BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA DECISION AND ORDER

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1 BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Against: ) ) ) NAGA RAJA THOTA, M.D. ) ) Physician's and Surgeon's ) Certificate No. A ) ) Respondent ) Case No DECISION AND ORDER The attached Stipulated Settlement and Disciplinary 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 5:00p.m. on March 2, IT IS SO ORDERED: February 1, MEDICAL BOARD OF CALIFORNIA By: IJ.._A~ '~ Howard Krauss, M.D., Chair PanelB

2 KAMALA D. HARRIS Attorney General of California ALEXANDRA M. ALVAREZ Supervising Deputy Attorney General MATTHEW M. DAVIS Deputy Attorney General State Bar No West Broadway, Suite 1800 San Diego, CA P.O. Box San Diego, CA Telephone: (619) Facsimile: (619) Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Against: NAGA RAJA THOTA, M.D Navajo Road El Cajon, CA Physician's and Surgeon's Certificate No. A Respondent. 18 Case No OAH No STIPULATED SETTLEMENT AND DISCIPLINARY ORDER 19 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the 20 above-entitled proceedings that the following matters are true: PARTIES Kimberly Kirchmeyer (complainant) is the Executive 23 Director of the Medical Board of California and is represented herein by Kamala D. Harris, 24 Attorney General ofthe State of California, by Matthew M. Davis, Deputy Attorney General Respondent Naga Raja Thota, M.D. (respondent), is 26 represented herein by Robert W. Frank, Esq., whose address is 1010 Second Ave., Ste San Diego, CA Ill Stipulated Settlement and Disciplinary Order (Case No )

3 JURISDICTION II On or about September 14, 1994, the Medical Board of California issued Physician's and Surgeon's Certificate No. A to respondent. The Physician's and Surgeon's Certificate was in full force and effect at all times relevant to the charges and allegations in No and will expire on August 31,2016, unless renewed. 4. On September 4, 2014, complainant Kimberly Kirchmeyer, in her official capacity as the Executive Director ofthe Board, filed No against respondent. On September 4, 2014, respondent was served with a true and correct copy of No. I , together with true and correct copies of all other statutorily required documents, at his address of record on file with the Board which was: 2732 Navajo Road, El Cajon, CA A true and correct copy of No is attached hereto as Attachment "A" and incorporated by reference as if fully set forth herein. On September 12,2014, respondent filed a Notice of Defense and requested a hearing on the charges and allegations contained in No. I ADVISEMENT AND WAIVERS 5. Respondent has carefully read, fully discussed with counsel, and fully understands the charges and allegations in No. I Respondent also has carefully read, fully discussed with counsel, and fully understands the effects ofthis Stipulated Settlement and Disciplinary Order. 6. Respondent is fully aware of his legal rights in this matter, including the right to a hearing on the charges and allegations in No. I ; the right to confront and cross-examine the witnesses against him; the right to present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel the attendance of witnesses and the production of documents; the right to reconsideration and court review of an adverse decision; and all other rights accorded by the California Administrative Procedure Act, the California Code of Civil Procedure and other applicable laws, having been fully advised of same by his attorney of record, Robert W. Frank, Esq. 2 Stipulated Settlement and Disciplinary Order (Case No )

4 7. Respondent, having the benefit of counsel, hereby voluntarily, knowingly, 2 and intelligently waives and gives up each and every right set forth above. 3 CULPABILITY 4 8. Respondent does not contest that, at an administrative hearing, complainant 5 could establish a prima facie case with respect to the charges and allegations in No. 6 I , a true and correct copy of which is attached hereto as Attachment "A," and that 7 he has thereby subjected his Physician's and Surgeon's Certificate No. A to disciplinary 8 action. Respondent further agrees to be bound by the Board's imposition of discipline as set forth 9 in the Disciplinary Order below. 10 II Respondent agrees that if he ever petitions for early termination or modification of probation, or if an accusation and/or petition to revoke probation is filed against him before the Medical Board of California, all ofthe charges and allegations contained in No shall be deemed true, correct and fully admitted by respondent for purposes of any such proceeding or any other licensing proceeding involving respondent in the State ofcalifornia. CONTINGENCY 10. The parties agree that this Stipulated Settlement and Disciplinary Order shall be submitted to the Board for its consideration in the above-entitled matter and, further, that the Board shall have a reasonable period of time in which to consider and act on this Stipulated Settlement and Disciplinary Order after receiving it. By signing this stipulation, respondent fully understands and agrees that he may not withdraw his agreement or seek to rescind this stipulation prior to the time the Board considers and acts upon it. 23 II. The parties agree that this Stipulated Settlement and Disciplinary Order 24 shall be null and void and not binding upon the parties unless approved and adopted by the Board, 25 except for this paragraph, which shall remain in full force and effect. Respondent fully 26 understands and agrees that in deciding whether or not to approve and adopt this Stipulated 27 Settlement and Disciplinary Order, the Board may receive oral and written communications from 28 its staff and/or the Attorney General's office. Communications pursuant to this paragraph shall 3 Stipulated Settlement and Disciplinary Order (Case No )

5 not disqualify the Board, any member thereof, and/or any other person from future participation II in this or any other matter affecting or involving respondent. In the event that the Board, in its discretion, does not approve and adopt this Stipulated Settlement and Disciplinary Order, with the exception ofthis paragraph, it shall not become effective, shall be of no evidentiary value whatsoever, and shall not be relied upon or introduced in any disciplinary action by either party hereto. Respondent further agrees that should the Board reject this Stipulated Settlement and Disciplinary Order for any reason, respondent will assert no claim that the Board, or any member thereof, was prejudiced by its/his/her review, discussion and/or consideration of this Stipulated Settlement and Disciplinary Order or of any matter or matters related hereto. ADDITIONAL PROVISIONS 12. This Stipulated Settlement and Disciplinary Order is intended by the parties herein to be an integrated writing representing the complete, final and exclusive embodiment of the agreements ofthe parties in the above-entitled matter. 13. The parties agree that copies ofthis Stipulated Settlement and Disciplinary Order, including copies of the signatures of the parties, may be used in lieu of original documents and signatures and, further, that such copies and signatures shall have the same force and effect as originals. 14. In consideration ofthe foregoing admissions and stipulations, the parties agree the Board may, without further notice to or opportunity to be heard by respondent, issue and enter the following Disciplinary Order: DISCIPLINARY ORDER IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. A issued to respondent Naga Raja Thota, M.D., (respondent) is revoked. However, the revocation is stayed and respondent is placed on probation for seven (7) years from the effective date of this decision on the following terms and conditions: I. Actual Suspension As part of probation, respondent is suspended from the practice of medicine for thirty (30) days beginning the sixteenth (16th) day after the effective date of this decision. 4 Stipulated Settlement and Disciplinary Order (Case No )

6 2. Controlled Substances- Partial Restriction II Respondent shall not order, prescribe, dispense, administer, furnish, or possess any controlled substances as defined by the California Uniform Controlled Substances Act, except for those drugs listed in Schedules IV and V ofthe Act. Respondent shall be subject to this restriction until he submits, to the Board or its designee, proof of completion of a course in prescribing practices equivalent to the Prescribing Practices Course at the Physician Assessment and Clinical Education Program, University of California, San Diego School ofmedicine. 3. Education Course Within 60 calendar days of the effective date of this Decision, and on an annual basis thereafter, respondent shall submit to the Board or its designee for its prior approval educational program(s) or course(s) which shall not be less than 40 hours per year, for each year of probation. The educational program(s) or course(s) shall be aimed at correcting any areas of deficient practice or knowledge and shall be Category I certified. The educational program(s) or course(s) shall be at respondent's expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure. Following the completion of each course, the Board or its designee may administer an examination to test respondent's knowledge ofthe course. Respondent shall provide proof of attendance for 65 hours ofcme ofwhich 40 hours were in satisfaction ofthis condition. 4. Prescribing Practices Course Within 60 calendar days ofthe effective date of this Decision, respondent shall enroll in a course in prescribing practices equivalent to the Prescribing Practices Course at the Physician Assessment and Clinical Education Program, University of California, San Diego School of Medicine (Program), approved in advance by the Board or its designee. Respondent shall provide the program with any information and documents that the Program may deem pertinent. Respondent shall participate in and successfully complete the classroom component of the course not later than six (6) months after respondent's initial enrollment. Respondent shall successfully complete any other component of the course within one (I) year of enrollment. The 28 5 Stipulated Settlement and Disciplinary Order (Case No )

7 prescribing practices course shall be at respondent's expense and shall be in addition to the 2 Continuing Medical Education (CME) requirements for renewal of licensure. 3 A prescribing practices course taken after the acts that gave rise to the charges in 4 the, but prior to the effective date ofthe Decision may, in the sole discretion of the 5 Board or its designee, be accepted towards the fulfillment of this condition if the course would 6 have been approved by the Board or its designee had the course been taken after the effective date 7 ofthis Decision. 8 Respondent shall submit a certification of successful completion to the Board or its 9 designee not later than 15 calendar days after successfully completing the course, or not later than calendar days after the effective date of the Decision, whichever is later Medical Record Keeping Course 12 Within 60 calendar days ofthe effective date of this Decision, respondent shall 13 enroll in a course in medical record keeping equivalent to the Medical Record Keeping Course 14 offered by the Physician Assessment and Clinical Education Program, University of California, 15 San Diego School of Medicine (Program), approved in advance by the Board or its designee. 16 Respondent shall provide the program with any information and documents that the Program may 17 deem pertinent. Respondent shall participate in and successfully complete the classroom 18 component of the course not later than six (6) months after respondent's initial enrollment. 19 Respondent shall successfully complete any other component of the course within one (1) year of 20 enrollment. The medical record keeping course shall be at respondent's expense and shall be in 21 addition to the Continuing Medical Education (CME) requirements for renewal of licensure. 22 A medical record keeping course taken after the acts that gave rise to the charges 23 in the, but prior to the effective date of the Decision may, in the sole discretion of the 24 Board or its designee, be accepted towards the fulfillment of this condition if the course would 25 have been approved by the Board or its designee had the course been taken after the effective date 26 ofthis Decision. 27 Respondent shall submit a certification of successful completion to the Board or its 28 designee not later than 15 calendar days after successfully completing the course, or not later than 6 Stipulated Settlement and Disciplinary Order (Case No. I )

8 15 calendar days after the effective date of the Decision, whichever is later Clinical Training Program 3 Within 60 calendar days ofthe effective date of this Decision, respondent shall 4 enroll in a clinical training or educational program equivalent to the Physician Assessment and 5 Clinical Education Program (PACE) offered at the University of California- San Diego School of 6 Medicine ("Program"). Respondent shall successfully complete the Program not later than six (6) 7 months after respondent's initial enrollment unless the Board or its designee agrees in writing to 8 an extension of that time. 9 The Program shall consist of a Comprehensive Assessment program comprised of I 0 II a two-day assessment of respondent's physical and mental health; basic clinical and communication skills common to all clinicians; and medical knowledge, skill and judgment 12 pertaining to respondent's area of practice in which respondent was alleged to be deficient, and at 13 minimum, a 40 hour program of clinical education in the area of practice in which respondent was 14 alleged to be deficient and which takes into account data obtained from the assessment, 15 Decision(s), (s), and any other information that the Board or its designee deems 16 relevant. Respondent shall pay all expenses associated with the clinical training program. 17 Based on respondent's performance and test results in the assessment and clinical 18 education, the Program will advise the Board or its designee of its recommendation(s) for the 19 scope and length of any additional educational or clinical training, treatment for any medical 20 condition, treatment for any psychological condition, or anything else affecting respondent's 21 practice of medicine. Respondent shall comply with Program recommendations. 22 At the completion of any additional educational or clinical training, respondent 23 shall submit to and pass an examination. Determination as to whether respondent successfully 24 completed the examination or successfully completed the program is solely within the program's 25 jurisdiction. 26 If respondent fails to enroll, participate in, or successfully complete the clinical 27 training program within the designated time period, respondent shall receive a notification from 28 the Board or its designee to cease the practice of medicine within three (3) calendar days after 7 Stipulated Settlement and Disciplinary Order (Case No )

9 being so notified. The respondent shall not resume the practice of medicine until enrollment or 2 participation in the outstanding portions ofthe clinical training program have been completed. If 3 the respondent did not successfully complete the clinical training program, the respondent shall 4 not resume the practice ofmedicine until a final decision has been rendered on the accusation 5 and/or a petition to revoke probation. The cessation of practice shall not apply to the reduction of 6 the probationary time period Monitoring-Practice 8 Within 60 calendar days ofthe effective date ofthis Decision, respondent shall 9 enroll in a professional enhancement program (PEP) equivalent to the one offered by the 10 Physician Assessment and Clinical Education Program at the University of California, San Diego II School of Medicine, that includes, at minimum, quarterly chart and prescribing practice review, 12 semi-annual practice assessment, and semi-annual review of professional growth and education. 13 Respondent shall participate in the professional enhancement program at respondent's expense 14 during the term of probation. 15 The PEP shall submit a quarterly written report to the Board or its designee which 16 includes an evaluation of respondent's performance, indicating whether respondent's practices are 17 within the standards of practice of medicine, and whether respondent is practicing medicine 18 safely. It shall be the sole responsibility of respondent to ensure that the monitor submits the 19 quarterly written reports to the Board or its designee within 10 calendar days after the end of the 20 preceding quarter. 21 If respondent fails to enroll in a professional enhancement program (PEP) 22 equivalent to the one offered by the Physician Assessment and Clinical Education Program at the 23 University of California, San Diego School of Medicine within 60 calendar days of the effective 24 date of this Decision, respondent shall receive a notification from the Board or its designee to 25 cease the practice of medicine within three (3) calendar days after being so notified. Respondent 26 shall cease the practice of medicine until he enrolls in a professional enhancement program (PEP) 27 equivalent to the one offered by the Physician Assessment and Clinical Education Program at the 28 University of California, San Diego School of Medicine. 8 Stipulated Settlement and Disciplinary Order (Case No. I )

10 8. Solo Practice Prohibition 2 Respondent is prohibited from engaging in the solo practice of medicine. 3 Prohibited solo practice includes, but is not limited to, a practice where: 1) respondent merely 4 shares office space with another physician but is not affiliated for purposes of providing patient 5 care, or 2) respondent is the sole physician practitioner at that location. 6 If respondent fails to establish a practice with another physician or secure 7 employment in an appropriate practice setting within 60 calendar days of the effective date of this 8 Decision, respondent shall receive a notification from the Board or its designee to cease the 9 practice of medicine within three (3) calendar days after being so notified. The respondent shall 10 not resume practice until an appropriate practice setting is established. 11 If, during the course of the probation, the respondent's practice setting changes 12 and the respondent is no longer practicing in a setting in compliance with this Decision, the 13 respondent shall notify the Board or its designee within 5 calendar days of the practice setting 14 change. If respondent fails to establish a practice with another physician or secure employment in 15 an appropriate practice setting within 60 calendar days of the practice setting change, respondent 16 shall receive a notification from the Board or its designee to cease the practice of medicine within 17 three (3) calendar days after being so notified. The respondent shall not resume practice until an 18 appropriate practice setting is established Notification 20 Within seven (7) days of the effective date of this Decision, the respondent shall 21 provide a true copy of this Decision and to the Chief of Staff or the Chief Executive 22 Officer at every hospital where privileges or membership are extended to respondent, at any other 23 facility where respondent engages in the practice of medicine, including all physician and locum 24 tenens registries or other similar agencies, and to the Chief Executive Officer at every insurance 25 carrier which extends malpractice insurance coverage to respondent. Respondent shall submit 26 proof of compliance to the Board or its designee within 15 calendar days. 27 This condition shall apply to any change(s) in hospitals, other facilities or 28 insurance carrier. 9 Stipulated Settlement and Disciplinary Order (Case No )

11 I 0. Supervision of Physician Assistants 2 3 During probation, respondent is prohibited from supervising physician assistants. 11. Obey All Laws 4 Respondent shall obey all federal, state and local laws, all rules governing the 5 practice of medicine in California and remain in full compliance with any court ordered criminal 6 probation, payments, and other orders Quarterly Declarations 8 Respondent shall submit quarterly declarations under penalty of perjury on forms 9 provided by the Board, stating whether there has been compliance with all the conditions of 10 probation. II Respondent shall submit quarterly declarations not later than 10 calendar days 12 after the end of the preceding quarter General Probation Requirements 14 Compliance with Probation Unit 15 Respondent shall comply with the Board's probation unit and all terms and 16 conditions of this Decision. 17 Address Changes 18 Respondent shall, at all times, keep the Board informed of respondent's business 19 and residence addresses, address (if available), and telephone number. Changes of such 20 addresses shall be immediately communicated in writing to the Board or its designee. Under no 21 circumstances shall a post office box serve as an address of record, except as allowed by Business 22 and Professions Code section 2021 (b). 23 Place of Practice 24 Respondent shall not engage in the practice of medicine in respondent's or 25 patient's place of residence, unless the patient resides in a skilled nursing facility or other similar 26 licensed facility. 27 License Renewal 28 Respondent shall maintain a current and renewed California physician's and 10 Stipulated Settlement and Disciplinary Order (Case No )

12 surgeon's license Travel or Residence Outside California Respondent shall immediately inform the Board or its designee, in writing, of travel to any areas outside the jurisdiction of California which lasts, or is contemplated to last, more than thirty (30) calendar days. In the event respondent should leave the State of California to reside or to practice respondent shall notify the Board or its designee in writing 30 calendar days prior to the dates of departure and return. 14. Interview with the Board or its Designee Respondent shall be available in person upon request for interviews either at respondent's place of business or at the probation unit office, with or without prior notice throughout the term of probation. 15. Non-practice While on Probation Respondent shall notify the Board or its designee in writing within 15 calendar days of any periods of non-practice lasting more than 30 calendar days and within 15 calendar days of respondent's return to practice. Non-practice is defined as any period oftime respondent is not practicing medicine in California as defined in Business and Professions Code sections 2051 and 2052 for at least 40 hours in a calendar month in direct patient care, clinical activity or teaching, or other activity as approved by the Board. All time spent in an intensive training program which has been approved by the Board or its designee shall not be considered nonpractice. Practicing medicine in another state of the United States or Federal jurisdiction while on probation with the medical licensing authority of that state or jurisdiction shall not be considered non-practice. A Board-ordered suspension of practice shall not be considered as a period of nonpractice. In the event respondent's period of non-practice while on probation exceeds 18 calendar months, respondent shall successfully complete a clinical training program that meets the criteria of Condition 18 of the current version of the Board's "Manual ofmodel Disciplinary Orders and Disciplinary Guidelines" prior to resuming the practice of medicine. 11 Stipulated Settlement and Disciplinary Order (Case No )

13 Respondent's period ofnon-practice while on probation shall not exceed two (2) years. Periods of non-practice will not apply to the reduction of the probationary tenn. Periods of non-practice will relieve respondent of the responsibility to comply with the probationary terms and conditions with the exception of this condition and the following terms and conditions of probation: Obey All Laws; and General Probation Requirements. 16. Completion of Probation Respondent shall comply with all financial obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the completion of probation. Upon successful completion of probation, respondent's certificate shall be fully restored. 17. Violation of Probation 11 Failure to fully comply with any term or condition of probation is a violation of 12 probation. If respondent violates probation in any respect, the Board, after giving respondent 13 notice and the opportunity to be heard, may revoke probation and carry out the disciplinary order 14 that was stayed.!fan, or Petition to Revoke Probation, or an Interim Suspension 15 Order is filed against respondent during probation, the Board shall have continuing jurisdiction 16 until the matter is final, and the period of probation shall be extended until the matter is final License Surrender 18 Following the effective date of this Decision, if respondent ceases practicing due 19 to retirement or health reasons or is otherwise unable to satisfy the terms and conditions of 20 probation, respondent may request to surrender his or her license. The Board reserves the right to 21 evaluate respondent's request and to exercise its discretion in determining whether or not to grant 22 the request, or to take any other action deemed appropriate and reasonable under the 23 circumstances. Upon formal acceptance ofthe surrender, respondent shall within 15 calendar 24 days deliver respondent's wallet and wall certificate to the Board or its designee and respondent 25 shall no longer practice medicine. Respondent will no longer be subject to the terms and 26 conditions of probation. If respondent re-applies for a medical license, the application shall be 27 treated as a petition for reinstatement of a revoked certificate. 28 Ill 12 Stipulated Settlement and Disciplinary Order (Case No )

14 19. Probation Monitoring Costs 2 Respondent shall pay the costs associated with probation monitoring each and ').) every year of probation, as designated by the Board, which may be adjusted on an annual basis ! Such costs shall be payable to the Medical Board of California and delivered to the Board or its designee no later than January 31 of each calendar year. ACCEPTANCE I, Naga Raja Thota, M.D., have carefully read this Stipulated Settlement and Disciplinary Order and, having the benefit of counsel, enter into it freely, voluntarily, intelligently, and with full knowledge of its force and effect on my Physician's and Surgeon's Certificate No. A I fully understand that, after signing this stipulation, I may not withdraw from it, that it shall be submitted to the Medical Board of California for its consideration, and that the Board shall have a reasonable period of time to consider and act on this stipulation after receiving it. By entering into this stipulation, I fully understand that, upon acceptance by the Board, my Physician's and Surgeon's Certificate No. A will be revoked, with the revocation stayed, and I shall be placed on probation and required to comply with all of the terms and conditions of the Disciplinary Order set forth above. I also fully understand that any failure to comply with the terms and conditions of the Disciplinary Order set for above shall constitute unprofessional conduct and a violation or violations of probation, will subject to my Physician's and Surgeon's Certificate No. A to fwiher disciplinary action and, in addition, that the Board, after giving me notice and opportunity to be heard, may carry out the disciplinary order that was stayed, i.e., revocation of my Physician's and Surgeon's Certificate No. A Ill Ill Ill Respondent 13 Stipulated Settlement and Disciplinary Order (Case No )

15 I have read and fully discussed with respondent Naga Raja Thota, M.D., the terms and 2 conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order. 3 I approve its form and content. ROBER~ 5 DATED: 1/-11- j)- 6 Attorney for Respondent ENDORSEMENT 9 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully 10 submitted for consideration by the Medical Board of California ofthe Department of Consumer 11 Affairs DATED: ~ilf/ ;~ IJ~JJ~S I I Respectfully Submitted, KAMALA D. HARRIS Attorney General of California ALEXANDRA M. ALVAREZ Supervising Deputy Attorney General ~Pl MATTHEW M. DAVIS Deputy Attorney General Attorneys for Complainant Stipulated Settlement and Disciplinary Order (Case No )

16 II Attachment "A" No Stipulated Settlement and Disciplinary Order (Case No )

17 KAMALA D. HARRIS Attorney General of California THOMAS S. LAZAR Supervising Deputy Attorney General ALEXANDRA M. ALVAREZ Deputy Attorney General State Bar No West "A" Street, Suite 1100 San Diego, CA P.O. Box San Diego, CJ\ Telephone: (619) Facsimile: (619) FILED STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA SACRAMENTO ~m*=~ '\-20 ''+ BY ~.~,n..~~~ ANALYST 8 Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Against: NAGA RAJA THOTA, M.D Navajo Road El Cajon, CA Case No ACCt:SATION 16 Physician's and Surgeon's Certificate No. A Respondent Complainant alleges: PARTIES 1. Kimberly Kirchmeyer (Complainant) brings this solely in her official 22 capacity as the Executive Director of the Medical Board of California, Department of Consumer 23 Affairs On or about September 14, 1994, the Medical Board ofcalifornia issued Physician's 25 and Surgeon's Certificate No. A to Naga Raja Thota, M.D., (Respondent). The Physician's 26 and Surgeon's Certificate No. A was in full force and effect at all times relevant to the 27 charges brought herein and will expire on August 31, 2016, unless renewed. 28 I I I

18 JURISDICTION 2 ~ J. This is brought before the Medical Board of California (Board), 3 Department of Consumer Affairs, under the authority of the following laws. All section 4 references are to the Business and Professions Code (Code) unless otherwise indicated Section 2227 of the Code provides that a licensee who is found guilty under the 6 Medical Practice Act may have his or her license revoked, suspended for a period not to exceed 7 one year, placed on probation and required to pay the costs of probation monitoring, be publicly 8 reprimanded and ordered to complete relevant educational courses, or have such other action 9 taken in relation to discipline as the Board or an administrative law judge deems proper Section 2234 of the Code, states: 11 "The board shall take action against any licensee who is charged with 12 unprofessional conduct. In addition to other provisions of this article, 13 unprofessional conduct includes, but is not limited to, the following: 14 "(a) Violating or attempting to violate, directly or indirectly, assisting in or 15 abetting the violation of, or conspiring to violate any provision of this chapter. 16 "(b) Gross negligence. 17 "(c) Repeated negligent acts. To be repeated, there must be two or more 18 negligent acts or omissions. An initial negligent act or omission followed by a 19 separate and distinct departure from the applicable standard of care shall constitute 20 repeated negligent acts. 21 "( 1) An initial negligent diagnosis followed by an act or omission medically 22 appropriate for that negligent diagnosis of the patient shall constitute a single 23 negligent act. 24 ''(2) When the standard of care requires a change in the diagnosis, act, or 25 omission that constitutes the negligent act described in paragraph ( 1 ), including, 26 but not limited to, a reevaluation ofthe diagnosis or a change in treatment, and the 27 licensee's conduct departs from the applicable standard of care, each departure 28 constitutes a separate and distinct breach of the standard of care. 2

19 "(d) Incompetence ''(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. "(f) Any action or conduct which would have warranted the denial of a certificate Section 2266 of the Code states: ''The failure of a physician and surgeon to maintain adequate and accurate records relating to the provision of services to their patients constitutes unprofessional conduct." 7. Section 725 ofthe Code states: ''(a) Repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering of drugs or treatment, repeated acts of clearly excessive use of diagnostic procedures, or repeated acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of the community of licensees is unprofessional conduct for a physician and surgeon, dentist, podiatrist, psychologist, physical therapist, chiropractor, optometrist, speech-language pathologist, or audiologist. "(b) Any person who engages in repeated acts of clearly excessive prescribing or administering of drugs or treatment is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($1 00) nor more than six hundred dollars ($600), or by imprisonment for a term of not Jess than 60 days nor more than 180 days, or by both that fine and imprisonment. "(c) A practitioner who has a medical basis for prescribing, furnishing, dispensing, or administering dangerous drugs or prescription controlled substances shall not be subject to disciplinary action or prosecution under this section. 28 Ill 3

20 ''(d) No physician and surgeon shall be subject to disciplinary action 2 pursuant to this section for treating intractable pain in compliance with Section " 4 FIRST CAUSE FOR DISCIPLINE 5 (Gross Negligence) 6 8. Respondent has subjected his Physician's and Surgeon's Certificate No. A to 7 disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (b), in 8 that he committed gross negligence in his care and treatment of patients F.S., L.A., T.S., L.S. and 9 Ch.S., as more particularly alleged hereinafter: 10 Patient F.S In or about 1999, patient F.S., a then 46 year old man, began seeing respondent for 12 low back pain and right greater than left lower extremity pain that was secondary to post 13 laminectomy syndromc 1 and radiculopathy. 2 At that time, patient F.S. was on Prozac 3 20 mg 14 b.i.d., Ultram 4 8 tablets per day, and Vicodin ES 5 6 tablets per day. Respondent discontinu(:d the 15 Ultram and prescribed patient F.S. with oxycodone 6 80 mg per day From on or about 1999 through 2007, patient F.S. continued to see respondent for pain management. During this time period, the amount of morphine equivalent daily dose 1 Post-laminectomy syndrome is a condition where the patient sutters from persistent pain in the back following surgery to the back. 2 Radiculopathy is caused by compression or irritation of a nerve as it exits the spinal column. Symptoms of radiculopathy include pain, numbness, tingling, or weakness in the arms or legs. 3 Prozac is a brand name of fluoxetine and is used to treat depression, panic attacks, obsessive compulsive disorder, and a certain eating disorder (bulimia). 4 Ultram is a brand name oftramadol and is a narcotic-like pain reliever and a dangerous drug within the meaning of California Business and Professions Code section Vicodin is a brand name for acetaminophen and hydrocodone bitartrate, a Schedule III controlled substance pursuant to Health and Safety Code section 11056, subdivision (e), and a dangerous drug pursuant to Business and Professions Code section Oxycodone is a Schedule II controlled substance pursuant to Health and Safety Code section , subdivision (b), and a dangerous drug pursuant to Business and Professions Code section

21 (YIEDD) of medications prescribed by respondent to patient F.S. increased from a MEDD of mg in 1999 to approximately a MEDD of 3800 mg in From on or about January 8, 2007, through December 5, 2007, patient F.S. saw 4 respondent approximately twelve times for pain management. At each visit, patient F.S. would 5 fill out a form indicating his pain level out of a 10 point scale and whether there was improvement 6 from the last visit. For each of the visits during this time period, patient F.S. noted that his pain 7 level was either at 9 or I 0 level out of a 10 point scale, repeatedly noted that the pain medications 8 did not always work or did not \VOrk at all, and that there had been no improvement since the last 9 office visit. Respondent's progress notes for these visits were inconsistent with patient F.S.' 10 forms. During this time period, respondent documented in patient F.S.' chart an analgesia 11 percentage (pain relief) range from 40% pain relief to 60% pain relief despite the fact that at each 12 visit patient F.S. would indicate a 9 or 10 pain level. The progress notes for each of these visits 13 were difficult to read and had various items checked or circled without any narrative explanation. 14 The progress notes for each of these visits did not contain the number of tablets and dosages for 15 the controlled substances prescribed to patient F.S From on or about January 8, 2007, through December 5, 2007, respondent wrote 17 patient F.S. 16 prescriptions for Methadone HCL 7 10 mg for a total of tablets, prescriptions for Kadian mg tor a total of835 tablets, and 3 prescriptions for Percocet 9 5 mg 19 for a total of 360 tablets From on or about January 8, 2007, through December S, 2007, respondent continued 21 to prescribe patient F.S. high doses of opioids without any clear positive response, such as a Methadone is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (c), and a dangerous drug pursuant to Business and Professions Code section Kadian (morphine sulfate) is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (c), and a dangerous drug pursuant to Business and Professions Code section Pcrcocet is a brand name for oxycodone and acetaminophen, a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (b), and a dangerous drug pursuant to Business and Professions Code section

22 decrease in pain level. The progress notes for these visits do not contain any assessment of 2 patient F.S.' pain level. Throughout the progress notes, the medications prescribed to patient F.S. 3 were started and stopped and the dosages were routinely increased and decreased without any 4 rationale or documentation From on or about January 8, 2007, through December 5, 2007, respondent did not 6 refer patient F.S. for any diagnostic studies to determine if other pathology existed for his pain 7 symptoms, refer him to physical therapy, or require patient F.S. to have a toxicology screen From on or about January 8, 2007, through December 5, 2007, respondent did not 9 review the course of pain treatment of patient F.S., assess the appropriateness of continued usc of 10 the current treatment plan, or consider the use of other therapeutic modalities From on or about January 2, 2008, through December 31, 2008, patient F.S. saw 12 respondent approximately eleven times for pain management. At each visit, patient F.S. would 13 fill out a form indicating his pain level out of a I 0 point scale and whether there was improvement 14 from the last visit. For each of the visits during this time period, patient F.S. noted that his pain 15 level was either at 9 or 10 level out of a 10 point scale, repeatedly noted that the pain medications 16 did not always work or did not work at all, and that there had been no improvement since the last 17 office visit. Respondent's progress notes for these visits were inconsistent with patient F.S.' 18 forms. During this time period, respondent documented in patient F.S.' chart an analgesia 19 percentage range from 40% pain relief to 60% pain relief despite the fact that at each visit patient 20 F.S. would indicate a 9 or 10 pain level. The progress notes for each of these visits were difficult 21 to read and had various items checked or circled without any narrative explanation. The progress 22 notes for each of these visits did not contain the number of tablets and dosages for the controlled 23 substances prescribed to patient F.S From on or about January 2, 2008, through December 31, 2008, respondent wrote 25 patient F.S. 11 prescriptions for Methadone HCL 10 mg for a total of tablets, 1 prescription 26 Ill 27 II I 28 I I I 6

23 for Kadian 100 mg 60 tablets, and 12 prescriptions for Oxycontin mg for a total of tablets From on or about January 2, 2008, through December 31, 2008, respondent continued 4 to prescribe high doses of opioids without any clear positive response, such as a decrease in pain 5 level. The progress notes for these visits did not contain any assessment of patient F.S.' pain 6 level. Throughout the progress notes, the medications prescribed to patient F.S. were started and 7 stopped and the dosages were routinely increased and decreased without any rationale or 8 documentation From on or about January 2, 2008, through December 31, 2008, respondent did not 10 refer patient F.S. for any diagnostic studies to determine if other pathology existed for his pain 11 symptoms, refer him to physical therapy, or require patient F.S. to have a toxicology screen From on or about January 2, 2008, through December 31, 2008, respondent did not 13 review the course of pain treatment of patient F.S., assess the appropriateness of continued use of 14 the current treatment plan, and consider the use of other therapeutic modalities From on or about January 28, 2009, through December 9, 2009, patient F.S. saw 16 respondent approximately twelve times for pain management. At each visit, patient F.S. would 17 fill out a form indicating his pain level out of a 10 point scale and whether there was improvement 18 from the last visit. For each ofthe visits during this time period, patient F.S. noted that his pain 19 level was either at 9 or 10 level out of a 10 point scale, repeatedly noted that the pain medications 20 did not always work or did not work at all, and that there had been no improvement since the last 21 office visit. Respondent's progress notes for these visits were inconsistent with patient F.S.' 22 forms. During this time period, respondent documented in patient F.S.' chart an analgesia 23 percentage range from 40% pain relief to 60% pain relief despite the fact that at each visit patient 24 F.S. would indicate a 9 or 10 pain level. The progress notes for each of these visits were difficult 25 to read and had various items checked or circled without any narrative explanation. The progress Oxycontin is a brand name for oxyeodone, a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (b), and a dangerous drug pursuant to Business and Professions Code section

24 notes for each of these visits did not contain the number of tablets and dosages for the controlled 2 substances prescribed to patient F.S From on or about January 28, 2009, through December 9, 2009, respondent wrote 4 patient F.S. 11 prescriptions for Methadone HCL 10 mg for a total of tablets, 11 5 prescriptions for Kadian 100 mg for a total of 780 tablets, and 5 prescriptions for Oxycontin 80 6 mg tor a total of600 tablets. In addition, respondent wrote patient F.S. 11 prescriptions for 7 Diazepam mg for a total of 1050 tablets. 8 From on or about January 28, 2009, through December 9, 2009, respondent continued 9 to prescribe high doses of opioids without any clear positive response, such as a decrease in pain 10 level. The progress notes for these visits did not contain any assessment of patient F.S.' pain 11 level. Throughout the progress notes, the medications prescribed to patient F.S. were started and 12 stopped and the dosages were routinely increased and decreased without any rationale or 13 documentation From on or about January 28, 2009, through December 9, 2009, respondent did not 15 refer patient F.S. for any diagnostic studies to determine if other pathology existed for his pain 16 symptoms, refer him to physical therapy, or require patient F.S. to have a toxicology screen From on or about January 28, 2009, through December 9, 2009, respondent did not 18 review the course of pain treatment of patient F.S., assess the appropriateness of continued use of 19 the current treatment plan, or consider the use of other therapeutic modalities From on or about January 5, 2010, through December 16,2010, patient F.S. saw 21 respondent approximately twelve times for pain management. At each visit from on or about 22 January through June 2010, patient F.S. would fill out a form indicating his pain level out of a point scale and whether there was improvement from the last visit. For each of the visits during 24 this time period, patient F.S. noted that his pain level was either at 9 or 10 level out of a 10 point 25 scale, repeatedly noted that the pain medications did not always work or did not work at all, and Diazepam is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision (d), and a dangerous drug pursuant to Business and Professions Code section

25 that there had been no improvement since the last oftice visit. Respondent's progress notes for 2 these visits were inconsistent with patient F.S.' forms. During this time period, respondent 3 documented in patient F.S.' chart an analgesia percentage (pain relief) range from 40% pain relief 4 to no greater than 60% pain relief despite the fact that at each visit patient F.S. would indicate a 9 5 or 10 pain level. The progress notes for each of these visits were difficult to read and had various 6 items checked or circled without any narrative explanation. The progress notes for each of these 7 visits did not contain the number of tablets and dosages for the controlled substances prescribed to 8 patient F.S On or about July 29,2010, respondent began maintaining electronic medical records 10 for patient F.S. From or about July 29, 2010, through December 16,2010, respondent's 11 electronic medical records for patient F.S. were essentially an exact copy of the previous record 12 with minor changes in the dates, vital signs, and pain scores From on or about January 5, 2010, through December 16,2010, respondent wrote 14 patient F.S. 13 prescriptions for Methadone HCL 10 mg for a total of tablets, prescriptions for Kadian 100 mg for a total of 1260 tablets, and 5 prescriptions for 16 APAPIOxycodone 325/5 mg for a total of 1590 tablets. In addition, respondent wrote patient F. S prescriptions for Diazepam 10 mg for a total of 1050 tablets From on or about January 5, 2010, through December 16,2010, respondent continued 19 to prescribe high doses of opioids without any clear positive response, such as a decrease in pain 20 level. The progress notes for these visits did not contain any assessment of patient F.S.' pain 21 level. Throughout the progress notes, the medications prescribed to patient F.S. were started and 22 stopped and the dosages were routinely increased and decreased without any rationale or 23 documentation From on or about January 5, 2010, through December 16,2010, respondent did not 25 refer patient F.S. for any diagnostic studies to determine if other pathology existed for his pain 26 symptoms, refer him to physical therapy, or require patient F.S. to have a toxicology screen. 27 I I I 28 I I I 9

26 31. From on or about January 5, 2010, through December 16,2010, respondent did not 2 review the course of pain treatment of patient F.S., assess the appropriateness of continued use of 3 the current treatment plan, or consider the use of other therapeutic modalities From on or about January 17,2011, through June 7, 2011, patient F.S. saw respondent 5 approximately six times for pain management. The progress notes for these office visits were 6 essentially an exact copy of the previous record with minor changes in the dates, vital signs, and 7 pain scores. In each progress note, respondent noted that patient F.S. was sad and depressed. 8 Respondent did not refer patient F.S. for treatment of his depression From on or about January 17,2011, through June 7, 2011, respondent wrote patient 10 F.S. 6 prescriptions for Methadone HCL 10 mg for a total of 5500 tablets, 5 prescriptions for 11 Kadian 100 mg for a total of 300 tablets, and 6 prescriptions for APAP/Oxycodone 325/5 mg for a 12 total of 990 tablets. In addition, respondent wrote patient F. S. 6 prescriptions for Diazepam mg for a total of 540 tablets From on or about January 17, 2011, through June 7, 2011, respondent did not refer 15 patient F.S. for any diagnostic studies to determine if other pathology existed for his pain 16 symptoms, refer him to physical therapy, or require patient F.S. to have a toxicology screen From on or about January 17, 2011, through June 7, 2011, respondent did not review 18 the course of pain treatment of patient F.S., assess the appropriateness of continued use of the 19 current treatment plan, or consider the use of other therapeutic modalities On or about June 17, 2011, patient F.S. was found unresponsive in the street and 21 admitted into the hospital for four days. He was discharged on June 21,2011, with a diagnosis of 22 opioid dependence with prescription medication. The attending physician was able to reduce the 23 amount of pain medication for patient F.S. to 20 mg of Methadone daily and 60 mg ofms 24 Cantin 12 twice daily, which was dramatically less than the amount of medication he had been MS Cantin is a brand name for morphine, a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (b), and a dangerous drug pursuant to Business and Professions Code section