00'19XAVIER BECERRA Attorney General of California E. A. JONES Supervising Deputy Attorney General CINDY M. LOPEZ Deputy Attorney General State Bar No. 119988 California Department of JustiCe 300 So. Spring Street, Suite 1702 -Los Angeles, CA 90013 Telephone: (213) 269- 6494 Facsimile. (213) 897- 9?395 Attorneys for Complainant FILED STATE OF CALIFORNIA BEFORE THE MEDICAL OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 800?2017?030675 Vorakiat Charuvastra, MD. A CC A I P.O-. Box 33317 . Los Angeles, CA 90033 Physician's and Surgeon's Certi?cate No. A 29784, 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 (Board). 2. On or about December 8, 1975, the Medical Board issued Physician's and Surgeon's . Certi?cate Number A 29784 to Vorakiat Charuvastra, MD. (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 January 31, 2021, unless renewed. 1 (VORAKIAT CHARUVASTRA, MID.) ACCUSATION NO. 800-2017?030675 10'28 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 oneryear, placed on probation and reduired to pay the costs of probation monitoring, or such other action taken in relation to discipline as the Board deems proper. 5. Section 223.4 of the Code, stateszl ?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: 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. 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. 1 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 (VORAKIAT CHARUVASTRA, M.D.) ACCUSATION NO. 800-2017-030675 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. 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.? CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 6. Respondent is subject to disciplinary action under section 2234, subdivision (0), in that he was repeatedly negligent in his care and treatment of patient B.H. The circumstances are . as follows: A. Patient B.H. was identi?ed as avpatient whose cause of death was related to prescription drugs issued by Respondent. He apparently died of an accidental overdose of medications. B. Patient B.H. was referred to Respondent through worker's compensation. They met . in 2007 for a surgical clearance B.H. dealt with depression and abused alcohol. I B.H. treated with Respondent from March 2007 through June 2013 for treatment. - C. During this time, Respondent prescribed combinations of Wellbutrin/bupropion (an anti-depressant); Celexa/Citalopram (an anti depressant that treats major depressive disorder); Buspar/Buspirone (to treat anxiety); Risperdal/Risperidone Seroquel/Quetiapine (another Valium/Diazepam (for anxiety and sleep); Ambien (for sleep); Theramine (helps with pain); and, Klonopin (treats seizures and panic disorder). .D. This patient was also prescribed morphine, Soma and hydrocodone by other physicians, at the same time that Respondent was prescribing his variety of 3 (VORAKIAT CHARUVASTRA, MD.) ACCUSATION NO. 800-2017?030675 00 \1 ON 'kll medications. Patient B.H. never seemed to have a prolonged improvement in his and eventually developed an opioid dependence. According to the patient?s Wife, when B.H. would return home after an appointment with the Respondent, he had a brown paper bag with pills in them, but his wife was I not allowed to see them. . Respondent admitted he knew the patient was simultaneously being prescribed significant doses Of morphine, 1\lorco, Soma. During thesevisits, there was no assessment of cognition, substance use and abuse, nor an estimation of the patient's suicide risk. There was no documentation of a discussion of respiratory risks associated with this medication combination. Allegations of Negligence: Respondent's prescriptions of Ambien (up to twice the FDA maximum), while also prescribing other respiratory depressants in high doses, Without documenting an . informed consent of the risks, is a simple departure each time he did so. There were 15 departures from January 2012 through May 2013, speci?cally: January 11, 2012; February 14, 2012;March 13, 2012; May 8, 2012; May 29, 2012; June 16, 2012; July 24, 2012; September 18, 2012; October'16, 2012; November 13, 2012; January 2, 2013;'February 19, 2013; March 17, 2013; and, May 9, 2013. 1 Between the dates of January 11, 2012, through May 9, 2013, Respondent was negligent when he failed to do an assessment of the patient's substance abuse and use; failed to estimate his suicide risk; and failed to document a speci?c discussion of the respiratory risks given the combination of Ambien and the many other medications he was prescribed. 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: 4 (VORAKIAT CHARUVASTRA, M.D.) ACCUSATION NO. 800?2017?030675 Revoking or suspending Physician's and Surgeon's Certi?cate Number A 29784, issued to Vorakiat Charuvastra, 2. Revoking, suspending or denying approval of Vorakiat Charuvastra, authority to supervise physician assistants and advanced practice nurses; 3. I Ordering Vorakiat' Charuvastra, M.D., if placed on probation, to pay the Board the 7 costs of probation monitoring; and 4. Taking such other and further action as deemed necessary and proper. 9, . 1111/ KIMBERLY Executive Dire Medical Board of California Department of Consumer Affairs State of California Complainant LA2019500032 5 (VORAKIAT CHARUVASTRA, M.D.) ACCUSATION NO. 800-2017-030675