BEFORE THE DIVISION OF MEDICAL QUALITY

MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation Against: )

ROBERT CHARLAP, M.D.

Physician's and Surgeon's Certificate No. G 85076

Respondent.

) ) ) ) ) " }

) )

File No. 17-2001-122308

DECISION

The attached Stipulated Settlement and Disciplinary Order is hereby adopted as the Decision and Order of the Division of Medical Quality of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00p.m. on June 12, 2003

IT IS SO ORDERED May l3, 2003

MEDICAL BOARD OF CALIFORNIA

By: vhtZ./14 Lorie G. Rice, Chair Panel A Division of Medical Quality

BILL LOCKYER, Attorney General of the State of California

2 KAREN B. CHAPPELLE, State Bar No. 141267 Deputy Attorney General

3 California Department of Justice 300 So. Spring Street, Suite 1702

4 Los Angeles, CA 90013 Telephone: (213) 897-8944

5 Facsimile: (213) 897-1071

Attorneys for Complainant 6

7

8

9

BEFORE THE

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12

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DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter ofthe Accusation Against:

ROBERT CHARLAP, M.D. 265 E. Orange Grove, Suite B Burbank, CA. 91502

Case No. 17-2001-122308

OAH No. L-2002-050289

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

Physician & Surgeon Certificate No. G 85076 14

Respondent 15

16

17 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the

18 above-entitled proceedings that the following matters are true:

19 PARTIES

20 1. Ron Joseph (Complainant) is the Executive Director of the Medical Board

21 of California. He brought this action solely in his official capacity and is represented in this

22 matter by Bill Lockyer, Attorney General of the State of California, by Karen B. Chappelle,

23 Deputy Attorney General.

24 2. Respondent Robert Charlap, M.D. (Respondent) is represented in this

25 proceeding by attorney Donald E. Karpel, Esq., whose address is ZELNER & KARPEL, 9777

26 Wilshire Blvd., Ste. 1000, Beverly Hills, Calif. 90212-1969.

27 3. On or about March 12, 1999, the Medical Board of California issued

28 Physician & Surgeon Certificate No. G 85076 to Robert Charlap, M.D. (Respondent). The

1

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

2 No. 17-2001-122308 and will expire on August 31, 2002, unless renewed.

3 JURISDICTION

4 4. Accusation No. 17-2001-122308 was filed before the Division of Medical

5 Quality (Division) for the Medical Board of California, Department of Consumer Affairs, and is

6 currently pending against Respondent. The Accusation and all other statutorily required

7 documents were properly served on Respondent on May 8, 2002. Respondent timely filed his

8 Notice of Defense contesting the Accusation. A copy of Accusation No. 17-2001-122308 is

9 attached as exhibit A and incorporated herein by reference.

10 ADVISEMENT AND WAIVERS

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

12 understands the charges and allegations in Accusation No. 17-2001-122308. Respondent has

13 also carefully read, fully discussed with counsel, and understands the effects of this Stipulated

14 Settlement and Disciplinary Order.

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

16 right to a hearing on the charges and allegations in the Accusation; the right to be represented by

1 7 counsel at his own expense; the right to confront and cross-examine the witnesses against him;

18 the right to present evidence and to testify on his own behalf; the right to the issuance of

19 subpoenas to compel the attendance of witnesses and the production of documents; the right to

20 reconsideration and court review of an adverse decision; and all other rights accorded by the

21 California Administrative Procedure Act and other applicable laws.

22 7. Respondent voluntarily, knowingly, and intelligently waives and gives up

23 each and every right set forth above.

24 CULPABILITY

25 8. Respondent admits that ifthe matter proceeded to hearing, a prima facie

26 case could be established for all causes of action with the exception of the allegations pertaining

27 to Medi-Cal billing and fraud in Accusation No. 17-2001-122308.

28 9. Respondent agrees that his Physician & Surge_on Certificate is subject to

2

discipline and he agrees to be bound by the Division of Medical Quality (Division) 's imposition

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

3 CIRCUMSTANCES IN MITIGATION

4 10. Respondent Robert Charlap, M.D. has never been the subject of any

5 disciplinary action. He is admitting responsibility at an early stage in the proceedings.

6 CONTINGENCY

7 11. This stipulation shall be subject to approval by the Division of Medical

8 Quality. Respondent understands and agrees that counsel for Complainant and the staff of the

9 Medical Board of California may commun!cate directly with the Division regarding this

10 stipulation and settlement, without notice to or participation by Respondent or his counsel. By

11 signing the stipulation, Respondent understands and agrees that he may not withdraw his

12 agreement or seek to rescind the stipulation prior to the time the Division considers and acts

13 upon it. Ifthe Division fails to adopt this stipulation as its Decision and Order, the Stipulated

14 Settlement and Disciplinary Order shall be of no force or effect, except for this paragraph, it shall

15 be inadmissible in any legal action between the parties, and the Division shall not be disqualified

16 from further action by having considered this matter.

17 12. The parties understand and agree that facsimile copies ofthis Stipulated

18 Settlement and Disciplinary Order, including facsimile signatures thereto, shall have the same

19 force and effect as the originals.

20 13. In consideration of the foregoing admissions and stipulations, the parties

21 agree that the Division may, without further notice or formal proceeding, issue and enter the

22 following Disciplinary Order:

23 DISCIPLINARY ORDER

24 IT IS HEREBY ORDERED that Physician & Surgeon Certificate No. G 85076

25 issued to Respondent Robert Charlap, M.D. is revoked. However, the revocation is stayed and

26 Respondent is placed on probation for three (3) years on the following terms and conditions.

27 Within 15 days after the effective date of this decision the respondent shall

28 provide the Division, or its designee, proof of service that respondent has served a true copy of

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1 this decision on the Chief of Staff or the Chief Executive Officer at every hospital where

2 privileges or membership are extended to respondent or at any other facility where respondent

3 engages in the practice of medicine and on the ChiefExecutive Officer at every insurance carrier

4 where malpractice insurance coverage is extended to respondent.

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6 1. ETHICS COURSE Within sixty (60) days of the effective date of this

7 decision, respondent shall enroll in a course in Ethics approved in advance by the Division or its

8 designee, and shall successfully complete the course during the first year of probation.

9 2. CLINICAL TRAINING PROGRAM Within ninety (90) days of the

10 effective date of this decision, respondent shall submit to the Division or its designee for prior

11 approval, a clinical training or educational program such as the Physician Assessment and

12 Clinical Education Program (PACE) offered by the University of California- San Diego School

13 of Medicine or equivalent program as approved by the Division or its designee. The exact

14 number of hours and specific content of the program shall be determined by the Division or its

15 designee.

16 Respondent shall successfully complete the training program and shall comply

17 with the clinical training program recommendation(s) and may be required to pass an

18 examination administered by the Division or its designee related to the program's contents. The

19 respondent shall pay the costs of all clinical training or educational programs.

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21 3. PHYSICIAN ASSESSMENT AND CLINICAL EDUCATION PROGRAM

22 Within 90 days from the effective date of this decision, respondent, at his/her expense,

23 shall enroll in The Physician Assessment and Clinical Education Program at the University of

24 California, San Diego School of Medicine (hereinafter the "PACE Program"). The PACE

25 Program consists of the Comprehensive Assessment Program which is comprised of two

26 mandatory components: Phase 1 and Phase 2. Phase 1 is a two-day program which assesses

27 physical and mental health; neuropsychological performance; basic clinical and communication

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

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specialty or sub-specialty of the respondent. After the results of Phase 1 are reviewed,

2 respondent shall complete Phase 2. Phase 2 comprises five (5) days (40 hours) of Clinical

3 Education in respondent's field of specialty. The specific curriculum of Phase 2 is designed by

4 PACE Faculty and the Department or Division of respondent's specialty, and utilizes data

5 obtained from Phase 1. After respondent has completed Phase 1 and Phase 2, the PACE

6 Evaluation Committee will review all results and make a recommendation to the Division or its

7 designee as to whether further education, clinical training (including scope and length), treatment

8 of any medical and/or psychological condition and any other matters affecting respondent's

9 practice of medicine will be required or recommended. The Division or its designee may at any

10 time request information from PACE regarding the respondent's participation in PACE and/or

11 information derived therefrom. The Division may order respondent to undergo additional

12 education, medical and/or psychological treatment based upon the recommendations received

13 from PACE.

14 Upon approval ofthe recommendation by the Division or its designee, respondent

15 shall undertake and complete the recommended and approved PACE Program. At the completion

16 ofthe PACE Program, respondent shall submit to an examination on its contents and substance.

17 The examination shall be designed and administered by the PACE Program faculty. Respondent

18 shall not be deemed to have successfully completed the program unless he/she passes the

19 examination. Respondent agrees that the determination ofthe PACE Program faculty as to

20 whether or not he passed the examination and/or successfully completed the PACE Program

21 shall be binding.

· 22 Respondent shall complete the PACE Program no later than six months after his

23 initial enrollment unless the Division or its designee agrees in writing to a later time for

· 24 completion.

25 Ifrespondent successfully completes the PACE Program, including the

26 examination referenced above, he agrees to cause the PACE Program representative to forward a

27 Certification of Successful Completion of the program to the Division or its designee. If

28 respondent fails to successfully complete the PACE Program within the time limits outlined

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1 above, he shall be suspended from the practice of medicine.

2 Failure to participate in, and successfully complete all phases ofthe PACE

3 Program, as outlined above, shall constitute a violation of probation.

4 4. EDUCATION COURSE: Within 90 days ofthe effective date of this

5 decision, and on an annual basis thereafter, respondent shall submit to the Division or its

6 designee for its prior approval an educational program or course to be designated by the Division

7 or its designee which shall be aimed at correcting any areas of deficient practice or knowledge

8 which shall not be less than 40 hours per year, for each year of probation. This program shall be

9 in addition to the Continuing Medical Education (CME) requirements for relicensure. Following

10 the completion of each course, the Division or its designee may administer an examination to test

11 respondent's knowledge of the course. Respondent shall provide proof of attendant for 60 hours

12 ofCME ofwhich 20 were in satisfaction ofthis conditionand were approved in advance by the

13 Division or its designee.

14 5. MONITORING Within thirty (30) days of the effective date of this

15 decision, respondent shall submit to the Division or its designee for its prior approval a plan of

16 practice in which respondent's practice shall be monitored by another physician in respondent's

17 field of practice, who shall provide periodic reports to the Division or its designee.

18 If the monitor resigns or is no longer available, respondent shall, within fifteen

19 (15) days, move to have a new monitor appointed, through nomination by respondent and

20 approval by the Division or its designee.

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22 6. SUPERVISION OF PHYSICIAN ASSISTANTS During probation,

23 respondent is prohibited from supervising physician assistants.

24 7. OBEY ALL LAWS Respondent shall obey all federal, state and local

25 laws, all rules governing the practice of medicine in California, and remain in full compliance

26 with any court ordered criminal probation, payments and other orders.

27 8. QUARTERLY REPORTS Respondent shall submit quarterly

28 declarations under penalty of perjury on forms provided by the Division, stating whether there

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has been compliance with all the conditions of probation.

2 .9. PROBATION SURVEILLANCE PROGRAM COMPLIANCE

3 Respondent shall comply with the Division's probation surveillance program. Respondent shall,

4 at all times, keep the Division informed of his business and residence addresses which shall both

5 serve as addresses of record. Changes of such addresses shall be immediately communicated in

6 writing to the Division. Under no circumstances shall a post office box serve as an address of

7 record, except as allowed by Business and Professions Code section 2021 (b).

8 Respondent shall, at all times, maintain a current and renewed physician's and

9 surgeon's license.

10 Respondent shall also immediately inform the Division, in writing, of any travel

11 to any areas outside the jurisdiction of California which lasts, or is contemplated to last, more

12 than thirty (30) days.

13 10. INTERVIEW WITH THE DIVISION. ITS DESIGNEE OR ITS

14 DESIGNATED PHYSICIANCS) Respondent shall appear in person for interviews with the

15 Division, its designee or its designated physician(s) upon request at various intervals and with

16 reasonable notice.

17 11. TOLLING FOR OUT-OF-STATE PRACTICE, RESIDENCE OR IN-

18 STATE NON-PRACTICE In the event respondent should leave California to reside or to

19 practice outside the State or for any reason should respondent stop practicing medicine in

20 California, respondent shall notify the Division or its designee in writing within ten (1 0) days of

21 the dates of departure and return or the dates of non-practice within California. Non-practice is

22 defined as any period of time exceeding thirty (30) days in which respondent is not engaging in

23 any activities defined in Sections 2051 and 2052 of the Business and Professions Code. All time

24 spent in an intensive training program approved by the Division or its designee shall be

25 considered as time spent in the practice of medicine. A Board-ordered suspension of practice

26 shall not be considered as a period of non-practice. Periods of temporary or permanent residence

27 or practice outside California or of non-practice within California, as defined in this condition,

28 will not apply to the reduction of the probationary order.

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1 Any respondent disciplined under Business and Professions Code sections 141(a)

2 or 2305 (sister-state discipline) may petition for modification or termination of penalty 1) if the

3 other state's discipline terms are modified, terminated or reduced; and 2) if at least one year has

4 elapsed from the effective date of the California discipline.

5 12. COMPLETION OF PROBATION Upon successful completion of

6 probation, respondent's certificate shall be fully restored.

7 13. VIOLATION OF PROBATION Ifrespondent violates probation in any

8 respect, the Division, after giving respondent notice and the opportunity to be heard, may revoke

9 probation and carry out the disciplinary order that was stayed. If an accusation or petition to

10 revoke probation is filed against respondent during probation, the Division shall have continuing

11 jurisdiction until the matter is final, and the period of probation shall be extended until the matter

12 is final.

13 14. COST RECOVERY The respondent is hereby ordered to reimburse the

14 Division the amount of$3,855.35 payment due for cost of investigation payable in equal

15 installments at the beginning of each of the three years of probation for its investigative and

16 prosecution costs. Failure to reimburse the Division's cost of investigation and prosecution shall

17 constitute a violation of the probation order, unless the Division agrees in writing to payment by

18 an installment plan because of financial hardship. The filing ofbankruptcy by the respondent

19 shall not relieve the respondent ofhis responsibility to reimburse the Division for its

20 investigative and prosecution costs.

21 15. PROBATION COSTS Respondent shall pay the costs associated with

22 probation monitoring each and every year of probation, as designated by the Division, which are

23 currently set at $ 2,488, but may be adjusted on an annual basis. Such costs shall be payable to

24 the Division of Medical Quality and delivered to the designated probation surveillance monitor

25 no later than January 31 of each calendar year. Failure to pay costs within 30 days of the due

26 date shall constitute a violation of probation.

27 16. LICENSE SURRENDER Following the effective date ofthis decision, if

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

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~~/28/2082 13:09 131€l2736'337 WANDER KARPEL ZEL~~ER PAGE 82

·.: ,••

213 897 1071 P.10

OCT-17-2002 14:37 DOJ ATTY GEN OFF I ct:

60 391:7d

1 tbe terms and conditions of probation, respondeat may vohmtarily tender his. cc:rtiReate to the

1 Board. The Division ~rves the rigbl to evaluate tho rozpondent'.s request and to cr~tercise its 3 d.iBCCetion whether to grant the reques•t, or to ualc.e any other action deemed 4ppropriato and

4 reasonable under the citclum5bnces. Upon fonnal acceptance of the toodored license, rcspondd"'t

S will not longer be subjeci to the term& iUld conditione of probation.

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7 ACCF.PTANCB

8 I have otrefully read tlul above Stipulatad ScttlemCllt and Disciplinary Order and

9 have fully diiiC~ed it witll my a1toro.ey, Donald B. Karpel, Esq.. 1 wder9tand the etipulation

10 and the effect it will baV'e on my Phy::ician & Sutgton Certificate. I enter into this Stipulated

11 Settlcnent and Dh:c:iplinnry Order vgluntarily, knowiil.gly, end intc:lligently, and agrc;:c to be

12 bound by the Decision and Order of the Division ofMedical Quality, Medic:al Board of

1 J California. 14 DATED: ___ 1_6 _l_z.r_lc_Q_.,_ __

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20 .DATED: II P~k2.-11

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ROBERT CHA.RLAP, M.D. Respondent

BNDQRSP..MENT

26 The fureKoiDa Stipul~ted Settlement and Disc.ipl.imlly Order is hereby respeetfillly

27 :aubmitted foc c.o.Wdontion by the Divilion of Medical QUality. Modic:al Board ofCalifomia of

2& 1he Departma\t ofConaumer Aff'airt.

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LE69ELZQt£1

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2 DATED:

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9 DOl ()o.;l(cl ~u..wr. 0357) 160-LA02 0094

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BILL LOCKYER, Attorney General of~tatc of California

KAREN ~pf± :1 eJL Deputy Attorney General

Attorneys for Complainant

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·'-

Exhibit A

Accusation No. 17-2001-122308

"._,.·:··· ·.·

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FILED 1 BILL LOCKYER, Attorney General of the State of California

2 KAREN B. CHAPPELLE, State Bar No. 141267 Deputy Attorney General

3 California Department of Justice 300 So. Spring Street, Suite 1702

4 Los Angeles, CA 90013 Telephone: (213) 897-8944

STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA

SACRAMENTO }JD..kch 22, 20 o2. ev l JiLw & i"ttOCtJJ ANALYST

5 Facsimile: (213) 897-1071

6 Attorneys for Complainant

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8

9

BEFORE THE

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DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

11 In the Matter of the Accusation Against:

12 ROBERT CHARLAP, M.D., 265 E. Orange Grove, Suite B

13 Burbank, California 91502

14 Physician and Surgeon Certificate No. G 85076

Respondent.

Complainant alleges:

PARTIES

Case No. 17-2001-122308

OAHNo. L-

ACCUSATION

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19 1. Ron Joseph (Complainant) brings this Accusation solely in his official capacity as

20 the Executive Director of the Medical Board of California, Department of Consumer Affairs.

21 2. On or about March 12, 1999, the Medical Board of California issued Physician&

22 Surgeon Certificate Number G 85076 to Robert Charlap, M.D. (Respondent). The Physician &

23 Surgeon Certificate was in full force and effect at all. times relevant to the charges brought herein

24 and will expire on August 31, 2002, unless renewed.

JURISDICTION 25

26 3. This Accusation is brought before the Division of Medical Quality, Medical

27 Board of California (Division), under the authority of the following sections of the Business and ' 'I·

28 Professions Code (Code).-. -, . .; ' '

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

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

3 one year, placed on probation and required to pay the costs of probation monitoring, or such

4 other action taken in relation to discipline as the Division deems proper.

5 5. Section 2234 of the Code states:

6 "The Division of Medical Quality shall take action against any licensee who is

7 charged with unprofessional conduct. In addition to other provisions of this article,

8 unprofessional conduct includes, but is not limited to, the following:

9 "(a) Violating or attempting to violate, directly or indirectly, or assisting in or

10 abetting the violation of, or conspiring to violate, any provision of this chapter [Chapter

11 5, the Medical Practice Act].

12 "(b) Gross negligence.

13 "(c) Repeated negligent acts.

14 "(d) Incompetence.

15 "(e) The commission of any act involving dishonesty or corruption which is

16 substantially related to the qualifications, functions, or duties of a physician and surgeon.

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

18 certificate."

19 6. Section 2266 ofthe Code states: "The failure of a physician and surgeon to

20 maintain adequate and accurate records relating to the provision of services to their patients

21 constitutes unprofessional conduct."

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7. Section 2261 of the Code states:

"Knowingly making or signing any certificate or other docunient directly or

indirectly related to the practice of medicine or podiatry which falsely represents the

existence or nonexistence of a state of facts, constitutes unprofessional conduct."

8. Section 810 of the Code states:

"(a) It shall constitute unprofessional conduct and grounds for disciplinary action,

including suspension or revocation of a license or certiticate, for a health care

2

1 professional to do any of the following in connection with his or her professional

2 activities:

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4

9. Section 14124.12 of the Welfare and Institutions Code states, in pertinent part:

"(a) Upon receipt of written notice from the Medical Board of California, the

5 Osteopathic Medical Board of California, or the Board of Dental Examiners of California,

6 that a licensee's license has been placed on probation as a result of a disciplinary action,

7 the department may not reimburse any Medi~Cal claim for the type of surgical service or

8 invasive procedure that gave rise to the probation, including any dental surgery or

9 invasive procedure, that was performed by the licensee on or after the effective date of

10 probation and until the termination of all probationary terms and conditions or until the

11 probationary period has ended, whichever occurs first. This section shall apply except in

12 any case in which the relevant licensing board determines that compelling circumstances

13 warrant the continued reimbursement during the probationary period of any Medi-Cal

14 claim, including any claim for dental services, as so described. In such a case, the

15 department shall continue to reimburse the licensee for all procedures, except for those

16 invasive or surgical procedures for which the licensee was placed on probation."

17 10. Section 125.3 of the Code provides, in pertinent part, that the Division may

18 request the administrative law judge to direct a licentiate found to have committed a violation or

19 violations of the licensing act to pay a sum not to exceed the reasonable costs of the investigation

20 and enforcement of the case.

21 "(1) Knowingly present or cause to be presented any false or fraudulent claim for

22 the payment of a loss under a contract of insurance.

23 "(2) Knowingly prepare, make, or subscribe any writing, with intent to present or

24 use the same, or to allow it to be presented or used in support of any false or fraudulent

25 claim.

26 "(b) It shall constitute cause for revocation or suspension of a license or

27 certificate for a health care professional to engage in any conduct prohibited under

·28 ' Section 1871.4 of the fusurance Code or Section 550 of the Penal Code.·

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1 "(c) As used in this section, health care professional means any person licensed or

2 certified pursuant to this division, or licensed pursuant to the Osteopathic Initiative Act,

3 or the Chiropractic Initiative Act."

4 FIRST CAUSE FOR DISCIPLINE

5 (Gross Negligence)

6 11. Respondent is subject to disciplinary action under section 2234, subdivision (b) in

7 that he engaged in acts of gross negligence in his reports pertaining to patients A.B., C.S., A 0.,

8 C.M., C.J., A.S., and C.B. The circumstances are as follows:

9 Patient A.0. 1

10 A. On or about Aprill, 1999, A.O. was seen with a complaint of pain to the

11 4th digit of the right hand from hitting a door, and a cold. The Physician Chart review from the

12 referring physician documented that the following tests were ordered: EKG, PFT,

13 Echocardiogram, and Nerve Conduction. No clinic data was provided to Respondent, and the

14 raw data submitted to Respondent included only testing of lower extremity nerves.

15 B. The nerve conduction study by Respondent stated that the raw data was

16 found to be within normal limits, except for borderline amplitude involving the distal left

17 Peroneal motor response. Respondent's report mentions abnormalities involving the Median

18 nerve, however the study was performed only on the lower extremities. The report refers to

19 abnormalities not present when the raw data was reviewed. Raw data showed that amplitude was

20 quite different on the right and on the left side. Respondent's conclusion was that "this study

21 correlates well for diagnosis of ... nerve conduction defects."

22 Patient C.M.

23 c. On or about April 7, 1999, 45 year-old male patient C.M. was seen with a

24 complaint of a cold, runny nose, and pain. The Physician chart Review for C.M. documents that

25 the following tests were ordered: EKG, CBC, PFT, Echocardiogram, and Nerve Conduction.

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27 1,, . 1. The full name of each patient is available to respondent upon a timely request for

28 discovery under Government Code section 11507.6. . . - .

4

1 D. The nerve conduction study report prepared by Respondent makes no

2 mention of any specific abnormality, nor does it give any guidance regarding potential

3 differential diagnosis or the need for additional testing such as EMG or MRI of the lumbar spine.

4 Respondent's report stated that "the conduction velocities were all normaL" However, in his

5 conclusion, Respondent states that "this study correlates well ... for nerve conduction defect."

6 The raw data revealed a drop-off in amplitude involving the proximal Peroneal motor response of

7 almost 50%.

8 Patient C.S.

9 E. On or about April 9, 1999, 54 year-old male patient C.S. was seen with a

10 complaint of being unable to sleep and shoulder pain. The following tests were ordered:

11 Echocardiogram, abdominal ultrasound, EKG, blood tests, a PFT, and Nerve Conduction.

12 F. The nerve conduction study report prepared by Respondent, which is a

13 word by word copy of the report for patient C.M., documents that the raw data was found to be

14 within normal limits. Central conduction times are used in determining if a lesion is present

15 between the cauda equina and the somatosensory cortex. No such determinations were present in

16 the raw data, and no information is present regarding the patient's height, which would be

17 necessary to perform the calculations. Respondent's conclusion stated that "this study correlates

18 well for diagnosis ofnerve disease or nerve conduction defect."

19 Patient C.J.

20 G. On or about May 6, 1999, 52 year-old male patient C.J. was seen with a

· 21 complaint of discomfort on the right side. The Physician Chart Review shows that the following

22 tests were ordered: EKG, PFT, CBC, and Nerve Conduction.

23 H. The nerve conduction study report prepared by Respondent, which is a

24 word for word copy of the reports prepared for patients A.B., and A.O., states that there was

25 abnormal conduction velocity for the median nerves, which were not tested. The report provides

26 inaccurate information and has no correlation with the findings on the computerized sheet.

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Patient A.B.

I. On or about May 19, 1999,47 year-old male patient A.B. was seen with a

complaint of right foot pain. The Physician Chart Review indicates A.B. had chest pain,

wheezing, anemia, and foot pain numbness. The tests ordered by the referring physician were:

EKG, PFT, CBC, and Nerve Conduction. Only the lower extremity nerves were tested.

J. The nerve conduction study report prepared by Respondent, which is a

word by word copy of the report for patient A.O., stated that the nerve conduction velocity was

normal in all nerves but reflects abnormalities in the "median nerve" including amplitude and

nerve conduction velocity. There is no median nerve in the lower extremities. The raw data

showed that the median nerve was not tested. The actual abnormalities in A.B.'s case involve

the sensory portion and proximal motor portion of the Posterior Tibial nerve and the H-reflex.

Respondent's report stated that the amplitudes were abnormal, but did not state in which leg and

in which nerve the amplitudes were abnormal. Respondent's conclusion stated that "this study

correlates well the diagnosis of nerve disease or nerve conduction defects ... " No nerve

conduction defect was documented in the study.

Patient A.S.

K. On or about May 17, 1999, 47 year-old male patient AS. was seen with a

complaint of back pain and headache. The Physician Chart review by the referring physician

contains a copy of the Nerve Conduction Study report by Respondent.

L. The nerve conduction study report by Respondent does not bear the

patient's name, and is a word for word copy of the report ofC.J., A.B., and A.O .. Only the lower

extremity studies were performed. The study performed involved only the lower extremities,

however, Respondent's report mentions abnormalities involving the Median nerve.

Respondent's conclusion states that "this study correlates well for the diagnosis of nerve disease

or nerve conduction defects. There was no nerve conduction defect detected in the raw data

submitted to Respondent. The report does not contain the patient's name.

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Patient C.B.

M. On or about May 26, 1999, 58 year-old male C.B. was seen with a

complaint of right hip and low back pain. The Physician Chart Review shows the following tests

were ordered: PFT, CBC, Echocardiogram, and Nerve Conduction.

N. The nerve conduction study report prepared by Respondent, which is a

word for word copy of the reports for patients C.J., A.B., A.O., and A.S., states that "the

conduction velocities were abnormal for the median nerves." In reality, no data for the median

nerve had been submitted, and only the lower extremities were tested. Respondent's conclusion

stated that "this study correlates well for diagnosis of nerve conduction defects ... " No nerve

conduction defect was documented in the raw data submitted for Respondent's interpretation.

0. Respondent has no certification in any field of medicine. He trained in

Neurology for five or six months while he was living in Phoenix, Arizona in 1999. Since April

1999, Respondent has been interpreting nerve conduction studies and somatosensory evoked

potentials. Respondent has no formal training in either the performance or interpretation ofnerve

conduction studies or somatosensory evoked potentials (neurodiagnostics).

P. The standard of care for a physician performing a neurodiagnostic

consultation is to evaluate a patient's complaint by performing and interpreting appropriate tests

within the consultant's training, competence and experience. After the results ofneurodiagnostic

tests are evaluated, an adequate report should be generated to the referring doctor with a clear

explanation of the findings, their neurophysiological significance, potential differential diagnosis

and recommendations for additional clinical and diagnostic examinations, if indicated. Ethical

and professional standards define the need for minimal appropriate training, experience and

competence for the performance and evaluation of these studies.

Q. Respondent is guilty of conduct constituting gross negligence in his

reports for patients A.O., C.M., C.S., C.J., A.B., A.S., and C.B. for the following reasons:

1. Respondent has no certification in any field of medicine. He has

only had five or six months of training in Neurology, which is insufficient to interpret nerve

28 conduction studies and somatose:r;.:;ory evok~;;d potentials. Respoud.:::"',t h::ts nc formal training jn

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either the performance or interpretation of nerve conduction studies or somatosensory evoked

potentials (neurodiagnostics).

2. On each of the aforementioned cases, Respondent's records

demonstrate the use of boilerplate reports, in which the same erroneous statements were made

repetitiously. In each case, there is a discrepancy between what the raw data showed and what

Respondent's report stated. With A.O., and AS. Respondent did not have the patient's names on

7 their reports.

8 3. Respondent's neurophysiological studies demonstrated an ongoing

9 pattern of inaccurate interpretation, recurrent errors and inadequate testing.

10 4. Respondent billed Medi-Cal for each inadequate report.

11 SECOND CAUSE FOR DISCIPLINE

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(Repeated Negligent Acts)

12. Respondent is subject to disciplinary action under section 2234, subdivision (c) in

that he committed repeated acts ofnegligence in his reports pertaining to patients A.B., C.S.,

A.O., C.M., C.J., AS., and C.B. The circumstances are as follows:

A. Complainant refers to and by this reference incorporates the facts and

allegations set forth in paragraph 11, subparagraphs A through Q, inclusive, above, as though set

forth fully.

B. Respondent is guilty of conduct constituting repeated acts of negligence in

his reports for patients A.O., C.M., C.S., C.J., A.B., A.S., and C.B. for the following reasons:

1. Respondent has no certification in any field of medicine. He has

only for five or six months of training in Neurology, which is insufficient to interpret nerve

conduction studies and somatosensory evoked potentials. Respondent has no formal training in

either the performance or interpretation of nerve conduction studies or somatosensory evoked

potentials (neurodiagnostics ).

2. On the reports of patients A.O., C.M., C.S., C.J., A.B., A.S., and

C.B., Respondent's records demonstrate the use ofboilerplate reports, in which the same

28 , erroneous statements were made repeutiously. in ~ach case~ there is a ri1s1.xepancy between 'N hat

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the raw data showed and whatRespondent's report stated.

3. Respondent's neurophysiological studies demonstrated an ongoing

pattern of inaccurate interpretation, recurrent errors and inadequate testing.

4. Respondent billed Medi-Cal for each inadequate report.

THIRD CAUSE FOR DISCIPLINE

(Incompetence)

13. Respondent is subject to disciplinary action under section2234, subdivision (d) in

that he demonstrated a lack of skill or knowledge ofhis subject matter in his reports pertaining to

patients A.B., C.S., A.O., C.M., C.J., A.S., and C.B. The circumstances are as follows:

A. Complainant refers to and by this reference incorporates the facts and

allegations set forth in paragraph 11, subparagraphs A through Q, inclusive, above, as though set

forth fully.

B. Respondent is guilty of conduct constituting incompetence negligence in

his reports for patients A.O., C.M., C.S., C.J., A.B., A.S., and C.B. for the following reasons:

1. Respondent has no certification in any field of medicine. He has

only for five or six months of training in Neurology, which is insufficient to interpret nerve

conduction studies and somatosensory evoked potentials. Respondent has no formal training in

either the performance or interpretation of nerve conduction studies or somatosensory evoked

potentials ( neurodiagnostics ).

2. On the reports of patients A.O., C.M., C.S., C.J., A.B., A.S., and

C.B., Respondent's records demonstrate the use ofboilerplate reportf:, in which the same

erroneous statements were made repetitiously. In each case, there is a discrepancy between what

the raw data showed and what Respondent's report stated.

3. Respondent's neurophysiological studies demonstrated an ongoing

pattern of inaccurate interpretation, recurrent errors and inadequate testing.

4. Respondent billed Medi-Cal for each inadequate report.

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FOURTH CAUSE FOR DISCIPLINE

(Failure to Maintain Adequate and Accurate Records)

Respondent is subject to disciplinary action under section 2266 in that he failed to

4 keep adequate and adequate records regarding patients A.B., C.S., A.O., C.M., C.J., A.S., and

5 C.B. The circumstances are as follows:

6 A. Complainant refers to and by this reference incorporates the facts and

7 allegations set forth in paragraph 11, subparagraphs A through Q, inclusive, above, as though set

8 forth fully.

9 B. Respondent has no certification in any field of medicine. He has only for

10 five or six months oftraining in Neurology, which is insufficient to interpret nerve conduction

11 studies and somatosensory evoked potentials. Respondent has no formal training in either the

12 performance or interpretation of nerve conduction studies or somatosensory evoked potentials

13 (neurodiagnostics).

14 c. On the reports of patients A.O., C.M., C.S., C.J., A.B., A.S., and C.B.,

15 Respondent's records demonstrate the use ofboilerplate reports, in which the same erroneous

16 statements were made repetitiously. In each case, there is a discrepancy between what the raw

17 data showed and what Respondent's report stated.

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D. Respondent's neurophysiological studies demonstrated an ongoing pattern

of inaccurate interpretation, recurrent errors and inadequate testing.

E. Respondent billed Medi-Cal for each inadequate report.

FIFTH CAUSE FOR DISCIPLINE

(False Statements in Medical Records)

15. Respondent is subject to disciplinary action under section 2261 in that he

knowingly made or signed reports pertaining to patients A.B., C.S., A.O., C.M., C.J., A.S., and

C.B. which falsely represented the accurate facts. The circumstances are as follows:

A. Complainant refers to, and by this reference,

B. Respondent has no certification in any field of medicine. He has only for

five or six months oftraining in Neurology, which is insufficient to interpret nerve conduction

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1 studies and somatosensory evoked potentials. Respondent has no formal training in either the

2 performance or interpretation of nerve conduction studies or somatosensory evoked potentials

3 (neurodiagnostics).

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C. On the reports of patients A.O., C.M., C.S., C.J., A.B., A.S., and C.B.,

Respondent's records demonstrate the use ofboilerplate reports, in which the same erroneous

statements were made repetitiously. In each case, there is a discrepancy between what the raw

data showed and what Respondent's report stated.

D. Respondent's neurophysiological studies demonstrated an ongoing pattern

of inaccurate interpretation, recurrent errors and inadequate testing.

E. Respondent billed Medi-Cal for each inadequate report.

SIXTH CAUSE FOR DISCIPLINE

(Dishonest Acts)

16. Respondent is subject to disciplinary action under section 2234, subdivision (e) in

that he knowingly presented false/fraudulent claims to be paid from Medi-Cal for reports on

patients A.B., C.S., A.O., C.M., C.J., A.S., and C.B. The circumstances are as follows:

A. Complainant refers to, and by this reference, incorporates the facts and

allegations 12, subparagraphs A through Q, inclusive, above, as though set forth fully.

SEVENTH CAUSE FOR DISCIPLINE

(Unprofessional Conduct)

17. Respondent is subject to disciplinary action under section 2234 in that his conduct

of report writing for patients A.B., C.S., A.O., C.M., C.J., AS., and C.B. constitutes

unprofessional conduct. The circumstances are as follows:

A. Complainant refers to, and by this reference, incorporates the facts and

allegations set forth in paragraph 11, subparagraphs A through Q inclusive, above, as though set

forth fully.

B. Respondent has no certification in any field of medicine. He has only for

five or six months of training in Neurology, which is insufficient to interpret nerve conduction

studies and somatosensory evoked potentials. Respondent has no fom1al 'i.raining in either tht

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1 performance or interpretation of nerve conduction studies or somatosensory evoked potentials

2 (neurodiagnostics).

3 c. On the reports of patients A.O., C.M., C.S., C.J., A.B., AS., and C.B.,

4 Respondent's records demonstrate the use of boilerplate reports, in which the same erroneous

5 statements were made repetitiously. In each case, there is a discrepancy between what the raw

6 data showed and what Respondent's report stated.

7 D. Respondent's neurophysiological studies demonstrated an ongoing pattern

8 of inaccurate interpretation, recurrent errors and inadequate testing. -

9 E. Respondent billed Medi-Cal for each adequate report.

10 PRAYER

11 \VHEREFORE, Complainant requests that a hearing be held on the matters herein

12 alleged, and that following the hearing, the Division of Medical Quality issue a decision:

13 1. Revoking or suspending Physician & Surgeon Certificate Number G 85076,

14 issued to Robert Cbarlap, M.D.;

15 2. Revoking, suspending or denying approval of Robert Cbarlap, M.D.'s authority

16 to supervise physician's assistants, pursuant to section 3527 of the Code;

17 3. Ordering Robert Cbarlap, M.D. to pay the Division ofMedica1 Quality the

18 reasonable costs ofthe investigation and enforcement of this case, and, if placed on probation,

19 the costs of probation monitoring;

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

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22 DATED: March 22, 2002

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Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant

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