Rommel... · 14 ROMMEL ROJAS NAVARRETE, M.D. 5111 Garfield Street, Suite A 15 La Mesa, CA 91941 16 Physician's and Surgeon's Certificate No. G81687, Case No. 10-2013-235466 OAHNo

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

Rommel Rojas Navarrete, M.D.

Physician's and Surgeon's Certificate No. G 81687

Respondent

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Case No. 10-2013-235466

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DECISION

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 July 15, 2016.

IT IS SO ORDERED: June 15, 2016.

MEDICAL BOARD OF CALIFORNIA

Howard Krauss, M.D., Chair Panel B

1 KAMALA D. HARRIS Attorney General of California

2 ALEXANDRA M. ALVAREZ Supervising Deputy Attorney General

3 KAROLYN M. WESTFALL Deputy Attorney General

4 State Bar No. 234540 600 West Broadway, Suite 1800

5 San Diego, CA 921 01 P.O. Box 85266

6 San Diego, CA 92186-5266 Telephone: (619) 645-3121

7 Facsimile: (619) 645-2061

8 Attorneys for Complainant

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13 In the Matter of the Accusation Against:

14 ROMMEL ROJAS NAVARRETE, M.D. 5111 Garfield Street, Suite A

15 La Mesa, CA 91941

16 Physician's and Surgeon's Certificate No. G81687,

Case No. 10-2013-235466

OAHNo. 2015051079

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

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Respondent.

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

22 1. Kimberly Kirchmeyer (complainant) is the Executive Director ofthe Medical Board

23 of California. She brought this action solely in her official capacity and is represented in this

24 matter by Kamala D. Harris, Attorney General of the State of California, by Karolyn M. Westfall,

25 Deputy Attorney General.

26 2. Respondent Rommel Navarrete, M.D. (respondent) is represented in this proceeding

27 by attorney Robert W. Frank, Esq., whose address is: 1010 Second Ave., Ste. 2500, San Diego,

28 CA 92101.

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STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (10-2013-235466)

1 3. On or about June 28, 1995, the Medical Board of California (Board) issued

2 Physician's and Surgeon's Certificate No. 081687 to respondent. The Physician's and Surgeon's

3 Certificate was in full force and effect at all times relevant to the charges brought in Accusation

4 No. 10-2013-235466, and will expire on October 31,2016, unless renewed.

5 JURISDICTION

6 4. On November 13,2014, Accusation No. 10-2013-235466 was filed against

7 respondent before the Board, and is currently pending against respondent. A true and correct

8 copy of Accusation No. 10-2013-235466 and all other statutorily required documents were

9 properly served on respondent at his address of record with the Board. Respondent timely filed

10 his Notice of Defense contesting the Accusation. A true and correct copy of Accusation No.

11 10-2013-235466 is attached hereto as Exhibit A and incorporated herein by this reference as if

12 fully set forth herein.

13 . ADVISEMENT AND WAIVERS

14 5. Respondent has carefully read, fully discussed with counsel, and understands the

15 charges and allegations in Accusation No. 10-2013-235466. Respondent has also carefully read,

16 fully discussed with counsel, and understands the effects of this Stipulated Settlement and

17 Disciplinary Order.

18 6. Respondent is fully aware ofhis legal rights in this matter, including the right to a '

19 hearing on the charges and allegations in Accusation No. 1 0-2013-235466; the right to confront

20 and cross-examine the witnesses against him; the right to present evidence and to testify on his

21 own behalf; the right to the issuance of subpoenas to compel the attendance of witnesses and the

22 production of documents; the right to reconsideration and court review of an adverse decision;

23 and all other rights accorded by the California Administrative Procedure Act and other applicable

24 laws.

25 7. Having the benefit of counsel, respondent voluntarily, knowingly, and intelligently

26 waives and gives up each and every right set forth above.

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1 CULPABILITY

2 8. Respondent agrees that, at an administrative hearing, complainant could establish a

3 primafacie case with respect to the charges and allegations contained in Accusation No._l0-2013-

4 235466, and that he has thereby subjected his Physician's and Surgeon's Certificate No. 081687

5 to disciplinary action. Respondent further agrees to be bound by the Board's imposition of

6 discipline as set forth in the Disciplinary Order below.

7 9. Respondent agrees that if an accusation is filed against him before the Board, or in

8 any other proceeding before the Board, all of the charges and allegations contained in Accusation

9 No. 10-2013-235466 shall be deemed true, correct, and fully admitted by respondent for purposes

10 of any such proceeding or any other licensing proceeding involving respondent in the State of

11 California.

12 CONTINGENCY

13 10. This Stipulated Settlement and Disciplinary Order shall be subject to approval of the

14 Board. The parties agree that this Stipulated Settlement and Disciplinary Order shall be

15 submitted to the Board for its consideration in the above-entitled matter and, further, that the

16 Board shall have a reasonable period of time in which to consider and act on this Stipulated

17 Settlement and Disciplinary Order after receiving it. By signing this stipulation, respondent fully

18 understands and agrees that he may not withdraw his agreement or seek to rescind this stipulation

19 prior to the time the Board considers and acts upon it.

20 11. The parties agree that this Stipulated Settlement and Disciplinary Order shall be

21 null and void and not binding upon the parties unless approved and adopted by the Board, except

22 for this paragraph, which shall remain in full force and effect. Respondent fully understands and

23 agrees that in deciding whether or not to approve and adopt this Stipulated Settlement and

24 Disciplinary Order, the Board may receive oral and written communications from its staff and/or

25 the Attorney General's Office. Communications pursuant to this paragraph shall not disqualify

26 the Board, any member thereof, and/or any other person from future participation in this or any

27 other matter affecting or involving respondent. In the event that the Board does not, in its

28 discretion, approve and adopt this Stipulated Settlement and Disciplinary Order, with the

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1 exception of this paragraph, it shall not become effective, shall be of no evidentiary value

2 whatsoever, and shall not be relied upon or introduced in any disciplinary action by either party r

3 hereto. Respondent further agrees that should this Stipulated Settlement and Disciplinary Order

4 be rejected for any reason by the Board, respondent will assert no claim that the Board, or any

5 member thereof, was prejudiced by its/his/her review, discussion and/or consideration of this

6 Stipulated Settlement and Disciplinary Order or of any matter or matters related hereto.

7 ADDITIONAL PROVISIONS

8 12. This Stipulated Settlement and Disciplinary Order is intended by the parties herein to

9 be an integrated writing representing the complete, final and exclusive embodiment of the

1 0 agreements of the parties in the above-entitled matter.

11 13. The parties agree that copies ofthis Stipulated Settlement and Disciplinary Order,

12 including copies ofthe signatures of the parties, may be used in lieu of original documents and

13 signatures and, further, that such copies shall have the same force and effect as originals.

14 14. In consideration of the foregoing admissions and stipulations, the parties agree the

15 Board may, without further notice to or opportunity to be heard by respondent, issue and enter the

16 following Disciplinary Order:

17 DISCIPLINARY ORDER

18 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. G81687 issued

19 to respondent Rommel Navarrete, M.D. is revoked. However, the revocation is stayed and

20 respondent is placed on probation for five (5) years on the following terms and conditions.

21 1. ACTUAL SUSPENSION. As part of probation, respondent is suspended from the

22 practice of medicine for thirty (30) days beginning the sixteenth (16th) day after the effective date

23 of this Decision. Respondent shall be subject to this suspension until he submits, to the Board or

24 its designee; (1) Proof of completion of a course in prescribing practices equivalent to the

25 Prescribing Practices Course at the Physician Assessment and Clinical Education Program,

26 University of California, San Diego School of Medicine; (2) Proof of completion of a course in

27 medical record keeping equivalent to the Medical Record Keeping Course at the Physician

28 Assessment and Clinical Education Program, University of California, San Diego School of

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Medicine; and (3) Proof of enrollment in a clinical training program equivalent to the Clinical

Training Program at the Physician Assessment and Clinical Education Program, University of

California, San Diego School of Medicine.

2. CONTROLLED SUBSTANCES- PARTIAL RESTRICTION. 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 of the Act. Respondent shall be subject to this restriction until he submits, to the Board or

its designee, proof of successful completion of a clinical training program equivalent to the

Clinical Training Program at the Physician Assessment and Clinical Education Program,

University of California, San Diego School of Medicine.

3. CONTROLLED SUBSTANCES- MAINTAIN RECORDS AND ACCESS TO

12 RECORDS AND INVENTORIES. Respondent shall maintain a record of all controlled

13 substances ordered, prescribed, dispensed, administered, or possessed by respondent, and any

14 recommendation or approval which enables a patient or patient's primary caregiver to possess or

15 cultivate marijuana for the personal medical purposes of the patient within the meaning of Health

16 and Safety Code section 11362.5, during probation, showing all the following: 1) the name and

17 address of patient; 2) the date; 3) the character and quantity of controlled substances involved;

18 · and 4) the indications and diagnosis for which the controlled substances were furnished.

19 Respondent shall keep these records in a separate file or ledger, in chronological order. All

20 records and any inventories of controlled substances· shall be available for immediate inspection

21 and copying on the premises by the Board or its designee at all times during business hours and

22 shall be retained for the entire term of probation.

23 4. PRESCRIBING PRACTICES COURSE. Within 60 calendar days of the effective

24 date of this Decision, respondent shall enroll in a course in prescribing practices equivalent to the

25 Prescribing Practices Course at the Physician Assessment and Clinical Education Program,

26 University of California, San Diego School of Medicine (Program), approved in advance by the

27 Board or its designee. Respondent shall provide the program with any information and

28 documents that the Program may deem pertinent. Respondent shall participate in and

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STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (I 0-20 I 3-235466)

1 successfully complete the classroom component of the course not later than six (6) months after

2 respondent's initial enrollment. Respondent shall successfully complete any other component of

3 the course within one ( 1) year of enrollment. The prescribing practices course shall be at

4 respondent's expense and shall be in addition to the Continuing Medical Education (CME)

5 requirements for renewal of licensure.

6 A prescribing practices course taken after the acts that gave rise to the charges in the

7 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

8 or its designee, be accepted towards the fulfillment of this condition if the course would have

9 been approved by the Board or its designee had the course been taken after the effective date of

1 0 this Decision.

11 Respondent shall submit a certification of successful completion to the Board or its

12 designee not later than 15 calendar days after successfully completing the course, or not later than

13 15 calendar days after the effective date of the Decision, whichever is later.

14 5. MEDICAL RECORD KEEPING COURSE. Within 60 calendar days of the effective

15 date ofthis Decision, respondent shall enroll in a course in medical record keeping equivalent to

16 the Medical Record Keeping Course offered by the Physician Assessment and Clinical Education

17 Program, University of California, San Diego School of Medicine (Program), approved in

18 advance by the Board or its designee. Respondent shall provide the program with any

19 information and documents that the Program may deem pertinent. Respondent shall participate in

20 and successfully complete the classroom component of the course not later than six (6) months

21 after respondent's initial enrollment. Respondent shall successfully complete any other

22 component of the course within one (1) year of enrollment. The medical record keeping course

23 shall be at respondent's expense and shall be in addition to the Continuing Medical Education

24 (CME) requirements for renewal of licensure.

25 A medical record keeping course taken after the acts that gave rise to the charges in the

26 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

27 or its designee, be accepted towards the fulfillment of this condition if the course would have

28 been approved by the Board or its designee had the course been taken after the effective date of

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STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (I 0-20 13-235466)

this Decision.

2 Respondent shall submit a certification of successful· completion to the Board or its

3 designee not later than 15 calendar days after successfully completing the course, or not later than

4 15 calendar days after the effective date of the Decision, whichever is later.

5 6. CLINICAL TRAINING PROGRAM. Within 60 calendar days of the effective date

6 of this Decision, respondent shall enroll in a clinical training or educational program equivalent to

7 the Physician Assessment and Clinical Education Program (PACE) offered at the University of

8 California- San Diego School of Medicine (Program). Respondent shall successfully complete

9 the Program not later than six (6) months after respondent's initial enrollment unless the Board or

10 its designee agrees in writing to an extension of that time.

11 The Program shall consist of a Comprehensive Assessment program comprised of a two-

12 day assessment of respondent's physical and mental health; basic clinical and communication

13 skills common to all clinicians; and medical knowledge, skill and judgment pertaining to

14 respondent's area of practice in which respondent was alleged to be deficient, and at minimum, a

15 40 hour program of clinical education in the area of practice in which respondent was alleged to

16 be deficient and which takes into account data obtained from the assessment, Decision,

17 Accusation, and any other information that the Board or its designee deems relevant. Respondent

18 shall pay all expenses associated with the clinical training program.

19 Based on respondent's performance and test results in the assessment and clinical

20 education, the Program will advise the Board or its designee of its recommendation(s) for the

21 scope and length of any additional educational or clinical training, treatment for any medical

22 condition, treatment for any psychological condition, or anything else affecting respondent's

23 practice of medicine. Respondent shall comply with the Program's recommendations.

24 At the completion of any additional educational or clinical training, respondent shall submit

25 to and pass an examination. Determination as to whether respondent successfully completed the

26 examination or successfully completed the program is solely within the Program's jurisdiction.

27 If respondent fails to enroll, participate in, or successfully complete the clinical training

28 program within the designated time period, respondent shall receive a notification from the Board

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or its designee to cease the practice of medicine within three (3) calendar days after being so ·

notified. Respondent shall not resume the practice of medicine until enrollment or participation

in the outstanding portions ofthe clinical training program has been completed. If respondent did

not successfully complete the clinical training program, respondent shall not resume the practice

of medicine until a final decision has been rendered on the accusation and/or a petition to revoke

probation. The cessation of practice shall not apply to the reduction ofthe probationary time

period.

A clinical training program taken after the acts that gave rise to the charges in the

Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

or its designee, be accepted towards the fulfillment of this condition if the program would have

been approved by the Board or its designee had the course been taken after the effective date of

this Decision.

7. MONITORING- PRACTICE. Within 30 calendar days ofthe effective date ofthis

Decision, respondent shall submit to the Board or its designee for prior approval as a practice

monitor, the name and qualifications of one or more licensed physicians and surgeons whose

licenses are valid and in good standing, and who are preferably American Board of Medical

Specialties (ABMS) certified. A monitor shall have no prior or current business or personal

relationship with respondent, or other relationship that could reasonably be expeCted to

compromise the ability of the monitor to render fair and unbiased reports to the Board, including

but not limited to any form ofbartering, shall be in respondent's field of practice, and must agree

to serve as respondent's monitor. Respondent shall pay all monitoring costs.

The Board or its designee shall provide the approved monitor with copies of the Decision

and Accusation, and a proposed monitoring plan. Within 15 calendar days of receipt of the

Decision, Accusation, and proposed monitoring plan, the monitor shall submit a signed statement

that the monitor has read the Decision and Accusation, fully understands the role of a monitor,

and agrees or disagrees with the proposed monitoring plan. If the monitor di~agrees with the

proposed monitoring plan, the monitor shall submit a revised monitoring plan with the signed

statement for approval by the Board or its designee.

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Within 60 calendar days of the effective date of this Decision, and continuing throughout

2 probation, respondent's practice shall be monitored by the approved monitor. Respondent shall

3 make all records available for immediate inspection and copying on the premises by the monitor

4 at all times during business hours and shall retain the records for the entire term of probation.

· 5 If respondent fails to obtain approval of a monitor within 60 calendar days of the effective

6 date of this Decision, respondent shall receive a notification from the Board or its designee to

7 cease the practice of medicine within three (3) calendar days after being so notified. Respondent

8 shall cease the practice of medicine until a monitor is approved to provide monitoring

9 responsibility.

1 0 The monitor shall submit a quarterly written report to the Board or its designee which

11 includes an evaluation of respondent's performance, indicating whether respondent's practices are

12 within the standards of practice of medicine, and whether respondent is practicing medicine

13 safely. It shall be the sole responsibility of respondent to ensure that the monitor submits the

14 quarterly written reports to the Board or its designee within 10 calendar days after the end of the

15 preceding quarter.

16 If the monitor resigns or is no longer available, respondent shall, within 5 calendar days of

17 such resignation or unavailability, submit to the Board or its designee, for prior approval, the

18 name and qualifications of a replacement monitor who will be assuming that responsibility within

19 15 calendar days. If respondent fails to obtain approval of a replacement monitor within 60

20 calendar days of the resignation or unavailability of the monitor, respondent shall receive a

21 notification from the Board or its designee to cease the practice of medicine within three (3)

22 calendar days after being so notified, and respondent shall cease the practice of medicine until a

23 replacement monitor is approved and assumes monitoring responsibility.

24 In lieu of a monitor, respondent may participate in a professional enhancement program

25 equivalent to the one offered by the Physician Assessment and Clinical Education Program at the

26 University of California, San Diego School of Medicine, that includes, at minimum, quarterly

27 chart review, semi-annual practice assessment, and semi-annual review of professional growth

28 and education. Respondent shall participate in the professional enhancement program at

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1 respondent's expense during the term of probation.

2 8. NOTIFICATION. Within seven (7) days ofthe effective date ofthis Decision,

3 respondent shall provide a true copy of this Decision and Accusation to the Chief of Staff or the

4 Chief Executive Officer at every hospital where privileges or membership are extended to

5 respondent, at any other facility where respondent engages in the practice of medicine, including

6 all physician and locum tenens registries or other similar agencies, and to the Chief Executive

7 Officer at every insurance carrier which extends malpractice insurance coverage to respondent.

8 Respondent shall submit proof of compliance to the Board or its designee within 15 calendar

9 days.

10 This condition shall apply to any change(s) in hospitals, other facilities or insurance carrier.

11 9. SUPERVISION OF PHYSICIAN ASSIST ANTS. During probation, respondent is

12 prohibited from supervising physician assistants.

13 10. OBEY ALL LAWS. Respondent shall obey all federal, state and 1ocallaws, all rules

14 governing the practice of medicine in California and remain in full compliance with any court

15 ordered criminal probation, payments, and other orders.

16 11. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations

17 under penalty of perjury on forms provided by the Board, stating whether there has been

18 compliance with all the conditions of probation.

19 Respondent shall submit quarterly declarations n9t later than 10 calendar days after the end

20 of the preceding quarter.

21 12. GENERAL PROBATION REQUIREMENTS.

22 Compliance with Probation Unit

23 Respondent shall comply with the Board's probation unit and all terms and conditions of

24 this Decision.

25 Address Changes

26 Respondent shall, at all times, keep the Board informed of respondent's business and

27 residence addresses, email address (if available), and telephone number. Changes of such

28 addresses shall be immediately communicated in writing to the Board or its designee. Under no

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1 circumstances shall a post office box serve as an address of record, except as allowed by Business

2 and Professions Code section 2021 (b).

3 Place of Practice

4 Respondent shall not engage in the practice of medicine in respondent's or patient's place

5 of residence, unless the patient resides in a skilled nursing facility or other similar licensed

6 facility.

7 License Renewal

8 Respondent shall maintain a current and renewed California physician's and surgeon's

9 license.

1 0 Travel or Residence Outside California

11 Respondent shall immediately inform the Board or its designee, in writing, of travel to any

12 areas outside the jurisdiction of California which lasts, or is contemplated to last, more than thirty

13 (30) calendar days.

14 In the event respondent should leave the State of California to reside or to practice,

15 respondent shall notify the Board or its designee in writing 30 calendar days prior to the dates of

16 departure and return.

17 13. INTERVIEW WITH THE BOARD OR ITS DESIGNEE. Respondent shall be

18 available in person upon request for interviews either at respondent's place of business or at the

19 probation unit office, with or without prior notice throughout the term of probation.

20 14. 'NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or

21 its designee in writing within 15 calendar days of any periods of non-practice lasting more than

22 30 calendar days and within 15 calendar days of respondent's return to practice. Non-practice is

23 defined as any period oftime respondent is not practicing medicine in California as defined in

24 Business and Professions Code sections 2051 and 2052 for at least 40 hours in a calendar month

25 in direct patient care, clinical activity or teaching, or other activity as approved by the Board. All

26 time spent in an intensive training program which has been approved by the Board or its designee

27 shall not be considered non-practice. Practicing medicine in another state of the United States or

28 Federal jurisdiction while on probation with the medical licensing authority of that state or

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1 jurisdiction shall not be considered non-practice. A Board-ordered suspension of practice shall

2 not be considered as a period of non-practice.

3 In the event respondent's period of non-practice while on probation exceeds 18 calendar

4 months, respondent shall successfully complete a clinical training program that meets the criteria

5 of Condition 18 ofthe current version ofthe Board's "Manual ofModel Disciplinary Orders and

6 Disciplinary Guidelines" prior to resuming the practice of medicine.

7 Respondent's period of non-practice while on probation shall not exceed two (2) years.

8 Periods of non-practice will not apply to the reduction of the probationary term.

9 Periods of non-practice will relieve respondent of the responsibility to comply with the

10 probationary terms and conditions with the exception of this condition and the following terms

11 and conditions of probation: Obey All Laws; and General Probation Requirements.

12 15. COMPLETION OF PROBATION. Respondent shall comply with all financial

13 obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the

14 completion of probation. Upon successful completion of probation, respondent's certificate shall

15 be fully restored.

16 16. VIOLATION OF PROBATION. Failure to fully comply with any term or condition

17 of probation is a violation of probation. If respondent violates probation in any respect, the

18 Board, after giving respondent notice and the opportunity to be heard, may revoke probation and

19 carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke

20 Probation, or an Interim Suspension Order is filed against respondent during probation, the Board

21 shall have continuing jurisdiction until the matter is final, and the period of probation shall be

22 extended until the matter is final.

23 17. LICENSE SURRENDER. Following the effective date of this Decision, if

24 respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy

25 the terms and conditions of probation, respondent may request to surrender his license. The Board

26 reserves the right to evaluate respondent's request and to exercise its discretion in determining

27 whether or not to grant the request, or to take any other action deemed appropriate and reasonable

28 under the circumstances. Upon formal acceptance of the surrender, respondent shall within 15

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STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (I 0-20 I 3-235466)

1 calendar days deliver respondent's wallet and wall certificate to the Board or its designee and

2 respondent shall no longer practice medicine. Respondent will no longer be subject to the terms

3 and conditions of probation. If respondent re-applies for a medical license, the application shall

4 be treated as a petition for reinstatement of a revoked certificate.

5 18. PROBATION MONITORING COSTS·. Respondent shall pay the costs associated

6 with probation monitoring each and every year of probation, as designated by the Board, which

7 may be adjusted on an annual basis. Such costs shall be payable to the Medical Board of

8 California and delivered to the Board or its designee no later than January 31 of each calendar

9 year. /

10 ACCEPTANCE

11 I have carefully read the above Stipulated Settlement and Disciplinary Order and have fully

1•2- discussed it with my attorney, Robert W. Frank, Esq. I understand the stipulation and the effect it

13 will have on myPhysician's and Surgeon's Certificate No. 081687. I enter into this Stipulated

14 Settlement and Disciplinary Order voluntarily, knowingly, and intelligently, and agree to be

15 bound by the Decision and Order of the Medical Board of California.

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DATED:

I have read and fully discussed with respondent Rommel Navarrete~ M.D. the terms and

conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order .

I approve its form and content.

DATED: Lt- iJ:2-/t

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. Y(A~ ROBERT W. FRAN: Attorney for Respondent

13 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (800-2013-235466)

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ENDORSEMENT

The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

submitted for consideration by the Medical Board of California.

Dated: 41 ~ / fo Respectfully submitted,

KAMALA D. HARRIS Attorney General of California ALEXANDRA M. ALY AREZ . Su visin Deputy Attorney General

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12223128.doc

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Exhibit A

Accusation No. 10-2013-235466

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KAMALA D. HARRIS Attorney General of California THOMAS S. LAZAR Supervising Deputy Attorney General MA TIHEW M. DAVIS Deputy Attorney General State Bar No. 202766

110 West "A" Street, Suite llOO San Diego, CA 92101 P.O. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 645-2093 Facsimile: (619) 645-2061

8 Attorneys for Complainant

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In the Matter of the Accusation Against: Case No. 10-2013-235466

ROMMEL ROJAS NAVARRETE, M.D. 5111 Garfield Street, Suite A La Mesa, CA 91941

ACCUSATION

16 Physician's and Surgeon's Certificate No.

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G 81687,

Complainant alleges:

Respondent.

PARTIES

21 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official

22 capacity as the Executive Director of the Medical Board of California, Department of Consumer

23 Affairs.

24 2. On or about June 28, 1995, the Board issued Physician's and Surgeon's Certificate

25 No. G 81687 to ROMMEL ROJAS NAVARRETE, M.D. (respondent.) Physician's and

26 Surgeon's Certificate No. G 81687 was in full force and effect at all times relevant to the charges

27 brought herein and will expire on October 31, 2016, unless renewed.

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.JURISDICTION

3. This Accusation is brought before the Medical Board of California, Department of

Consumer Affairs (Board), under the authority of the following laws. All sections referenced are

to the Business and Professions Code (Code) unless otherwise indicated.

4. Section 2227 of the Code states:

"(a) A licensee whose matter has been heard by an administrative law judge of the

Medical Quality Hearing Panel as designated in Section 11371 of the Government Code, or

whose default has been entered, and who is found guilty, or who has entered into a stipulation for

disciplinary action with the board, may, in accordance with the provisions of this chapter:

"( 1) Have his or her license revoked upon order of the board.

"(2) Have his or her right to practice suspended for a period not to exceed one year

upon order of the board.

"(3) Be placed on probation and be required to pay the costs of probation monitoring

upon order of the board.

"(4) Be publicly reprimanded by the board. The public reprimand may include a

requirement that the licensee complete relevant educational courses approved by the board.

"(5) Have any other action taken in relation to discipline as part of an order of

probation, as the board or an administrative law judge may deem proper.

"(b) Any matter heard pursuant to subdivision (a), except for warning letters, medical

review or advisory conferences, professional competency examinations, continuing

education activities, and cost reimbursement associated therewith that are agreed to with the

board and successfully completed by the licensee, or other matters made confidential or

privileged by existing law, is deemed public, and shall be made available to the public by

the board pursuant to Section 803.1."

5. Section 2234 of the Code states:

"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:

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"(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 [Chapter 5, the Medical

Practice Act].

"(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

appropriate for that negligent diagnosis of the patient shall constitute a single negligent act.

"(2) When the standard of care requires a change in the diagnosis, act, or omission

that constitutes the negligent act described in paragraph ( 1 ), including, but not limited to, a

reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the

applicable standard of care, each departure constitutes a separate and distinct breach of the

standard of care.

"(d) Incompetence.

" "

6. Section 725 of the Code states, in pertinent part:

"(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.

" ,

7. 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."

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1 8. Unprofessional conduct under Business and Professions Code section 2234 is conduct

2 which breaches the rules or ethical code of the medical profession, or conduct which is

3 unbecoming to a member in good standing of the medical profession, and which demonstrates an

4 unfitness to practice medicine. (Shea v. Board of Medical Examiners (1978) 81 Cal.App.3d 564,

5 575.)

6 FIRST CAUSE FOR DISCIPLINE

7 (Gross Negligence)

8 9. Respondent has subjected his Physician's and Surgeon's Certificate Number G 81687

9 to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (b),

10 of the Code, in that he committed gross negligence in his care and treatment of patient L.B. as

11 more particularly alleged hereinafter:

12 10. In or about July 2002, patient L.B., a then sixty-two (62) year old female, began

13 treating with respondent. Patient L.B. had a complex medical history which included: diabetes,

14 obesity, hyperlipidemia, anemia, renal failure, hypothyroidism, congestive heart failure,

15 peripheral neuropathy secondary to diabetes, coronary artery disease, urinary tract infections, and

16 osteoarthritis.

17 11. Between in or about 2005 and September 25,2013, respondent saw patient L.B. for

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multiple physical complaints. Respondent prescribed multiple medications to patient L.B., that

included: Oxycodone/APAP\ Hydrocodone/APAP2, Percocet3

, Lortab4, and Morphine Sulfate5

for treatment of various pain complaints.

1 Oxycodone/ AP AP is 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 4022.

2 Hydrocodone/APAP is 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 4022.

3 Percocet 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 4022.

4 Lortab is a brand name for hydrocodone, a Schedule III controlled substance pursuant to Health and Safety Code section 11056, subdivision (e), and a dangerous drug pursuant to Business and

(continued ... )

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1 12. In or about October 2008, patient L.B. was prescribed Percocet while hospitalized.

2 Respondent continued this prescription without documenting an indication. Respondent noted

3 that a nursing home added Temazepam6 to patient L.B. 's medication regiment for sleep.

4 Respondent was also prescribing Alprazolam7 to patient L.B. for anxiety.

5 13. On or about July 8, 2009, patient L.B. presented with cramping and peripheral

6 neuropathy. Respondent prescribed Morphine Sulfate.

7 14. On or about February 8, 2010, patient L.B. presented to respondent with complaints

8 of lower back pain for two weeks. Respondent continued patient L.B. on Lortab and Morphine

9 Sulfate.

10 15. On or about March 15, 2010, respondent saw patient L.B. regarding a fall.

11 Respondent did not document her medication regiment (opiates or benzodiazepines) as a possible

12 contributor to her fall.

13 16. On or about June 10, 2010, respondent documented concerns about polypharmacy8

14 and reviewed patient L.B.'s medications but maintained patient L.B. on Hydrocodone/APAP,

15 Benzodiazepines9 and Cyclobenzaprine. 10

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Professions Code section 4022.

5 Morphine Sulfate is 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 4022.

6 Temazepam 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 4022.

7 Alprazolam 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 4022.

8 Polypharmacy is the use of multiple medications by a patient.

9 Benzodiazepines are Schedule IV controlled substances pursuant to Health and Safety Code section 11057, subdivision (d), and dangerous drugs pursuant to Business and Professions Code section 4022.

1° Cyclobenzaprine is a central nervous system muscle relaxant and a dangerous drug pursuant to Business and Professions Code section 4022.

5 Accusation No. 10-2013-235466

1 17. Between on or about June 2010, and July 2011, patient L.B. was seen by respondent

2 on ten ( 10) occasions. There is limited mention of pain or opiate use in any of the chart notes for

3 these visits despite respondent's continuing prescriptions for medications including, Morphine

4 Sulfate, Hydrocodone/APAP, Temazepam and Alprazolam during this time.

5 18. On or about August 12, 2011, patient L.B. presented to respondent after three recent

6 hospitalizations for being "out of it." Respondent documented patient L.B. 's sedation may be due

7 to anemia, renal failure and polypharmacy. Respondent did not list or adjust any of patient LB.'s

8 medications.

9 19. On or about September 12, 2011, respondent documented polypharmacy in patient

10 L.B.'s chart note.

11 20. On or about October 3, 2011, respondent telephoned a refill for patient L. B.'s

12 Morphine Sulfate prescription.

13 21. Between on or about February 3, 2012, and September 24, 2012, patient L.B. was

14 seen by respondent on nine (9) occasions. There is limited mention of pain or opiate use in any of

15 the chart notes for these visits despite respondent's continuing prescriptions for medications

16 including, Morphine Sulfate, Oxycodone/APAP, and Hydrocodone/APAP during this time.

17 22. On or about May 9, 2012, respondent increased patient L.B.' s Morphine Sulfate

18 prescription to 80 mg twice daily as needed and added a prescription for Ox ycodone/ AP AP.

19 23. Between on or about February 11, 2012, and September 25, 2013, respondent

20 provided approximately fifty-two (52) prescriptions for Hydrocodone/APAP to patient L.B.

21 24. On or about August 14, 2013, respondent received a CURES report from a pharmacy

22 that documented patient LB.'s prescription and refill pattern for prescriptions provided by

23 respondent. The CURES report showed multiple refills at multiple pharmacies resulting in the

24 distribution of excessive amounts of opiates.

25 25. On or about August 16, 2013, respondent saw patient L.B. Patient L.B. admitted

26 sharing her Hydrocodone/ AP AP medication with her husband. Respondent counseled patient

27 L.B. and provided patient L.B. a prescription for 360 Hydrocodone/APAP 325/10 mg tablets.

28 Respondent did not document that patient L.B. was sharing her medication with her husband.

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1 26. On or about August 27, 2013 respondent provided patient L.B. a prescription for

2 Hydrocodone/APAP.

3 27. On or about September 9, 2013, respondent provided patient L.B. a prescription for

4 Hydrocodone/APAP.

5 28. Between on or about September 9, 2012, and September 9, 2013, patient L.B. filled

6 multiple prescriptions from respondent for Hydrocodone/APAP 325/10 mg on a weekly basis.

7 Respondent refilled patient LB.'s telephonic requests for medication without review of his prior

8 prescriptions. During this time patient L.B. was receiving an average 617 Hydrocodone/APAP

9 325/10 tablets per month.

10 29. Respondent committed gross negligence in his care and treatment of patient L.B.

11 which included, but was not limited to, the following:

12 (a) Respondent continued to prescribe controlled substances despite knowing

13 illegal diversion was occurring;

14 (b) Respondent failed to document the illegal diversion of controlled substances in

15 his chart notes; and

16 (c) Respondent failed to institute a monitoring program for patient L.B., after he

17 discovered she was illegally diverting her medication.

18 SECOND CAUSE FOR DISCIPLINE

19 (Repeated Negligent Acts)

20 30. Respondent has further subjected his Physician's and Surgeon's Certificate Number

21 G 81687 to disciplinary action under sections 2227 and 2234, as defined by section 2234,

22 subdivision (c), of the Code, in that he committed repeated negligent acts in his care and

23 treatment of patients L.B., C.B., and P.E., as more particularly alleged hereinafter:

24 Patient L.B.

25 31. Paragraphs 9 through 29, above, are hereby incorporated by reference and realleged

26 as if fully set forth herein.

27 32. Respondent committed repeated negligent acts in his care and treatment of patient

28 L.B. which included, but was not limited to, the following:

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(a) Respondent improperly prescribed Morphine Sulfate CR for as needed pain;

(b) Respondent chronically prescribed Benzodiazapines in a patient at risk for

3 complications without a trial of a safer first line agent; and

4 (c) Respondent excessively prescribed opiate medication.

5 Patient C.B.

6 33. In or about July 2001, patient C.B., a then forty-five (45) year old male, began

7 treating with respondent. Patient C.B. had a complex medical history which included: type 2

8 diabetes, diabetic nephropathy with microalbuminuria, diabetic retinopathy, diabetic neuropathy,

9 hypertension, hyperlipidemia, obesity, carpal tunnel syndrome, epicondylitis, plantar faciitis,

10 chronic venous stasis disease, cholecystitis, and L4 radiculopathy.

11 34. Between on or about August 2009 and May 2014, respondent routinely prescribed

12 opiate medication and benzodiazepines to patient C.B. These medications included

13 Oxycodone/APAP, Hydrocodone/APAP, Vicodin11, Darvocet12

, and Alprazolam. Respondent

14 did not adequately document indications for the prescription of these medications or patient

15 C.B.'s responses to these medications.

16 35. On or about August 17, 2009, respondent saw patient C.B. for back pain. Respondent

17 did not perform a back exam. Respondent added Oxycodone/APAP to patient C.B.'s medication

18 regiment.

19 36. On or about August 24, 2009, respondent saw patient C.B. for cellulitis and diabetes.

20 Respondent noted that Oxycodone/APAP would be used sparingly with Vicodin. Respondent did

21 not provide and/or document instructions on how to safely use these medications together.

22 37. On or about September 8, 2009, respondent saw patient C.B. for pain related to

23 cellulitis. Respondent maintained patient C.B. on Oxycodone/APAP.

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11 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 4022.

12 Darvocet is a brand name for acetaminophen and propoxyphene napsylate, a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision (c), and a dangerous drug pursuant to Business and Professions Code section 4022.

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1 38. On or about September 22, 2010, respondent saw patient C.B. for pain related to

2 cellulitis. Respondent refilled the prescription for Oxycodone/APAP.

3 39. On or about June 16, 2011, respondent saw patient C.B. for right ankle pain.

4 Respondent prescribed Hydrocodone/ AP AP.

5 40. On or about December 7, 2011, patient C.B. presented to respondent with chronic

6 pain in the left leg. Respondent performed a limited physical exam and prescribed

7 Oxycodone/APAP but did not provide and/or document instructions on how to safely use

8 Oxycodone/APAP with an existing prescription for Vicodin.

9 41. On or about May 22, 2014, respondent provided a written summary of the care and

10 treatment he provided to Patient C.B. In that summary, respondent opined that patient C.B.'s

11 pain complaints were due to radiculopathy, diabetic neuropathy, and venous stasis disease.

12 Respondent's clinical notes do not indicate diabetic neuropathy as an ongoing problem.


14 C.B. which included, but was not limited to, the following:

15 (a) Respondent failed to document adequate indications for his prescriptions of

16 opiate pain medication;

17 (b) Respondent prescribed Benzodiazapines without assessing the status of patient

18 C.B.'s anxiety or function;

19 (c) Respondent failed to document informed consent for the use of opiates and

20 Benzodiazepines;

21 (d) Respondent failed to document patient C.B.'s response to opioid therapy; and

22 (e) Respondent failed to document Patient C.B.'s response to Benzodiazepine

23 therapy.

24 Patient P.E.

25 43. In or about December 2005, patient P.E., a then seventy-one (71) year old female,

26 began treating with respondent. Patient P.E. had a complex medical history which included: type

27 2 diabetes, hypertension, dyslipidemia, chronic obstructive pulmonary disease, and chronic hip

28 pain.

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1 44. On or about December 27,2007, respondent began prescribing Hydrocodone/APAP

2 to patient P.E. for osteoarthritis of the hips.

3 45. In or about August 2009, patient P.E. underwent a total right hip replacement.

4 46. On or about January 26, 2010, respondent saw patient P.E. for ongoing left hip pain.

5 Respondent refilled a prescription for Vicodin initially provided by her surgeon, Dr. B.

6 47. Between on or about January, 2010 and June 3, 2014, respondent saw patient P.E.

7 approximately nine (9) times and on a monthly basis prescribed Hydrocodone/APAP to patient

8 P.E. Respondent did not adequately document periodic reviews, response to opiate treatment or

9 pain assessments in his chart notes for these visits.


11 P.E. which included, but was not limited to, the following:

12 (a) Respondent failed to perform and/or document periodic reviews of his

13 treatment of patient P.E.;

14 (b) Respondent failed to perform and/or document patient P.E.'s response to opioid

15 therapy; and

16 (c) Respondent failed to perform and/or document pain assessments of patient

17 P .E.'s painful condition.

18 TIDRD CAUSE FOR DISCIPLINE

19 (Incompetence)

20 49. Respondent has further subjected his Physician's and Surgeon's Certificate No.

21 G 81687 to disciplinary action under sections 2227 and 2234, as defined by section 2234,

22 subdivision (d), of the Code, in that he has demonstrated incompetence in his care and treatment

23 of patient L.B., as more particularly alleged hereinafter:



26 /II

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1 FOURTH CAUSE FOR DISCIPLINE

2 (Excessive Prescribing)


4 G 81687 to disciplinary action under sections 2227 and 2234, as defined by section 725 of the

5 Code, in that he excessively prescribed controlled substances and dangerous drugs to patient L.B.,

6 as more particularly alleged hereinafter.



9 FIFTH CAUSE FOR DISCIPLINE

10 (Failure to Maintain Adequate and Accurate Medical Records)

11 53. Respondent has further subjected his Physician's and Surgeon's Certificate Number

12 G 81687 to disciplinary action under section 2227 and 2234, as defined by section 2266, of the

13 Code, in that he failed to maintain adequate and accurate records in connection with his care and

14 treatment of patients L.B., C.B. and P.E. as more particularly alleged hereinafter.



17 SIXTH CAUSE FOR DISCIPLINE

18 (General Unprofessional Conduct)


20 G 81687 to disciplinary action under section sections 2227 and 2234, as defined by section 2234,

21 of the Code, in that he has engaged in conduct which breaches the rules or ethical code of the

22 medical profession, or conduct which is unbecoming to a member in good standing of the medical

23 profession, and which demonstrates an unfitness to practice medicine, as more particularly as

24 more particularly alleged hereinafter:



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28 Ill

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1 PRAYER

2 WHEREFORE, Complainant requests that a hearing be held on the matters herein

3 alleged, and that following the hearing, the Medical Board of California issue a decision:

4 1. Revoking or suspending Physician's and Surgeon's Certificate Number

5 G 81687, issued to respondent ROMMEL ROJAS NAVARRETE, M.D.;

6 2. Revoking, suspending or denying approval of respondent ROMMEL ROJAS

7 NAVARRETE, M.D.'s authority to supervise physician assistants, pursuant to section 3527 of the

8 Code;

9 3. Ordering respondent ROMMEL ROJAS NAVARRETE, M.D., to pay the

10 Medical Board of California, if placed on probation, the costs of probation monitoring; and,

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DATED: November 13, 2014 K Executive Direct r Medical Board of California Department of Consumer Affairs State of California Complainant

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Documents

Rommel... · 14 ROMMEL ROJAS NAVARRETE, M.D. 5111 Garfield Street, Suite A 15 La Mesa, CA 91941 16 Physician's and Surgeon's Certificate No. G81687, Case No. 10-2013-235466 OAHNo