BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA. Case No DECISION AND ORDER

Transcription

1 BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: ) ) ) ALEJANDRO ESTEBAN GIL, 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 5:00 p.m. on February 8, IT IS SO ORDERED: January 9, MEDICAL BOARD OF CALIFORNIA

2 1 XAVIER BECERRA Attorney General of California 2 E. A. JONES III Supervising Deputy Attorney General 3 BENETH A. BROWNE Deputy Attorney General 4 State Bar No California Department of Justice So. Spring Street, Suite 1702 Los Angeles, CA Telephone: (213) Facsimile: (213) Attorneys for Complainant.~ -_ BEFORETHE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: ALEJANDRO ESTEBAN GIL, M.D. 240 North Virgil Avenue, #14 Los Angeles, CA Physician's and Surgeon's Certificate No. A 37558,. Respondent. Case No OAH No STIPULATED SETTLEMENT AND DISCIPLINARY ORDER 19 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above- 20 entitled proceedings that the following matters are true: 21 PARTIES Kimberly Kirchmeyer (Complainant) is the Executive Director of the Medical Board 23 of California (Board). She brought this action solely in her official capacity and is represented in 24 this matter by :Xavier Becerra, Attorney General of the State of California, by Berreth A. Browne, 25 Deputy Attorney General ALEJANDRO ESTEBAN GIL, M.D. (Respondent) is represented in this proceeding 27 by attorney Tracy Green, whose address is: 800 W. 6th Street, Suite 450, Los Angeles, CA ~ STIPULATED SETTLEMENT ( ).--,..,,'.. ; "< '.

3 1 3. On or about October 13, 1981, the Board issued Physician's and Surgeon's Certificate 2 No. A to Respondent. The Physician's and Surgeon's Certificate was in full force and 3. effect at all times relevant to th~ charges brought in Accusation No , and will 4 expire on August 31, 2019, unless renewed. 5 JURISDICTION 6 4. Accusation No : was filed before the Board, and is currently 7 pending against Respondent. The Accusation and all other statutorily required documents were 8 properly served on Respondent on December 15, Respondent timely filed his Notice of 9 Defense contesting the Accusation A copy of Accusation No is attached as exhibit A and incorporated 11.herein by reference. 12 ADVISEMENT AND WAIVERS Respondent has carefully read, fully discussed with counsel, and understands the 14 charges and allegations in Accusation No Respondent has also carefully read, 15. fully discussed with counsel, and understands the effects of this Stipulated Settlement and 16 Disciplinary Order Respondent is fully aware of his legal rights in this matter, including the right to a 18 hearing on the charges and allegations in the Accusation; the right to confront and cross-examine 19 the witnesses against him; the right to present evidence and to testify on his own behalf; the right 20 to the issuance of subpoenas to compel the attendance of witnesses and the production of 21 documents; the right to reconsideration and court review of an adverse decision; and all other 22 rights accorded by the California Administrative Procedure Act and other applicable laws Respondent voluntarijy, knowingly, and intelligently waives and gives up each and 24 every right set forth above. 25 CULP ABILITY Respondent understands and agrees that the charges and allegations in Accusation 27 No ~ , if proven at a hearing, constitute cause for imposing discipline upon his 28 ' Physician's and Surgeon's Certificate. 2 STIPULA,TED SETTLEMENT ( )...,_._ "-. -..,

4 10. Respondent does not contest that, at an administrative hearing, complainant could 2 establish a prima facie case with respect to the charges and allegations contained in Accusation 3 No and that he has thereby subjected his license to disciplinary action Respondent agrees that if he ever petitions for early, termination or modification of 5 probation, or if the Board ever petitions for revocation of probation, all of the charges and 6 allegations contained in Accusation No shall be deemed true, correct and fully 7 admitted by Respondent for purposes of that proceeding or any other licensing proceeding 8 involving Respondent in the State of California Respondent agrees that his Physician's and Surgeon's Certificate is subject to 1 O discipline and he agrees to be bound by the Board's probationary terms as set forth in the i'l Disciplinary Order below. 12 CONTINGENCY This stipulation shall be subject to approval by the Medical Board of California. 14 Respondent understands and agrees that counsel for Complainant and the staff of the Medical 15 Board of California may communicate directly with the Board regarding this stipulation and 16 settlement, without notice to or participation by Respondent or his counsel. By signing the 17 stipulation, Respondent understands and agrees that he may not withdraw his agreement or seek 18 to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails 19 to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary 20 Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal 21 action between the parties, and the Board shall not be disqualified from further action by having 22 considered this matter The parties understand and agree that Portable Document Format (PDF) and facsimile 24 copies of this Stipulated Settlement and Disciplinary Order, including PDF and facsimile 25 signatures thereto, shall have the same force and effect as the originals In consideration of the foregoing admissions and stipulations, the parties agree that 27 the Board may, without further notice or formal proceeding, issue and enter the following 28 Disciplinary Order: 3 STIPULATED SETTLEMENT ( )

5 1 DISCIPLINARY ORDER 2 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. A issued 3 to Respondent ALEJANDRO ESTEBAN GIL, M.D. is revoked. However, the revocation is 4 stayed and Respondent is placed on probation for eight (8) years on the following terms and 5 conditions CONTROLLED SUBSTANCES - PARTIAL RESTRICTION. Respondent shall not 7 order, prescribe, dispense, administer, furnish, or possess any controlled substances as defined by 8 the California Uniform Controlled Substances Act,.except for those drugs listed in Schedule V of 9 the Act. 1 O Respondent shall not issue an oral or written recommendation or approval to a patient or a 11 patient's primary caregiver for the possession or cultivation of marijuana for the personal medical 12 purposes of the patient within the meaning of Health and Safety Code section If 13 Respondent forms the medical opinion, after an appropriate prior examination and medical 14 indication, that a patient's medical condition may benefit from the use of marijuana, Respondent 15 shall so inform the patient and shall refer the patient to another physician who, following an 16 appropriate prior examination and medical indication, may independently issue a medically 17 appropriate recommendation or approval for the possession or cultivation of marijuana for the 18 personal medical purposes of the patient within the meaning of Health and Safety Code section In addition, Respondent shall inform the patient or the patient's primary caregiver that 20 Respondent is prohibited from issuing a recommendation or approval for the possession or 21 cultivation of marijuana for the personal medical purposes of the patient and that the patient or 22 the patient's primary caregiver may not rely on Respondent's statements to legally'possess or 23 cultivate marijuana for the personal medical purposes of the patient. Respondent shall fully 24 document in the patient's chart that the patient or the patient's primary caregiver was so 25 informed. Nothing in this condition prohibits Respondent from providing the patient or the 26 patient's primary caregiver information about the possible medical benefits resulting from the use 27 of marijuana. 28 Within 15 calendar days after the effective date of this Decision, Respondent shall submit 4 STIPULATED SETTLEMENT{S )._.-,..: : : '~-. ' ~.-

6 1 proof that Respondent has completed and submitted DEA Form 104 surrendering privileges to 2 handle controlled substances listed in Scheduled II, III and IV to the Drug Enforcement 3 Administration which shall result in him being issued a new registration certificate limited "to 4 Schedule V. Within 15 calendar days after the effective date of issuance of a new DEA permit, 5 Respondent shall submit a true copy of the permit to the Board or its designee CONTROLLED SUBSTANCES.: MAINTAIN RECORDS AND ACCESS TO 7 RECORDS AND INVENTORIES. Respondent shall maintain a record of all controlled 8 substances ordered, prescribed, dispensed, administered, or possessed by Respondent, and any 9 recommendation or approval which enables a patient or patient's primary caregiver to possess or 10 cultivate marijuanafor the personal medical purposes of the patient within.the meaning of Health 11 and Safety Code section , during probation, showing all of the follo.wing: 1) the name and 12 address of the patient; 2) the date; 3) the character and quantity of controlled substances involved; 13 and 4) the indications and diagnosis for which the controlled substances were furnished. 14 Respondent shall keep these records in a separate file or ledger, in chronological order. All 15 records and any inventories of controlled substances shall be available for immediate inspection 16 and copying on the premises by the Board or its desigfiee at all times during business hours and 17 shall be retained for the entire term of probation EDUCATION COURSE. Within 60 calendar days of the effective date of this 19 Decision, and on an annual basis thereafter, Respondent shall submit to the Board or its designee '. 20 for its prior approval educational program(s) or course(s) which shall not be less than 40 hours 21 per year, for each year of probation. The educational program(s) or course(s) shall be aimed at 22 correcting any areas of deficient practice or knowledge and shall be Category I certified. The 23 educational program(s) or course(s) shall be at Respondent's expense and shall be in addition to 24 the Continuing Medical Education (CME) r~quirements for renewal oflicensure. Following the 25 completion of each course, the Board or its designee may administer an examination to test 26 Respondent's knowledge of the course. Respondent shall provide proof of attendance for hours of CME of which 40 hours were in satisfaction of this condition PRESCRIBING PRACTICES COURSE. Within 60 calendar days of the effective 5 STIPULATED SETTLEMENT ( )

7 1 date of this Decision, Respondent shall enroll in a course in prescribing practices appro~ed in 2 advance by the Board or its designee. Respondent shall provide the approved course provider 3 :with any information and documents that the approved course provider may.deem pertinent. 4 Respondent shall participate in and successfully complete the classroom component of the course 5 not later than six (6) months after Respondent's initfal enrollment. Respondent shall successfully 6 complete any other component of the course within one (1) year of enrollment.. The prescribing 7 practices course shall be at Respondent's expense and shall be in addition to the Continuing 8 Medical Education (CME) requirements for renewal -oflicensure. 9 A prescribing practices course taken after the acts that gave rise to the charges in the 1 O Accusation, but prior to the effective date of the Decision ~ay,.in the sole discretion of the Boa.rd 11 or its designee, be accepted towards the fulfillment of this condition if the course would have 12 been approved by the Board or its designee had the course been taken after the effective date of 13 this Decision. 14 Respondent shall submit a certification of successful completion to the Board or its 15 designee not later than 15 calendar days after successfully completing the course, or not later than calendar days after the effective date of the D ecision, whichever is later MEDICAL RECORD KEEPING COURSE. Within 60 calendar days of the effective 18 date of this _Decision, Respondent shall enroll in a course in medical record keeping approved in 19 advance by the.board or its designee. Respondent shall provide the approved course provider 20 with any information and ~ocuments that the approved course provider may deem pertinent. 21 Respondent shall participate in and successfully complete the classroom component of the course 22 not later than six (6) months after Respondent's initial enrollment. Respond~nt shall successfully 23 complete any other component of the course within one (1) year of enrollment. The medical 24 record keeping course shall be at Respondent's expense and shall be in addition to the Continuing 25 Medical Education (CME) requirements for renewal oflicensure. 26 A medical record keeping course taken after the acts that gave rise to the charges in the 27 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board 28 or its designee, be accepted towards the fulfillment of this condition if the course would have 6 STIPULATED SETTLEMENT (800-: )

8 . 1 been approved by the Board or its designee had the course been taken after the effective date of 2 this Decision. 3 Respondent shall submit a certification of successful completion to the Board or its 4 designee not later than 15, calendar days after successfully completing the course, or not later than 5 15 calendar days after the effective date of the Decision, whichever is later CLINICAL. COMPETENCE ASSESSMENT PROGRAM. Within 60 calendar da:ys 7 of the effective date of this Decision, Respondent shall enroll in a clinical competence assessment 8 program approved in advance by the.board or its designee. Respondent shall successfully 9 complete the program not later than six (6) montl;is after Respondent's initial enrollment unless 1 O the Board or its designee agrees in writing to an extension of that time. 11 The program shall consist of a comprehensive assessment of Respondent's physical and 12 mental health and the six general domains of clinical competence as defined by the Accreditation 13 Council on Graduate Medical Education and American Board of Medical Specialties pertaining to 14 Respondent's current or intended area of practice. The program shall take into account data 15 obtained from the pre-assessment, self-report forms and interview, and the Decision(s), 16 Accusation(s), and any other information that the Board or its designee deems relevant. The 17 program shall require Respondent's on-site participation for a minimum of three (3) and no more 18 than five (5) days as determined by the program for the assessment and clinical education 19 evaluation. Respondent shall pay all expenses associated with the clinical competence 20 assessmentprogram. 21 At the end of the evaluation, the program will submit a report to the Board or its designee 22 which unequivocally states whether the Respondent has demonstrated the ability to practice 23 safely and independently. Based on Respondent's performance on the clinical competence 24 assessment, the program will advise the Board or its designee of its recommendation(s) for the 25 scope and length of any additional educational or clinical training, evaluation or treatment for any 26 medical condition or psychological condition, or anything else affecting Respondent's practice of 27 medicine. Respondent shall comply with the program's recommendations. '. 28 Determination as to whether Respondent successfully completed the clinical competence 7.. :,' - - -:.' :- -- STIPULATED SETTLEMENT ( ) '.-- -_,.._

9 1 assessment program is solely within the program's jurisdiction. 2 If Respondent fails to enroll, participate in, or successfully complete the clinical 3 competence assessment program within the designated time period, Respondent shall receive a 4 notification from the Board or its designee to cea~e the practice of medicine within three (3) 5 calendar days after being so notified. The Respondent shall not resume the practice of medidne 6 until enrollment or participation in the outstanding portions ofthe clinical competence assessment 7 program have been completed. If the Respondent did not successfully complete the clinical 8 competence assessment program, the Respondent shall not resume the practice of medicine until a 9 final decision has been rendered on the accusation and/or a petition to revoke probation. The 10 cessation of practice shall not apply to the reduction of the probationary time period. 11 Within 60 days after Respondent has successfully completed the clinical competence 12 assessment program, Respondent shall participate in a professional enhancement program 13 approved irt advance by the Board or its designee, which shall include quarterly chart review, 14 semi-annual practice assessment, and semi-annual review of professional growth and education. 15 Respondent shall participate in the professional enhancement program at Respondent's expense 16 during the term of probation, or until the Board or its designee determines that further 17 participation is no longer necessary NOTIFICATION. Within seven (7) days of the effective date of this Decision, the 19 Respondent shall provide a true copy of this Decision and Accusation to the Chief of Staff or the 20 Chief Executive Officer at every hospital where privileges or membership are extended to 21 Respondent, at any other facility where Respondent engages in the practice of medicine, 22 including all physician and locum tenens registries or other similar agencies, and to the Chief 23 Executive Officer at every insurance carrier which extends malpractice insurance coverage to 24 Respondent. Respondent shall submit proof of compliance to the Board or its designee within calendar days. 26 This condition shall apply to any change(s) in hospitals, other facilities or insurance carrier SUPERVISION OF PHYSICIAN ASSISTANTS AND ADV AN CED PRACTICE 28 NURSES. During probation, Respondent is prohibited from supervising physician assistan~s and 8 STIPULATED SETTLEMENT ( }~002064)

10 1 advanced practice nurses OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules 3 governing the practice of medicine in California and remain in full compliance with any court 4 ordered criminal probation, payments, and other orders QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations 6 under penalty of perjury on forms provided by the Board, stating whether there has been 7 compliance with all the conditions of probation. 8 Respondent shall submit quarterly declarations not later than 10 calendar days after the end 9 of the preceding quarter GENERAL PROBATION REQUIREMENTS. 11 Compliance with Probation Unit 12. Respondent shall comply with the Board's probation unit. 13 Address Changes 14 Respondent shall, at all times, keep the Board informed of Respondent's business and 15 residence addresses, address (if available), and telephone number. Changes of such 16 addresses shall be immediately communicated in writing to the Board or its designee. Under no 17 circumstances shall a post office box serve as an address of record, except as allowed by Business 18 and Professions Code section 2021 (b). 19 Place of Practice 20 Respondent shall not engage in the practice of medicine in Respondent's or patient's place 21 of residence, unless the patient resides in a skilled nursing facility or other similar licensed 22 facility. 23 License Renewal 24 Respondent shall maintain a current a~d renewed California physician's and surgeon's 25 license. 26 Travel or Residence Outside California 27 Respondent shall immediately inform the Board or its designee, in writing, of travel to any 28 areas outside the jurisdiction of California which lasts, or is contemplated to last, more than thirty 9. _... STIPULATED SETTLEMENT ( ).

11 1 (30) calendar days. 2 In the event Respondent should leave the State of California to reside or to practice 3 Respondent shall notify the Board or its designee in writing 30 calendar days prior to the dates of 4 departure and rtttum INTERVIEW WITH THE BOARD OR ITS. DESIGNEE. Respondent shall be 6 available in person upon request for interviews either atrespondent's place of business or at the 7 probation unit office, with or without prior notice throughout the term of probation NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or l 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 arty period of time Respondent is not practicing medicine 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. If Respondent resides in California_ and is considered to be in non-practice, _Respondent shall comply with all terms and conditions of probation. All time spent in an intensive training program which has been approved by the Board or its designee shall not be considered nonpractice and does not relieve Respondent from complying with all the terms and conditions of. probation. Practicing medicine in another state of the United States or Federal jurisdiction while '. on probation with the medical licensing authority of that ~tate or jurisdiction shall not be considered non-practice. A Board-ordered suspension of practice shall not be considered as a... period of non-practice. In the event Respondent's period of non-practice while on probation exceeds 18 calendar months, Respondent shall successfully complete the Federation of State Medical Boards' Special Purpose Examination, or, at the Board's discretion, a clinical competence assessment program that meets the criteria o(condition 18 of the current version of the Board's "Manual of Model Disciplinary Orders and Discipll.nary Guidelines" prior to resuming the practice of medicine. Respondent's period of non-practice while on probation shall not exceed two (2) years. Periods of non-practice will not apply to the reduction of the probationary term. -..-; ~ STIPULATED SETTLEMENT (8? ). :,.. _-_,.,_.._.-. -

12 1 Periods of non-practice for a Respondent residing outside of California will relieve 2 Respondenf of the responsibility to comply with the probationary terms and conditions with the 3 exception of this condition and the following terms and conditions of probation: Obey All Laws; 4 General Probation Requirements; Quarterly Declarations; Abstain from the Use of Alcohol and/or 5 Controlled Substances; and Biological Fluid Testing COMPLETION OF PROBATION. Respondent shall comply with all financial 7 obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the 8 completion of probation. Upon successful completion of probation, Respondent's certificate shall 9 be fully restored VIOLATION OF PROBATION. Failure to fully comply with any term or conditio~ 11 of probation is a violation of probation. If Respondent violates probation in.any respect, the 12 Board, after giving Respondent no~ice and the opportunity to be heard, may revoke probation and 13 carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke Probation, 14 or an Interim Suspension Order is filed against Respondent during probation, the B,oard shall have 15 continuing jurisdiction until the matter is final, and the period of probation shall be extended until 16- the matter is final LICENSE SURRENDER. Following the effective date of this Decision, if 18 Respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy 19 the terms and conditions of probation, Respondent may request to surrender his or 4er license. 20 The Board reserves the right to evaluate Respondent's request and to exercise its discretion in 21 determining whether or not to grant the request, or to take any other action deemed appropriate 22 and reasonable under the circumstances. Upon formal acceptance of the surrender, Respondent 23 shall within 15 calendar days deliver Respondent's wallet and wall certificate to the Board or its 24 designee and Respondent shall no longer practice medicine. Respondent will no longer be subject 25 to the terms and conditions of probation. If Respondent re-applies for a medical license, the 26 application shall be treated as a petition for reinstatement of a revoked certificate PROBATION MONITORING COSTS. Respondent shall pay the costs associated 28 with probation monitoring each and every year of probation, as designated by the Board, which 11 STIPULATED SETTLEMENT ( ) -_ ;-_.,--.. _ -.~.. -

13 may be adjt1sted on_ an amwal basis. Stich costs shall be payable to the Medical Board of 2 California and delivered to the Board or its designee no later th_an January 31 of each calendar 3 year. 4 ACCEPTANCE 5 I have carefully read the above Stipulated Settlement and Disciplinary Order and have folly 6 disc~ssedjt with my attorney, Tracy Green, I understand the stipulatioti and the effect it will 7 have on niy Physician's and Surgeon's Certificate. I enter into this Stipulated Settleni,ent and \ 8. DisciplinaryOrder \ 1 oluntatily, kuowingly, and ii1tellige11tly, and agree to be bound by the 10 9 Dedsion and Order of the Medical Board of Califon. ' 11 DATED: 'Mit'j ll }o I g I I have read and fully discussed with Respondent ALEJAt~DRO ESTEBAN GIL, iv.ld. th~ 15 tenns and conditions and o.ther matters contained in the above Stipulated Settlement and I 6 17 Disciplinary Order. I approve its form and content. 18 DATED: 5" IL. U II I I II /II I II I II /// II I II I 12 STIPULATED SETTLEMENT (800-~013"002064)

14 ENDORSEMENT 2 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully 3 submitted for consideration by the Medical Board of California. 4 Dated: May 11, Respectfully submitted, LA doc I 13 STIPULATED SETTLEMENT ( )

15 Exhibit A Accusation No :, - :-~--- ''.. -. :' _.., '

16 KAMALA D. HARRIS Attorney General of California E. A. JONES III Supervising Deputy Attorney General BENETH A. BROWNE Deputy Attorney General State Bar No California Department of Justice 300 So. Spring Street, Suite 1702 Los Angeles, CA Telephone: (213) Facsimile: (213) Attorneys for Complainant FILED STATE OF CALIFORNIA MEDICAL BOABD OF CALIFORNIA SACRAMENTO V f.\ S 20 _j.k_ BY \L. \=,v-~~ ANALYST BEFORE THE MEDICAL BOARD OF.CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: ALEJANDRO ESTEBAN GIL, M.D. 240 North Virgil Avenue, #14 Los Angeles, CA Physician's and Surgeon!s Certificate No. A37558, Respondent.. Case No ACCUSATION 18 Complainant alleges: 19 PARTIES Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official 21 capacity as the Executive Director of the Medical Board of California, Department of Consumer 22 Affairs (Board) On or about October 13, 1981, the Medical Board issued Physician's and Surgeon's 24 Certificate Number A to Alejandro Esteban Gil, M.D. (Respondent). The Physician's and 25 Surgeon's Certificate was in full force and effect at all times relevant to the charges brought herein 26 and will expire on August 31, 2017, unless renewed. 27 JURISDICTION This Accusation is brought before the Board, under the authority of the following 1

17 laws. All section references are to the Business and Professions Code unless otherwise indicated Section 2227 of the Code provides that a licensee Who is found guilty under the 3 Medical Practice Act may have his or her license revoked, suspended for a period not to exceed 4 one year,' placed on probation and required to pay the costs of probation monitoring, or such other 5 action taken in relation to discipline as the Board deems proper Section 2234 of the Code, states: 7 "The board shall take action against any lic'ensee who is charged with unprofessi?nal 8 conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not 9 limited to, the following: 10 "(a) Violating or attempting to violate, direct_ly or indirectly, assisting in or abetting the 11 violation of, or conspiring to violate any provision of this chapter. 12 "(b) Gross negligence. 13 "(c) Repeated negligent acts. To be ~epeated, there must be two or more negligent acts or 14. omissions.. An initial negligent act or omission followed by a separate and distinct departure from 15 the applicable standard of care shall constitute repeated negligent acts. 16 "(1) An initial negligent diagnosis followed by an act or omission medically appropriate 17 for that negligent diagnosis of the patient shall constitute a single negligent act. 18 "(2) When the standard of care requires a change in the diagnosis, act, or omission that 19 constitutes the negligent act described in paragraph ( 1 ), including, but not limited to, a 20 reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the 21 applicable standard of care, each departure constitutes a separate and distinct breac~ of the 22 standard.of care. 23. "( d) Incompetence. 24 "(e) The commission of any act involving dishonesty or corruption which is substantially 25 related to the qualifications, functions, or duties of a physician and surgeon. 26 "(f) Any action or conduct which would have warranted the denial of a certificate. 27 "(g) The practice of medicine from this state into another state or country without meeting 28 the legal requirements of that state or country for the practice of medicine. Section 2314 shall not 2 (-ALEJANDRO ESTEBAN GIL, M.D.) ACCUSATION NO

18 1 apply to this subdivision. This subdivision shall become operative upon the implementation of the 2 proposed registration program described in Section "(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and 4 participate in an interview by the board. This subdivision shall only apply to a certificate holder 5 who is the subject of an investigation by the board." Section 2266 of the Code states: "The failure of a physician and surgeon to maintain 7 adequate and accurate records relating to the provision of services,to their patients constitutes 8 unprofessional conduct." 9 7. Section 2264 of the Code states; 1 O "The employing, directly or indirectly, the aiding, or the abetting of any unlicensed persori 11 or any suspended, revoked, or unlicensed practitioner to engage in the practice of medicine or any 12 other mode of treating the sick.or afflicted which requires a license to practice constitutes 13 unprofessional conduct." 14 FIRST CAUSE FOR DISCIPLINE 15 (Gross Negligence) Respondent Alejandro Esteban Gil;M.D. is subject to disciplinary action under 17 section 2234, subdivision (b), of the Code in that he was grossly negligent in the care and.. 18 treatment of patients. The circumstances are as follows: 19 Patient G.C On or about March 3, 2011, Respondent evaluated G.C. for a complaint of coid, 21 co~gh, joint stiffness, nausea, and abdominal pain. The history notes nausea and constipation but 22 no history about the joint stiffness and no evaluation about her response to pain medications. 23 Respondent only documented ankle swelling on the extremity examination. Respondent 24 diagnosed G.C. with OA (osteoarthritis) and prescribed Soma 1 (a-powerful-muscle relaxer); Soma is a brand name for the generic drug carisoprodol which is used as a muscle relaxer. It is a schedule IV controlled substance, as designate by Health and Safety Code ~ection 11057, and a dangerous drug pursuant to Business and Professions Code section

19 1 Valium (a powerful and long-acting benzodiazepine); Vicodin 2 (a narcotic); Xanax 3 (another 2 benzodiazepine); and Ultram 4 (another narcotic). Respondent diagnosed the patient with 3 generalized abd9minal pain, constipation, and abdominal bloatedness but did not discuss how the 4 medications he prescribed could be contributing to these abdominal issues On or about April 4 and May 4, 2011, Respondent provided refills of 6 hydrocodone/acetaminophen to G.C. even though a CURES report 5 in the medical records shows 7 that the patient received the same narcotic from two other providers on November 1, 2010, and. 8 March 16, Respondent did not document any discussion.with the patient about why she 9 was receiving narcotics from multiple providers nor did he document counseling that controlled IO substances should only be prescribed by one provid~r. Respondent did not chart a written pain 11 management contract with G.C. and did not do toxicology screens to make sure G.C. was taking 12 the medications that were being prescribed to her On or about April 5, 2011, Respondent evaluated G.C. for a complaint ofdizziness, 14 fatigue, shortness of breath, headache, abdominal pain, and diarrhea. Respondent did not 15 document any information about the dizziness and did not perform an examination focused on 16 this complaint. The dizziness was not mentioned in. the assessment or plan. This was a patient 17 with end stage ren~l disease on dialysis, heart disease, diabetes, COPD, and previous transient 18 ischemic attack in whom dizziness could be a sign of a serious underlying medical problem. 19 Respondent prescribed Flagyl, an antibiotic, without adequate.documentation to justify its use Vicodin is a brand name for a compound of acetaminophen (aka AP AP) and hydrocodone, a Schedule III controlled substance as designated by Health and Safety Code section 11056, subdivision (e)(4), and a dangerous dmg pursuant to Business and Professions Code section Xanax is a brand name for the generic drug alprazolam (a benzodiaze.pine) which is used to treat anxiety disorders, panic disorders and anxiety caused depression. It is a schedule IV controlled substance, as designated by Health and Safety Code section 11057, subdivision (d)(l), and a-dangerous drug pursuant to Business and Professions Code section Ultram is a a brand name for tramadol, an effective pain reliever (analgesic) and is categorized as a dangerous drug pursuant to Business and Professions Code section "CURES" refers fo the Controlled Substance Utilization Review and Evaluation System which is a database of Schedule II, III and IV controlled substance prescriptions dispensed in California serving the public health, regulatory oversight agencies, and law enforcement. The CURES program is intended to reduce prescription dmg abuse and diversion without affecting legitimate medical practice or patient care. 4

20 I Respondent noted in the review of systems that G.C had shortness of breath and chest pains; yet 2 there was no additional history documented about these symptoms. Respondent did not document 3 any diagnosis related to these symptoms and did not order laboratory studies, chest x-ray, or 4 electrocardiogram to evaluate these symptoms. These symptoms are potentially very concerning 5 in a patient with known congestive heart failure, chronic obstructive pulmonary disease, coronary 6 artery disease, and chronic renal failure because they could represent a worsening or instability of 7 these serious disease processes. Also, the patient had been hospitalized from March 23, 2011, to 8 March 28, 2011, for congestive heart failure and chest pain. However, Respondent did not 9 document anything related to the rec.ent hospitalization. IO 12. On or about April 21, 2011, Respondent evah.~ated G.C. for right wrist pain. 11 Respondent documented right wrist pain, stiffness~ swelling, and numbness of the right index 12 finger for four to five days, including swelling in the wrist as well as tenderness and decreased 13 sensation to light touch over the right index finger. These exam findings are not cqnsistent ~ith 14 carpal tunnel syndrome. Typi'cal findings of carpal tunnel syndrome are. reproduction of the 15 numbness, tingling, or pain when the palmar side of the wrist is tapped over the carpal tunnel or 16. when the wrist is held in flexion. There may also be findings of decreased sensation in the thumb, 17 index finger, and middle finger. In advanced.cases of carpal tunnel syndrome, there can.be loss of 18 muscle mass at the base of the thumb. Despite a history. and exam that did not support a diagnosis 19 of carpal tunnel syndrome, Respondent diagnosed G.C. with carpal tunnel syndrome. Respondent 20 then performed a therapeutic injection of the wrist but did not doclll'i\ent where in the wrist he 21 injected or what medication he injected into the wrist On or about June 6, 2011, Respondent performed an incision and drainage (I&D) of an abscess on,the right thigh of G.C., Respondent did not send a sample of the pus for culture. Respondent prescribed Keflex, 6 which is not considered to be adequate therapy for an abscess because it does not treat methicillin-resistant Staphylococcus aureus (MRSA), which is a frequent. cause of abscesses. 6 Keflex, a brand name for cephalexin, is a dangerous drug pursuant to Business and Professions Code section 4022 and is used to treat bacterial infections. 5 (ALEJANDRO ESTEBAN GIL,, M.D.) ACCUSATION NO

21 1 14. On or about January 6, 2012, Respondent evaluated G.C. fora number of complaints 2 including cough. Respondent prescribed Keflex, an antibiotic, without documenting his 3 reasoning for doing so. This patient had long complained of cough, but Respondent did not 4 document what was different this time or why he suspected a bacterial infection that would justify 5 the antibiotic. Even if an antibio~ic were justified, Keflex does not provide adequate treatment for 6 the bacteria that infect the respiratory tract On or about January 12, 2012, Respondent evaluated G.C. for continued cough and 8 shortness of breath. Respondent diagnosed acute bronchitis, whi.ch is most commonly caused by a 9 virus. Respondent did not order a chest x-ray. Respondent prescribed Avelox, 7 a broad-spectrum 10 antibiotic, without adequate supporting documentation for doing so On or about February 8, 2012, Respondent evaluated G.C. for cold, cough, shortness 12 of breath, fatigue, dizziness, headaches, and back paill. Respondent did not document any history 13 about these complaints. Vital signs were normal. Respondent did not document an examination 14 of the lungs but wrote "abnormal shortness of breath, coughing." A chest X-ray was not ordered. 15 Respondent diagnosed lumbago, acute nasopharyngitis (typically a viral illness), cough, and 16.shortness of breath. Respondent prescribed a Z-pack, 8 an antibiotic, without supporting 17 documentation that a bacterial infection was suspected. Respondent also prescribed Tamiflu, 9 an 18 antiviral medication indicated for the treatment of influenza, without documentation supporting 19 the diagnosis of influenza On or about March 21, 2012, Respondent evaluated patient G.C. for a rash but did not 21 document a skin examination. 2:2 18. On or about May 8, 2012, Respondent evaluated G.C. for dysuria (painful urination) 23 but did not document any history related to the dysuria and did not order a urinalysis to try to A velox, a brand name for moxifloxacin, is a dangerous drug pursuant to Business and Professions Code section 4022 and is used to treat bacterial infections. 8 Z-Pak is a brand name for azithromycin, an antibiotic used to treat bacterial infections and a dangerous drug pursuant to Business and Professions Code section Tamiflu, a brand name for oseltamivir, is an antiviral medication that blocks the actions "Of influenza viruses and a dangerous drug pursuant to Business and Professions Code section

22 determine the cause of the patient's symptoms. Respondent evaluated G.C. for neck pain and 2 stiffness, low back pain, and knee pain. Respondent did not document a history of present illness. 3 Respondentdid not document an examination of the back or the knee. The diagnoses included 4 cervical pain, low back pain, and urine burning but no mention of knee pain. Respondent did not 5 document any history aboumhe knee pain. Respondent did not include the knee pain in his 6 diagnosis or in his treatment plan and did not order any.studies such as an x-ray of the knee, yet 7 he prescribed a narcotic. The patient was prescribed Soma and Vicodin. The patient was 8 prescribed Phenergan 10 despite no pulmonary complaints being documented. Respondent 9 evaluated G.C. for various issues as noted above, but there is no mention of depression or anxiety 1 O in the history or review of symptoms. The patient did not complain of depressive symptoms, and 11 Respondent did not use a tool such as the PHQ-9 to evaluate the patient for depression. 12 Respondent did not diagnose depression or anxlety, yet he started the patient on Prozac, 11 an 13 antidepressant, for reasons that are unclear On or about June 5, 2012, Respondent evaluated G.C. for knee pain but did not 15. document an examination of the knee. Despite not documenting an exam, Respondent proceeded 16 to perform an arihrocentesis (inserting a needle to remove fluid) of the knee On or about October 4, 2012, Respondent evaluated G.C. for cough but did not 18 document a heart or lung-examination On or about November 21, 2012, Respondent evaluated G.C. for a cough but did not 20 document a. heart or lung examination as would be expected for such a complaint On or about December 4, 2012, Respondent evaluated G.C. for knee pain but did not 22 document an examination of the knee or about April 4, 2013, Respondent evaluated G.C. for a cough but failed to 24 document a heart or lung examination Phenergan, a brand name for promethazine, an antihistamine, is a dangerous drug pursuant to Business and Professions Code section Prozac, a brand name for fluoxetine hydrochforide, an antidepressant used to treat multiple conditions including major depressive disorder, is a dangerous drug pursuant to Business and Professipns code section (ALEJANDRO ~STEBAN GIL, M.D.) ACCUSATION NO

23 24. On or about June 25, 2013, Respondent signed a physician order for Heavenly Home 2 Health, Inc. documenting that G.C. required a walker and an electric wheelchair. Respondent 3 performed a face-to-face. encounter as required but did not adequately document the need for the 4 wheelchair when he failed to document "what is the patient condition that he/she cannot walk 5 with cane, walker or why cannot propel a manual wheelchair." On or about September 23, 2013, Respondent wrote an admission history and. 7 physical when G.C. was admitted to Temple Community Hospital. Respondent documented 8 allergies to aspirin, penicillin, and Tylenol but did not document what type of allergic reactions 9 the patient had. However, Respondent documented that the patient "is on aspirin and Plavix." 12 1 O Allegatio.ns of Gross Negligence On or about March 3, 2011, April 4, 2011, May 4, 2011, March 21, 2012, May 8, , June 5, 2012, October 4, 2012, November 21, 2012, December ( 2012, and April 4, 2013, 13 Respondent was grossly negligent when he repeatedly failed to maintain adequate and accurate 14 medical records_ of the medical services provided to patient G.C On or about March 3, 2011, April 4, 2011, May 4, 2011, and May 8, 2012, 16 Respondent was grossly negligent when he repeatedly prescribing controlled substances without 17 an appropriate history, physical examination, workup, or justification for prescribing the 18 controlled substances, as well as for not maintaining appropriate medical records pertaining to the 19 use of these controlled substances On or about April 5, 2011, Respondent was grossly negligent when he failed to 21 adequately evaluate patient G.C.'s complaints oflightheadedness and dizziness On cir about April 5, 2011, January 6, 2012, January 12, 2012, and February 8, 2012, 23 Respondent was grossly negligent when he repeatedly Inappropriately prescribed antibiotics On pr about April 5, 2011, Respondent was grossly negligent when he failed to 25 appropriately evaluate complaints of shortness of breath and chest pain in patient G.C. who had Plavix, a brand name for clopidogrel bisulfate, an antidepressant used to prevent blood clots and heart attacks, is a dangerous drug pursuant to Business and Professions Code section

24 known heart disease, lung disease, and kidney disease On or about May 8, 2012, Respondent was grossly negligent when he failed to obtain 3 a history or perform a physical exam of the knee in patient G.C. who had presented with knee 4 pain On or about May 8, 2012, Respondent was grossly negligent when he started patient 6 G.C. on an antidepressant without documenting a complaint of depressive or anxious symptoms, 7 without documenting any symptoms related to depression, without using a screening tool for 8 depression, and without documenting a diagnosis of depression or.anxiety On or about Juhe 25, 2013, Respondent was grossly negligent when he provided 10 attestations to a governmental agency that did not accurately reflect patient G.C. 's medical 11 conditions and needs. 12 Patient J.B On or about December 7, 2012, Respondent evaluated J.B. as a new patient. 14 Respondent noted a history of "DM, HTN, etc." "Etc." is not adequate documentation of a 15 patient's history. Respondent documented that the patient "fell 3 weeks ago on a booth" and that 16 he "can't walk without a walker." Respondent did not document any history about the patient's leg 17 pain or his difficulty walking. Re&pondent did not document an examination of the patient's legs, 18 and did not document a neurologic examination in a patient with Parkinson's dis.ease who had 19 recently fallen. Respondent noted additional diagnoses of Parkinson's disease and fracture 'of the 20 patella (kneecap). There is no information documented about any.of these conditions. With 21 respect to diabetes ("DM"), Respondent noted a diagnosis of diabetes, but did not document any 22 medications that the patient was taking for diabetes, did not order any tests to evaluate. the status 23 of his diabetes, a~d did not prescribe any medications for diabetes On or about January 12, 2013, Respondent evaluated J.B. for lower back pain. 25 Respondent did not document how the patient's blood sugars were doing or any other information 26 about the diabetes. Respondent did not no~e any lab results. Respondent included type-2 diabetes 27 in his assessment but di~ not include anything in the plan other than "meds refill." On or about February 6,. 2013, Respondent evaluated patient J.B. for hypertension and 9 (ALEJANDRO ESTEBAN GIL, M.D.) ACCUSATION NO

25 1 bilateral leg pain. Blood pressure was documented as 140/95, which is elevated. Respondent did 2 not document any symptoms related to hypertension such as whether the patient had chest pain or 3. shortness of breath. Respondent did not perform a heart or lung examination. Respondent did not 4 include hypertensfon in his assessment and or his treatment plan. Respondent again did not 5 address the patient's diabetes On or about March 27, 2013, Respondent evaluated J.B. for back pain and again did 7 not address his diabetes. Further, Respondent, in evaluating J.B. for a complaint of back pain, did 8 not document any history about the back pain, did not document a review of systems, did not 9 perform an examinatiod; of the back, and did not document a neurologic examination On or about April 24, 2013, Respondent evaluated J.B. and noted lightheadedness in 11 the physical examination though there is no information about the patient's symptoms in the 12 history. Patient J.B. had a significant medical history including diabetes and Parkinson's disease, 13 yet Respondent did not perform an exam focused on this complaint, did not include 14 lightheadedness in the assessment, did not discuss the potential causes ofthe patient's symptoms, 15. and did not evaluate the lightheadedness with any studies On or about August 15, 2013, Respondent evaluated J.B. Respondent ordered 17 continuing home nursing care for wound care. However, there is no documentation of a wound in 18 the history' no documentation of a wound in.the exam, and no documentation of a wound_ in the 19 assessment or plan. Respondent also evaluated J.B. for complaints of weakness, headache, and 20 back pain. Respondent did not document any additional historical information about these 21 complaints. On the examination of the head and neck, Respondent simply wrote "headache~,". 22 which i~ not adequate documentation of an examination. Respondent doc':lmented that the 23 neurologic examination was abnonnal but did not indicate what was abnormal or even what parts 24 of the neurologic examination he performed. Respondent did not include the weakness, 25 headache, or back pain in his assessment, and did not indude any discussion about what the 26 cause of the patient's symptoms might be. Respondent did not outline any type of treatment plan 27 except "meds refill." No laboratory or imaging studies were ordered to evaluate the patient's 28 symptoms, which could have represented a seri_ous underlying medical problem such as a 10