SAC~ENTOiliawJ.v- 5'

Transcription

1 XAVIER BECERRA Attorney General of California JANE ZACK SIMON Supervising Deputy Attorney General JOSHUA M. TEMPLET Deputy Attorney General State Bar No Golden Gate A venue, Suite San Francisco, CA Telephone: (415) Facsimile: (415) Attorneys for Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA FILcD STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA SAC~ENTOiliawJ.v- 5' BY ~Vl:TP?:::J ANALYST In the Matter of the Accusation Against: Fred William Wakil, M.D. P.O. Box 159 Bayside, CA Physician's and Surgeon's Certificate No. G 49172, Respondent. Case No ACCUSATION 17 Complainant alleges: 18 PARTIES Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official 20 capacity as the Executive Director of the Medical Board of California, Department of Consumer 21 Affairs (Board) On October 25, 1982, the Medical Board issued Physician's and Surgeon's Certificate 23 Number G to Fred William Wakil, M.D. (Respondent). The Physician's and Surgeon's. ' 24 Certificate was in full force and effect at all times relevant to the charges brought herein and will 25 expire on August 31, 2018, unless renewed. 26 JURISDICTION This Accusation is brought before the Board, under the authority of the following laws. All section references are to the Business and Professions Code unless otherwise indicated. 1

2 1 4. Section 2004 of the Code provides that the Board shall have the responsibility for the 2 enforcement of the disciplinary and criminal provisions of the Medical Practice Act Section 2227 of the Code authorizes the Board to take action against a licensee who 4 has been found guilty under the Medical Practice Act by revoking his or her license, suspending 5 the license for a period not to exceed one year, placing the license on probation and requiring 6 payment of costs of probation monitoring, or taking such other action as the Board deems proper Section 2234 of the Code states, in pertinent part: The board shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following: (a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. (b) Gross negligence. ( c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts. (1) An initial negligent diagnosis followed by an act or omission medically 15 appropriate for that negligent diagnosis of the patient shall constitute a single negligent act. 16 (2) When the standard of care requires a change in the diagnosis, act, or omission that 17 constitutes the negligent act described in paragraph (1), including, but not limited to, a reevaluation of the diagnosis or a change ih treatment, and the licensee's conduct 18 departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care Section 2266 of the Code states: "The failure of a physician and surgeon to maintain 22 adequate and accurate records relating to the provision of services to their patients constitutes 23 unprofessional conduct." 24 FACTS At all times relevant to this matter, the Respondent was licensed and practicing 26 emergency medicine in California. 27 Ill Ill 2

3 PATIENT P-1 1 Patient P-1, a then 91-year-old woman, was taken by ambulance to the Emergency 3 Department on June 4, 2016 after experiencing sudden severe lower back pain after parking her 4 car and while standing with a friend at the theatre The Respondent was on duty at the Emergency Department and documented that he 6 saw P-1 at approximately 5:09 p.m. He noted thatp-1 's pain reportedly radiated to her right leg 7 and was associated with right foot numbness. She was unable to stand due to the severity of the 8 pain. The Respondent further noted that there was no urinary incontinence or saddle anesthesia. 9 In his History of Present Illness (HPI), the Respondent said there was numbness and radiating 1 O pain to the patient's legs. In his Review of Systems {ROS), he documented the presence of 11 paresthesia without numbness There is no documented physical examination in the Respondent's chart notes except 13 for P-l's vital signs, taken at 4:49 and 6:25 p.m. He ordered medication (narcotic and anti- 14 inflammatory analgesics, an anti-emetic, and a steroid) and tests (a complete blood count (CBC), 15 a chemistry study, and a coagulation panel) for P He augmented his chart notes at 6:01 p.m., stating that after his initial evaluation, P-1 17 had developed bilateral paralysis with loss of sensation in her lower extremities bilaterally, that he 18 had called the neurosurgeon and gotten his answering machine, and that he had cancelled a CT 19 scan and ordered an MRI. His primary impression was lower extremity paralysis and he 20 considered P-1 's condition to be critical The Respondent did not include a significant discussion of his medical decision- 22 making in his Emergency Department chart notes The nursing staff notified the Respondent that P-1 did not have any pulses in her legs and, at approximately 7: 15 p.m., the Respondent re-evaluated P-1 and found that her legs were still warm. Soon thereafter, however, the nursing staff notified the Respondent that P-1 's right leg had become cold and pale. The Respondent states that, despite the clinical evidence of vascular 27

4 '' ' 1 occlusion, he did not call the vascular surgeon at that time because he did not have definitiye 2 evidence of vascular occlusion. He ordered a CT scan to evaluate P-1 for arterial occlusion in 3 addition to the MRI to evaluate for acute spinal cord emergency The MRI could not be performed at the hospital and required transport to an off-site 5 outpatient facility. The Respondent had signed P-1 out to the hospitalist for admission to the 6 hospital by the time P-1 was transported to the MRI facility and was no longer on duty. The 7 round-trip transfer and the MRI took three to four hours. The MRI did not show a definitive 8 etiology of P-1 's pain When P-1 returned to the hospital, a CT angiogram was performed. It illustrated a IO distal aortic vascular occlusion requiring emergent vascular surgery. The three- to four-hour delay 11 for the MRI increased operative mortality Despite the signs and symptoms of acute vascular ischemia, the Respondent did not 13 order that the CT angiogram, which could have been done at the hospital, be done before the 14 MRI, which required transport to an off site facility The Respondent did not document having updated the hospitalist regarding the evidence of acute vascular ischemia when he signed P-1 out to her. FIRST CAUSE FOR DISCIPLINE (Gross Negligence and/or Repeated Acts of Negligence and Failure to Maintain Adequ~te Records) The Respondent is guilty of unprofessional conduct and subject to disciplinary action 21 under sections 2234, subdivision (b) (gross negligence) and/or (c) (repeated negligent acts), and of the Code, in that the Respondent engaged in the conduct described above and below 23 including, but not limited to, the following: 24 A. The Respondent failed to prioritize imaging of an acute arterial occlusion and to 25. update the.hospitalist to whom he had signed Patient P-1 over for admission to the hospital of the 26 evolving symptoms of acute ischemia in Patient P-1 's right leg. 27 B. The Respondent failed to obtain a vascular surgery consult when an ischemic limb was suspected. 4 (FRED WILLIAM W AKIL, M.D.) ACCUSATION NO

5 1 C. The Respondent failed to document a physical examination and medical decision- 2 making in his Emergency Department chart. 3 PATIENT P Patient P-2 is a 79-year-old man with a history of congestive heart failure (CHF), 5 ischemic cardiomyopathy, coronary artery disease with myocardial infarction and stents, status 6 post coronary artery bypass, and other serious conditions. He complained of worsening 7 abdominal bloating and leg swelling for the previous two weeks and was sent by his primary care 8 physician on May 16, 2016 to the Emergency Department for evaluation of elevated liver 9 enzymes and to rule out CHF The Respondent's physical examination of Patient P-2 reflected normal vital signs, 11 including oxygen saturation on room air. He was noted to be+/- icteric Gaundiced) with clear 12 lung sounds and bilateral lower extremity pitting edema. Ascites (abnormal accumulation fluid in 13 the abdominal cavity) was suggested on abdominal examination and confirmed by CT scan. P-2 14 was anemic with hemoglobin of 8.8; his creatinine was elevated at 2.02 (normal levels are ), consistent with renal insufficiency; and he had an elevated bilirubin of 3.4 (nl ), 16 AST of 310 (nl 15-41), ALT of 419 (nl 5-46), BNP of approximately 3000 (nl <100), and an INR 17 of 1.6 (nl 2-3). A CT of the abdomen showed gallstones and minimal ascites. An arterial blood 18 gas indicated borderline hypoxia with an oxygen saturation of 92% on room air The Respondent gave P-2 40 mg of intravenous furosemide 2, and P-2 felt improved 20 with decreased dyspnea. After several hours in the Emergency Department, the Respondent 21 diagnosed P-2 with acute decompensated congestive heart failure and discharged him with a 22 prescription for furosemide, 40 mg twice daily, and instructions to follow-up with his primary 23 care physician the next day. The Respondent did not document a discussion of the cause of the 24 acute or chronic heart failure decompensation Furosemide (trade name Lasix) is a loop diuretic (water pill) that prevents salt absorption, allowing the salt instead to be passed in the urine. Furosemide is used to treat fluid retention (edema) in people with congestive heart failure, liver disease, kidney disorder such as nephrotic syndrome, and high blood pressure. 5

6 1 23. When the Respondent discharged P-2 on 40 mg offurosemide twice daily, he did not 2 adjust P-2's other antihypertensive medications, ramipril and HCTZ Despite P-2's numerous abnormal laboratory studies, the Respondent did not 4 document a chart review of prior laboratory values. P-2's anemia had developed since his last 5 Complete Blood Count (CBC) in January 2016 when his hemoglobin was 12.5 and his renal 6 function had declined since January and March 2016 when his creatinine was 1.4 and 1.24, 7 respectively P-2 was admitted directly to the hospital the following day, May 17, 2016, for 9 treatment for exacerbation of his congestive heart failure. During his three'-day hospitalization, he 1 O lost approximately twenty pounds of water weight. 11 SECOND CAUSE FOR DISCIPLINE 12 (Gross Negligence and/or Repeated Acts of Negligence) The Respondent is guilty of unprofessional conduct and subject to disciplinary action 14 under section 2234, subdivision (b) (gross negligence) and/or (c) (repeated negligent acts), of the 15 Code in that the Respondent engaged in the conduct described above including, but not limited to, 16 basing his treatment of Patient P-2 entirely on his respiratory response to furosemide, apparently 17 not recognizing the numerous signs of acute end organ dysfunction and impairment, such as the 18 following, which were consistent with a significant decompensation of congestive heart failure 19 requiring acute hospitalization or consultation: 20 A. The Respondent noted+/- icterus in his physical examination of Patient P-2 without 21 addressing the markedly elevated transaminases (AST and ALT) and bilirubin which were likely 22 due to hepatic congestion from decompensated congestive heart failure. 23 B. The Respondent failed to recognize or address P-2's significant anemia which 24 increased the risk of inadequate cardiac perfusion. 25 C. The Respondent discharged P-2 with an additional diuretic and failed to make or 26 consider dose adjustments of his.other antihypertensive medications, which could have further 27 exacerbated his impaired ren~l perfusion. 6

7 1 D. The Respondent failed to address P-2's borderline oxygen saturation which was I 2 consistent with pulmonary congestion. 3 E. The Respondent did not address P-2's elevated creatinine suggesting that P-2 did not 4 have adequate renal perfusion. 5 F. Except to administer and prescribe furosemide, the Respondent did not address the 6 likelihood that P-2 was total body fluid overloaded as evidenced by abdominal bloating, lower 7 extremity edema, and ascites. 8 PRAYER 9 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, 1 O and that following the hearing, the Medical Board of California issue a decision: Revoking or suspending Physician's and Surgeon's Certificate Number G 49172, 12 issued to Fred William Wakil, M.D.; Revoking, suspending or denying approval of Fred William Wakil, M.D.'s authority 14 to supervise physician assistants and advanced practice nurses; Ordering Fred William Wakil, M.D., if placed on probation, to pay the Board the 16 costs of probation monitoring; and Taking such other and further action as deemed necessary and proper DATED: ~~D~ec~e~m~b~e~r~5~ ~2~0~1~7~~ Executive Dire or Medical Board of California Department of Consumer Affairs State of California Complainant 23 SF docx