before the medical board of california department of ...4patientsafety.org/documents/mohamed, ehab a...

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Second Accusation ) Against: )

) )

EHAB A. MOHAMED, M.D. ) )

Physician's and Surgeon's ) Certificate No. A-72575 )

) Respondent )

DECISION

Case No. 06-2008-189018

The attached Stipulated Surrender of License and Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00 p.m. on February 21, 2013

IT IS SO ORDERED February 14, 2013.

KAMALA D. HARRIS Attorney General of California

2 E. A. JONES III Supervising Deputy Attorney General

3 JUDITH T. ALVA RADO Deputy Attorney General

4 State Bar No. 155307 TRINA L. SAUNDERS

5 Deputy Attorney General State Bar No. 207764

6 300 So. Spring Street, Suite 1702 Los Angeles, CA 90013

7 Telephone: (213)620-2193 Facsimile: (213) 897-9395

8 Attorneys for Complainant

9 BEFORE THE MEDICAL BOARD OF CALIFORNIA

10 DEPARTMENT OF CONSUMER AFFAIRS

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STATE OF CALIFORNIA

In the Matter of the Second Amended Accusation Against:

EHAB A. MOHAMED, M.D. 16260 Ventura Boulevard, Suite 720 Encino, California 91436

Physician's and Surgeon's Certificate No. A72575,

Case No. 06-2008-189018

OAH No. 2010090743

Consolidated with Case Nos. 06-2008-193751 06-2006-194493 05-2010-209475 05-2010-207878

STIPULATED SURRENDER OF Respondent. LICENSE AND ORDER

20 IT IS HEREBY STIPULATED AND AGREED by and between the parties in this

21 proceeding that the following matters are true:

22 PARTIES

23 1. Linda K. Whitney (Complainant) is the Executive Director of the Medical Board of

24 California. She brought this action solely in her official capacity and is represented in this matter

25 by Kamala D. Harris, Attorney General of the State of California, by Judith T. Alvarado and

26 Trina L. Saunders, Deputy Attorneys General.

27 2. Ehab A. Mohamed, M.D. (Respondent) is in Pro Per. On or about July 1, 2000, the

28 Medical Board of California issued Physician's and Surgeon's Certificate No. A 72575 to Ehab A.

1

Stipulated Surrender of License (Case No. 06-2008-189018)

Mohamed, M.D. That certificate was in full force and effect at all times relevant to the charges

2 brought in Second Amended Accusation No. 06-2008-189018, which is consolidated with Case

3 Nos. 06-2008-193751, 06-2006-194493, 05-2010-209475 and 05-2010-207878. On February 3,

4 2011, an Interim Suspension Order was issued against Respondent's license. Respondent's

5 license expired on October 31, 2011.

6 JURISDICTION

7 3. Second Amended Accusation No. 06-2008-189018 was filed before the Medical

8 Board of California (Board), Department of Consumer Affairs, and is currently pending against

9 Respondent. The Second Amended Accusation and all other statutorily required documents were

10 properly served on Respondent on January 27, 2011. Respondent timely filed his Notice of

11 Defense contesting the Second Amended Accusation. A copy of the Second Amended

12 Accusation is attached as Exhibit A and incorporated by reference.

13 ADVISEMENT AND WAIVERS

14 4. Respondent has carefully read and understands the charges and allegations in Second

15 Amended Accusation No. 06-2008-189018. Respondent also has carefully read and understands

16 the effects of this Stipulated Surrender of License and Order.

17 5. Respondent is fully aware of his legal rights in this matter, including the right to a

18 hearing on the charges and allegations in the Second Amended Accusation; the right to be

19 represented by counsel, at his own expense; the right to confront and cross-examine the witnesses

20 against him; the right to present evidence and to testify on his own behalf; the right to the

21 issuance of subpoenas to compel the attendance of witnesses and the production of documents;

22 the right to reconsideration and court review of an adverse decision; and all other rights accorded

23 by the California Administrative Procedure Act and other applicable laws.

24 6. Respondent voluntarily, knowingly, and intelligently waives and gives up each and

25 every right set forth above.

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CULP ABILITY

2 7. Respondent understands that the charges in Second Amended Accusation No. 06-

3 2008-189018, if proven at hearing, constitute cause for imposing discipline against his

4 Physician's and Surgeon's Certificate No. A72575.

5 8. Respondent hereby admits that his ability to practice medicine safely is impaired due

6 to mental and physical disability which affect competency. Respondent hereby gives up his right

7 to a hearing on the charges in the Second Amended Accusation.

8 9. Respondent understands that by signing this stipulation he enables the Board to issue

9 an order accepting the surrender of his Physician's and Surgeon's Certificate without further

10 process.

11 CONTINGENCY

12 10. This stipulation shall be subject to approval by the Board. Respondent understands

13 and agrees that counsel for Complainant and the staff of the Medical Board of California may

14 communicate directly with the Board regarding this stipulation and surrender, without notice to or

15 participation by Respondent or his counsel. By signing the stipulation, Respondent understands .

16 and agrees that he may not withdraw his agreement or seek to rescind the stipulation prior to the

17 time the Board considers and acts upon it. If the Board fails to adopt this stipulation as its

18 Decision and Order, the Stipulated Surrender and Disciplinary Order shall be of no force or

19 effect, except for this paragraph, it shall be inadmissible in any legal action between the parties,

20 and the Board shall not be disqualified from further action by having considered this matter.

21 11. The parties understand and agree that facsimile copies of this Stipulated Surrender of

22 License and Order, including facsimile signatures thereto, shall have the same force and effect as

23 the originals.

24 12. In consideration of the foregoing admissions and stipulations, the parties agree that

25 the Board may, without further notice or formal proceeding, issue and enter the following Order:

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1 O~@

2 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. A72575, issued

3 to Respondent EHAB A. MOHAMED, M.D., is surrendered and accepted by the Medical Board

4 of California.

5 13. The surrender of Respondent's Physician's and Surgeon's Certificate and the

6 acceptance of the surrendered license by the Board shall constitute the imposition of discipline

7 against Respondent. This stipulation constitutes a record of the discipline and shall become a part

8 of Respondent's license history with the Board.

9 14. Respondent shall lose all rights and privileges as a physician and surgeon in

10 California as of the effective date of the Board's Decision and Order.

11 15. Respondent shall cause to be delivered to the Board his pocket license and, if one was

12 issued, his wall certificate on or before the effective date of the Decision and Order.

13 16. If Respondent ever files an application for licensure or a petition for reinstatement in

14 the State of California, the Board shall treat it as a petition for reinstatement. Respondent must

15 comply with all the laws, regulations and procedures for reinstatement of a revoked license in

16 effect at the time the petition is filed.

17 17. If the Board should ever grant a petition for reinstatement filed by Respondent, as a

18 condition precedent to the reinstatement of Respondent's physician's and surgeon's certificate

19 and in addition to any other condition the Board may impose, Respondent shall submit to both a

20 psychiatric examination and a complete physical examination. Both examinations are to be

21 conducted by physicians chosen by the Board. The psychiatric examination shall include

22 psychological testing, by a psychologist or psychiatrist (at the option of and chosen by the Board).

23 The physical examination may include but not be limited to non-invasive biological fluid testing

24 to determine the presence of scheduled and/or illicit drugs, if deemed necessary by the examining

25 physician. The individuals examining Respondent (collectively "the Examiners") shall be

26 directed to determine whether Respondent is impaired due to a mental or physical illness or

27 disability which affects his competence to practice medicine safely. Respondent's physician's

28 and surgeon's certificate will not be reinstated unless the Examiners determine that Respondent

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does not have a mental or physical illness or disability which affects his competence to practice

2 medicine safely.

3 18. The Examiners shall provide detailed written reports of the findings and conclusions

4 of their examinations of Respondent. The reports of the Examiners may be received as direct

5 evidence in any administrative proceedings concerning Respondent's certificate to practice

6 medicine or that may be filed as a result of the mental and physical examinations.

7 ACCEPTANCE

8 I have carefully read the above Stipulated Surrender of License and Order. I understand the

9 stipulation and the effect it will have on my Physician's and Surgeon's Certificate. I enter into

1 O this Stipulated Surrender of License voluntarily, knowingly, and intelligently, and agree to be

11 bound by the Decision and Order of the Medical Board of California.

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13 DATED: \?- 11 i \ 26 \ L_ -----""'-----------+

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EHAB A. MOHAMED, M.D. Respondent

ENDORSEMENT

The foregoing Stipulated Surrender of License and Order is hereby respectfully submitted

for consideration by the Medical Board of California of the Department of Consumer Affairs.

Dated: December i, 2012 Respectfully submitted, KA.MALAD. HARRIS Attorney General of California E. A. JONES III Supervising Deputy Attorney General

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TRINA L. SAUNDERS Deputy Attorney General JUDITH T. ALVA RADO Deputy Attorney General Attorneys for Complainant


Exhibit A

Second Amended Accusation No. 06-2008-189018

KAMALA D. HARRIS Attorney General of California

2 GLORIA L. CASTRO Supervising Deputy Attorney General

3 JUDITH T. ALVARADOL Deputy Attorney General

4 State Bar No. 155307 TRINA L. SAUNDERS

5 Deputy Attorney General State Bar No. 207764

6 300 South Spring Street, Suite 1702 Los Angeles, CA 90013

7 Telephone: (213) 576-7149 Facsimile: (213) 897-9395

8 Attorneys for Complainant

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FILED ST ATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA SACRAMENTO~./ \::\ 20~

~- \'. '\ ~ N BY:~~·.; \\,\.J=u CV;,,,. A ALYST c - -

BEFORE THE

10 MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS ST A TE OF CALIFORNIA

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In the Matter of the Second Amended Accusation Against:

EHAB A. MOHAMED, M.D.

16260 Ventura Boulevard, Suite 720 Encino, California 91436

Physician's and Surgeon's Certificate No. A 72575

Respondent.

20 Complainant alleges:

Primary Case No. 06-2008-189018

Consolidated with Case Nos. 06-2008-193 751 06-2006-194493 05-2010-209475 05-2010-207878

OAH No. 2010090743

SECOND AMENDED ACCUSATION

21 PARTIES

22 1. Linda K. Whitney ("Complainant") brings this Second Amended Accusation solely in

23 her official capacity as the Executive Director of the Medical Board of California ("Board").

24 2. On or about July 1, 2000, the Medical Board of California issued Physician's and

25 Surgeon's Certificate Number A 72575 to EHAB A. MOHAMED, M.D. ("Respondent"). That

26 certificate was in full force and effect at all times relevant to the charges brought herein and

27 expired on October 31, 2011.

28 Ill

SECOND AMENDED ACCUSATION (OAH No. 2010090743)

1 JURISDICTION

2 3. This Accusation is brought before the Board under the authority of the following

3 laws. All section references are to the Business and Professions Code unless otherwise indicated.

4 4. Section 2234 of the Code states:

5 "The Board shall take action against any licensee who is charged with unprofessional

6 conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not

7 limited to, the following:

8 "(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the

9 violation of, or conspiring to violate any provision of this chapter [Chapter 5, the Medical

1 O Practice Act].

11 "(b) Gross negligence.

12 "( c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or

13 omissions. An initial negligent act or omission followed by a separate and distinct departure from

14 the applicable standard of care shall constitute repeated negligent acts.

15 "( 1) An initial negligent diagnosis followed by an act or omission medically appropriate for

16 that negligent diagnosis of the patient shall constitute a single negligent act.

17 "(2) When the standard of care requires a change in the diagnosis, act, or omission that

18 constitutes the negligent act described in paragraph ( 1 ), including, but not limited to, a

19 reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the

20 applicable standard of care, each departure constitutes a separate and distinct breach of the

21 standard of care.

22 "( d) Incompetence.

23 "( e) The commission of any act involving dishonesty or corruption which is substantially

24 related to the qualifications, functions, or duties of a physician and surgeon.

25 "(f) Any action or conduct which would have warranted the denial of a certificate."

26 5. Section 2266 of the Code states: The failure of a physician and surgeon to maintain

27 adequate and accurate records relating to the provision of services to their patients constitutes

28 unprofessional conduct."

2 SECOND AMENDED ACCUSATION

(OAH No. 2010090743)

6. Section 2236 of the Code states:

2 "(a) The conviction of any offense substantially related to the qualifications, functions, or

3 duties of a physician and surgeon constitutes unprofessional conduct within the meaning of this

4 chapter. [Chapter 5, the Medical Practice Act]. The record of conviction shall be conclusive

5 evidence only of the fact that the conviction occurred.

6 "(b) The district attorney, city attorney, or other prosecuting agency shall notify the

7 Division of Medical Quality 1 of the pendency of an action against a licensee charging a felony or

8 misdemeanor immediately upon obtaining information that the defendant is a licensee. The

9 notice shall identify the licensee and describe the crimes charged and the facts alleged. The

1 O prosecuting agency shall also notify the clerk of the court in which the action is pending that the

11 defendant is a licensee, and the clerk shall record prominently in the file that the defendant holds

12 a license as a physician and surgeon.

13 "( c) The clerk of the court in which a licensee is convicted of a crime shall, within 48 hours

14 or after the conviction, transmit a certified copy of the record of conviction to the board. The

15 division may inquire into the circumstances surrounding the commission of a crime in order to fix

16 the degree of discipline or to determine if the conviction is of an offense substantially related to

17 the qualifications, functions, or duties of a physician and surgeon.

18 "( d) A plea or verdict of guilty or a conviction after a plea of no lo contendere is deemed to

19 be a conviction within the meaning of this section and section 2236.1. The record of conviction

20 shall be conclusive evidence of the fact that the conviction occurred."


22 "(a) In addition to any other action that a board is permitted to take against a licensee, a

23 board may suspend or revoke a license on the ground that the licensee has been convicted of a

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1 Business and Professions Code section 2002, effective January 1, 2008, provides that, unless otherwise expressly provided, the term "board" as used in the State Medical Practice Act (Bus. & Prof. Code, § 2000 et seq.) means the "Medical Board of California," and references to the "Division of Medical Quality" and "Division of Licensing" in the Act or any other provision of law shall be deemed to refer to the Board.


(OAH No. 2010090743)

crime, if the crime is substantially related to the qualifications, functions, or duties of the business

2 or profession for which the license was issued.

3 "(b) Notwithstanding any other provision oflaw, a board may exercise any authority to

4 discipline a licensee for conviction of a crime that is independent of the authority granted under

5 subdivision (a) only if the crime is substantially related to the qualifications, functions, or duties

6 of the business or profession for which the licensee's license was issued.

7 "( c) A conviction within the meaning of this section means a plea or verdict of guilty or a

8 conviction following a plea of no lo contendere. Any action that a board is permitted to take

9 following the establishment of a conviction may be taken when the time for appeal has elapsed, or

1 O the judgment of conviction has been affirmed on appeal, or when an order granting probation is

11 made suspending the imposition of sentence, irrespective of a subsequent order under the

12 provisions of Section 1203 .4 of the Penal Code.

13 "( d) The Legislature hereby finds and declares that the application of this section has been

14 made unclear by the holding in Petropoulos v. Department of Real Estate (2006) 142 Cal.App.4th

15 554, and that the holding in that case has placed a significant number of statutes and regulation in

16 question, resulting in potential harm to the consumers of California from licensees who have been

17 convicted of crimes. Therefore, the Legislature finds and declares that this section establishes an

18 independent basis for a board to impose discipline upon a licensee, and that the amendments to

19 this section made by Senate Bill 797 of the 2007-08 Regular Session do not constitute a change

20 to, but rather are declaratory of, existing law."


22 "Notwithstanding any other provision oflaw, in a proceeding conducted by a board within

23 the department pursuant to law to deny an application for a license or to suspend or revoke a

24 license or otherwise take disciplinary action against a person who holds a license, upon the

25 ground that the applicant or the licensee has been convicted of a crime substantially related to the

26 qualifications, functions, and duties of he licensee in question, the record of conviction of the

27 crime shall be conclusive evidence of the fact that the conviction occurred, but only of that fact,

28 and the board may inquire into the circumstances surrounding the commission of the crime in

4 SECOND AMENDED A CCU SA TJON

(OAH No. 2010090743)

order to fix the degree of discipline or to determine if the conviction is substantially related to the

2 qualifications, functions, and duties of the licensee in question.

3 "As used in this section, 'license' includes 'certificate,' 'permit,' 'authority,' and

4 'registration.'"

5 FIRST CAUSE FOR DISCIPLINE

6 (Gross Negligence)

7 Patient Z.H.2

8 9. Patient Z.H., a 77-year-old female, sought consultation with Respondent on May 17,

9 2010, for treatment of facial wrinkles with collagen and removal of abdominal fat. Respondent

1 O recommended the use of fillers, such as Radiesse, Perlane and Juvederm, for Z.H.' s face, along

11 with Thermage3 and Intense Pulsed Light4 treatment of the face, neck, chest, arms and hands.

12 Respondent recommended ultra high definition sculpting (also known as Vaser Li po Selection 5) of

13 Z.H.' s body. He advised Z.H. that as a result of the body sculpting her overall health would be

14 improved with reduction in risk from coronary artery disease, stroke, diabetes, and hypertension.

15 Further, that these health benefits rendered the treatment tax deductible.

16 10. Respondent quoted the cost of the procedures as $50,000.00 for the face and neck

17 sculpting; $150,000.00 for the ultra high definition body sculpting; $19,000.00 for nasal/chin/lip

18 sculpting. Discounts were offered if Z.H. agreed to participate in his "Harvard study."

19 11. Z.H. advised Respondent that she did not want any procedures done to her face as she

20 would be attending her granddaughter's wedding in one month. She was, however, interested in

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2 In this Accusation, the patients are referred to by initial. The full names of the patients will be disclosed to Respondent when discovery is provided pursuant to Government Code section 11507 .6.

3 Thermage uses radiofrequency to smooth, tighten and contour skin. 4 Computer regulation of high intensity of pulses of light to rid the skin of various

complalnts. 0 Vaser-assisted tumescent LipoSelection is performed under local anesthesia. The

anesthetic solution is injected into the fatty tissue causing the area to become hard and swollen (tumescent). The Vaser probe is inserted into the fatty layer and delivers ultrasonic vibrating energy to emulsify the fatty tissue. The emulsified fatty tissue is then aspirated using suction cannula. Vaser-assisted tumescent LipoSelection is a form of liposuction.


(OAH No. 2010090743)

the body sculpting procedure and she agreed to participate in his "Harvard study." Respondent

2 requested a cashier's check for the sum of $35,000.00 before he would schedule the procedure.

3 12. On May 19, 2010, Z.H. presented to Respondent's office for her initial procedure.

4 When Z.H. arrived she advised Respondent's medical assistant, Judy Evans that she had eaten a

5 full breakfast and had taken her daily medications which included aspirin, a blood thinner.

6 Nevertheless, Z.H. was given two tablets of Vicodin6 at 9:50 a.m. and Xanax7 at 11 :20 a.m. In

7 his procedure note, Respondent states that when he made the incision for the lower abdominal

8 port there was bleeding from the incision and he stopped the body contouring procedure.

9 Because the patient had been taking baby aspirin, Respondent cancelled the body sculpting

1 O procedure.

11 13. Instead, Respondent proceeded with the facial contouring procedure, even though

12 Z.H. had previously indicated that she did not want anything done to her face prior to her

13 granddaughter's wedding. Notably, Z.H. consented to the facial procedure after she had been

14 sedated with the Vicodin and Xanax.

15 14. On May 21, 2010, Respondent performed liposculpting on Z.H.'s body, inserting

16 4000cc of tumescent fluid, which consisted of 1 OOOcc of normal saline and 3 OOOcc of 1 %

17 lidocaine and sodium bicarbonate. Respondent removed a total of 7600cc of aspirate from Z.H. 's

18 abdomen, waist area, hip area, lumbar area and subscapular area. He also performed Thermage

19 and Intense Pulsed Light treatments to Z.H. 's face. Z.H. was medicated for the procedure with

20 Vicodin and Xanax at 9:30 a.m. and 12:40 p.m. When Z.H. awoke after her procedures,

21 Respondent had left his office. Ms. Evans requested the aid of Z.H. 's husband to help put a

22 compression garment on Z.H. as Ms. Evans was the only staff member in the office.

23 15. Notably, Respondent did not employ a urinary catheter to assess hydration status or a

24 pulse oximeter to assess oxygen saturation. There was no regular heart monitoring via

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6 Vicodin or hydrocodone, is an opiate, narcotic analgesic. It contains 5 mg of hydrocodone and 500 mg of acetaminophen.

7 Xanax or aprazolam is a benzodiazepine. It is used to treat anxiety disorders and panic attacks.


(OAH No. 2010090743)

1 cardioscope or any other monitoring equipment. There is no separate vital sign log or intake and

2 output log. Indeed, Z.H.' s vital signs were not recorded during any of the procedures performed

3 by Respondent. There was no crash cart on the premises. Respondent's medical office is not a

4 general acute care hospital or out-patient surgery center.

5 16. Z.H. complained that she had drainage from the incisions on her hips and buttocks for

6 two to three weeks following the procedure. Respondent prescribed a diuretic to rid her body of

7 excess fluids.

8 17. Z.H. developed redness and pain to her face following the May 19, 2010, Thermage

9 treatment. The "filler" applied to the bridge of her nose has resulted in a lump. She also suffers

1 O from midline headaches. Before and after photos of Z.H. 's face show no significant change.

11 Z.H. complains of numbness of her back and her abdomen has a flattened shelf with fat

12 protruding above and below the shelf. Her hips are asymmetric.

13 False Advertising

14 18. Respondent advertises his cosmetic procedures in various print publications including

15 the Los Angeles Times and Los Angeles Magazine, and on the internet. Respondent claims in his

16 advertisements that the benefits of his cosmetic procedures include "no downtime, no general

17 anesthesia, no cutting and no surgical risk." To the contrary, there is downtime following the

18 procedures, Respondent gives medications to patients that rises to the level of general anesthesia

19 and there are surgical risks, including death. Respondent offered patient Z.H. a discount for her

20 cosmetic procedures if she agreed to participate in a "Harvard study." Respondent has no

21 affiliation with Harvard Medical School and his purported "study" does not exist. These actions

22 of Respondent are dishonest and corrupt acts within the meaning of Code Section 2234,

23 subdivision ( e ).

24 Lack of Informed Consent

25 19. The standard of care requires that a physician provide the patient with an informed

26 consent of all proposed procedures. This includes a discussion regarding the risks and benefits of

27 the procedure, as well as alternatives to the procedure.

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(OAH No. 2010090743)

1 20. Not only did Respondent fail to accurately advise Z.H. of the risks of the procedures,

2 he exaggerated the benefits. Respondent misrepresented that the use of fillers on Z.H. 's face

3 would give her a youthful appearance. Likewise, the removal of abdominal fat with external skin

4 tightening from Thermage could not produce the desired effects that Respondent promised.

5 21. Moreover, Respondent failed to offer Z.H. any alternatives to the procedures he

6 recommended.

7 22. Respondent's failure to obtain a proper informed consent from Z.H. is an extreme

8 departure from the standard of care.

9 Lack of Accreditation

1 O 23. The rules for the amount of liposuction extraction have been mandated by the

11 legislature in 16 California Code of Regulations Section 1356.6, which provides:

12 "(a) A liposuction procedure that is performed under general anesthesia or intravenous sedation or that results in the extraction of

13 5,000 or more cubic centimeters of total aspirate shall be performed ·in a general acute-care hospital or in a setting specified in Health and Safety

14 Code Section 1248.1." (Cal. Code Regs., tit. 16, § 1356.6.)

15 24. Thus, given that Respondent extracted far more than 5,000cc of aspirate from Z.H.,

16 he was required by law to have performed her procedure in either a general acute care hospital or

17 in an out-patient surgery center.

18 25. 16 California Code of Regulations Section 13 56. 6, further provides:

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"(b) The following standards apply to any liposuction procedure not required by subsection (a) to be performed in a general acute-care hospital or a setting specified in and Safety Code Section 1248 .1:

( 1) Intravenous Access and Emergency Plan. Intravenous access shall be available for procedures that result in the extraction of less than 2,000 cubic centimeters or total aspirate and shall be required for procedures that result in the extraction of 2,000 or more cubic centimeters of total aspirate. There shall be a written detailed plan for handling medical emergencies and all staff shall be informed of that plan. The physician shall ensure that trained personnel, together with adequate and appropriate equipment, oxygen, and medication, are onsite and available to handle the procedure being performed and any medical emergency that may arise in connection with that procedure. The physician shall either have admitting privileges at a local general acute-care hospital or have a written transfer agreement with such a hospital or with a licensed physician who has admitting privileges at such a hospital.

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SECOND AMENDED ACCUSATJON (OAH No. 2010090743)

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(2) Anesthesia. Anesthesia shall be provided by a qualified licensed practitioner. The physician who is performing the procedure shall not also administer or maintain the anesthesia or sedation unless a licensed person certified in advanced cardiac life support is present and is monitoring the patient.

(3) Monitoring. The following monitoring shall be available for volumes greater than 150 and less than 2,000 cubic centimeters of total aspirate and shall be required for volumes between 2,000 and 5,000 cubic centimeters of total aspirate:

(A) Pulse oximeter

(B) Blood pressure (by manual or automatic means)

(C) Fluid Loss and replacement monitoring and recording

(D) Electrocardiogram

(4) Records. Records shall be maintained in the manner necessary to meet the standard of practice and shall include sufficient information to determine the quantities of drugs and fluids infused and the volume of fat, fluid and supernatant extracted and the nature and duration of any other surgical procedures performed during the same session as the liposuction procedure.

(5) Discharge and Postoperative-care Standards

(A) A patient who undergoes any liposuction procedure, regardless of the amount of total aspirate extracted, shall not be discharged from professionally supervised care unless the patient meets the discharge criteria described in either the Aldrete Scale or the White Scale. Until the patient is discharged, at least one staff person who holds a current certification in advanced cardiac life support shall be present at the facility.

(B) The patient shall only be discharged to a responsible adult capable of understanding postoperative instructions." (Cal. Code Regs., tit. 16, § 1356.6.)

21 26. Respondent violated the provisions of the 16 Califorina Code of Regulations Section

22 13 56.6 subdivision (b ), as neither he nor his medical assistant are certified in Advanced Cardiac

23 Life Support. Respondent performs large volume liposuction in his office and the only

24 monitoring equipment he offers his patients is a blood pressure cuff and a stethoscope. His record

25 keeping is poor to non-existent; he does not appropriately monitor and record vital signs every

26 fifteen minutes and he fails to note vital signs and intake and output on a separate document.

27 Respondent only loosely monitors fluid intake and output. Obviously, the untrained personnel

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SECOND AMENDED ACCUSATION (OAH No. 20 I 0090743)

present and providing post-operative care to patient Z.H. did not meet the provisions of the

2 California Regulations.

3 27. Respondent believes that the oral sedation he provides does not impair a patient's

4 reflexes, yet Z.H. became unconscious under his oral sedation.

5 Excessive Administration of Sedatives

6 28. The administration of simple sedation is appropriate in the outpatient setting when

7 narcotics and sedatives are administered in low doses and the patient is appropriately monitored

8 by trained staff.

9 29. During the procedures performed on Z.H. she became heavily sedated and lost

1 O consciousness. Z.H. has little to no recollection of the procedures. Respondent noted that he had

11 to support Z.H. 's airway until she had sufficiently recovered.

12 30. The amount of sedation Respondent delivered to Z.H. during her procedures

13 exceeded simple sedation and moved to the level of conscious sedation.

14 31. Respondent's administration of sedation to Z.H. was reckless and constitutes an

15 extreme departure from the standard of care.

16 Qualifications of Staff

17 32. When an invasive procedure is performed, the standard of care requires the presence

18 of qualified staff to: assist with the procedure; perform intra-operative monitoring of the patient;

19 assist with any complications that might arise; and to perform post-operative monitoring of the

20 patient. Respondent did not have qualified staff on the premises to perform any of these

21 described functions.

22 33. The only staff present during Z.H. 's procedures was Respondent's medical assistant,

23 Judy Evans. Ms. Evans is 65 years old and her only medical training is some nursing school

24 courses and receipt of a medical assistant certificate "years ago." Respondent had Ms. Evans

25 serve as Z. H. 's pre-operative nurse and administer narcotic medication and benzodiazepines to

26 Z.H. without Respondent being present in the office. This alone is an extreme departure from the

27 standard of care, as an unlicensed medical assistant cab only administer medications following a

28

10


written order, while the physician is on the premises. This is also a violation of Section 2069 (a)

2 (1) of the Code.

3 34. Ms. Evans also served as scrub tech during Z.H. 's procedures, handing Respondent

4 the necessary surgical instruments.

5 35. Ms. Evans also served as circulating nurse during Z.H. 's procedures, charting, and

6 getting supplies when needed.

7 36. Ms. Evans also served as a nurse anesthetist. She provided medications to Z.H.

8 during her various surgeries. She was also charged with monitoring vital signs and "loosely

9 monitoring" fluid intake and output, during each procedure. Yet, Ms. Evans failed to chart Z.H. 's

1 O vital signs during any of the procedures performed at Respondent's office.

11 37. Ms. Evans also served as the recovery room nurse following Z.H. 's procedures.

12 38. Ms. Evans also served as maintenance technician following Z.H. 's procedures. She

13 was charged with cleaning the procedure room following the patient's surgeries.

14 39. Respondent allowed Ms. Evans to perform these duties despite the fact that she lacks

15 the requisite training of a scrub nurse or technician, a circulating nurse and a nurse anesthetist or

16 patient monitor. The patient's vital signs were not appropriately monitored every five minutes or

17 even every fifteen minutes. The patient's fluid intake and output were not accurately monitored.

18 40. Respondent's failure to maintain the appropriate number of qualified staff to safely

19 manage an out-patient procedure center is an extreme departure from the standard of care.

20 Furthermore, no competent physician or surgeon would perform any type of procedure without

21 the assistance of appropriately trained staff.

22 Inadequate Equipment

23 41. When performing out-patient procedures where high doses of narcotics are

24 administered, the standard of care requires that the appropriate equipment be on hand for patient

25 monitoring and for potential emergencies.

26 42. As noted above, during her procedures Z.H. was given high doses of medications that

27 resulted in deep sedation. Respondent, however, did not have any equipment to properly monitor

28 the patient. He did not have a cardioscope to provide constant cardiac monitoring. This is

11

SECOND AMENDED ACCUSATION (OAH No. 20 I 0090743)

extremely dangerous and inappropriate when lidocaine, a drug that is cardio-toxic, is

2 administered in high doses. Respondent did not have a pulse oximeter to measure if the patient is

3 receiving proper oxygenation. Respondent did not have an automatic blood pressure cuff which

4 would provide a constant read-out of the patient's blood pressure. This would be extremely

5 useful during tumescent liposuction when the patient's fluid balance is in constant flux. Most

6 importantly, Respondent did not have a "crash cart." He did not maintain equipment to start an

7 intravenous line or keep emergency life-saving medications on his premises.

8 43. Respondent's failure to secure appropriate equipment for patient monitoring and his

9 failure to maintain emergency equipment and medications, is an extreme departure from the

1 O standard of care. Furthermore, no competent physician or surgeon would perform any type of

11 procedure without ensuring that the appropriate patient monitoring and emergency equipment is

12 readily available.

13 Lack of NP08 Status at Time of Procedure

14 44. The standard of care requires that a patient not eat or drink for eight hours prior to a

15 surgical procedure. The purpose of this protocol is to ensure that the patient will not have

16 anything in their stomach during surgery in the event of aspiration 9 with sedation when the

17 patient's protective reflexes are diminished.

18 45. When Z.H. arrived for her procedure on May 19, 2010, she advised the medical

19 assistant that she had consumed a full breakfast and had taken her daily medications. Z.H. was

20 sedated for the anticipated liposuction procedure.

21 46. Respondent's failure to ensure that Z.H. had not consumed anything prior to her

22 procedures and his failure to have an NPO protocol in place at his facility, is an extreme departure

23 from the standard of care. Furthermore, Respondent's actions in performing a surgical procedure

24 when the patient has not been NPO for a minimum of 8 hours demonstrates a wanton disregard

25 for patient safety and constitutes incompetence.

26

27

28

8 Nil per os, Latin phrase which translates as nothing by mouth. 9 The entry of secretions or foreign material into the trachea or lungs.


(OAH No. 2010090743)

47. Respondent's treatment of Z.H. as set forth above in paragraphs 9 through 46

2 includes the following acts and/or omissions which constitute extreme departures from the

3 standard of practice:

4 A. Respondent falsely represented to Z.H. that as a result of the body sculpting her

5 overall health would be improved with reduction in risk from coronary artery disease, stroke,

6 diabetes, and hypertension. Further, that these health benefits rendered the treatment tax

7 deductible.

8 B. Respondent falsely represented to Z.H. that he was conducting a study on behalf of

9 Harvard Medical School.

1 O C. Respondent's failure to obtain a proper informed consent from Z.H.

11 D. Respondent's failure to comply with the provisions of 16 California Code of

12 Regulations Section 1356.6.

13

14

E.

F.

Respondent's excessive administration of sedation medication to Z.H.

Respondent's failure to have qualified staff to assist with the surgical procedures he

15 performed on Z.H.

16 G. Respondent's failure to have qualified staff to perform intra-operative monitoring of

17 Z.H.

18 H. Respondent's failure to have qualified staff to assist with complications that might

19 arise during the surgical procedures he performed on Z.H.

20 I. Respondent's failure to have qualified staff to assist with post-operative monitoring

21 of Z.H.

22 J. Respondent's failure to have the appropriate equipment for intra-operative monitoring

23 of Z.H.

24 K. Respondent's failure to have life-saving emergency equipment available during the

25 procedures he performed on Z.H.

26 L. Respondent's failure to ensure that Z.H. had not consumed anything prior to the

27 procedures he performed on her.

28 M. Respondent's failure to have an NPO protocol in place at his facility.

13


48. Respondent's acts and/or omissions as set forth in paragraphs 9 through 47, inclusive,

2 above, whether proven individually, jointly, or in any combination thereof, constitute gross

3 negligence pursuant to section 2234 subdivision (b) of the Code. Therefore, cause for discipline

4 exists.

5 SECOND CAUSE FOR DISCIPLINE

6 (Gross Negligence)

7 Patient S.C.

8 49. S.C. was 61 years old when she presented to Respondent on August 17, 2010 for

9 consultation for permanent weight loss in response to one of Respondent's advertisements. She

1 O sought correction of her sagging breasts and other area of excess adipose tissue, including her

11 face, neck, back, hips, buttocks, thighs and knees. Respondent advised S.C. that she would have

12 permanent results in 3-7 days with no loss of sensation, no hematomas and no complications. She

13 agreed to be a participant in his "study," having signed the participation form on August 17, 2010.

14 50. S.C.'s medical history was significant for hypertension, elevated cholesterol,

15 hypothyroidism and mild obesity. Pre-operative laboratory tests were performed on August 19,

16 2010 and August 21, 2010. No other pre-operative testing or examination was conducted or

17 requested. S.C. paid Respondent $100,000.00 via wire transfer into his bank account on August

18 19, 2010, for the cosmetic procedures.

19 51. S.C. was scheduled to undergo "neck to knees" Vaser LipoSelection on August 21,

20 2010. At 9:09 a.m. a Fentanyl IO patch was placed. She was given two Vicodin tablets and Xanax

21 at 10:47 a.m. Respondent did not start the procedure until 1: 10 p.m. At 2:35 p.m. she was given

22 more Xanax and two tablets of Percocet 11 at4:45 p.m. Respondent infused a total of 4000cc of

23 tumescent fluid, which was composed of 1 OOOcc of normal saline, 1 OOcc of 2% lidocaine and 1 cc

24 of l: 1000 epinephrine. He also infiltrated 50cc oflocal anesthetic at each of the 13 port sites.

25 S.C. was reported to be conscious through most of the procedure and drank 3500cc of fluid. Her

26

27

28

1° Fentanyl is a fast acting, potent, narcotic analgesic. 11 Percocet or oxycodone with paracetamol/acetaminophen is an opoid analgesic.


(OAH No. 2010090743)

total intake was 7500cc. Respondent aspirated 6000cc from S.C.'s upper abdomen, lower

2 abdomen, waist area, lumbar area, subscapular area, axillary area and hip area.

3 52. Respondent did not employ a urinary catheter to assess hydration status or a pulse

4 oximeter to assess oxygen saturation. There was no regular heart monitoring via cardioscope or

5 any other monitoring equipment. There is no separate vital sign log or intake and output log.

6 Rather, S. C.' s vital signs are jotted down the side of another record.

7 53. At some point during the procedure, in the afternoon or the early evening, S.C.

8 experienced nausea and vomited. Anti-nausea medication, ondansetron, was administered and

9 Respondent continued the procedure.

1 O 54. Despite the lack of monitoring equipment, according to Respondent's medical

11 assistant, Ms. Evans, at the direction of Respondent, she contacted Encino-Tarzana Hospital to

12 request intravenous fluids and intravenous tubing as Respondent thought the patient was

13 becoming dehydrated. The hospital refused to "sell" Respondent the requested medical supplies.

14 Despite his concerns of dehydration, Respondent continued with the procedure.

15 55. At approximately 12:17 a.m. of August 22, 2010, more than ten hours after the

16 procedure began, S.C. was noted to have shallow and intermittent breathing. Respondent

17 attempted to revive S.C. by calling out her name and then inserting an oropharyngeal airway and

18 began resuscitative measures. At 12:25 a.m., S.C. became unresponsive; she was pulseless. Ms.

19 Evans was instructed to call 911. S.C. was transferred from the operating table to the floor where

20 Respondent began chest compressions. The Los Angeles Fire Department paramedics arrived at

21 12:26 a.m. and administered life-saving measures. S.C. was pronounced dead at 12:50 a.m.

22 Notwithstanding, Respondent continued resuscitative measures until 1 :25 a.m.

23 56. An autopsy was performed on S.C. by the Los Angeles County Coroner. The cause

24 of death is ascribed to lidocaine, Fentanyl and oxycodone toxicity. The Coroner also concluded

25 that Respondent committed acts of gross negligence and significant errors in medical judgment.

26 False Advertising

27 57. Respondent advertises his cosmetic procedures in various print publications including

28 the Los Angeles Times and Los Angeles Magazine, and on the internet. Respondent claims in his

15


advertisements that the benefits of his cosmetic procedures include "no downtime, no general

2 anesthesia, no cutting and no surgical risk." To the contrary, there is downtime following the

3 procedures, Respondent gives medications to patients that rises to the level of general anesthesia

4 and there are surgical risks, including death. Respondent offered patient S.C. a discount for her

5 cosmetic procedures if she agreed to participate in a "Harvard study.'' Respondent has no

6 affiliation with Harvard Medical School and his purported "study" does not exist. These actions

7 of Respondent are dishonest and corrupt acts within the meaning of Code Section 2234,

8 subdivision (e).

9 Lack of Informed Consent

1 O 58. The standard of care requires that a physician provide the patient with an informed

11 consent of all proposed procedures. This includes a discussion regarding the risks and benefits of

12 the procedure, as well as alternatives to the procedure.

13 59. Respondent failed to accurately advise S.C. of the risks of the procedures and he

14 exaggerated the benefits.

15 60. Respondent told S.C. that he could accomplish a breast lift using the Vaser procedure.

16 A breast lift cannot be accomplished with ultrasonically assisted liposuction.

17 61. Moreover, Respondent failed to offer S.C. any alternatives to the procedures he

18 recommended.

19 62. Respondent's failure to obtain a proper informed consent from S.C. is an extreme

20 departure from the standard of care.

21 Lack of Accreditation

22 63. The rules for the amount of liposuction extraction have been mandated by the

23 legislature in 16 California Code of Regulations Section 1356.6, which provides:

24 "(a) A liposuction procedure that is performed under general anesthesia or intravenous sedation or that results in the extraction of

25 5,000 or more cubic centimeters of total aspirate shall be performed in a general acute-care hospital or in a setting specified in Health and Safety

26 Code Section 1248.1."

27 I I I

28 I I I

16


64. Respondent extracted far more than 5,000cc of aspirate from S.C. As such, he was

2 required by law to have performed her procedure in either a general acute care hospital or in an

3 out-patient surgery center.

4 65. 16 California Code of Regulations Section 1356.6, further provides:

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

..

" (b) The following standards apply to any liposuction procedure not required by subsection (a) to be performed in a general acute-care hospital or a setting specified in and Safety Code Section 1248.1:

( 1) Intravenous Access and Emergency Plan. Intravenous access shall be available for procedures that result in the extraction of less than 2,000 cubic centimeters or total aspirate and shall be required for procedures that result in the extraction of 2,000 or more cubic centimeters of total aspirate. There shall be a written detailed plan for handling medical emergencies and all staff shall be informed of that plan. The physician shall ensure that trained personnel, together with adequate and appropriate equipment, oxygen, and medication, are onsite and available to handle the procedure being performed and any medical emergency that may arise in connection with that procedure. The physician shall either have admitting privileges at a local general acute-care hospital or have a written transfer agreement with such a hospital or with a licensed physician who has admitting privileges at such a hospital.

(2) Anesthesia. Anesthesia shall be provided by a qualified licensed practitioner. The physician who is performing the procedure shall not also administer or maintain the anesthesia or sedation unless a licensed person certified in advanced cardiac life support is present and is monitoring the patient.

(3) Monitoring. The following monitoring shall be available for volumes greater than 150 and less than 2,000 cubic centimeters of total aspirate and shall be required for volumes between 2,000 and 5,000 cubic centimeters of total aspirate:

(A) Pulse oximeter

(B) Blood pressure (by manual or automatic means)

(C) Fluid Loss and replacement monitoring and recording

(D) Electrocardiogram

( 4) Records. Records shall be maintained in the manner necessary to meet the standard of practice and shall include sufficient information to determine the quantities of drugs and fluids infused and the volume of fat, fluid and supernatant extracted and the nature and duration of any other surgical procedures performed during the same session as the liposuction procedure.

(5) Discharge and Postoperative-care Standards


(OAH No. 20 I 0090743)

2

3

4

5

6

(A) A patient who undergoes any liposuction procedure, regardless of the amount of total aspirate extracted, shall not be discharged from professionally supervised care unless the patient meets the discharge criteria described in either the Aldrete Scale or the White Scale. Until the patient is discharged, at least one staff person who holds a current certification in advanced cardiac life support shall be present at the facility.

(B) The patient shall only be discharged to a responsible adult capable of understanding postoperative instructions." (Cal. Code Regs., tit. 16, § 1356.6.)

7 66. Respondent violated the provisions of the 16 CCR 13 56.6 (b ), as neither he nor his

8 medical assistant are certified in Advanced Cardiac Life Support. Respondent performs large

9 volume liposuction in his office and the only monitoring equipment he offers his patients is a

1 O blood pressure cuff and a stethoscope. His record keeping is poor to non-existent; S.C. 's vital

11 signs were not monitored and recorded every fifteen minutes. He also failed to note vital signs

12 and intake and output on a separate document. Respondent only loosely monitored S.C.'s fluid

13 intake and output.

14 67. Furthermore, Respondent had no equipment, medications or personnel available to

15 handle S.C.'s medical emergency. There was no one trained in advanced cardiac life support to

16 attend to S. C. during her medical emergency, and even if there had been, there was no crash cart

17 available to provide the necessary emergency equipment to successfully resuscitate the patient.

18 68. Respondent believes that the oral sedation he provides does not impair a patient's

19 reflexes, yet S.C. became unconscious under his oral sedation.

20 Inappropriate Pre-Operative Evaluation

21 69. Elective cosmetic surgery, as with any surgical procedure in a patient over 50 years of

22 age, requires a pre-operative evaluation.

23 70. Respondent learned from S.C. that she suffered from several risk factors, including

24 hypertension, coronary artery disease, elevated cholesterol and mild obesity. However,

25 Respondent failed to perform any type of pre-operative evaluation on her. He also failed to

26 obtain a surgical clearance from her primary care physician to ensure that S.C. was sufficiently

27 stable to undergo a surgical procedure. Respondent's failure to perform a proper pre-operative

28

18


evaluation on S.C. and obtain a surgical clearance from her physician is an extreme departure

2 from the standard of care.

3 Excessive Administration of Sedatives

4 71. The administration of simple sedation is appropriate in the outpatient setting when

5 narcotics and sedatives are administered in low doses and the patient is appropriately monitored

6 by trained staff.

7 72. As noted above, S.C. was given high doses of medications during her surgery that

8 resulted in deep sedation, leading to cardiopulmonary arrest.

9 73. S.C. 's cause of death is ascribed to lidocaine, Fentanyl and oxycodone toxicity.

1 O Qualifications of Staff

11 74. When an invasive procedure is performed, the standard of care requires the presence

12 of qualified staff to: assist with the procedure; perform intra-operative monitoring of the patient;

13 assist with any complications that might arise; and to perform post-operative monitoring of the

14 patient. Respondent did not have qualified staff on the premises to perform any of these

15 described functions.

16 75. The only staff present during S.C.'s procedure was Respondent's medical assistant,

17 Judy Evans. As stated above, Ms. Evans is 65 years old and her only medical training is some

18 nursing school courses and receipt of a medical assistant certificate "years ago." Respondent had

19 Ms. Evans serve as S.C. 's pre-operative nurse and administer narcotic medication and

20 benzodiazepines to S.C. without Respondent being present in the office. Again, this alone is an

21 extreme departure from the standard of care, as an unlicensed medical assistant can only

22 administer medications following a written order, while the physician is on the premises. This is

23 also a violation of Section 2069 (a) (1) of the Code.

24 76. Ms. Evans also served as scrub tech during S.C. 's procedure, handing Respondent the

25 necessary surgical instruments.

26 77. Ms. Evans also served as circulating nurse during S.C.'s procedure, charting, and

27 getting supplies when needed.

28

19

SECOND AMENDED A CC USA TJON (OAH No. 20 I 0090743)

1 78. Ms. Evans also served as a nurse anesthetist. She provided medications to S.C.

2 during her surgery. She was also charged with monitoring vital signs and "loosely monitoring"

3 fluid intake and output, during the lengthy procedure. She also recorded the patient's vital signs

4 and intake and output.

5 79. Ms. Evans also served as maintenance technician following S.C. 's procedure. She

6 was charged with cleaning the procedure room following the patient's surgery.

7 80. Ms. Evans lacks the requisite training of a scrub nurse or technician, a circulating

8 nurse and a nurse anesthetist or patient monitor. The patients' vital signs were not appropriately

9 monitored every five minutes or even every fifteen minutes. The patient's intake and output were

1 O not accurately monitored. When S.C. sustained an intraoperative complication, Ms. Evans was

11 not even able to assist with cardiopulmonary resuscitation as she was not current on her CPR

12 training.

13 81. Respondent's failure to maintain the appropriate number of qualified staff to safely

14 manage an out-patient procedure center is an extreme departure from the standard of care.

15 Furthermore, no competent physician or surgeon would perform any type of procedure without

16 the assistance of appropriately trained staff.

17 Inadequate Equipment

18 82. When performing out-patient procedures where high doses of narcotics are

19 administered, the standard of care requires that the appropriate equipment be on hand for patient

20 monitoring and for potential emergencies.

21 83. As noted above, S.C. was given high doses of medications during her surgery that

22 resulted in deep sedation. Respondent, however, did not have any equipment to properly monitor

23 this patient. He did not have a cardioscope to provide constant cardiac monitoring. This is

24 extremely dangerous and inappropriate when lidocaine, a drug that is cardio-toxic, is

25 administered in high doses. Respondent did not have a pulse oximeter to measure if the patient is

26 receiving proper oxygenation. This could have alerted Respondent that S.C. was getting into

27 trouble during her surgery. Respondent did not have an automatic blood pressure cuff which

28 would provide a constant read-out of the patient's blood pressure. This would be extremely

20 SECOND AMENDED ACCUSATJON

(OAH No. 2010090743)

useful during tumescent liposuction when the patient's fluid balance is in constant flux. Most

2 importantly, Respondent did not have a "crash cart." He didn't so much as maintain equipment to

3 start an intravenous line or keep emergency life-saving medications.

4 84. Respondent's failure to secure appropriate equipment for patient monitoring and his

5 failure to maintain emergency equipment and medications, is an extreme departure from the

6 standard of care. Furthermore, no competent physician or surgeon would perform any type of

7 procedure without ensuring that the appropriate patient monitoring and emergency equipment is

8 readily available.

9 Excessive Removal of Liposuction Aspirate

10 85. California has mandated that the volume of liposuction extraction should be 5,000cc's

11 or less, if the procedure is performed in a non-accredited outpatient setting.

12 86. On August 21, 2010, Respondent performed an outpatient liposuction extraction

13 procedure on patient S.C. at his non-accredited medical office. During the procedure he removed

14 6000cc's of liposuction aspirate from S.C.

15 87. Respondent's removal of excessive liposuction aspirate from S.C. in a non-accredited

16 facility was unlawful and in violation of 16 California Code of Regulations 13 56.6.

17 88. Respondent's removal of excessive liposuction aspirate from patient S.C. in a non-

18 accredited facility was an extreme departure from the standard of care.

19 Excessive Administration of Lidocaine

20 89. Lidocaine is a local anesthetic. An overdose of lidocaine can cause lightheadedness,

21 drowsiness, tinnitus, slurred speech, shivering, muscle twitching, convulsions, apnea and

22 cardiovascular depression and heart beat cessation. When lidocaine is used during tumescent

23 liposuction procedures the American Academy of Dermatology guidelines indicate that the

24 maximum dose oflidocaine to be administered is 55mg per kilogram of the patient's body

25 weight. This is because the lidocaine solution is removed shortly after it has been administered.

26 90. The maximum dose of lidocaine Respondent should have administered to patient S.C.

27 during her August 21, 2010 liposuction procedure was 4.5 gm (calculated as 55mg x 82.5 kg. or

28 181.6 lbs.= 4.5 gm). However, Respondent administered 8 gm. oflidocaine to S.C., which

21

SECOND AMENDED A CCU SA TION (OAH No. 2010090743)

resulted in her suffering from lidocaine toxicity and contributed to her death. Respondent's

2 administration of an excessive dose of lidocaine to S.C. was an extreme departure from the

3 standard of care.

4 Lack of NPO Status at Time of Procedure

5 91. The standard of care requires that a patient not eat or drink for eight hours prior to a

6 surgical procedure. The purpose of this protocol is to ensure that the patient will not have

7 anything in their stomach during surgery in the event of aspiration with sedation when the

8 patient's protective reflexes are diminished.

9 92. During S.C.'s liposuction procedure on August 21, 2010, Respondent encouraged her

10 to take oral fluids. The medical record indicates that S.C. consumed 3500cc of fluids during her

11 procedure.

12 93. Respondent's failure to ensure that S.C. had not consumed anything prior to or during

13 their procedures and his failure to have an NPO protocol in place at his facility, is an extreme

14 departure from the standard of care. Furthermore, Respondent's actions in performing a surgical

15 procedure when the patient has not been NPO for a minimum of 8 hours demonstrates a wanton

16 disregard for patient safety and constitutes incompetence.

17 Length of Surgical Procedure

18 94. Patient safety is the most crucial aspect of any surgical procedure and is required by

19 the standard of care. Exposing a patient to a prolonged surgical procedure places the patient at

20 risk for fluid imbalances, bleeding, infection, anesthetic drug reactions and deep venous

21 thrombosis.

22 95. The procedure Respondent performed on S.C. on August 21, 2010 was over 10 hours

23 long. There is no indication from the medical record to explain why the procedure was so

24 prolonged. Liposuction to the hips, abdomen, back and tail of the breast should not take more

25 than 5 hours to perform. Respondent should have recognized that the patient was not tolerating

26 the lengthy procedure. Respondent should have terminated the procedure when he recognized

27 that S.C. was dehydrated. Respondent could have easily performed the cosmetic liposuction on

28 S.C. in stages.

22


96. Subjecting S.C. to an excessively long elective procedure was an extreme departure

2 from the standard of care. Respondent's failure to recognize that his patient was not tolerating the

3 prolonged procedure and his failure to terminate the surgery when he recognized the patient was

4 dehydrated constitutes incompetence.

5 97. Respondent's treatment of S.C. as set forth above includes the following acts and/or

6 omissions which constitute extreme departures from the standard of practice:

7 A. Respondent falsely represented to S.C. that she would have permanent results in

8 3-7 days with no loss of sensation, no hematomas and no complications.

9 B. Respondent falsely represented to S.C. that he was conducting a study on behalf

1 O of Harvard Medical School.

11

12

13

C. Respondent's failure to obtain a proper informed consent from S.C.

D. Respondent's failure to comply with the provisions of 16 CCR 1356.6.

E. Respondent's failure to obtain a pre-operative surgical clearance from S.C.' s

14 primary care physician.

15

16

F. Respondent's excessive administration of sedative medication to S.C.

G. Respondent's failure to have qualified staff to assist with the surgical

17 procedures he performed on S.C.

18 H. Respondent's failure to have qualified staff to perform intra-operative

19 monitoring of S.C.

20 I. Respondent's failure to have qualified staff to assist with complications that

21 arose during S.C.'s surgical procedure.

22 J. Respondent's failure to have the appropriate equipment for intra-operative

23 monitoring of S.C.

24 K. Respondent's failure to have emergency equipment available during the

25 procedures he performed on S.C.

26 L. Respondent's removal of excessive liposuction aspirate from S.C. in a non-

27 accredited facility.

28

23


M. Respondent's excessive administration oflidocaine which resulted in lidocaine

2 toxicity and contributed to S.C.'s death.

,.., _) N. Respondent's failure to ensure that S.C. had not consumed anything prior to the

4 procedures he performed on her.

5

6

0. Respondent's failure to have a NPO protocol in place at his facility.

P. Respondent's performance of an excessively long surgical procedure on S.C.

7 Q. Respondent's failure to recognize that S.C. was not tolerating the prolonged

8 surgical procedure and his failure to terminate the surgery when he recognized that the

9 patient was dehydrated.

10 98. Respondent's acts and/or omissions as set forth in paragraphs 49 through 96,

11 inclusive, above., whether proven individually, jointly, or in any combination thereof, constitute

12 gross negligence pursuant to section 2234 subdivision (b) of the Code. Therefore cause for

13 discipline exists.

14 THIRD CAUSE FOR DISCIPLINE

15 (Repeated Negligent Acts)

16 Patient Z.H.

17 99. Respondent is subject to disciplinary action under section 2234, subdivision (c) of the

18 Code in that his care and treatment of patient Z.H. constitutes repeated negligent acts. The

19 circumstances are as follows:

20 100. The allegations of the First Cause for Discipline are incorporated herein by reference

21 as if fully set forth.

22 Inappropriate Pre-Operative Evaluation

23 101. Elective cosmetic surgery, as with any surgical procedure in a patient over 50 years of

24 age, requires a pre-operative evaluation.

25 102. In the case of Z.H., although Respondent touted that a benefit of body sculpting

26 would result in improved cardiac risk factors, he failed to perform a cardiac or pulmonary

27 assessment of the patient. He also failed to obtain a surgical clearance from her primary care

28

24


physician. Respondent's failure to perform a proper pre-operative evaluation on Z.H. and obtain

2 a surgical clearance from her physician is a simple departure from the standard of care.

3 Excessive Removal of Liposuction Aspirate

4 103. California has mandated that the volume of liposuction extraction should be 5 liters or

5 less, if the procedure is performed in a non-accredited outpatient setting.

6 104. On May 21, 2010, Respondent performed an outpatient liposuction extraction

7 procedure on patient Z.H. at his non-accredited medical office. During the procedure he removed

8 7600cc of liposuction aspirate from Z.H.

9 105. Respondent's removal of excessive liposuction aspirate from Z.H. in a non-accredited

1 O facility was a simple departure from the standard of care.

11 Excessive Administration of Lidocaine

12 106. Lidocaine is a local anesthetic. An overdose of lidocaine can cause lightheadedness,

13 drowsiness, tinnitus, slurred speech, shivering, muscle twitching, convulsions, apnea and

14 cardiovascular depression and heart beat cessation. When lidocaine is used during tumescent

15 liposuction procedures the American Academy of Dermatology guidelines indicate that the

16 maximum dose of lidocaine to be administered is 55mg per kilogram of the patient's body

17 weight. This is because the lidocaine solution is removed shortly after it has been administered.

18 107. The maximum dose of lidocaine Respondent should have administered to patient Z.H.

19 during her May 21, 2010 liposuction procedure was 4.2 gm (calculated as 55mg x 75.9 kg. or 167

20 lbs. = 4.2 gm). However, Respondent administered 30 gm. of lidocaine to Z.H. Respondent's

21 administration of an excessive dose of lidocaine to Z.H. was a simple departure from the standard

22 of care.

23 108. Respondent's treatment of Z.H. as set forth above includes the following acts and/or

24 omissions which constitute departures from the standard of practice:

25 A. Respondent's failure to perform a proper pre-operative evaluation on Z.H. and

26 obtain a surgical clearance from her primary care physician.

27 B. Respondent's removal of excessive liposuction aspirate from Z.H. in a non-

28 accredited facility.


(OAH No. 2010090743)

C. Respondent's administration of an excessive dose of lidocaine to Z.H.


3 inclusive, above, whether proven individually, jointly, or in any combination thereof, constitute

4 repeated negligent acts pursuant to section 2234 ( c) of the Code. Therefore cause for discipline

5 exists.

6 FOURTH CAUSE FOR DISCIPLINE


8 Patient S.C.

9 110. Respondent is subject to disciplinary action under section 2234, subdivision (c) of the

1 O Code in that his care and treatment of patient S. C. constitutes repeated negligent acts. The

11 circumstances are as follows:

12 111. The allegations of the Second Cause for Discipline are incorporated herein by

13 reference as if fully set forth.



16 repeated negligent acts pursuant to section 2234 subdivision ( c) of the Code. Therefore, cause for

17 discipline exists.

18 FIFTH CAUSE FOR DISCIPLINE


20 Patient A.M.

21 113. On or about September 16, 2008, patient A.M. presented to Respondent for a "Face

22 Conture Consult." A note is included in the patient chart, indicating that the patient complained

23 of extensive sun damage to her face and body, sagging of eyebrows, upper and lower eyelids and

24 neck. After examination, Respondent documented severe rosacea, sun damage and actinic

25 keratosis of the face, neck, cheek, both arms and thighs. There is documentation of a discussion

26 of procedures to be performed, but not of a discussion related to the risks, benefits and

27 alternatives of those treatments.

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(OAH No. 20 l 0090743)

114. There are three separate handwritten procedure notes contained in the chart of patient

2 AM. that are dated on the same day as the consult. The first documents IPL of the face, neck and

3 chest. A second describes Thermage of the face and the third describes the injection of facial

4 fillers, including 3 cc of Radiesse and 10.4 cc of Perlane into multiple facial areas. The chart

5 does not include a signed information sheet related to the use of Radiesse. There is no

6 documentation of the patient being given Vicodin and Xanax during her office visit.

7 115. On or about September 17, 2008, patient AM. called Respondent and reported that

8 she vomited on her way home from his office on the prior day. In that same conversation she

9 canceled all future appointments.

1 O 116. On or about September 19, 2008, Respondent's medical assistant made an entry to the

11 patient's medical chart, related to patient A.M.'s September 16, 2008, visit. The note indicates

12 that the patient was escorted to her car after her procedures. The patient was "a little drowsy" and

13 "a little nauseous," but indicated that she felt that she could drive.

14 117. On June 24, 2009, Respondent presented to the Cerritos District Office of the Medical

15 Board of California for an interview. During this interview Respondent reported that patient

16 AM. received Vicodin and Xanax before her procedures. He further indicated that the

17 Respondent was alert following the procedures.

18 118. The chart includes a statement that the patient received a discount for enrollment in

19 the "study" which is "non cancelable as well as non-refundable." Respondent provided the Board

20 with a one-page listing of a very basic protocol entitled "Harvard- BHAL Long Term Follow Up

21 Five Year Study." There is no further documentation showing that such a study exists at Harvard

22 University or anywhere else. Specifically, no Institutional Review Board ("IRB") approval

23 documentation exists.

24 119. The standard of care requires that patients who receive sedating medications not be

25 allowed to drive until the effects of the medications are entirely gone.

26 120. The standard of care requires that any study involving human subjects requires

27 approval by an Institutional Review Board.

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(OAH No. 2010090743)

121. Respondent's treatment of A.M. as set forth above includes the following acts and/or


3 A Respondent's administration of narcotics and sedatives to patient A.M.,

4 documenting her status as less than fully awake and then permitting AM. to drive herself

5 home.

6 B. Respondent's misrepresentation to AM. that he was conducting a study on

7 behalf of Harvard Medical School and/or purporting to conduct such a study without

8 Institutional Review Board approval.


1 O inclusive, above, whether proven individually, jointly, or in any combination thereof, constitute


12 exists.

13 SIXTH CAUSE FOR DISCIPLINE


15 Patient S.S.

16 123. On or about August 27, 2007, patient S.S. presented to Respondent for a "Fillers

17 Consult." No medical history was documented. A handwritten note indicated that the patient

18 wanted, "to get rid of the wrinkles around the mouth, jowls and cheek sagging." Respondent's

19 exam documented, "severe jowls, perioral wrinkles & marionette lines and exaggerated NLFs."

20 A closing notation indicates a discussion ofrisk, benefit and alternatives of Thermage, Per lane

21 and Radiesse.

22 124. A procedure note dated on August 27, 2007, documented injection of 3 cc of Per lane

23 to the perioral and periorbital areas. Thermage was also performed on this date.

24 125. A rate quote sheet dated September 24, 2007, documented a $40,000.00 discount for

25 participation in "study with Harvard" for "Full Face sculpting" and Fraxel_ treat:nents.

26 126. On or about September 25, 2007, a procedure note documented facial Thermage. A

27 second procedure note bearing the same date documented 10.4 cc (8 syringes) of Radiesse

28 injected into the perioral and periorbital areas.


(OAH No. 2010090743)

127. On or about October 9, 2007, patient S.S. had Fraxel to the face, neck, chest and

2 hands.

3 128. A procedure note dated October 23, 2007, indicated the injection of 1.5 cc of Kenalog

4 40 into unspecified areas.

5 129. On or about November 6, 2007, patient S.S. had Fraxel #2 to the same areas and .6 cc

6 of Kenalog (strength not indicated) injected in to the periorbital areas. There is no interval note

7 documentation indicating the reason Kenalog was administered in either instance.

8 130. A note dated November 27, 2007, documented a Fraxel as well as Kenalog injection

9 into the left eyebrow. The strength and amount are not documented. The settings of the Fraxel

1 O are not included.

11 131. A January 8, 2008, note documented a Face and Neck IPL treatment.

12 132. The patient chart does not contain documentation of any discussion of the risks or

13 benefits of Kenalog injections or IPL before or after the administration of the procedures. The

14 chart is also void of any information sheets signed or initialed by the patient for these procedures.

15 133. The semi-permanent filler, Radiesse, is recommended for long term improvements of

16 moderate to severe wrinkles near the nose and mouth. It should be used in a gradual fashion to

17 help minimize the potential problems and is not recommended for use near the eyes.

18 134. Respondent's treatment of S.S. as set forth above includes the following acts and/or


20 A. Respondent's administration of a very large amount of Radiesse, all at one

21 time, and use of the filler in ill-advised target regions.

22 B. Respondent's misrepresentation to S.S. that he was conducting a study on.

23 behalf of Harvard Medical School and/or purporting to conduct such a study without

24 Institutiqnal Review Board approval.




28 exists.

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SEVENTH CAUSE FOR DISCIPLINE

(Repeated Negligent Acts)

Patient J.T.

136. On or about July 12, 2007, patient J.T. presented to Respondent for an "arm

tightening consult." The patient chart contains a blank medical history page. Chart notes

indicates that upon examination the patient had severe bilateral arm wrinkles, chest wrinkles and

sun damage. Thermage and Fraxel treatments to the chest and arms were recommended. The

risks and benefits of Thermage and Fraxel treatments were discussed.

137. On or about July 13, 2007, information sheets documenting the risks ofThermage

and Fraxel therapies were initialed and signed. The patient had Thermage treatments of her arms

and chest. This was followed by her first Fraxel treatment of the same areas.

138. On or about August 10, 2007 and September 14, 2007, the patient had second and

third Fraxel treatments to the chest and arms with progressively higher system energy. The

number of passes was not documented by Respondent.

139. On or about October 25, 2007, a microdermabrasion and Fraxel treatment was

performed. Four passes were documented.

140. The standard of care requires that when using prescriptive medical devices and

injections for cosmetic purposes a physician must document his/her evaluation of the patient

before undergoing treatment and again at appropriate intervals during and after the completion of

the procedures.

141. Respondent's treatment of J.T. as set forth above includes the following acts and/or

omissions which constitute departures from the standard of practice. Respondent's failure to take

the patient's medical history and failing to make any interval notes in the patient chart.

142. Respondent's acts and/or omissions as set forth in paragraphs 136 through 140,

inclusive, above, whether proven individually, jointly, or in any combination thereof, constitute

repeated negligent acts pursuant to section 2234 subdivision ( c) of the Code. Therefore, cause for

discipline exists.

111

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EIGHTH CAUSE FOR DISCIPLINE

2 (Incompetence)

3 Patient Z.H.

4 143. Respondent is subject to disciplinary action under section 2234, subdivision (d) of the

5 Code in that his care and treatment of patient Z.H. was incompetent as he lacked the education,

6 knowledge, and experience to discharge the duties and responsibilities of his license, resulting in

7 the los of human life. The circumstances are as follows:

8 144. The allegations of the First Cause for Discipline paragraphs 32 through 46 are

9 incorporated herein by reference as if fully set forth.

10 NINTH CAUSE FOR DISCIPLINE

11 (Incompetence)

12 Patient S.C.

13 l 45. Respondent is subject to disciplinary action under section 2234, subdivision ( d) of the

14 Code in that his care and treatment of patient Z.H. was incompetent as he lacked the education,

15 knowledge, and experience to discharge the duties and responsibilities of his license, resulting in

16 the los of human life. The circumstances are as follows:

17 146. The allegations of the Second Cause for Discipline paragraphs 71 through 84 and 89

18 through 96 are incorporated herein by reference as if fully set forth.

19 TENTH CAUSE FOR DISCIPLINE

20 (Dishonest or Corrupt Acts)

21 14 7. Respondent is subject to disciplinary action under section 2234, subdivision ( e ), of

22 the Code in that Respondent committed dishonest or corrupt acts substantially related to the

23 qualifications, functions, or duties of a physician and surgeon. The circumstances are as follows:

24 148. The allegations set forth in paragraphs 9, 10, 18, 19, 20, 21, 49, 57, 58, 59, 60, 61,

25 113, 118, 119, 120, 123, 124, and 125 are incorporated by reference as if fully set forth herein.

26 149. The standard of care requires a physician to represent himself truthfully to his

27 patients.

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150. Respondent falsely represented to his patients and in advertisements that he was a

2 professor at Harvard Medical School. He prominently advertised on the web that he was

3 conducting a study on behalf of Harvard Medical School. He told patients Z.H., S.C., A.M. and

4 S.S. that he was conducting a "Harvard Medical School clinical study" and offered them

5 discounted rates for treatment in exchange for their participation in a study that does not exist to

6 induce them to undergo medically unnecessary cosmetic procedures. He inflated his credentials

7 to coerce these patients to pay extraordinary fees for ordinary treatment.

8 151. Respondent also advertised and explained that the procedures would result in no

9 complications and there would be no "down time." It is axiomatic that every medical procedure

1 O has the potential for complications. And whether you call it a procedure or a surgery, liposuction,

11 LipoSelection, or body sculpting, the patient will have to endure post-operative recovery or

12 healing time, and may suffer severe complications as did S.C.

13 152. Respondent's representation to patient Z.H. that she would enjoy health benefits from

14 body sculpting were also misleading. The risk improvement cited by Respondent has not been

15 proven.

16 15 3. Respondent also represented to Z.H. that her procedures would be tax deductible.

1 7 This too is a misstatement.

18 154. Respondent's misstatements and misrepresentations to Z.H., S.C., A.M. and S.S. are

19 unethical and constitute dishonest and corrupt acts, pursuant to section 2234 subdivision ( e) of the

20 Code.

21 Therefore, cause for discipline exists.

22 ELEVENTH CAUSE FOR DISCIPLINE

23 (Failure to Maintain Adequate Records)

. 24 155. Respondent is subject to disciplinary action under section 2266 of the Code in that

25 Respondent failed to maintain adequate records of his care and treatment of patients Z.H., S.C.,

26 A.M., S.S. and J.T. The circumstances are as follows:

27 Ill

28 Ill

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SECOND AMENDED ACCUSATJON (OAH No. 2010090743)

156. The allegations set forth in paragraphs 15, 25, 36, 39, 52, 65, 66, 78, 80, 113, 114,

2 116, 118, 124, 126, 127, 128, 129, 130, 132, 136, 138, 139,and 140areincorporatedbyreference

3 as if fully set forth herein.

4 TWELFTH CAUSE FOR DISCIPLINE

5 (Conviction of a Crime Substantially Related to the Practice of Medicine)

6 157. Respondent is subject to disciplinary action under Business and Professions Code

7 section 2236, subdivision (a), for his conviction of a crime which was substantially related to the

8 qualifications, functions, or duties of his profession. The circumstances are as follows:

9 158. On or about January 6, 2012, in a criminal proceeding entitled The People of the State

1 O of California v. Ehab Mohamed, in Los Angeles County Superior Court, Case Number

11 LA0696 l 0, Respondent was charged in a Felony Complaint with two criminal counts relating to

12 the acts that occurred on or about July 22, 2011. The two criminal counts were as follows:

13 Count 1: Penal Code sections 664/487(a), Attempted Grand Theft of Personal Property;

14 Count 2: Penal Code sections 664/487(a), Attempted Grand Theft of Personal Property.

15 159. On or about March 9, 2012, ajury found Respondent guilty of both of the above

16 described felony counts.

17 160. On or about March 21, 2012, the court denied probation and sentenced Respondent to

18 serve eight months in County Jail as to count 1, and four months in County Jail as to Count 2, to

19 run concurrently. The circumstances with respect to the conviction are as follows:

20 161. On or about July 22, 2011, Respondent attempted to sell medical equipment,

21 specifically, a Vaser Amplifier and Vent-X Console, exceeding $950.00 in value, and owned by

22 Sound Surgical Technologies, to an individual, Nikki Rasmussen, for $20,000. Prior to the date

23 of the attempted sale Respondent listed the equipment on eBay with a price of $20 ,000. In

24 imposing sentence the court considered the following factors in aggravation: (1) There was great

25 potential financial loss for sound surgical and for Nikki Rasmussen; (2) The defendant was the

26 only active participant in the crime; (3) The manner in which the crime was carried out

27 demonstrated criminal sophistication on the part of Respondent; ( 4) The defendant took

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advantage of trust to commit the crime; and (5) The defendant is not remorseful and perjured

2 himself on the witness stand.

3 PRAYER

4 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,

5 and that following the hearing, the Medical Board of California issue a decision:

6 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 72575

7 issued to Ehab A. Mohamed, M.D.

8 2. Revoking, suspending or denying the approval of Respondent Ehab Mohamed,

9 M.D.'s authority to supervise physician's assistants, pursuant to section 3527 of the Code;

,.., .) . Ordering him to pay the Medical Board of California the costs of probation 10

11 monitoring, if placed on probation;

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4. Taking such other and further action as d

DATED: May 14, 2012

Executive Director Medical Board of Ca · ornia Department of Co umer Affairs State of California Complainant

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before the medical board of california department of ...4patientsafety.org/documents/mohamed, ehab a...

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