BEFORE THE DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA ) ) ) ) ) ) ) ) ) DECISION

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1 BEFORE THE DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: David E. Sosin, M.D. Certificate# GM13099 Respondent. ) ) ) ) ) ) ) ) ) File No: 04M1996M66892 DECISION The attached Stipulation is hereby adopted by the Division of Medical Quality of the Medical Board of California as its Decision in the abovementitled matter. This Decision shall become effective at 5:00p.m. on June 14, It is so ordered MaY 13, DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA ~~~ Carole Hurvitz, M.D. Chair PanelB

2 1 BILL LOCKYER, Attorney General of the State of California 2 Sherry L. Ledakis, Deputy Attorney General, State Bar No Department of Justice 0 West A Street, Suite 00 4 Post Office Box San Diego, California Telephone: (619) Attorneys for Complainant 7 8 BEFORE THE DIVISION OF MEDICAL QUALITY 9 MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS 10 STATE OF CALIFORNIA 12 In the Matter of the Accusation Against: 13 DAVID E. SOSIN, M.D East Garry Avenue, Suite #6 Santa Ana, California Physician's and Surgeon's 16 Certificate No. G NO STIPULATION IN SETTLEMENT AND DECISION 17 Respondent IT IS HEREBY STIPULATED AND AGREED by and between the 20 parties to the above-entitled proceedings that the following 21 matters are true: An Accusation in Case No was filed by 23 the Medical Board of California ("Board") on May 13, 1998, and is 24 currently pending against David E. Sosin, M.D. ("respondent") The Accusation, together with all statutorily 26 required documents, was duly served on the respondent on or about 27 May 15, 1998, and respondent filed his Notice of Defense 1.

3 r contesting the Accusation on or about May 22, A 2 copy of Accusation No is attached as Attachment "A" 3 and incorporated by reference as if fully set forth Complainant, Ron Joseph, is the Executive Director 5 of the Medical Board of California and brought this action solely 6 in his official capacity. The Complainant is represented by the 7 Attorney General of California, Bill Lockyer, by and through 8 Deputy Attorney General.Sherry L. Ledakis. Respondent is 9 represented by Timothy J. Stafford, Esq., Stafford & Hall, E. First Street, Ste. 1010, Santa Ana, California, At all times relevant herein respondent has been 12 licensed by the Board under Physician's and Surgeon's Certificate 13 No. G~ Respondent and his attorney have fully read and 15 discussed the charges contained in Accusation No Respondent has been fully advised regarding his legal rights and 17 the effects of this Stipulated Settlement and Disciplinary Order Respondent understands the nature of the charges 19 alleged in the Accusation and that, if proven at hearing, the 20 charges and allegations may constitute cause for imposing 21 discipline upon his Certificate to practice medicine. Respondent 22 is fully aware of his right to a hearing on the charges and 23 allegations contained in the Accusation, his right to confront 24 and cross-examine witnesses against him, his right to the use of 25 subpoenas to compel the attendance of witnesses and the 26 production of documents in both defense and mitigation of the 27 charges, his right to reconsideration, appeal and all other 2.

4 1 rights accorded pursuant to the California Administrative 2 Procedure Act and other applicable laws Respondent knowingly, voluntarily, irrevocably and 4 upon advice of counsel, waives and gives up each of these rights For the purpose of resolving Accusation No , respondent agrees that, at a hearing, complainant may 7 establish a factual basis for the charges in the Accusation. 8 Respondent hereby gives up his right to contest the charges and 9 allegations in the Accusation and agrees to be bound by the 10 Division's Disciplinary Order as set forth below. 9. Respondent understands and agrees that if he ever 12 files an application for modification or early termination of 13 probation, he will plead nolo contendre to all of the charges and 14 allegations contained in Accusation No , when the 15 Division determines whether to grant or deny the application The stipulations made by respondent herein are for 17 the purpose of this proceeding and any other proceedings in which 18 the Medical Board of California, or other professional licensing 19 agency is involved, and shall not be admissible in any other 20 criminal or civil proceedings. 21. The parties agree that the Stipulation recited 22 herein shall be null and void and not binding upon the parties 23 unless approved by the Division, except for this paragraph, which 24 shall remain in effect. The respondent understands and agrees 25 that in deciding whether or not to adopt this Stipulation the 26 Board may receive oral and written communications from its staff 27 and the Attorney General's office. Communications pursuant to 3.

5 1 this paragraph shall not disqualify the Division or other persons 2 from future participation in this or any other matter affecting 3 respondent. In the event the Board in its discretion does not 4 approve this settlement, this Stipulation, with the exception of 5 this paragraph, is withdrawn and shall be of no evidentiary value 6 and shall not be relied upon or introduced in any disciplinary 7 action by either party hereto. Respondent agrees that should the 8 Division reject this Stipulation and if this case proceeds to 9 'hearing, respondent will assert no claim that the Board was 10 prejudiced by its review and discussion of this Stipulation or of any records related hereto The parties agree that facsimile copies of this 13.Stipulation, including facsimile signatures of the parties, may 14.be used in lieu of original documents and signatures. The 15 acsimile copies will have the same force and effect as 16 originals In consideration of the foregoing, the parties 18 agree that the Division may, without further notice of formal 19 proceeding, issue and enter an Order as follows: 20 ORDER 21 IT IS HEREBY ORDERED that Physician's and Surgeon's 22 Certificate number G issued to David E. Sosin, M.D. is 23 revoked. However, the revocation of said certificate is stayed 24 and respondent is placed on probation for 3 years on the terms 25 and conditions set forth below. Within 15 days after the 26 effective date of this decision, respondent shall provide the 27 Division, or its designee, proof of service that respondent has 4.

6 1 served a true copy of this decision on the Chief of Staff or the 2 Chief Executive Officer at every hospital where privileges or 3 membership are extended to respondent or where respondent is 4 employed to practice medicine and on the Chief Executive Officer 5 at every insurance carrier where malpractice insurance coverage 6 is extended to respondent COMPLETION OF PACE PROGRAM Within 90 days of the 8 effective date of this Stipulation, Respondent shall 9 successfully complete the physician assessment and clinical 10 evaluation program (PACE) conducted at the University of California at San Diego. The PACE program shall include a 12 prescribing practices course for psychiatrists, and prescribing 13 of controlled substances in the treatment of Attention Deficit 14 Disorder, and Attention Deficit Hyperactivity Disorder in adults 15 and children. There shall be an oral and or written examination 16 at the completion of the program. Respondent shall pay all costs 17 associated with the clinical education and training program MONITORmG Within 15 days of the effective date of 19 this decision, respondent shall submit to the Division for its 20 prior approval a plan of practice in which respondent's practice 21 shall be monitored by another physician in respondent's field of 22 practice, who shall provide monthly reports to the Division. 23 Said monitor shall review all cases in which respondent has 24 prescribed any amount of controlled substances in Schedules II 25 through V. 26 If the monitor resigns or is no longer available, 27 respondent shall, within 15 days, move to have a new monitor 5.

7 1 appointed, through nomination by respondent and approval by the 2 Division CONTROLLED DRUGS- MAINTAIN RECORD Respondent shall 4 maintain a record of all controlled substances prescribed, 5 dispensed or administered by respondent during probation, showing 6 all the following: 1) the name and address of the patient, 2) the 7 date, 3) the character and quantity of controlled substances 8 involved, and 4) the indications and diagnosis for which the 9 controlled substance was furnished. 10 Respondent shall keep these records in a separate file or ledger, in chronological order, and shall make them available 12 for inspection and copying by the Division or its designee, upon 13 request CONTINUING MEDICAL EDUCATION COURSES Respondent agrees 15 that he will attend an additional 40 hours of continuing medical 16 education courses in an area to be designated by the Division 17 during each of the three years immediately following the 18 effective date of this Stipulation OBEY ALL LAWS Respondent shall obey all federal, 20 state and local laws, all rules governing the practice of 21 medicine in California, and remain in full compliance with any 22 court ordered criminal probation, payments and other orders QUARTERLY REPORTS Respondent shall submit 24 quarterly declarations under penalty of perjury on forms provided 25 by the Division, stating whether there has been compliance with 26 all the conditions of probation. 27 I I I 6.

8 ..,,,_,,,.,,.. _'.>, '""''"''"'"'.-,. :...,,;,.,.,.., 1 7. PROBATION SURVEILLANCE PROGRAM COMPLIANCE Respondent 2 shall comply with the Division's probation surveillance program. 3 Respondent shall, at all times, keep the Division informed of his 4 business and residence addresses which shall both serve as 5 addresses of record. Changes of such addresses shall be 6 immediately communicated in writing to the Division. Under no 7 circumstances shall a post office box serve as an address of 8 record. 9 Respondent shall also immediately inform the Division, 10 in writing, of any travel to any areas outside the jurisdiction of California which lasts, or is contemplated to last, more than 12 thirty (30) days INTERVIEW WITH THE DIVISION, ITS DESIGNEE OR ITS DESIGNATED PHYSICIAN(S) 15 Respondent shall appear in person for interviews with 16 the Division, its.designee or its designated physician(s) upon 17 request at various intervals and with reasonable notice TOLLING FOR OUT-OF-STATE PRACTICE. RESIDENCE OR IN-STATE NON PRACTICE 20 In the event respondent should leave California to 21 reside or to practice outside the State or for any reason should 22 respondent stop practicing medicine in California, respondent 23 shall notify the Division or its designee in writing within ten 24 (10) days of the dates of departure and return or the dates of 25 non-practice within California. Non-practice is defined as any 26 period of time exceeding thirty (30) days in which respondent is ~7 not engaging in any activities defined in Sections 2051 and

9 -.,..,.,.,,...,...,.,,.A"'"''"' "',_,,,. i'"..1, '"n"~ " 1 of the Business and Professions Code. All time spent in an 2 intensive training program approved by the Division or its 3 designee shall be considered as time spent in the practice of 4 medicine. Periods of temporary or permanent residence or 5 practice outside California or of non-practice within California, 6 as defined in this condition, will not apply to the reduction of 7 the probationary period COMPLETION OF PROBATION Upon successful completion 9 of probation, respondent's certificate shall be fully restored. 10. VIOLATIONOFPROBATION If respondent violates probation in any respect, the Division, after giving respondent 12 notice and the opportunity to be heard, may revoke probation and 13 carry out the disciplinary order that was stayed. If an 14 accusation or petition to revoke probation is filed against 15 respondent during probation, the Division shall.have continuing 16 jurisdiction until the matter is final, and the period of 17 probation shall be extended until the matter is final COSTRECOVERY The respondent is hereby ordered to 19 reimburse the Division the amount of $ within ninety (90) 20 days of the effective date of this decision for its investigative 21 and prosecution costs. Failure to reimburse the Division's cost 22 of investigation and prosecution shall constitute a violation of 23 the probation order, unless the Division agrees in writing to 24 payment by an installment plan because of financial hardship. 25 The filing of bankruptcy by the respondent shall not relieve the 26 respondent of his responsibility to reimburse the Division for 27 its investigative and prosecution costs. 8.

10 1 13. PROBATION COSTS Respondent shall pay the costs 2 associated with probation monitoring each and every year of 3 probation, which are currently set at $ but may be 4 adjusted on an annual basis. Such costs shall be payable to the 5 Division of Medical Quality and delivered to the designated 6 probation surveillance monitor at the beginning of each calendar 7 year. Failure to pay costs within 30 days of the due date shall 8 constitute a violation of probation CERTIHCATESURRENDER Following the effective date 10 of this decision, if respondent ceases practicing due to retirement, health reasons or is otherwise unable to satisfy the 12 terms and conditions of probation, respondent may voluntarily 13,tender his certificate to the Board. The Division reserves the 14 right to evaluate the respondent's request and to exercise its 15 discretion whether to grant the request, or to take any other 16 action deemed appropriate and reasonable under the circumstances. 17 Upon formal acceptance of the tendered certificate, respondent 18 I I I 19 I I I 20 I I I

11 1 will not longer be subject to the terms and conditions of 2 probation. 3 CONCURRENCE 4 We concur in the Stipulation and Order DATED: DATED: Bill Lockyer, Attorney General of the State of California s!::l.~ak~ Deputy Attorney General Attorneys for Complainant 47 9'1 ACKNOWLEDGMENT BY RESPONDENT 16 I have carefully read and fully understand the 17 Stipulation and Order set forth above. I have discussed the 18 terms and conditions set forth in the Stipulation and Order with 19 my attorney Timothy Stafford, Esq. I understand that in signing 20 this Stipulation I am waiving my right to a hearing on the 21 charges set forth in the Accusation on file in this matter. I 22 further understand that in signing this Stipulation the Division 23 may enter the foregoing order placing certain requirements, 24 restrictions and limitations on my right to practice medicine in 25 the State of California. I agree that a facsimile copy of this 26 I I I 27 I I I 10.

12 1 2 Stipulation, including a facsimile copy of my signature may be t as the originals David E. Sosin, M.D. Respondent

13 1 DANIEL E. LUNGREN, Attorney General of the State of California 2 Sherry L. Ledakis, Deputy Attorney General, State Bar No. 3 Department of Justice 0 West A Street, Suite 00 4 Post Office Box San Diego, California Telephone: (619) FILED STATE OF CALIFORNIA MEDICAL BOA OF CALIFOR SAC NTO / M~~fL.L~~(g_ Attorneys for Complainant BEFORE THE DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATEOF CALIFORNIA 12 In the Matter of the Accusation Against: 13 DAVID E. SOSIN, M.D East Garry Avenue, Suite #6 Santa Ana,. California Physician's and Surgeon's 16 Certificate No. G NO ACCUSATION 17 Respondent Complainant Ron Joseph, as cause for disciplinary 20 action, alleges: 21 PARTIES Complainant is the Executive Director of the 23 Medical Board of California ("Board") and makes and files this 24 accusation solely in his official capacity. 25 License Status On or about April 19, 1967, Physician's and 27 Surgeon's Certificate No. G was issued by the Board to 1.

14 ~r -- OJ> ~. ~...,,._. 1 David E. Sosin, M.D. ("respondent"), and at all times relevant 2 herein, said Physician's and Surgeon's Certificate was, and 3 currently is, in full force and effect. Said certificate is 4 valid with an expiration date of October 31, There is no 5 Board record of disciplinary action having been taken against the 6 above named respondent by the State of California. Respondent is 7 not currently approved as a supervisor of a physician assistant. 8 JURISDICTION 9 3. This accusation is made with reference to the 10 following statutes of the California Business and Professions Code ("Code") : 12 A. Code section 2227, which provides that the 13 Division of Medical Quality of the Board ("Division") may 14 revoke,. suspend for a period not to exceed one year, or 15 place on probation and order the payment of probation 16 monitoring costs, the license of any licensee who has been 17 found guilty under the Medical Practice Act. 18 B. Code section 2234, which provides that 19 unprofessional conduct includes, but is not limited to, the 20 following: 21 "(a) Violating or attempting to violate, directly 22 or indirectly, or assisting in or abetting the 23 violation of, or conspiring to violate, any provision 24 of this chapter II (b) " (c) " (d) Gross negligence. Repeated negligent acts. Incompetence. 2.

15 (e) The commission of any act involving dishonesty or corruption which is substantially related to the qualifications, functions, or duties of a physician and surgeon. 5 "(f) Any action or conduct which would have 6 warranted the denial of a certificate. 7 8 " C. Code section 725, which provides, in part, that repeated acts of clearly excessive pres.cribing 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, psychologist, physical therapist, chiropractor, or optometrist. D. Code section 2242, which provides, in part, that prescribing, dispensing, or furnishing dangerous drugs as defined in section 42 without a good faith prior examination and medical indication therefor, constitutes unprofessional conduct. E. Code section 42, which provides that a dangerous drug is defined as any drug which is unsafe for self-medication, and includes any drug or device which by federal or state law can be lawfully dispensed only on prescription or furnished by a laboratory pursuant to section 4240 of the Business and Professions Code. 3.

16 F. Code section 125.3, which provides, in part, that the Board may request the administrative law judge to direct any licentiate found to have committed a violation or violations of the licensing act, to pay the Board a sum not to exceed the reasonable costs of the investigation and enforcement of the case. 5. Ritalin is a Schedule II controlled substance within the meaning of the Health and Safety Code and a dangerous drug as defined in Code section Dexedrine is a Schedule II controlled substance within the meaning of the Health and Safety Code and a dangerous drug as defined in Code section Section of the Budget Act of the 14 State of California provides, in pertinent part, that: (a) no funds appropriated by this act may be expended to pay any Medi Cal claim for any service performed by a physician while that physician's license is under suspension or revocation due to a disciplinary action of the Medical Board of California; and, (b) no funds appropriated by this act may be expended to pay any Medi-Cal claim for.any surgical service or other invasive procedure performed on any Medi-Cal beneficiary by a physician if that physician has been placed on probation due to a disciplinary 23 ac~ion of the Medical Board of California related to the performance of that specific service or procedure on any patient, except in any case where the board makes a determination during its disciplinary process that there exist compelling I I I 4.

17 1 circumstances that warrant continued Medi-Cal reimbursement 2 during the probationary period. 3 FACTS 4 8. Respondent David E. Sosin, M.D., is subject to 5 disciplinary action on account of the following: 6. A. On or about May 10, 1984, patient M.P., a 7 female who was then 34 years of age, made an initial visit 8 to the medical office of respondent, a psychiatrist, with 9 complaints of headache. The practice of respondent was 10 known as "Headache Treatment Center of Orange County" and was located at 141 Newport Avenue, Tustin, California. 12 Respondent's initial evaluation states: 13 Impressions and Recommendations 14 A tendency toward depression/watch 15 Mixed headache 16 Prob classical migraine 17 Respondent also diagnosed daily muscle contraction 18 headaches. Respondent prescribed tricyclic antidepressant 19 medication, and about one month later respondent reported to 20 the referring physician, S.W., M.D., that the patient's mood 21 and headache pattern were significantly improved and she was 22 no longer experiencing daily headaches. Respondent 23 instituted a treatment program which included ergonovine in 24 addition to the tricyclic antidepressant, and biofeedback. 25 B. Between about 1988 and 1990, respondent began 26 prescribing Dexedrine to M.P., upon a diagnosis of menstrual 27 migraine headache, severe premenstrual syndrome (PMS), and 5.

18 .,... ~,------~ ~...,_ 1 depression. By about February of 1991, M.P. reported no 2 longer being "out of it," seemed calmer, and was better able 3 to work. At about that time, respondent wrote that the 4 patient's response was typical for a patient suffering from 5 attention deficit disorder (ADD). Patient M.P. developed 6 hypertension as the result of Dexedrine, and respondent 7 instituted a regimen of Ritalin instead. In about April of , the patient again reported feeling better. Respondent 9 continued the patient on large and varying dosages of 10 Dexedrine and Ritalin, frequently in combination, until about May of 1997, when respondent discontinued Ritalin and 12 changed the patient's medication to cylert, a noncontrolled- 13 stimulant._ 14 C. From on or about January 22, 1991, through 15 and including about October 19, 1992, respondent regularly 16 prescribed Dexedrine to patient M.P. upon a diagnosis of 17 "affective disorder." From about October 19, 1992, 18 Dexedrine and Ritalin were prescribed by respondent upon the 19 diagnosis "ADD residual type." 20 D. From on or about December 1, 1994, through 21 and including about June 17, 1997, respondent regularly 22 prescribed Dexedrine and Ritalin to patient M.P. Said 23 prescribing included, but is not limited to, the following 24 transactions: 25 Excessive Prescribing of Dexedrine 26 (1) On or about February 15, 1995, 27 respondent prescribed Dexedrine, 5 mg tablets, quantity 6.

19 1 360 dose units, two or three to be taken three times a 2 day. This was intended to be a 30-day supply. 3 4 Accordingly the patient would be expected to ingest between 180 and 270 dose units between visits to 5 respondent. The number of dose units prescribed by respondent on that date was from 90 to 180 dose units in excess of the number of dose units he directed to be taken by the patient M.P. (2) Twenty-five days later, on or about March 9, 1995, respondent again prescribed Dexedrine, 5 mg tablets, quantity 360 dose units, two or three to be 12 taken three times a day. Accordingly the patient would be expected to have.ingested, during those 25 days, a maximum of 225 dose units. Therefore, the number of dose units prescribed by respondent on February 15, 1995, was found to be 135 dose units in excess of the number of dose units he directed to be taken by the patient M.P. (3) Twenty-two days later, on or about March 31, 1995, respondent again prescribed Dexedrine, 5 mg tablets, quantity 360 dose units. On this occasion respondent increased the number to four that were to be 23 taken three times a day. Accordingly the patient would 24 be expected to have ingested, during those 22 days, a 25 maximum of 264 dose units. Therefore, the number of dose units prescribed- by respondent on March 9, 1995, even if to be taken at the rate of four, three times a 7.

20 day, was found to be 96 dose units in excess of the number of dose units he directed to be taken by the patient M.P. (4) Four days later, on or about April 4, 1995, respondent again prescribed Dexedrine, 5 mg tablets, quantity 360 dose units. The patient would be expected to have ingested, during those 4 days, at 12 dose units per day,.a maximum of 48 dose units. Therefore, the number of dose units prescribed by respondent on March 31, 1995, was found to be 312 dose units in excess of the number of dose units he directed to be taken by the patient M.P. Excessive Prescribing of Ritalin (5) On or about August 12, 1996, respondent 15 prescribed Ritalin, 20 m~ tablets, quantity 240 dose 16 units, one or two to be taken four times a day. This 17 was intended to be a 30-day supply. Accordingly the patient would be expected to ingest between 120 and 240 dose units between visits to respondent. (6) Fifteen days later, on or about August 27, 1996, respondent again prescribed Ritalin, 20 mg tablets, quantity 360 dose units, to be taken three or 23 four per day. Accordingly the patient would be expected to have ingested, during those 15 days, a maximum of 2 dose units. Therefore, the number of dose units prescribed by respondent on August 12, 1996, was found to be 128 dose units in excess of the number 8.

21 of dose units he directed to be taken by the patient M.P. (7) Twenty days later, on or about September 16, 1996, respondent prescribed Ritalin, 20 mg tablets, 5 quantity 360 dose units. The patient would be expected 6 to have ingested between 180 and 240 dose units between 7 visits to respondent. Therefore, the number of dose units prescribed by respondent on August 27, 1996, was found to be 120 to 180 dose units in excess of the number of dose units he directed to be taken by the patient M.P. (8) Seventeen days later, on or about October 3, 1996, respondent prescribed Ritalin, 20 mg 14 tablets, quantity 4~0 dose units, to be taken two to 15 three and up to four per day. The patient would be expected to have ingested 1.02 dose units between visits to respondent if she had taken six dose units per day; if she had taken 12 dose units per day, she would be expected to have taken 204 dose units. Accordingly, the number of dose units prescribed by respondent on September 1.6, 1.996, was found to be at least 156 to 258 dose units in excess of the number of dose units he directed to be taken by the patient M.P. (9) Twenty-two days later, on or about October 25, 1996, patient M.P. returned to the office 26 of respondent. The patient would be expected to have 27 ingested between 1.76 and 264 dose units between visits 9.

22 to respondent, depending upon whether she took two or four dose units dai~y between October 3 and October 25, Accordingly, again the number of dose units prescribed by respondent on October 3, 1996, was found to be from 136 to 224 dose units in excess of the number of dose units he directed to be taken by the patient M.P. FIRST CAUSE OF ACTION (Excessive Prescribing) As a result of the conduct described in paragraph 8 above, respondent David E. Sosin, M.D., committed repeated acts 12 of clearly excessive prescribing of drugs as determined by the 13 standard of the community of licensees, in violation of Code 14 section 725, in that: A. Complainant realleges paragraph 8 in its entirety at this point. B. Respondent repeatedly and excessively prescribed the controlled substances Dexedrine and Ritalin in amounts greater than the maximum recommended dosage and in quantities exceeding the numbers of drugs prescribed for the numbers of days between visits of the patient M.P. SECOND CAUSE OF ACTION (Repeated Negligent Acts) 10. As a result of the conduct described in paragraph 25 8 above, respondent David E. Sosin, M.D., committed repeated acts 26 of negligence, in violation of Code section 2234, subdivision 27 (c), in that: 10.

23 A. Complainant realleges paragraph 8 in its entirety at this point. B. Respondent repeatedly and excessively prescribed the controlled substances Dexedrine and Ritalin to patient M.P. in amounts greater than the maximum recommended dosage and in quantities exceeding the number of dose units appropriate for the number of days between visits. c. By prescribing Dexedrine and Ritalin in the amounts and in the intervals described herein, respondent subjected the patient M.P. to the unreasonable risk of drug abuse or dependence, a danger inherent in the use of central nervous.system stimulant medication. THIRD CAUSE OF ACTION (Gross Negligence). As a result of the conduct described in paragraph 8 above, respondent David E. Sosin, M.D., committed gross negligence, in violation of Code section 2234, subdivision (b), in that: A. Complainant realleges paragraph 8 in its entirety at this point. B. Respondent failed to document any psychiatric evaluation of patient M.P. which would substantiate a diagnosis of affective disorder and subsequently of attention deficit disorder, and specifically: (1) Respondent took meager details of the patient's complaints..

24 (2) Respondent failed to explore or to document the patient's mental status and failed to formulate a differential or presumptive diagnosis in sufficient detail or order to permit the development of a detailed treatment plan. (3) Respondent failed to document any psychiatric evaluation supporting a diagnosis other than headache and tendency toward depression. C. Respondent repeatedly and excessively prescribed the central nervous system stimulant medications Dexedrine and/or Ritalin, (1) By prescribing dosages grossly exceeding recommended levels for initial use by a patient, and later, (2) In the course of treatment, by prescribing both Ritalin and Dexedrine in dosages grossly exceeding the recommended maximum levels. D. Respondent concurrently prescribed Ritalin and Dexedrine, both of which are central nervous system stimulants and controlled substances, and both bearing a high potential for drug dependence and abuse. E. Respondent failed to monitor the interval between visits of patient M.P. and in relation to the quantities of medications he had prescribed, respondent both (1) Failed to write any new prescription for M.P. in a lesser quantity in order to account for the presumably unused drugs, and 12.

25 1 (2) Wrote prescriptions for quantities of 2 drugs exceeding the maximum patient M.P. would be 3 expected to use, if she used the drugs in accordance 4 with the directions he gave. 5 FOURTH CAUSE OF ACTION 6 (Prescribing Dangerous Drugs Without a Good Faith 7 Prior Examination and Medical Indication Therefor) As a result of the conduct described in paragraph 9 8 above; respondent David E. Sosin, M.D., prescribed dangerous 10 drugs without a good faith prior examination and medical indication therefor, in violation of Code section 2242, in that: 12 A. Complainant realleges paragraph 8 in its 13 entirety at this point. 14 B. Respondent prescribed the central nervous 15 system. stimulants Dexedrine and/or Ritalin without a good 16 faith prior examination, in that there is no documentation 17 of any psychiatric evaluation of patient M.P. which would 18 substantiate a diagnosis of affective disorder or attention 19 deficit disorder c. Respondent prescribed the central nervous system stimulants Dexedrine and/or Ritalin without a medical indication therefor, in that respondent failed to document any medical indication for these drugs at the particular 24 levels prescribed, or any level whatsoever. 2s I I I 26 I I I 27 I I I 13.

26 1 PRAYER 2 WHEREFORE, complainant requests that a hearing be held 3 on the matters alleged herein, and that following said hearing, 4 the Division issue a decision: Revoking, suspending, or otherwise imposing discipline upon Physician's and Surgeon's 7 8 Certificate Number G ~3099 David E. Sosin, M.D.; issued to respondent Awarding the Board its costs of investigation and prosecution as provided by statute; and, 3. Taking such other and further action as the Division deems proper Ron Joseph Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant