by:~~~ mumtaz... · 2018. 1. 9. · 6 modification of probation, in any proceeding before the...

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation ) Against: )

) )

Mumtaz Almansour, M.D. ) )

Physician's and Surgeon's ) Certificate No. A 55926 )

) Respondent )

Case No. 800-2014-002628

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 5:00 p.m. on February 5, 2016.

IT IS SO ORDERED January 8, 2016.

MEDICAL BOARD OF CALIFORNIA

By:~~~ Jamieiiht, Chair Panel A

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KAMALA D. HARRIS Attorney General of California THOMAS S. LAZAR Supervising Deputy Attorney General MARTIN W. HAGAN Deputy Attorney General State Bar No. 155553

600 West Broadway, Suite 1800 San Diego, CA 92101 P.O. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 645-2094 Facsimile: (619) 645-2061

Attorneys for Complainant

BEFORE THE MEDICAL BOARD OF CALIFORNIA


In the Matter of the Accusation Against:

MUMT AZ ALMANSOUR, M.D. 415 S. Magnolia Avenue El Cajon, CA 92020

Physician's and Surgeon's Certificate No. A55926,

Respondent.

Case No. 80020 I 4002628 OAH No. 2015060516

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

11---------------------------------~ IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above-

entitled proceedings that the following matters are true:

PARTIES

22 1. Kimberly Kirchmeyer ("Complainant") is the Executive Director of the Medical

23 Board of California. She brought this action solely in her official capacity and as such is

24 represented in this matter by Kamala D. Harris, Attorney General of the State of California, by

25 Martin W. Hagan, Deputy Attorney General.

26 2. Respondent Mumtaz Almansour, M.D. ("respondent") is represented in this

27 proceeding by DanielS. Belsky, Esq., and Bruce W. Boetter, Esq., of Belsky and Associates

28 whose address is: 591 Camino de Ia Reina, Suite 640, San Diego, CA 921 08.

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (8002014002628)

3. On April 10, 1996, the Medical Board of California issued Physician's and Surgeon's

2 Certificate No. A55926 to respondent. The Physician's and Surgeon's Certificate was in full

3 force and effect at all times relevant to the charges and allegations brought in Accusation No.

4 80020 14002628 and will expire on December 31, 2015, unless renewed.

5 JURISDICTION

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4. On April21, 2015, Accusation No. 8002014002628 was filed before the Medical

Board of California (Board), Department of Consumer Affairs, and is currently pending against

respondent. A true and correct copy of Accusation No. 8002014002628 and all other statutorily

required documents were properly served on respondent. Respondent timely filed his Notice of

Defense contesting the Accusation. A true and correct copy of Accusation No. 8002014002628 is

attached hereto as Exhibit A and incorporated by reference as if fully set forth herein.

ADVISEMENT AND WAIVERS

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

charges and allegations in Accusation No. 8002014002628. Respondent has also carefully read,

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

Disciplinary Order.

6. Respondent is fully aware of his legal rights in this matter, including the right to a

18 hearing on the charges and allegations in Accusation No. 80020 14002628; the right to confront

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

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

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

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

23 laws.

24 7. Having the benefit of counsel, respondent hereby voluntarily, knowingly, freely, and

25 intelligently waives and gives up each and every right set forth above.

26 CULPABILITY

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

28 prima facie case with respect to the charges and allegations contained in Accusation No.

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STIPULATED SETILEMENT AND DISCIPLINARY ORDER (8002014002628)

8002014002628, and that he has thereby subjected his Physician's and Surgeon's Certificate No.

2 A55926 to disciplinary action. Respondent further agrees to be bound by the Board's imposition

3 of discipline as set forth in the Disciplinary Order below.

4 9. Respondent agrees that if an accusation and/or petition to revoke probation is filed

5 against him before the Medical Board of California, or if he ever petitions for early termination or

6 modification of probation, in any proceeding before the Medical Board of California, all of the

7 charges and allegations contained in Accusation No. 8002014002628 shall be deemed true,

8 correct and fully admitted by respondent for purposes of any such proceeding or any other

9 licensing proceeding involving respondent in the State of California.

I 0 CONTINGENCY

11 1 0. The parties agree that this Stipulated Settlement and Disciplinary Order shall be

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

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

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

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

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

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

18 and void and not binding upon the parties unless approved and adopted by the Board, except for

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

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

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

22 the Attorney General's office. Communications pursuant to this paragraph shall not disqualify

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

24 other matter affecting or involving respondent. In the event that the Board, in its discretion, does

25 not approve and adopt this Stipulated Settlement and Disciplinary Order, with the exception of

26 this paragraph, it shall not become effective, shall be of no evidentiary value whatsoever, and

27 shall not be relied upon or introduced in any disciplinary action by either party hereto.

28 Respondent further agrees that should the Board reject this Stipulated Settlement and Disciplinary

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Order for any reason, respondent will assert no claim that the Board, or any member thereof, was

2 prejudiced by its/his/her review, discussion and/or consideration of this Stipulated Settlement and

3 Disciplinary Order or of any matter or matters related hereto.

4 ADDITIONAL PROVISIONS

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

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

7 agreements of the parties in the above-entitled matter.

8 13. The parties agree that copies of this Stipulated Settlement and Disciplinary Order,

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

10 signatures and, further, that such copies and signatures shall have the same force and effect as

11 originals.

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

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

14 following Disciplinary Order:

15 DISCIPLINARY ORDER

16 A. PUBLIC REPRIMAND

17 IT IS HEREBY ORDERED that respondent Mumtaz Almansour, M.D., Physician's

18 and Surgeon's Certificate No. A55926, shall be and is hereby Publicly Reprimanded pursuant to

19 California Business and Professions Code section 2227, subdivision (a)(4). This Public

20 Reprimand, which is issued in connection with respondent's care and treatment of patient K.R., as

21 set forth in Accusation No. 8002014002628, is as follows:

22 You committed repeated negligent acts and failed to maintain adequate

23 and accurate medical records in your care and treatment of patient K.R. from on or

24 about January 25, 2012, to on or about March 1, 2014, as more fully set forth in

25 Accusation No. 8002014002628, a true and correct copy of which is attached

26 hereto as Exhibit A and incorporated by reference as if fully set forth herein.

27 /Ill

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B. EDUCATION PROGRAM

2 Within 60 calendar days of the effective date ofthis Decision, and on an annual basis

3 thereafter, respondent shall submit to the Board or its designee for its prior approval educational

4 program(s) or course(s) which shall not be less than 40 hours per year, for each year of probation.

5 The educational program(s) or course(s) shall be aimed at correcting any areas of deficient

6 practice or knowledge and shall be Category I certified. The educational program(s) or course(s)

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

8 (CME) requirements for renewal of licensure. Following the completion of each course, the

9 Board or its designee may administer an examination to test respondent's knowledge of the

1 0 course. Respondent shall provide proof of attendance for 65 hours of CME of which 40 hours

11 were in satisfaction of this condition.

12 Failure to participate in and successfully complete the education program requirements as

13 outlined above shall constitute unprofessional conduct and grounds for further disciplinary action.

14 C. MEDICAL RECORD KEEPING COURSE

15 Within 60 calendar days ofthe effective date of this Decision, respondent shall enroll

16 in a course in medical record keeping equivalent to the Medical Record Keeping Course offered

17 by the Physician Assessment and Clinical Education Program, University of California, San

18 Diego School of Medicine (Program), approved in advance by the Board or its designee.

19 Respondent shall provide the program with any information and documents that the Program may

20 deem pertinent. Respondent shall participate in and successfully complete the classroom

21 component of the course not later than six (6) months after respondent's initial enrollment.

22 Respondent shall successfully complete any other component of the course within one ( 1) year of

23 enrollment. The medical record keeping course shall be at respondent's expense and shall be in

24 addition to the Continuing Medical Education (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

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been approved by the Board or its desigi,.ee bad the coW:SC beet1 tabm after the etreCtive date of this Decision.

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

designee _not later than 15 calendar days after successfully comp~eting the co~. or not later than

1 S cal~dar days after the_ effective date of the ~ion, whichever is later.

Failure to participate in and successfully complete the medical reco~ k~p~· oo~ as

outlined above sball constitute unprofessional conduct and grounds for further diSciplinary action.

ACCEPTANCE

I have carefully read the above Stipulated Settlement and Disciplinary Order and, having . . . the benefit of counse~ enter intO it freely, voluntarily, intelligently, and with full knowledge of its force and. effect on my Physician's and Surgeon's Certificate No. ASS926. I fully undorstand'

that, after signing this· ~pulation, I~ not withdmw fro~ i1, that it shall be submitted to the . . ' ' . ~ . . . ~ . . . . . . .. . Medical Board ofCalifomia ~r its consideration, and that the Board sbali have a reasonable

period. of time to consider.and act on~ stipulation after ~ving it By entering into this

stipulation, I fully underStand that, ~ fqm1al acceptanCe l)y the Board, I shall be publicly ·

reprimanded by the Bo~ and shall be requin:d to comply with.all of the terms and conditions of

.the Disciplinary Order set forth above. I also ftilly.~d that any failure to comply with the

terms and _conditions 9f the DiscipliDary Order set forth aboVe sball constitute_ unprofessio~ ·

conduct and will·subject my Physician's and Surgeon's C · ASS926 to further

./~~-~----/' ~~ ..

, ¢"?'"'""'_,., ..

disciplinary action.

DATED: -.- .,_ -. ""Miliif

ENDORSEMENT

2 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

3 submitted tor consideration by the Medical Board of California.

4 Dated: I I / ':>"' ";' ~ 1 5

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81186721.doc

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Respectfully submitted,

KAMALA D. HARRIS Attorney General of California THOMAS S. LAZAR Supervising Deputy Attqrney General

_lfr:i . (./+y MAJriN W. HAGAN t:/' Deputy Attorney General Attorneys for Complainant


Exhibit A

Accusation No. 8002014002628

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KAMALA D. HARRfS Attorney General of California TJIOMAS S. lAZAR Supervising Deputy Altorney General MARTIN W. llAGAN Deputy Attorney General State Bar No. 155553

110 West "A" Stret:t, Suite 1100 San Diego, CA 92101 P.O. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 645-2094 Facsimile: (619) 645-2061

FILED STATE OF CALIFORNIA

r.IEDICAL BOARD OF CALIFORHt:. S~~RAiliENt\:>..Aegit.. 7 1 .... _:t;.;~:SY· -::Jl.(O::Utl.e._c.!=,_M~P.~-Y~ T

8 A rtorneys/iJr Complainant

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BEFORE THE MEDICAL BOARD OF CALU'ORNIA


In the Matter of the Accusation Against:

Mumtaz Almansour, M.D. 416 S. Magnolia Avenue El Cajon, CA 92020

Physician's and Surgeon's Certificate No. A55926,

Respondent.

11---------------------------------~ Complainant alleges:

Case No. 8002014002628

ACCUSATION

PARTIES

I. Kimberly Kirchmcycr (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 (Board).

24 2. On or about April 10, 1996, the Medical Board issued Physician's and Surgeon's

25 Certificate Number /\55926 to Mumtaz Almansour, M.D. (Respondent). The Physician's and

26 Surgeon's Ccrtiticatc was in full force and effect at all times relevant to the charges and

27 allegations brought ht:rcin and will expire on December 31,2015, unless renewed.

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3. Section 2227 of the Code provides that a licensee who is found guilty under the

Medical Practice Act may have his or her license revoked, suspended for a period not to exceed

one year, be placed on probation and required to pay the costs of probation monitoring, be

publicly reprimanded, or have such other action taken in relation to discipline as the Board deems

proper.

4. Section 2234 of the Code, states:

''The board shall take action against any licensee who is charged with

unprotcssional concuct. 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 ot~ or conspiring to violate any provision of this chapter.

·'(c) Repeah:d negligent acts. To be repeated, there must be two or more

negligent acts or omissions. An initial negligent act or omission followed by a

separat~ 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.

"(f) Any action or conduct which would have warranted the denial of a

certi lie ate.

2 -----··------·


Ill/

2 5. Section 2266 of the Code states:

3 "The failure of a physician and surgeon to maintain adequate and accurate

4 records relating to the provision of services to their patients constitutes

5 unprofessional conduct."

6 FIRST CAUSE FOR DISCIPLINE

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8 6.

(Repeated Negligent Acts)

Respondent is subject to disciplinary action under sections 2227 and 2234, as defined

9 by section 2234, subdivision (c), of the Code, in that he committed repeated negligent acts in his'

10 care and treatment of patient K.R., as more particularly alleged hereinafter:

11 7. On or about January 25, 2012, patient K.R., a then 33 year-old female, had her first

12 visit with respondent at the La Macstra Community Health Center. The handwritten medical

13 record for this visit is largely illegible. Patient K.R.' s blood pressure for this visit was 153/96.

14 The chief complaint was listed as a one year abscess on patient K.R.'s right side with right side

15 abdominal pressure for the past three days. On examination, respondent noted skin and abdomen

16 as abnormal and recorded "right lower abdominal wall. Cystic swelling, 2 x 2 em, semi-solid,

17 non-tender, mobile," no discharge and no induration. The assessment was mild muscular sprain

18 in the ahdominal v.'all and right abdominal wall cyst, sebaceous possible. Respondent's plan was

19 to avoid manipulation of the lesion, take Keflex® 500 mg q.i.d. (four times a day) for 14 days,

20 use Estracc·'R'; cream (vaginal cream with estrogen) t.i.d. (three times a day); Flexeril® for muscle

21 spasm and topical antibiotics. There was no detailed history taken and/or documented regarding

22 patient K.lt 's elevated blood pressure and there was no management plan discussed and/or

23 documented concerning patient K.R. 's elevated blood pressure.

24 8. On or about August 3, 2013, patient K.R. was seen m the Alvarado Hospital

25 Emergency Room tor abdominal pain, flank pain and fever. She complained of flank pain, body

26 aches, diz1.incss and feeling weak. Patient K.R.'s blood pressure was 162/84, normal

27 temperature, pulse 88 and pulse oximetry 100% on room air. Patient K.R.'s experienced right

28 lower quadrant discomfort when her abdomen was palpated. Patient K.R. was diagnosed with a

3 ·---- ... - ... -----------------


urinary tract infection (UTI) with pyelonephritis (bacterium or virus infecting the kidneys) and

2 given Keflex® q.i.d. (four times a day) for seven days with instructions to increase her fluid

3 intake and check hack into the ER if her condition did not improve in two days or ifhcr pain got

4 worse. The clinical impression also included acute lumbar spasm with patient K.R. being

5 provided with a small dose of Flexcril® for the muscle spasm.

6 9. On or about August 16, 2013, patient K.R. was seen again in the Alvarado Hospital

7 Emergency Room for her complaints of back pain, headaches, muscle aches and a rash. The

8 medical record tor this visit referenced the ER visit of August 3, 2013, and noted "patient has not

9 followed up with her primary care [and] she wants to get rechecked at this time ... [andl fs]he

I 0 wants a school note and a work note and a refill on pain medicine and muscle relaxer." The

II review of systems was unremarkable with the exception of"low back pain" with pain measured at

12 6 on a 10-point pain scale. Patient K.R.'s blood pressure for this visit was 138/92. Patient K.R.'s

13 physical examination was unremarkable with the exception of mild tenderness of her paraspinal

14 muscles bilaterally. Patient K.R. was "convinced that she had a kidney infection" which was not

15 supported by her urinalysis or other laboratory results (but could not be specifically ruled out).

16 The medical record for this visit states, in pertinent part, " ... [patient K.R.) was convinced that she

1 7 had a kidney infection, so we checked her urinalysis and it was negative. There was a high

18 specific gravity at greater than 1.030, which goes with her dehydration. It was also contaminated

19 with squamous epithelial cells, so I cannot rule out an infection, but there was no sign of an

20 infection there." The ER physician ultimately concluded patient K. R. had "muscoskeletal back

21 pain" and the diagnostic impression was low back pain, dehydration and a skin rash which

22 appeared chronic. Patient was prescribed ibuprofen 400 mg #30, I tablet every 6 hours as needed

23 for pain; Soma® 350 mg #20, 1 tablet every 6-8 hours as needed for muscoske1etal pain and

24 stiffness; and tramadol hydrochloride 50 mg #20, 1 tablet every 6 hours as needed for pain (not to

25 be taken with the Soma®).

26 10. On or about August 23,2013, at approximately 2:00p.m., patient K.R. was seen by a

27 La Maestra Community Health Center Physician Assistant A.M. The documented history of

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present illness (TIP!) for this visit was documented as "H/0 [history of] enlarged[ 1] [right]

2 kidney'' with symptoms reported as severe and "occur[ing] frequently" with a notation that

3 "Patient has been to the ER where she had an abnormal CT and needs urology referral." The HPI

4 also documented a rash which began approximately three weeks ago. The blood pressure tor this

5 visit was 136194. Patient K.R.'s overall appearance was listed as "ill appearing'' and the

6 "abdomen'' section of the medical record indicated "CV A tenderness reveals Right kidney

7 tenderness.·· 'l he assessment was "acquired asymmetrical kidneys" and the plan wa referral to

8 urology, continue Motrin(R) as needed for pain; with an advisement to go to the ER if patient

9 K.R.'s condition worsened.

10 ll. On or about August 23, 2013, patient K.R. was seen at Sharp Grossmont Hospital

11 Emergency Room at approximately 7:30p.m. for her complaint of right flank pain. The medical

12 record for this visit indicated patient K.R.'s history of present illness which set forth her recent

13 ER visits and medications, with a notation that "[s]he sees Dr. Almansour [and] [sjhc is trying to

14 1 get referred to a nephrologist, but says she is tired of waiting, the pain is persisting, so Dr.

15 Almansour sent her to a different ER tonight." The past medical history was listed as

16 "Pyelonephritis, chronic back pain." Patient K.R.'s review of systems was unremarkable and, on

17 examination, she was noted as having blood pressure of 160/96 (later measured at 132/80).

18 Patient K.R. 's physical exam was benign with the exception of "positive right CV A

19 [costovertebral anglel tenderness."2 A renal ultrasound showed a "small right kidney, otherwise

20 negative.'' The medical record for this visit noted that patient K.R. was upset that she was not

21 seen by a nephrologist as part of her visit and that "rs]he needs to see Dr. Almansour Monday to

22 get rechecked and push this rcterral through for Nephrology and Urology." The clinical

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impression was t1ank pain, a chronic appearing atrophic right kidney (as shown on the

ultrasound); and chronic pain. Patient K.R. was instructed to discard her tramadol and was given

a prescription for Percocet(R) and a ''muscle relaxer."

1 The notation of an '"enlarged'' kidney was in error and, in actuality, should have described a smaller kidney.

2 A positive CV A is potentially indicative of an infection around the kidney, a kidney infection and/or a kidney stone.

5 --- -- ----------- - ----·-------------


12. On or about August 31, 2013, patient K.R., had her second visit with respondent. The

2 history of present illness for this visit was documented as "flu [follow upj on [rightj kidney

3 problem., and •·eye discharge.'' The medical record indicated patient K.R. had an appointment

4 scheduled with a nephrologist and an urologist, Dr. E.R. Patient K.R. 's blood pressure for this

5 visit was 137/91. Respondent documented benign examinations of the head, eyes, car, nose and

6 throat, cardiac and respiratory, muscoskeletal, extremities, and neurological. Patient K.R. was

7 noted as having "bilateral back pain. no deformity, no swclling."3 Respondent's assessment was

8 back pain and acute conjunctivitis. Respondent recommended artificial tears for the conjunctivitis

9 and continue previously prescribed pain medications for the back pain. Despite patient K.R. 's

10 history of elevated blood pressure, there was no detailed history taken and/or documented

II regarding elevated blood pressure, and there was no management plan discussed and/or

12 documented concerning patient K.R.'s elevated blood pressure. There also was no detailed

13 history taken and/or documented concerning patient K.R.'s back pain.

14 13. On or about September 9, 2013, patient K.R. had her nephrology consultation with

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Dr. J.T. Dr. J.T. noted patient K.R. 's history of intermittent back pain, right side flank pain after

her UTT diagnosed August 4, 2013. Respondent's prior lab results were reviewed. Patient K.R.'s

blood pressure was recorded at 1 S0/80 and she was noted to not be in any acute distress. On

examination, patient K.R. ·s back was noted to have mild tenderness, there was "some

costovertebral angle tenderness"' and ;;some pain with rotation, flexion and extension ofthe

lumbar thoracic spine." Otherwise. the physical exam was normaL Dr . .I.T.'s impression was

mild ongoing lower back pain which he believed was unrelated to any kidney abnormality and

instead was likely muscoskeletal in nature. Dr. J. T. recommended flat bed rest, taper off and then

discontinue pain medications, return to work in 2 weeks and a conditioning program for the back

pain once the pain subsided.

3 During the investigation of this matter, additional documents were received after La Maestra Community Health Center's original production of certified records. Those additional documents, which were also ccrtiticd, included screenshots from the electronic health records. The screen shot for the visit of August 31, 2013, included a comments section that stated "bilateral back pain, no deformity, no swelling." This comment was not included in the actual electronic chart note for August 31, 2013.

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14. On or about September 30, 2013, patient K.R. had a urology consultation with Dr.

2 R.E, who noted, among other things, patient K.R. 's history of being diagnosed with a smaller

3 sized right kidney and an injury to the kidney from a prior auto accident. On examination, Dr.

4 R.E. noted no CY/\ tenderness and that patient K.R.'s abdominal exam was nonnal. Dr. R.E.

5 further noted patient K. R. · s presumed pyelonephritis on the right side since August 2013 and her

6 continued pain. Dr. R.E. prescribed Macrobid® for one month (typically used to treat acute

7 uncomplicated UTI's) and other medication for K.R. 'spain at night with a recommendation to

8 follow up with him in one month if no significant improvement. The clinical impression also

9 included back pain and right flank pain.

10 15. On or about January 20, 2014, patient K.R. had a urology follow up with Dr. R.E.

11 The medical record ror this visit indicates that patient K.R. did not have a UTI on this visit but

12 was noted as having hypertension, constipation and proteinuria (abnormal amount of protein in

13 urine). Dr. R.E. recommended patient K.R.'s renal etiology be evaluated by a nephrologist.

14 16. On or about January 22, 2014, patient K.R., had her third visit with respondent. The

15 history of present illness for this visit was documented as back pain, "read specialist report"

16 (referring to Dr. R.E.'s report) and '·Jab/nephrology." The medical record for this visit documents

17 "having atrophic unilateral kidney'' and a chronic problem of "acquired asymmetrical kidneys."

18 Patient K.R.'s recorded blood pressure for this visit was 130/93 and her current medications were

19 listed as tramadol and Soma®. The review of systems was normal with the exception of patient

20 K.R.'s complaint of back pain. Respondent's physical examination of patient K.R. was

21 unremarkable. The muscoskeletal examination noted "normal range of motion, muscle strength,

22 and stability in all extremities with no pain on inspection." Respondent's assessment and plan for

23 this visit listed low back pain to be treated with medication, patient referral to nephrology; and

24 neck pain (which was not listed in the HPI section) to be treated with medication, a neck collar

25 and physical therapy and occupational therapy. Despite patient K.R. 's history of elevated blood

26 pressure and/or hypertension, there was no detailed history taken and/or documented regarding

27 elevated blood pressure and/or hypertension, and there was no management plan discussed and/or

28 documented concerning patient K.R.'s elevated blood pressure and/or hypertension. The

7 1-··----·- __ .. _____ -·-. Accusation No. 80020140026281

"medications" section of the medical record indicated a prescription for hydrochlorothiazide

2 which is typically used to treat hypertension. However, the medical record tailed to indicate the

3 basis for the prescription and hypertension was not listed in the "Assessment Plan" section of the

4 medical record. There also was no detailed history taken and/or documented concerning patient

5 K.R.'s back and neck pain, and there was no focused physical examination of patient K.R.'s back

6 and/or neck conducted and/or adequately documented.

7 17. On or about March I, 20 14, patient K.R., had her fourth visit with respondent. The

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history of present illness for this visit was documented as "hypertension (follow up)" and "f/u

(follow up] on back pain" with patient K.R. noted to be on medications for her hypertension. The

medical record further indicated "flu (follow up] with chiropractor," an MVA !motor vehicle

acddentj in \!ovember 2013, and that the patient was taking medication for pain. Patient K.R.'s

blood pressure for this visit was J 49/1 01. '\"he review of systems was normal with the exception

of back pain and constipation. Respondent's physical examination of patient K.R. was

unremarkable. The electronic chart note for this visit does not indicate the results of any

muscoskeletal examination and/or back examination.4 Respondent's assessment and plan for this

visit was low back pain with a recommendation to continue to treat with current medications and

follow up with chiropractor and physical therapy; and constipation with a recommendation for a

high fiber diet and a prescription for Co lace® I 00 mg, 1 tablet every night, as needed. Despite

patient K.R. 's history of elevated blood pressure and/or hypertension, there was no detailed

history taken and/or documented regarding elevated blood pressure and/or hypertension and there

was no management plan discussed and/or documented concerning patient K.R.'s elevated blood

pressure and/or hypertension. The .. medications" section of the medical record indicated the prior

prescription f(Jr hyrdrochlorothiazid on January 22, 2014, presumably tor hypertension.

4 During the investigation of this matter, this matter received additional documents after La Maestra Community Health Center's original production of certified records. Those additional documents, which were also certified, included scrcenshots from the electronic health records. The screenshot from the visit of March 1, 2014, included a comments section that was related to an examination of patient K.R. 's back which stated, "Back: Tenderness at the lower paraspinal regeon [sic], mildly decrease ROM [range of motion], M&S [motor and sensory] without deticict r sic J .''

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However, hypertension was not listed in the "Assessment Plan" section ofthe medical record.

2 Moreover, there was, once again, no detailed management plan for treating patient K.R. 's history

3 of elevated blood pressure and/or hypertension nor any documentation of any management plan

4 being discussed with the patient.

5 18. Respondent committed repeated negligent acts in his care and treatment of patient

6 K.R., which included. but was not limited to, the following:

7 (a) Respondent failed to obtain and document adequate histories for patient

8 K.R. ·s back pain and/or neck pain;

9 (b) Respondent failed to conduct and document adequate physical

10 examinations Cor patient K.R. 's back pain and/or neck pain;

11 (c) Respondent failed to obtain and document adequate histories for patient

12 K.R. 's elevated blood pressure and/or hypertension; and

13 (d) Respondent failed to manage and document a clear and thorough action

14 plan to manage patient K.R.'s elevated blood pressure and/or hypertension.

15 SECOND CAUSE FOR DISCIPLINE

16 (Failure to Maintain Adequate and Accurate Records)

17 19. Respondent is further subject to disciplinary action under sections 2227 and 2234, as

18 defined by section 2266, of the Code, in that he failed to maintain adequate and accurate medical

19 records regarding his care and treatment of patient K.R., as more particularly alleged in

20 paragraphs 7 through 18, above, which are incorporated by reference and rcalleged as if tully set

21 forth herein.

22 Ill!

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----------9---------A-c-cu-.,t;on No. 8002014002628 j

PRAYER

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

3 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 A55926 issued

5 to respondent Mumtaz Almansour, M.D.;

6 2. Revoking, suspending or denying approval of respondent Mumtaz Almansour,

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

8 3. Ordering respondent Mumtaz Almansour, M.D., if placed on probation, to pay the

9 Board the costs of probation monitoring; and

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4. Taking such other and further action as deemed necessary and proper.

12 DATED: Apr i =--=--= ~ ~:_:___ __

13 Executive Di ector Medical Board of California

14 Department of Consumer Affairs State of California

15 Complainant

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7103341 O.doc

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by:~~~ mumtaz... · 2018. 1. 9. · 6 modification of probation, in any proceeding before the...

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