BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA. Respondent.

1 XAVIER BECERRA Attorney General of California 2 E. A. JONES III Supervising Deputy Attorney General 3. CLAUDIA RAMIREZ Deputy Attorney General 4 State Bar No. 205340 California Department of Justice 5 300 South Spring Street, Suite 1702 Los Angeles, California 90013 6 Telephone: (213) 269-6482 Facsimile: (213) 897-9395 7 Attorneys for Complainant FILED STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNI~ SAC8AJAENT~ r1 20.J_ BY ~ ~ ANALYST 8 9 10 BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA 11 12 13 14 15 16 17 In the Matter of the Accusation Against: ANDRO NASHAAT SHAROBIEM, M.D. P.O. Box 2057 Riverside, California 92516 Physician's and Surgeon's Certificate No. A 100752, Respondent. Case No. 800-2015-011080 ACCUSATION 18 Complainant alleges: 19 PARTIES 20 1. 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"). ~3 2. On or about July 11, 2007, the Board issued Physician's and Surgeon's Certificate 24 Number A 100752 to Andro Nashaat Sharobiem, M.D. ("Respondent"). That'Certificate was in 25 full force and effect at all times relevant to the charges brought herein and will expire on October 26 31, 2018, unles,s renewed. 27 JURISDICTION 28 3. This Accusation is brought before the Board, under the authority of the following 1

1 laws. All section references are to the Business and Professions Code unless otherwise indicated. 2 4. 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 r~voked, suspended for a period not to exceed 4 one year, pla,ced 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. 6 5. Section 2234 of the Code, states: 7 "The board shall take action against any licensee who is charged with unprofessional 8 conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not 9 limited to, the following: 1 O "(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the. I 11 violation of, or conspiring to violate any provision of this chapter. 12 "(b) Gross negligence. 13 "( c) Repeated negligent acts. To be repeated, 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 applica~le 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 I 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 breach 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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16. 17 apply to this subdivision. This subdivision shall become operative upon the implementation of the proposed registration program described in Section 2052.5. "(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and participate ih an interview by the board. This subdivision shall only apply to a certificate holder. who is the subject of an investigation by the board." 6. 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." FIRST CAUSE FOR DISCIPLINE (Repeated Negligent Acts-Patients A, B, and C) 7. Respondent Andro Nashaat Sharobieril, M.D. is subject to disciplinary action under section 2234, subdivision ( c ), of the Code in that he engaged in repeated negligent acts in the care and treatment of patients A, B, and C. The circumstances are as follows: Patient A 8. From on or about September 18, 2012, to in or around January of2015, and on or about July 12, 2015, to in or around November of2015, Respondent treated Patient A, a seventyyear-old female. During the first office visit, Patient A sought to establish primary care with 18 Respondent. She complained oflethargy, weight gain, and tremors.. Respondent's assessment 19 was abnormal weight gain, Hepatitis C, hypertension, health maintenance, and homocysteinemia. 20 His management plan included laboratory studies, ultrasound of the abdomen/thyroid, Benadryl 21 for itching, hypertension management, and specialty referral for Hepatitis C. 22 9. Respondent saw Patient A on a regular basis until in or around January of2ois for 23 the management of her chronic medical problems, chronic pain syndrome, major depression and 24 anxiety. Respondent's management plan for chronic pain included oral opiates and non-narcotic 25 agents. On or about July 12, 2015, Respondent saw Patient A to re-establish care. He treated her 26 until in or around November of2015 when he released her from his care. 27 10. Patient A received regular prescriptions of opiates and benzodiazepines from 28 Respondent. During this same time period, a number of clinicians prescribed narcotics and/or 3

1 benzodiazepines to her~ 2 11. On or about May 31, 2013, and July 16, 2013, Respondent prescribed 3 APAP/Hydrocodone Bitartrate, 325 mg-10 mg, 120 tablets, 1 and Temazepam 30 mg, 30 tablets. 2 4 12. On or about June 10, 2013, Respondent prescribed Hydromorphone-Hydrochloride, 2 5 mg, 90 tablets. 3 6 13. On or about June 7, 2013, and August 7, 2013, Respondent prescribed Zolpidem 7 Tartrate, 10 mg, 30 tablets. 4 8 14. On or about July 25, 2013, Respondent prescribed Zolpidem Tartrate, 5 mg, 30 9 tablets. 10 15. On or about July 29, 2013, and August 26, 2013, Respondent prescribed Alprazolam, 11 0.5 mg, 30 tablets. 12 16. On or about June 6, 2013; September 9, 2013; October 10, 2013; November 12, 2013; 13 and January 6, 2014, Respondent prescribed Temazepam; 30 mg, 30 tablets. 14 17. On or about September 20, 2013, and October 28, 2013, Respondent prescribed 15 Diazepam, 5 mg, 30 tablets. 16 18. On or about January 8, 2014, Respondent prescribed APAP/Hydrocodone Bitartrate, 17 325 mg-10 mg, 150 tablets. 18 19 20 21 22 23 24 25 26 27 28 1 Hydrocodone/Acetaminophen (Norco, Lortab, Vicodin) is an opioid pain medication. It is a Schedule II controlled substance as defined by 21 Code of Federal Regulations part 1308.12(b)(l)(vi) and Health and Safety Code section 11055, subdivision (b)(l)(i). It is a dangerous drug as defined in Business and Professions Code section 4022. 2 Benzodiazepines are a class of drugs that produce Central Nervous System depression and are most commonly used to treat insomnia and anxiety. They include alprazolam (e.g., Xanax), lorazepam (e.g., Ativan), diazepam (e.g., Valium), and temazepam (Restoril). They are Schedule IV controlled substances as defined by 21 Code of Federal Regulations part 1308.14(c)(2), (c)(16), (c)(30), (c)(5) and California Health and Safety Code section 11057, subdivisions (d)(l), (d)(9), (d)(16), and (d)(29). They are dangerous drugs as defined in California Business and Professions Code section 4022. 3 Hydromorphone Hydrochloride (Dilaudid) is an opioid pain medication. It is a Schedule II controlled substance as defined by 21 Code of Federal Regulations part 1308.12(b)(l)(vii) and California Health and Safety Code section 11055, subdivision (b)(l)(j). It is a danferous drug as defined in California Business and Professions Code section 4022. Zolpidem (Ambien) is a sedative, also called a hypnotic. It is used to treat insomnia. It is a Schedule IV controlled substance as defined by 21 Code of Federal Regulations part 1308.14(c)(54) and California Health and Safety Code section 11057, subdivision (d)(32). It is a dangerous drug as defined in California Business and Professions Code section 4022. 4 (ANDRO NASHAAT SHAROBIEM, M.D.) ACCUSATION NO. soo.:2015-011080

. 1 19. On or about December 9, 2013, Respondent prescribed Temazepain, 30 mg, 30 2 tablets, and APAP/Hydrocodone Bitartrate, 325 mg-10 mg, 150 tablets. 3 20. On or about February 5, 2014; February 28, 2014; and March 25, 2014, Respondent 4 prescribed AP AP/Hydrocodone Bitartrate, 325 mg-10 mg, 150 tablets, and Temazepam 30 mg, 30 5 tablets. 6 21. On or about April 28, 2014; June 5, 2014; and September 4, 2014, Respondent 7 prescribed APAP/Hydrocodone Bitartrate, 325 mg-10 mg, 150 tablets. 8. 22. On or about April 30, 2014; June 3, 2014; July 7, 2014; August 5, 2014; and 9 September 3, 2014, Respondent prescribed Temazepam 30 mg, 30 tablets. 10 23. On or about June 17, 2014; July 24, 2014; and August 7, 2014, Respondent 11 prescribed Hydromorphone-Hydrochloride, 2 mg, 120 tablets. 12 24. On or about September 18, 2014, Respondent prescribed Hydromorphone- 13 Hydrochloride, 8 mg, 120 tablets. \ 14 25. On or about July 24, 2014, Respondent prescribed Lorazepam, 1 mg, 90 tablets. 15 26. On or about September 16, 2014, and December 15, 2014, Respondent prescribed 16 Diazepam, 10 mg, 30 tablets. 17 27. On or about October 2, 2014, Respondent prescribed Diazepam, 10 mg, 60 tablets. 18 28. On or about October 28, 2014, Respondent prescribed Diazepam, 10 mg, 14 tablets, 19 and APAP/Hydrocodone Bitartrate, 325 mg-10 mg, 56 tablets. 20 29. On or about November 11, 2014, Respondent prescribed APAP/Hydrocodone 21 Bitartrate, 325 mg-10 mg, 120 tablets, and Diazepam, 10 mg, 30 tablets. 22 30. On or about December 15, 2014, Respondent prescribed Alprazolam, 1 mg, 90 23 tablets, and APAP/Hydrocodone Bitartrate, 325 mg-10 mg, 120 tablets. 24 31. Respondent committed a departure from the standard of care with respect to his 25 prescribing of opioids for chronic pain to Patient A. He failed to include a complete pain 26 assessment. He poorly documented functional status, accurate exam findings in the area of 27 reported pain, previous diagnostic evaluation, and prior treatment. Respondent failed to develop a 28 comprehensive treatment plan, including pain and functional goals. He re-filled.controlled 5

1 substances at regular intervals without attempts to taper or assess appropriateness for continued 2 use. A significant escalation of the Hydromorphone dose from 2 mg to 8 mg during the 3 September 16, 2014, office visit was not clinically justified and posed significant patient risk. 4 Controlled Substance Utilization Review and Evaluation System ("CURES") 5 review, informed 5 consent, and urine drug testing were not evident in the medical record. Respondent's medical 6 record for Patient A did not include examination of areas of reported pain or psychiatric 7 assessment. He poorly documented the medical indication for controlled substance dose 8 escalation. 9. 32. Respondent also committed a departure from the standard of care when he failed to 1 O maintain adequate and accurate medical records for Patient A. 11 Patient B 12 33.. From in or around February 2014, to in or around November of 2015, Respondent 13 treated Patient B, an eighty-seven-year-old male. He saw Patient B during regular monthly visits 14 for the management of chronic medical conditions, anxiety, and depression. He regularly 15 prescribed multiple benzodiazepines for a prolonged period of time. The benzodiazepines 16 included Alprazolam 0.5 mg (15 tablets); Alprazolam 1 mg (ranging from 15 to 120 tablets); 17 Lorazepam 1 mg (ranging from 15 to 120 tablets); Lorazepam 2 mg (ranging from 120 to 132 18. tablets); Lorazepam 2 mg/ml (18 ml); Diazepam 5 mg (ranging from 15 to 16 tablets); and 19 20 21 22 23 24 25 26 27 28 Temazepam 15 mg (30 tablets). He also prescribed Zolpidem 5 mg and Promethazine-Codeine Syrup 6.25-10 mg/5 ml (360 ml). 6 A number of clinicians prescribed multiple controlled substances to Patient B during this same time period. Respondent performed a limited assessment of Patient B's anxiety and depression. 5 CURES refers to the Controlled Substance Utilization Review and Evaluation System, which is a government database containing information on Schedule II through IV controlled substances dispensed in California.. 6 Promethazine with Codeine (Phenergan with Codeine) is a combination medicine used to treat cold or allergy symptoms. Codeine is a pain reliever and cough suppressant. Promethazine is an antihistamine. Substances containing not more than 200 milligrams of codeine per 100 milliliters or 100 grams are Schedule V controlled substances as defined by 21 Code of Federal Regulations part 1308.15(c)(l) and California Health and Safety Code section 11058,.subdivision (c)(l). It is a dangerous drug as defined in Business and Professions Code section 4022. 6. (ANDRO NASHAAT SHAROBIEM, M.D.) ACCU.SATION NO. 800-2015-011080

1 34. Respondent committed a departure from the standard of care when he failed to 2 maintain adequate and accurate medical records for Patient B. He prescribed multiple 3 benzodiazepines to.patient B for anxiety, depression, and insomnia. He performed the initial and 4 subsequent follow-up assessments, but his documentation of these assessments was poor and 5 incomplete. Psychiatric examinations, appropriateness of continued use of benzodiazepines, 6 informed consent, consideration for psychiatric consultation, and risk assessment were not evident 7 in the medical record for Patient B. 8 Patient C. 9 35. From on or about February 20, 2013, to approximately the present, Respondent 1 O treated Patient C, a sixty-year-old female. During the first office visit, she had complaints of 11 anxiety and worsening depression. Respondent's assessment was chronic, recurrent major 12 depressive disorder, 'fibromyalgia, hypertension, right knee pain, osteoarthritis, health 13 maintenance, and morbid obesity. His management plan included Lorazepam, oral opiates, and 14 X-ray of the knee. 15 36. Respondent saw Patient C on a regular basis. He managed her chronic medical 16 conditions, chronic pain from osteoarthritis, carpal tunnel syndrome, and lumbar degenerative 17 joint disease. Respondent regularly prescribed opiates to her for a number of chronic pain 18 indications including knee osteoarthritis, fibromyalgia, and multi-level degenerative joirit disease 19 of the spine and plantar fasciitis. He prescribed Hydrocodone Bitartrate and Acetaminophen 325 20 mg-5 mg (ranging from 120 to 240 tablets); Hydrocodone Bitartrate and Acetaminophen 3251:Ilg- 21 10 mg (ranging from 120 to 240 tablets); Tramadol Hydrochloride 50 mg (180 tablets); 7 and 22 Nucynta Extended Release 100 mg (60 tablets). 8 He also prescribed Lorazepam 0.5 mg (90 23 tablets) and Phentermine HCL 15 mg (30 tablets). 24 25 26 27 28 7 Tramadol (Ultram) is a narcotic-like pain reliever. It is a Schedule IV controlled substance as defined by 21 Code of Federal Regulations part 1308.14(b)(3). It is a dangerous drug as defined in California Business and Professions Code section 4022. 8 Tapentadol Extended-Release Tablets (Nucynta ER) is an opioid pain medication. It is a Schedule II controlled substance a~ defined by 21 Code of Federal Regulations part 1308.12(c)(28). It is a dangerous drug as defined in California Business and Professions Code section 4022. 7

1 37. Respondent committed a departure from the standard of care when he failed to 2 maintain adequate and complete medical records for Patient C. Respondent's electronic medical 3 records consistently documents normal examinations despite her complaints of poorly controlled 4 pain and his escalation of analgesic classes. Respondent's pain assessment and treatment plan 5 were incomplete in that they were missing key items, including functional status, goals for pain 6 and fun.ction, and patient risk assessment for chronic narcotic use. 7 38. Respondent's acts and/or omissions.as set forth in paragraphs 8 through 37, inclusive 8 above, whether proven individually, jointly, or in any combination thereof, constitute repeated 9 negligent acts pursuant to section 2234, subdivision ( c ), of the Code with respect to patients A, B, 1 O and C. Therefore, cause for discipline exists. 11 SECOND CAUSE FOR DISCIPLINE 12 (Inadequate and Inaccurate Recordkeeping-Patients A, B, and C) 13 39. Respondent Andro Nashaat Sharobiem, M.D. is subject to disciplinary action under 14 section 2266 of the Code in that he failed to maintain adequate and accurate medical records with 15 respect to patients A, B, and C. The circumstances are as follows: 16 40. The facts and allegations in Paragraphs 8 through 37, above, are incorporated by 17 ref~rence and re-alleged as if fully set forth herein. 18 41. Respondent's acts and/or omissions as set forth in paragraph 40, inclusive above, 19 whether proven individually, jointly, or in any combination thereof, constitute inadequate and 20 inaccurate record keeping pursuant to section 2266 of the Code with respect to patients A, B, and 21 C. Therefore, cause for discipline exists. 22 THIRD CAUSE FOR DISCIPLINE 23 (Unprofessional Conduct--Patients A, B, and C) 24 42. Respondent Andro Nashaat Sharobiem, M.D. is subject to disciplinary action under 25. section 2234 of the Code for unprofessional conduct with respect to patients A, B, and C. The 26 circumstances are as follows: 27 43. The facts and allegations in Paragraphs 7 through 41, above, are incorporated by 28 reference and re-alleged as if fully set forth herein. 8

1.44. "Respondent's acts and/or omissions as set forth in paragraph 43, inclusive above, 2 whether proven individually, jointly, or in any combination thereof, constitute unprofessional. 3 conduct pursuant to section 2234 of the Code with respect to patients A, B, and C. Therefore, 4 cause for discipline exists. 5 PRAYER 6 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, 7 and that following the hearing, the Medical Board of California issue a decision: 8 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 100752, 9 issued to Respondent Andro Nashaat Sharobiem, M.D.; 10 2. Revoking, suspending or denying approval of Respondent Aiidro Nashaat Sharobiem, 11 M.D.'s authority to supervise physician assistants and advanced practice nurses; 12 3. Ordering RespondentAndro Nashaat Sharobiem, M.D., if placed on probation, to pay 13 the Board the costs of probation monitoring; and. 14 4. Taking such other and further action as deemed necessary and proper. 15 16 17 DATED: January 17, 2018 18 Executive Dire tor Medical Board of California 19 Department of Consumer Affairs State of California 20 Complainant 21 22 23 24 25 26 LA2018600011 62663993.docx 27 28 9