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10
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'13FILED

 

XAVIER BECERRA A

. . - STATE OF CALIFORNIA
Att 1 
JA?ErgegC?g??gN?fCallf?mla MEDICAL BOARD OF CALIFORNIA
Supervising Deputy Attorney General SACRAMENTOW 20 .41..
LYNNEK. DOMBROWSKI BY ANALYST
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
E- mail: Lynne. Dombrowski@doj. ca. gov
Attorneys for Complainant

BEFORE THE
. . MEDICAL BOARD OF CALIFORNIA
- DEPARTMENT OF CONSUMER AFFAIRS

 

STATE 
.In the Matter of the Accusation Against: Case No. 800-2017-03 5705
JENNIFER ANN WILSON, M.D. ACCUSATION

Community Health Clinic OLE
1141 Pear. Tree Lane, Suite 100
Napa, CA 94558

Physician's and Surgeon's Certi?cate
No. A 86620,

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 April 2, 2004, the Medical Board issued Physician's and Surgeon?s
Certi?cate Number A 86620 to Jennifer Ann Wilson, 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 April 30, 2020, unless renewed.

 

(JENNIFER ANN WILSON, M.D.) ACCUSATION NO. 800-2017-035705

 

1all times alleged herein, Respondent was board-certi?ed in Family Medicine and
worked at the Community Health Clinic OLE (?Clinic OIsE?)in Napa, California. 
I JURISDICTION 
4. 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.
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:

Violating or attempting to violate, directly or indirectly, assisting in or abetting the
violation of, or conspiring to violate any provision of this chapter. I.

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 achange 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 I

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.

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

2
(JENNIFER ANN WILSON, MD.) ACCUSATION NO. 800-201-7-035705

 

 



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.N r?d r?t n?A p?A 

 

 

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 attendand
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 2228 Of the Code states, in pertinent part:

?The authority of the board . . . to discipline a licensee by placing him or her on probation
includes, but is not limited to, the following: I

Requiring the licensee to obtain additional professional training and to pass an
examination upon the completion of the training. The examination may be written or oral, or
both, and may be a practical or clinical examination, or both, at the option of the board?or the
administrative law judge.

Requiring the licensee to submit toa complete diagnostic examination by one or more

physicians and surgeons appointed by the bOard. If an examination is Ordered, the board shall

receive and consider any other report of a complete diagnostic examination given by one or more

physicians and surgeons of the licensee?s choice.

Restricting or limiting the extent, scope, or type of practice of thelicensee, including
requiring notice to applicable patients that the licensee is unable to perform the indicated
treatment, where appropriate. .

?(dj Providing the option of alternative community service in cases other than violations
relating to quality of care.? 

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 medicalindication, constitutes unprofessional 
conduct. -

No licensee shall be found to have. c0mmitted unprofessional conduct within the
meaning of this section if, at the time the drugs were prescribed, dispensed, or furnished, any of

the following applies:

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(JENNIFER ANN WILSON, ACCUSATION NO. 800-2017-035705

 

 

'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 caseino longer than 72 hours. i

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?s records. 

The practitioner was designated as the practitioner to serve in the absence of the

patient?s physician and surgeon or podiatrist, as the case may be.

The licensee was a designated practitioner serving in the absence of the patient?s
physician and surgeon or podiatrist, as the case may be, and was in possession of or had utilized 1
the patient?s records and ordered the renewal of a medically indicated prescription for an amount -
not exceeding the original prescription in strength or amount or for more than one re?ll.

The licensee was acting in accordance with Section 120582 of the Health and Safety
Code.?

8. Section 725 of the Code states:

Repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering
of drugs or treatment, repeated acts of clearly excessive use of diagnostic procedures, or repeated
acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of
the community of licensees is unprofessional conduct for a physician and surgeon, dentist,
podiatrist, physical therapist, chiropractor, optometrist, speech-language 
pathologist, or audio'logist. I i i

Any person who engages in repeated acts of clearly excessive prescribing or
administering of drugs or treatment is guilty of a misdemeanor and shall be punished by a ?ne of
not less than one hundred dollars ($100) nor more than six hundred dollars or by
imprisonment for a term of not less than 60 days?nor more than 180 days, or by beth that ?ne and
imprisonment. .

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(JENNIFER ANN WILSON, M.D.) ACCUSATION N0. 800-2017?035705.

 

 

\0100 LII 

 

 

A practitioner who has a medical basis for prescribing, furnishing, dispensing, or
administering dangerous drugs or preseription controlled substances shall not be subject to
disciplinary action or prosecution under this Section.

. No physician and surgeon shall be subject to disciplinary action pursuant to this section
for treating intractable pain in compliance with Section 2241.5.?

. 9. 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?- I

PERTINENT CONTROLLED DRUCS 

10. Alprazolam, l<nown by the trade name Xanax, is a triazolo-analogue of
the 1,4 benzodiazepine class of central nervous system-active compounds Xanax 1s used for the
management of anxiety disorders or for the short-term relief of the of anxiety. It 13 a
dangerous drug as de?ned 1n section 4022 and a Schedule IV 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.

11. biazepam, known by the trade name Valium, is a drug of the .
benzodiazepine class that is used for! the management of anxiety disordersor 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.

12. Gabapentin, knoWn by the trade name Neurontin, is an anticdnvulsant that is used to
prevent and control seizures and is also used to relive nerVe-pain', peripheral neuropathy. It is a 
dangerous drug as de?ned in Basiness and Professions Code section 4022. i

13. Hydrocodone bitartrate with acetaminophen, which is known by the trade names
Norco or Vicodin, is a opioid analgesic. It is a Schedule II controlled substance as

de?ned by section 11055, subdivision of the Health and Safety Code, and by section 1308.13

5
(JENNIFER ANN WILSON, MD.) ACCUSATION NO. 800-2017?035705

 

 

Amid



Title 21 of the Code of Federal Regulationsl, and-is a dangerous drug as de?ned in
Business and Professions Code section 4022. 

14. . Methadone hydrochloride is a narcotic analgesic with multiple actions
quantitatively similar to those of morphine. It is a dangerbus drug as de?ned in section 4022 and
a Schedule II controlled substance and narcotic as de?ned by section 11055, subdivision 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.

15. Seroquel, a trade name for quetiapine fumarate, is an drug that is

sedating and is used to treat mental/mood disorders such as schizophrenia, major depressive

disorder, and bipolar disorder. It is a dangerous drug as de?ned in Business and ?Professions 
Code section 4022.

i 16. Temazepam, known by the trade name Restoril, is a benzodiazepine hypnotic agent
used in the short-term treatment of insomnia 'It is a Schedule IV controlled substance
and narcotic as de?ned by section 11057 of the Health and Safety Code and is a dangerous drug 
as de?ned in Business and Professions Code section 4022. 

17. Zolpidem tartrate, known by the trade name Ainbien, is a non?benzodiazepine central
nervous system (CNS) depressant of the imidazopyridine class. It is a Schedule IV controlled
substance under Health and Safety Code section 11057, subdivision and is a dangerous
drug as de?ned in Business and Professions Code section'4022. It is indicated for the short-term

treatment of insomnia. It is a CNS depressant and should be used cautiously in combination with

- other CNS depressants. It should be administered cautiously to patients exhibiting signs or I

of depression because of the risk of suicide. Because of the risk of habituation and
dependence, individuals with a history of addiction to or abuse of drugs or alcohol should be

carefully monitored while receiving Ambien. I

 

1 Effective 10/06/2014, all hydrocodone combination products were re-scheduled from
Schedule to Schedule II controlled substances by the Federal Drug Enforcement Agency
section 1308.12 of Title 21 of the Code of Federal Regulations.

6 . .
(JENNIFER ANN WILSON, M.D.) ACCUSATION NO. 800-2017-035705

 

 



U.)

 

 

FIRST CAUSE FOR 
(Unprofessional Conduct: Gross Negligence and/or Repeated Negligent Acts and/our
Excessive Prescribing and/or Prescribing without Appropriate Examination: Patient A.) 
18. Respondent is subject to disciplinary action for unprofessional conduct for gross 
negligence and/or repeated acts of negligence and/or prescribing without appropriate prior
eXamination and medical indications and/or repeated acts of clearly excessive prescribing, under .
sections 2234, subd. and/or 2234, .subd. (0) and/or 2242 and/or 725, as described herein below.
19. In or about October 2006, Respondent began treating Patient A for chronic pain
The patient?s chronic pain arose from a work-related injury thatnearly amputated his
leg. Patient A also had a history of alcohol abuse and suffered from major depression and
anxiety. i
20. . In or about January 2007, Patient A began participating in' a Chronic Pain
Management Support Group at Clinic OLE that included Visits with Respondent. 

21. During the course of Patient A?s treatment, Respondent prescribed methadone in.

- combination with other Controlled substances while Patient A was also struggling with alcohol

abuse. .

22. From about October 2009 to November 2010, Patient A moved from Napa County to
Lake County and received treatment and controlled substances from another physician in Lake
County. I

23. On or about February 7, 2012, Respondent saw Patient A and prescribed to him
multiple controlled substances: #150 Norco 10-325rmg. ., #150 Methadone 10 mg., #90
Ibuprofen 800 mg. Respondent stopped prescribing Valium 5 mg. and prescribed #60 .
Temazepam.. Respondent referred Patient A to a Licensed Clinical Social Worker, a behavioral
health consultant, because he was struggling with alcohol abuse and depressive 

24. On or about February 13, 2012, Patient A saw a Licensed Clinical social Worker

at the Clinic OLE. During that session, Patient A disclosed that, four months earlier

he had attempted suicide with a gun and that he had a history of alcohol and of marij uana abuse.

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(JENNIFER ANN WILSON, M.D.) ACCUSATION NO. 800-2017-03 5705

 

 

mlwa



about July 24, 2012, Respondent saw Patient A who was. complaining of
increased knee pain. Respondent noted that the patient reported that his last alcoholic drink was?
?ve weeks ago and that he had been arrested for having an altered ?firearm, a shotgun.
Respondent Continued to prescribe for Patient A: #150 Methadone 10 mg, #120 Norco
10- 325 mg, #60 Temazepam 30 mg, and #90 Ibuprofen 800 mg. Respondent also added a
prescription for Gabapentin 100 mg. i

26. On or about August 2, 2012, Patient A saw the LCSW about his depression. The
LCSW noted in the patierit?s chart a diagnosis of Disorder NOS. 

27. On or about August 14, 2012, Respondent saw Patient A and noted in his chart that it I
was unclear whether his Disorder NOS was ?substance-abuse related or true mental
illness.? Respondent noted that the patient began to drink alcohol at age 13 and Consistently
consumed alcohol for 40 years. Although Respondent mentioned in the chart note that she
discussed with the patient how each prescribed medication worked, she did not document a
discussion about the dangers of a potential overdose should he drink alcohol while consuming the
combination of prescribed drugs. Respondent re?lled prescriptions for #150 Methadone, #120 
Norco 10-325 mg, Ibuprofen 800 mg, and #90 Gabapentin 100 mg. Respondent also added a
prescription for #30 Seroquel 200 mg with three re?lls. .

28, On or about September 4, 2012, Respondent saw Patient A as part of his 
chronic pain group session. Respondent continued to prescribe Gabapentin 100 mg, Ibuprofen
800 mg, Temazeparn 30 mg, #180 Methadone .10 mg, and #120 Norco 10-325 mg, and
#30 Risperdal 3 mg. Respondent noted that the patient agreed to meet with a consulting
?for clari?cation of diagnosis.? Respondent also noted that the patient reported that
he could not afford-the Seroquel and didnot get the Risperdal prescription.

?29. On or about September 12, 2012, Respondent saw Patient A for a 
consultation. Respondent noted a discussion with the consultant at Clinic OLE who
agreed that the patient was exhibiting and agreed with using Seroquel and
avoiding all benzodiazepines. Patient A asked for a prescription for Xanax because he had tried

some of his friend?s supply and felt great. Respondent noted that she reiterated that he was to

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(JENNIFER ANN WILSON, M.D.) ACCUSATION NO. 800?2017-035705

 

 



.26"

27
28.



 

 

avoid all benzodiazepines ?given his extensive. struggle with alcohol.? Respondent also noted
that the patient was to start Seroquel and avoid all other sleep aids. Respondent prescribed #60
Seroquel 100 mg. with three re?lls and noted that she was stopping the Risperdal 3 mg. and
Tem'azepam August 2012, Respondent documented reviewing a CURES report for Patient A

and obtaining a urine toxicology screen, which did not include a test for alcohol; 3

31. On or about January 8, 2013, Respondent'n'ext saw Patient A Who reported that he did
not want to take Norco. Respondent increased the preseription of Methadone to #180 Methadone I
10 mg, and added a prescription for #30 Zolpidem tartrate. 12.5 mg. extended release. Patient A
was also still taking Gabapentin 100 mg? Ibuprofen 800 mg., and Seroquel 100 mg.- ReSpondent
noted that the ?patient will price the sleep aid and purchase whichever is most affordable, .. 
pharmacy instructed to void other Rx. 

32. In January, February, April, and May 2013, Patient A ?lled concurrent prescriptions
from'Respondent for both Zolpidem tartrate and Ternazepam. I

33. On or about February 5, 2013, Respondent saw Patient A and ordered a urine
toxicology drug screen, which did not include testing for alcohol. Although it was noted in the
patient? 3 chart that a ?pain contract? was done, there was no copy of a pain contract in Patient A?s
records. Respondent noted stopping the Norco and continuing prescriptions for Gabapentin,
Methadone, and Ibuprofen. -

34. On or about March 5, 2013, Respondent saw Patient A and re?lled the prescription

for #180 Methadone 10 mg. and continued Ibuprofen 800 mg. Patient A was to follow-up in

four weeks, to attend the chronic pain management support group. Respondent made a note
under ?depression? that appears to indicate that Gabapentin'was to be replaced with Temazepam
30 mg. at bedtime, although neither drug is indicated for treatment of depression. Respondent,
however, did not stop the Gabapentin but actually increased the dose of Gabapentin from'100 mg.
to 300 mg. Respondent?s Chart note for theyisit was not signed until March 16, 2018.

35. From March through May 2013, Patient A continued to ?ll prescriptions from

Respondent for Methadone, Temazepam, and Zolpidem tartrate.

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(JENNIFER ANN WILSON, MD.) ACCUSATION NO. 800-2017-035705

 

 





36. Patient A?s next, and last, Visit with Respondent was on or'about July2, 2013. This
visit was focused on the patient?s shoulder pain and numbness. The patient reported being seen I
and getting medications from a physician in Lake COunty. Respondent noted that the patient .
reported drinking 1-2 'beers a night. It was noted that the patient said that the Methadone was
making him sick and that the Seroquel was? not working as well, wanted to go back to taking
Temazepam. Respondent appears to have prescribed (restarted) gabapentin for Patient A. It is
mentioned under the treatment plan for chronic pain but without an explanation for why it Was
stopped and-restarted. Respondent prescribed #180 Methadone-HCI and wrote 'a prescription for
Temaz'epam, without decumenting medical indications for these prescriptions. Respondent also i I
prescribed #90 Gabapentin 300 mg. with three re?lls, #90 Ibuprofen 800 mg., and Seroquel 100
mg. andissued a new prescription for #30 Lunesta with three re?lls. The patient was to folloW-
up with a Visit-in four weeks. Respondent?s chart note for the visit was not signed until July 9,
2013.

37. At an interview during the Medical Board?s investigation, Respondent stated that she
thought that, at the my 2, 2013 visit, Patient A?s reported nausea from Methadone was related to .
his drinking alcohol-and that hisgastritis was also related to alcohol abuse. .

38. On July 4, 2013, Patient A, at age 55, was pronounced dead due to acute methadone
toxicity, per the coroner?s investigation. .

39. Respondent?s overallconduct, acts and/or omissions, with regard to Patient A, as set
forth in paragraphs 18 through 38' herein, constitutes unprofessional conduct through gross
negligence and/or repeated negligent acts, and/or prescribing ?without an appropriate prior
examination and a medical indication and/or excessive prescribing, pursuant to Business and

Professions Code Sections 2234, subdivisions and/or and/or section 2242 and/or section

725, and is therefore subject to disciplinary action. More speci?cally, Respondent is guilty of

unprofessional conduct with regard to Patient A as follows:
a. Respondent failed to adequately monitor Patient A while prescribing controlled

substances and other prescription medications with synergistic sedating prOperties in a patient

10

 

(JENNIFER ANN WILSON, MD.) ACCUSATION NO. 800-2017-035705

 

.28

dangers of a potential overdose and death.

 

 

with a substance use (alcohol) disorder, which constitutes an extreme departure from the standard
of care. I i

b. Respondent prescribed Methadone to Patient A, in combination with Gabapentin and -
benzodiazepines, with, the knowledge of Patient A?s continued use/abuse of - alcohol, without
clearly documenting treatment goals and obj ectiVes, which constitutes an extreme?depart'ure from I
the standard of care. I I . I

c. After Respondent stOpped prescribing benzodiazepines in September 2012 to Patient
A because of his struggles with alcohol, Respondent later prescribed a benzodiazepine without
documenting a medical indication and without a further warning to the patient about the risks,

d. During the course of treatment, Respondent did not document having?any discussion
with Patient A about the risks ?of overdose and death with taking the combination of prescribed
medications such a methadone, gabapentin, Ambien, and benzodiazepines.

e. During the course of treatment, Respondent failed to document counselling Patient A



on the risks of his medication pro?le in combination with his use of alcohol, particularly the

f. Respondent prescribed different sleep medications, such as benzodiazepines,
Gab?apentin and Ambien, Without documenting any discussion with the patient about sleep
hygiene or about other non-prescription drug-type treatments. ReSpondent also failed to Clearly
document the medical indication for the prescribing of the different sleep medications, whether
the medications were being prescribed for sleep or for chronic pain.

g. When Respondent became aware that Patient A was receiving prescription
medications, controlled substances, from another physician, Respondent failed to appropriately
respond, such as with closer monitoring.

h. During the course of treatment, when Respondent became aware that the patient was
craving or actually consuming alcOhol while taking the combination of prescribed controlled
substances with synergistic sedating properties, Respondent did not perform random toxicology

testing for alcohol prior to prescribing more opioids and benzodiazepines.

1 1
(JENNIFER ANN WILSON, M.D.) ACCUSATION NO. 800-2017-035705

 

 





Although Respondent referred Patient A to Respondent did not discuss or
appear to consider prescribing antidepressants to Patient A.

j. At the last visit in July 2013, Respondent prescribed a high dose of Methadone
despite the patient reporting that he 'had recently received controlled substances from another
physician and without consulting the CURES. Respondent also prescribed Methadone even
though the patient reperted that it caused him nausea. .

k. In 2013, Respondent did not consult the CURES database to monitor Patient A?s

receipt of controlled substances prescriptions.

1. During at least 2013, Respondent continued to prescribe controlled substances
without adequate follow-up. I

m. There was no copy of a pain management agreement in Patient A?s medical records.

11. Respondent often did not timely write her entries in Patient A?s medical records.

0. During the course of treatment, Respondent did not obtain objective measurements to
determine whether Patient A was consuming alcohol, such as a toxicology. or a liver function test.
Respondent also did not provide treatment recommendations or referrals for alcohol cessation,
such as referral to a substance abuse treatment specialist or to AA. 

p. In March 2013, Respondent stopped prescribing gabapentin without documenting an
eXplanation or a medical indication for her treatment plan.

SECOND CAUSE FOR DISCIPLINE
(Unprofe'ssional Conduct: Failure to Maintain Adequate Medical Records (Patient A)

40. Respondent is subject to disciplinary action for unprofessional under section 2266 for -
failing to maintain adequate and accurate records for Patient A. "Paragraphs 18 through 39 are
incorporated herein by reference as if fully. setforth. 



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 Certificate Number A 86620,
issued to Jennifer Ann Wilson, 

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(JENNIFER ANN WILSON, M.D.) ACCUSATION NO. 800-2017-03?5705

 

 



Revoking, suspending or denying approval of Jennifer Ann Wilson, M.D.'s authority
to supervise physician assistants and advanced practice nurses;
- -3. Ordering iermifer Ann Wilson, M.D., if placed on probation, to pay the Board the
costs of probation monitoring; and I I i I

Taking such other and further action as deemed necessary and proper.

DATED: January 11, 2019 

KYMBE KIRCHME ER
Executi Iiygirector by
Medical Board of California
Department of Consumer Affairs
State of California

Complainant

SF20.18201631

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(JENNIFER ANN WILSON, MD.) ACCUSATION NO. 800-2017-035705