every three to four hours as necessary for severe acute pain. 14. Norco is a. trade name for hydrocodone bitratrate with acetaminophen. Norco tablets contain 10 mg. of hydrocodone bitartrate and 350 mg. of acetaminophen. Acetaminophen is a non-opiate, non-salicylate analgesic and antipyretic. Hydroc'odone bitartrate is narcotic analgesic and a dangerous drug as de?ned in section 4022 of-the Business and Professions Code. Norco is a schedule II controlled substance and narcotic as de?ned by section 11055, subdivision of the Health and Safety Code. Repeated administration of hydrocodone over a course of several weeks may result in and physical dependence. The usual adult dosage is- one tablet every four to- six hours as needed for pain. Dosage should be adjusted according to the severity of the pain and the response of the patient. However, it should be kept . 5 . (RICHARD ANDREW LANNON, MD.) ACCUSATION NO. 800-20 17-0343 84 mind that tolerance to hydrocodone can develop with continued use and that the incidence of untoward effects 13 dose related. The total 24- hour dose should not exceed 6 tablets. 15. Triazolam, known by the trade name HalciOn, IS a hypnotic drug indicated for the short-term treatment of insomnia (generally 7-10 days). I. It is-a dangerous drug as de?ned in section 4022 and a schedule IV controlled substance as de?ned by section 11057 of the Health and'S?afety Code. Halcion has central nervous system depressant effects and patients should be cautioned about the concomitant ingestion of alcohol and other CNS depressant drugs during treatment with Halcion tablets. The risk of drug dependence for Halcion is increased in patients with a history of alcoholism or drug abuse. Such dependence-prone individuals should be under careful surveillance when receiving Halcion. The recommended dosage for most adults is 0.25 mg. before retiring. 16. 7 Zoloft, a' trade name for sertraline is a selective serotonin reuptake inhibitor (SSRI) chemically unrelated to other'SSRIs, tricyclic, tetracyclic, or other available 7 antidepressant agents. It is a dangerous drug as de?ned by section 4022. Zoloft is used for the treatment of depression, obsessive compulsive disorder, and panic disorder. Zoloft causes decreased clearance of diazepam (Valium). It has side effects including nausea, diarrhea, dyspepsia,'tremor, dizzineSs, insomnia and somnolence. 17. In July 11 first presented to Respondent complaining of severe anxiety, - depression, and insomnia. Respondent initially prescribed the benzodiazepines, alprazolam and triazolom. 18. Respondent c0ntinued to treat and prescribe controlled substances to Pt. 1 for the next twenty-?ve years. ?19. On January 27, 2(111, Respondent examined Pt. 1,'increased the dosing of Zoloft received by,the patient, and prescribed three to ?ve diazepam daily. The medical records fail to 1 The patient is identi?ed herein as Pt. 1 to preserve con?dentiality. The patient? 5 name - will be provided to Respondent 1n discovery. . 6 (RICHARD ANDREW LANNON, M.D.) ACCUSATION NO. 800?2017-0343 84 ooqoxin-bob describe the rationale for increasing the Zoloft dosing, and the notes do not follow any narrative structure. 20. Between January 27, 2011 and August 7, 2013, Pt. 1 received diazepam on 32 occasions and triazolam on 18 occasions, without examination, each prescribed by Respondent, . 21. Between January 27, 2011 and August 7, 2013, Pt. 1 also received Norco 10 mg./325 mg. on 29 occasions, and methadone 10 mg. on: 22 occasions, prescribed by another physician, G.M., MD. I I 22. Respondent was aware that Pt. 1 was being prescribed Norco and methadone at that time byanother provider, but never contacted or'spoke withthat provider. A 23. ReSpondent stated that re?lls of existing prescriptions were provided-after Pt. 1 called on the telephone and told him that she was stable on the current medication doses. Respondent would then sign and fax to the pharmacies, prescription renewals.- Respondent has lost all the prescription renewal faxes and has no other notes regarding the prescription re?lls. 24. On August 2013, RespOndent examined Pt. 1, who complained of severe pain and disability; Respondent provided an early re?ll of diazepam 10 mg., #120, lasting thirty days, - along with four re?lls. A - 25. On October 24, 2013, Pt. 1 expired FIRST CAUSE FOR DISCIPLINE (Unprofessional Conduct: Furnishing Dangerous Drugs Without An Appropriate Prior I A Examination), I 26. The allegations of paragraphs 16 through 24' are incorporated by reference as if set out in full. Respondent is Subject to disciplinary action under section 2234 [unprofessional conduct], and/or section 2242 [furnishing dangerotts drugs without an appropriate prior examination], in that, as described above, Respondent repeatedly failed to conduct an appropriate prior examination of Pt. 1 while authorizing re?lls of dangerous drugs. SECOND CAUSE FOR DISCIPLINE (Unprofessional Conduct: Gross Negligence/ Repeated Negligent Acts) 27.? The allegations of'paragraphs16 through 24 are incorporated by reference as if set 7 (RICHARD ANDREW LANNON, M.D.) ACCUSATION NO. 800-2017-034384 full. Respondent is subject to disciplinary action Under section 2234 conduct; [gross negligence], and/or 2234(0) [repeated negligent acts or omissions], in.that, as described above, Respondent repeatedly failed to contact or speak with another provider who Respondent knew was prescribing dangerous drugs to Pt. 1 at the same time that Respondent was treating and providing dangerous drugs to Pt. 1. - I THIRD CAUSE FOR DISCIPLINE (Failure to Maintain Adequate Medical Records) 28. The allegations of paragraphs 16 through 24 above are incorporated by reference as if set out in full. Respondent?s license is subject to disciplinary action in that Respondent?s failure to maintain adequate and accurate records relating to his medical care and treatment of Pt. 1 constitutes unprofessional conduct by application bf section 2266. DISCIPLINE CONSIDERATIONS 29. To determine the degree of discipline, if any, to be imposed on Respondent, Complainant I I alleges that. Respondent has been subject to prior discipline, as follows: 1 i A. On December 9, 2002, in a prior disciplinary action entitled ?In the Matter of the Accusation ?led Against Richard A. Lannon, Case No. 03-1999-102369, the Medical Board of California revoked Respondent?s Phy-sician?sand Surgeon?s Certi?cate No. A 23592, stayed the revocation and placed respondent on probation for two years. That Decision is now . - final and is incorporated by'reference as if fully set forth. Respondent?s license was fully restored to clear status'following successful completion of probation, effective December 9, 2004. 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: 9 1. Revoking or suspending Physician's and Surgeon's Certi?cateNumber A 23592, issued to RichardAndrew Lannon, i A 2. Revcking, suspending or denying approvalof Richard'Andrew Lannon, M.D.'s authority to supervise physician assistants and advanced practice nurses; 8 . (RICHARD ANDREW LANN ON, MD.) ACCUSATION NO. 800-2017-0343 84 .28? U.) Ordering Richard Andrew Lannon, M.D., if placed on probation, to pay the Board the- costs of probation monitoring; and 4. Taking other and further action as deemed necessary and proper.' 15W January 8, 2019 KIRCHMEYER Executive Director Medical Board of California Department of Consumer Affairs State of California - Complainant 9 (RICHARD ANDREW LANNON, MD.) ACCUSATION NO. 800-2017-0343 84