BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA. Respondent. ORDER GRANTING INTERIM SUSPENSION

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1 BEFORE THE MEDCAL BOARD OF CALFORNA DEPARTMENT OF CONSUMER AFFARS STATE OF CALFORNA n the Matter of the Ex Parte Petton for nterm Suspenson Order Aganst: BRENT EDWARD SLVERS, M.D., Physcan's and Surgeon's Certfcate No. A49201, Case Nos and OAH No Respondent. ORDER GRANTNG NTERM SUSPENSON On November 2; 2019, Carla L. Garrett, Admnstratve Law Judge (ALJ) wth the Offce of Admnstrat~ve Hearngs (OAH), heard the ex-parte petton of Kmberly Krchmeyer (Pettoner), Executve Drector of the Medcal Board of Calforna (Board), Department of Consumer Affars (Department), for ssuance of an nterm Order of Suspen.son (SO) pursuant_ to Government Code secton E.A. Jones, Supervsng Deputy Attorney General, represented Pettoner. Mchael J. Khour, Attorney at Law, represented Brent Edward Slvers, M.D. (Respondent), who was present.. The ALJ read and consdered the ex parte petton and supportng documents, and the ALJ heard and consdered the partes' oral argument at the hearng. The matter was submtted on November 2, FACTUAL FNDNGS. 1. Pettoner fled the Petton for SO (Petton) whle actng n her o:ffdal capacty as the Executve Drector of the Board. 2. On March 4, 1991, the Board ssued Physcan's and Smgeon's Certfcate Number A49201 to Respondent. Respondent's certfcate s scheduled to expre on November 30, 2018, unles~ renewed. ll

2 Background 3.. As establshed by the declaratons and supportng documents attached to the petton, n March 2016, the Board's Central Complant Unt (CCU) receved a complant concernng Respondent's ftness to practce medcne. Specfcally, the complant alleged that Respondent had been treatng patents whle under the nfluence of alcohol, had been experencng memory lapses due to hs alcohol abuse, and had been exhbtng erratc behavor. The complant also alleged that Respondent had been gvng hs patents Atvan, Norco, and wne pror to ther procedures, whch resulted n several patents vomtng durng or after the procedures. The Board ntated an nvestgaton whch ncluded ntervews of several wtnesses, ncludng Respondent's medcal assstant and hs physcan assstant. l. l.! t : l.! 4. Accordng to the declaraton of Respondent'.s medcal assstant, who had worked for hm from January 2015 untl her resgnaton n June 2016, she frequently observed Respondent dsplay rratonal, sometmes hyper, and ma~c behavor, such as scrapng pant off of the walls n the presence of patents, and makng napproprate statements to patents, lke "Don't drnk the water. Fsh fuck n water." Respondent would also nstruct the medcal assstant to gve patents wne, Atvan, and Norco pror to ther lposucton procedures, renderng patents unable to walkfollow.ng the procedure. She also observed that at one tme, the smell of an alcoholc beverage emttng from Respondent just pror to Respondent performng a surgcal procedure Accordng to the declaraton of Respondent's physcan assstant, who had worked for hm from January 2015 untl her resgnaton n Aprl 11, 2016, she wtnessed Respondent dsplay "ncredble mood swngs" and erratc behavor, such as screamng n the hallway and followng a patent to the parkng lot to contnue an argument. (Exhbt 4, page 2.) She also observed hm.appear at work on several occasons wth red eyes, flushed skn, and wth the smell of alcohol on hs person, and appeared to be ntoxcated. Addtonally, the physcan's assstant wtnessed Respondent sufferng frequent and severe memory lapses, seemngly un_able to recall events that occurred n hs offce. -She also wtnessed Respondent sobbng and statng that he was.gong to kll hmself. 6. Other employees also wtnessed Respondent arrvng to work wth bloodshot. eyes and wth the odor of alcohol emanatng from hs breath, even as early as 9:30 ~n the mornng. and wtnessed Respondent's apparent ntoxcaton. They also observed Respondent's memory lapses. 7. Durng the nvestgaton, Respondent partcpated n an ntervew on March 28, 2016, and admtted that at one tme he would offer hs patents wne pror to ther procydures to help them relax, but that he no longer engaged n that practce. Pursuant to the Board's request, Respondent agreed to tndergo mental and physcal examnatons by Board-:-retaned experts.

3 Examnatqns 8. Respondent suffered three hosptalzatons from September 11, 2016 to June 27, 207 as a result of sezure actvty, acute alcohol ntoxcaton, and alcohol wthdrawal sezures, respectvely. Records of neu!omagng revealed evdence of an old nfarct n hs occptal lobe.. '. ; 9.. On May 26, 2017, Respondent underwent a neuropsychologcal evaluaton conducted by a Board-retaned expert, Davd Anderson, Ph.D. Dr. Anderson prepared a wrtten report admnsterng tests desgned to assess for mld cogntve dysfuncton, ntellectual ablty, perceptonal reasonng, workng memory, processng speed, verbal learnng and memory, vsual memory, language functonng, vsual-organzatonal functonng, executve functonng, and objectve personalty. Dr. Anderson's repo~t showed that Respondent performed n the average range n the areas of verbal comprehenson and perceptual reasonng sklls, and n the low average range n the areas of workng memory and mental processng speed. t also showed that Respondent demonstrated severe verbal/audtory memory and non-verbal vsual memory mparment, as well as sgnfcant mparment n executve functonng ablty for hs age. Based on these results, Dr. Anderson opned that Respondent was not competent to practce medcne due to severe memory and executve functonng defcts. Dr. Anderson recommended that Respondent undergo a complete medcal evaluaton ncludng a neurologcal evaluaton'to rule out any underlyng medcal bass for Respondent's memory and executve functonng mparment On February 28, 2017, Respondent underwent a psychatrc evaluaton conducted by a Board-retaned expert, Markam Krsten, M.D. Dr. Krsten conducted an examnaton, and_ dagnosed Respondent wth moderate to severe alcohol use dsorder (n early remsson), and mld cogntve dsorder stemmng possbly from a concusson and subdural hematoma suffered by Respondent after he fell down some stars whle ntoxcated_. Dr. Krsten stated that "even modest amounts.of alcohol use by an ndvdual wth already mpared functon can cause aggressve, unnhbted behavor and amnesa." (Exhbt 9.) He further stated that the "addctve effects of alcohol and subtle bran mparment can be dangerous and mpar judgment, release mpulses, and result n unsafe medcal practce." (bd.) 11. On May 23, 2017, Respondent underwent a neurologcal evaluaton conducted by a Board-retaned expert, Martn J. Backman, M.D. Based on Respondenes representaton, Dr. Backman noted that Respondent no longer consumed alcohol at an excessve rate, and dd not appear to have a medcal condton that rendered hm unsafe to practce medcne or would pose a threat to patent safety provded that Respondent receved addtonal montorng.. ll

4 12. On July 30, 2017, Dr. Krsten submtted a supplemental report after revewng the reports of Dr. Anderson and Dr. Backman, as well as,nformaton n the~ Board's nvestgatve reportthat ncluded a Controlled Substance Utlzaton Revew and Evaluaton System (CURES) report showng that Respondent had receved a number of prescrptons for opates and sedatves. Dr. Krsten dagnosed Respondent wth severe alcohol use dsorder (n sustaned remsson), mld cogntve dsorder stemmug probably from bran trauma and substance use, mld opate use dsorder (sustaned. remsson), and mld sedatve use dsorder (sustaned remsson). Dr. Krsten opned that Respondent suffered a current mental llness or other condton that mpacts or could have mpacted Respondent's ablty to engage n the practce of medcne, as Respondent suffered from a mld cogntve dsorder wth memory and executve functonng defdts Order Grantng nterm Suspenson 13. On August 25, 2017, Complanant fled a petton for an nterm suspenson order seekng to restrct or suspend Respondent's lcense. On September 26, 2017, after revewng the petton and supportng documents, and after hearng oral argument regardng the petton on September 15, 2017, AU Samuel Reyes ssued an order grantng the petton for nterm suspenson, and restrcted Respondent's lcense pendng a full determnaton of Respondent's ftness to practce medcne. ALJ Reyes also ordered Respondent to obtan a practce montor and pay all montor.qg costs. 14. Respondent procured a practce montor approved by the Board, who began submttng monthly practce montorng reports n November 20l7after, completng on-ste audts at Respondent's offce. n all of the monthly reports through October 1, 2018, the practce montor stated that he could fnd no ssues regardng Respondent's practce, chartng, or patent management. Patent A 15. Accordng to the supportng documentaton accompanyng the petton, on May 24, 2017, Patent A, who had been a patent of Respondent for two years, agreed for Responelent to perform a bone densty examnaton on her. Respondent drected Patent A nto a separate room where the bone densty scannng machne was kept. Respondent told Patent A that she would need to remove her clothng ncludng her bra, and change nto a gown. When Patent A faled to remove her pantes, Respondent told Patent A that the pantes would nterfere wth the 'results of bone densty tes.ts and nstructed her to remove them. Patent A told Respondent that she was on her menstrual cycle" and was worred that f she removed her pantes, she would bleed. Consequently, she told Respondent that she world come back at a later tme for her bone densty examnaton. Respondent told her to stay and complete the test, because he ha.d the machne calbratng; Patent A agreed to stay. Whle lyng on her back on the exam table, stuated underneath the bone densty machne,

5 Respondent provded her wth heavy-dark glasses to wear, whch rendered her unable to see. Fve or ten mnutes after commencng the test, Respondent opened Patent A's gown, exposng her breasts, and stated, "'m sorry, know t's knd of werd you have to have the gown open for ths test." She was completely naked durng the course of the scan and could not see anythng due to the glasses. After Respondent completed the scan, he told Patent A to get dressed, but he dd not leave the room as Patent A put her clothes back on. Respondent commented, "You have a nce fgure, 'm used to seeng a lot of overweght people." 16. Later, durng the telephone call between Patent A and Respondent, Patent A questoned why she needed to be undressed for the test. Respondent repled, "Well you are not supposed to have anythng n the way of the magng. They used to do them wth a gown on and they found the mages weren't good." Patent A told Respondent that she had asked a frend, who had undergone a bone.densty exam, whether she had to dsrobe to receve a bone densty scannng test. The frend responded n the negatve and told Patent A that she had the test wth her clothes on. Patent A asked Respondent why he dd not have a nurse or anybody n the room wth them durng the test, to whch Respondent repled, "That was a mstake, apologze for that, agree wth you, that was an oversght~ do them for a long tme and ddn't thnk of t.'~ Patent A further asked, "Why was undressed... wth exposed... breasts?" Respondent told her that everyone s naked for the exam, but that he typcally had a female (chaperone) n the room. 17. On June 29, 2017, offcers from the rvne Polce Department questoned Respondent amount hs bone densty exam of Patent A. Respondent told the offcers that t was standard for everyone to wear a gown for the procedure; When. the offcers asked whether Patent A was unclothed n the room wthout a gown, Respondent repled that he dd not.recall and that he always had a female n the room wth hm when he dd procedures on women. Respondent dened openng Patent A's gown because he had no reason to. Respondent asked the offcers whether Patent A beleved that she was exposed, and the offcer repled n the affrmatve. Respondent, then stated, "f she was, don't remember t." The offcers asked Respondent f Patent A had been naked, would that had been out of the ordnary, to whch Respondent repled n the postve. Respondent further told the offcers that f Patent A "was dsrobed, don't recall t and Pm not sure why she would have been, usually keep the gown on." When the offcers asked Respondent whether he had spoken to Patent A snce the exam, Respondent stated that he dd not recall and then sad, "f t was somethng lke t11s would have remembered, ths s ldnda scary." When questoned agan about whether he had spoken to Patent A snce t~e exam, Respondent sad, " don't recall, f she had some ldnd of complant lke ths, would have remembered and she dd not speak to me about ths." When the offcers demanded that Respondent answer honestly about whether he had spoken to Patent A snce the exam, Respondent stated, " don't remember; ths s not dshonesty, just got out of the hosptal."

6 18. A Board nvestgator ntervewed Respondent on February 14, Durng the ntervew, Respondent stated that he had dsmantled and dsposed of hs bone densty scanner machne. The nvestgator noted that Respondent could not remember the last names of hs employees; could not remember the year he graduated from medcal school; could not remember when he completed hs resdency tranng; could 11ot remember the name of the bone densty scanner or how long he had owned t; could not remember when he was hosptalzed; and could not remember hs conversatons wth the offcers of the rvne Polce Department. When the nvestgator asked Respondent whether he had suffered any falls or njures that could have mpared hm, Respondent st_ated that he had fallen down the stars the year pror. PatentB ' : 19. Patent B, who happened to work n Respondent's medcal offce for approxmat.ely four months n 2017 as a medcal assstant tranee and subsequently as a medcal assstant, chaperoned at least four bone densty scans performed by Respondent on female patents. Those patents were completely nude durng the bone densty exams pursuant to Respondenfs nstructons to them~ 20. Respondent requested Patent B to allow herself to be scanned n order for Respondent to "check" the machne to ensure t was workng correctly. Patent B agreed. Respondent performed the exam after nstructng Patent B to get completely nude. Supplemental Reports 21. On February 22, 2018, Dr. Krsten submtted a supplemental report after revewng the ntal and supplemental reports from the rvne Polce Department, a transcrpt of Respondent's ntervew, and a neul'opsychatrc evaluaton report prepared by Dr. Nathan Lavd. Dr. Krsten dagnosed Respondent wth moderate to severe alcohol use dsorder (no longe: n remsson), mld cogntve dsorder stemmng probably from bran trauma and substance use, 111.ld opate use dsorder (sustaned remsson), and mld sedatve use dsorder (sustaned remsson). Dr. Kfrsten opned that Respondent should have hs lcense to practce medcne suspended untl he completed an alcohol treatment program. 22. On September.15, 2018, Dr. Krsten submtted a supplemental report summarzng hs prevous reports and reteratng hs opnon that Respondent was. cogntvely mpared and, because practcng nternal and podatrc medcne requ:red a hgher level of cogntve resources, Respondent was not capable of contnung hs solo practce wthout makng sgnfcant errors, and th'erefore should be suspended. 23. On October 8; 2018, Dr. Backman submtted a s~pplemental medcal neurology expert report after revewng the psychatrc evaluaton reports of Dr. Krsten, a medcal evaluaton by Dr. Nehal Patel, the neuropsychologcal of Dr.

7 Anderson, the ntal and supplemental report of the rvne Polce Department, and the transcrpt of Respondent's ntervew. Dr. Backman noted that Respondent suffered from a mld cogntve dsorder secondary to chronc substance use, compounded wth the after effects of a traumatc bran njury, and complcated by the development of a subdural hematoma. Dr. Backman concluded that Respondent had an llness or condton that mpacted hs ablty to safely practce medcne. Alleged Departure~ from Standard of Care 24. Accordng to th~ declaraton of Dr. Afsaneh Maghsoudy, who was a Board-retaned expert to evaluate Respondent's performance of bone densty exams, the applcable standard of care n 2017 dd not requre that physcans perform bone densty scans on nude patents, dd not requre that physcans test or calbrate bone densty scannng. equpment on a nude patent, and dd not requre that the physcan reman n the room whle the patent dressed or undressed. Dr. Maghsoudy concluded that Respondent's performance of any bone densty exams on any nude female patent consttuted an extreme departure from the standard of care. Addtonally, Dr. Maghsoudy concluded that remanng n the same room wth a patent whle the patent dressed or undressed was a departure from the standard of care. f-5. Accordng to the declaraton of Dr. Jeffrey L. Rosenberg, who was a. Board-retaned expert to evaluate Respondent's use of wne wth patents, and concluded that provdng wne to a patent prfor to the admnstraton of narcotcs and sedatves consttuted an extreme departure from the standard of care, gven the profound respratory depresson that could result therefrom. Dr. Rosenberg also stated that that the combnaton of these drugs coulq result n vomtng, whch could lead to aspraton. LEGAL CONCLUSONS 1. Pettoner seeks relef under Government Code (Code) secton 11529, whch authorzes lcensure suspenson and the mposton of other condtons pendng a resoluton of underlyng dscplnary allegatons. 2. Code secton 11529, subdvson (a), provdes for nterm relef f the.affdavts n support of the petton show that the lcensee has engaged n, or s about to engage n, volatons of the Medcal Practce Act; s unable to practce safely due to a mental or physcal condton; and allowng hm to contnue to practce wll endanger the publc health, safety, or welfare. 3. Code secton 11529, subdvson (b), provdes that the lcensee shall be gven at least 15.days' notce of the hearng for an nterm suspenson unless affdavts establsh that serous njury would result to the publc before the matter could be heard.

8 4. Code secton 11529, subdvson (e), provdes: "[t]he admnstratve law judge shall grant the nterm order where, n the exercse of dscreton, the admnstratve law judge concludes that: [,-r] (1) There s a reasonable probablty that the pettoner wll preval n the underlyng acton. (11] (2) The lkelhood of njury to the publc n not ssung the order outweghs the lkelho.od of njury to the lcensee n ssung the order." l. 5. The ssuance of.an Order of nterm Suspenson, on an ex-parte bass, s warranted at ths tme because Respondent presents a rsk of mmedate and serous njury to hs patents. ORDER 1. The Ex Parte Petton for an nterm Order of Suspenson.s granted. 2. Physcan's and Surgeon's Certfcate Number A49201l, ssued to Respondent Brent Edward Slvers, M.D., s hereby suspended pendng a full admnstratve determnaton of Respondent's ftness to practce medcne, unless otherwse ordered followng the notced hearng on the Petton for nterm Ord.er of Suspenson. 3. Respondent shall not: a. Practce or attempt to practce any aspect of medcne n the State of Calforna untl the fnal decson of the Board followng an admnstratve hearng; b; Be present n any locaton whch s mantaned for the purpose of practcng medcne, except as a patent; c. Advertse, by any means, or hold hmself out as practcng or avalable to practce medcne. d. Do any other act, not specfcally prohbted above, for whch a physcan's and surgeon's certfcate s requred. 4. A notce hearng on the Petton wll be held on the Petton for nterm Suspenson shall be held on Monday, November26, 2018, at 9~00 a.m., at the Offce of Admnstratve Hearngs, located at 320 West Fourth Street, Sute 630, Los Angeles, Calforna. Pettoner shall gve notce of the hearng n complance wth the provsons of Busness and Professons Code secton 11529, subdvson ( c). 5. Any further documents offered n support of the Petton for nterm Order of Suspenson and any documents offered n opposton to the Petton for

9 nterm Order shall be fled and served no later than fve calendar days pror to the date set for the hearng on the Petton for nterm Order of Suspenson. 6. All documents shall be fled wth OA-'s Los Angeles offce electroncally at When flng a document electroncally, please do not fle a hard copy of the same document by any other means, such as personal delvery or mal. Before flng any document electroncally, revew OAH's electronc flng and namng gudelnes on the OAH webste at To ensure that OAH wll accept an electronc flng, the flng must comply wth the gudelnes. DATED: November 9, 2018 l!! ~ l l ' ~.,. l A mnstratve Law Judge. Offce of Admnstratve Hearngs. ' '