BEFORE THE MEDICAL BOARD OF CALIFORNIA ...4patientsafety.org/documents/Gogna, Ravi Kant 2014-08-01.pdfRAVI KANT GOGNA, M.D. OAHNo. 2013070282 7417 Spyglass Drive Modesto, CA 95356

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against: ) ) )

RA VI KANT GOG NA, M.D. ) )

Physician's and Surgeon's ) Certificate No. A 39659 )

) Respondent. )

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Case No. 02-2011-214299

DECISION AND ORDER

The attached Stipulated Settlement and Disciplinary Order is hereby adopted by the Medical Board of California, Department of Consumer Affairs, State of California, as its Decision in this matter.

This Decision shall become effective at 5:00 p.m. on August 29, 2014.

IT IS SO ORDERED August 1, 2014.

MEDICAL BOARD OF CALIFORNIA

By:~~~~~~----11--~~~ Barbara Y arosla Panel A

1 KAMALA D. HARRIS Attorney General of California

2 E. A. JONES III Supervising Deputy Attorney General

3 MARA FAUST Deputy Attorney General

4 State Bar No. 111729 California Department of Justice

5 1300 I Street, Suite 125 P.O. Box 944255

6 Sacramento, CA 94244-2550 Telephone: (916) 324-5358

7 Facsimile: (916) 327-2247 Attorneys for Complainant

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BEFORE THE

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MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation Against: Case No. 02-2011-214299

RAVI KANT GOGNA, M.D. OAHNo. 2013070282 7417 Spyglass Drive Modesto, CA 95356 STIPULATED SETTLEMENT AND Physician's and Surgeon's Certificate No. A DISCIPLINARY ORDER 39659

Respondent.

19 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 of the Medical

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

24 this matter by Kamala D. Harris, Attorney General of the State of California, by Mara Faust,

25 Deputy Attorney General.

26 2. Respondent RA VI KANT GOGNA, M.D. ("Respondent") is represented in this

27 proceeding by attorney Paul R. Baleria, whose address is: 2150 River Plaza Drive, Suite 250

28 Sacramento, CA 95833.

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STIPULATED SETTLEMENT (02-2011-214299)

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3. On or about April 4, 1983, the Medical Board of California issued Physician's and

Surgeon's Certificate No. A 39659 to RA VI KANT GOGNA, M.D. (Respondent). The

Physician's and Surgeon's Certificate was in full force and effect at all times relevant to the

charges brought in Accusation No. 02-2011-214299 and will expire on July 31, 2014, unless

renewed.

JURISDICTION

4. Accusation No. 02-2011-214299 was filed before the Medical Board of California

(Board), Department of Consumer Affairs, and is currently pending against Respondent. The

Accusation and all other statutorily required documents were properly served on Respondent on

May 17, 2013. Respondent timely filed his Notice of Defense contesting the Accusation.

5. A copy of Accusation No. 02-2011-214299 is attached as exhibit A and incorporated

herein by reference.

ADVISEMENT AND WAIVERS

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

charges and allegations in Accusation No. 02-2011-214299. Respondent has also carefully read,

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

Disciplinary Order.

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

19 hearing on the charges and allegations in the Accusation; the right to be represented by counsel at

20 his own expense; the right to confront and cross-examine the witnesses against him; the right to

21 present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel

22 the attendance of witnesses and the production of documents; the right to reconsideration and

23 court review of an adverse decision; and all other rights accorded by the California

24 Administrative Procedure Act and other applicable laws.

25 8. Respondent voluntarily, knowingly, and intelligently waives and gives up each and

26 every right set forth above.

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CULP ABILITY

9. Respondent does not contest that, at an administrative hearing, complainant could

3 establish a prima facie case with respect to the charges and allegations contained in Accusation

4 No. 02-2011-214299 and that he has thereby subjected his license to disciplinary action.

5 Regarding the violations of Business and Professions Code section 2266 (failure to keep

6 adequate and accurate records), on June 16, and 17, 2011, after the events alleged in the

7 Accusation, Respondent enrolled in and successfully completed the PACE Record Keeping

8 Course. The parties agree that this course constitutes partial remediation of the record keeping

9 violations.

1 O Respondent agrees that if he ever petitions for early termination or modification of

11 probation, or ifthe Board ever petitions for revocation of probation, all of the charges and

12 allegations contained in Accusation No. 02-2011-214299 shall be deemed true, correct and fully

13 admitted by respondent for purposes of that proceeding or any other licensing proceeding

14 involving respondent in the State of California.

15 10. Respondent agrees that his Physician's and Surgeon's Certificate is subject to

16 discipline and he agrees to be bound by the Board's probationary terms as set forth in the

17 Disciplinary Order below.

18 CIRCUMSTANCES IN MITIGATION

19 11. Respondent RA VI KANT GOGNA, M.D. has never been the subject of any

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

21 RESERVATION

22 12. The admissions made by Respondent herein are only for the purposes of this

23 proceeding, or any other proceedings in which the Medical Board of California or other

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professional licensing agency is involved, and shall not be admissible in any other criminal or

2 civil proceeding.

3 CONTINGENCY

4 13. This stipulation shall be subject to approval by the Medical Board of California.

5 Respondent understands and agrees that counsel for Complainant and the staff of the Medical

6 Board of California may communicate directly with the Board regarding this stipulation and

7 settlement, without notice to or participation by Respondent or his counsel. By signing the

8 stipulation, Respondent understands and agrees that he may not withdraw his agreement or seek

9 to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails

1 o to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary

11 Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal

12 action between the parties, and the Board shall not be disqualified from further action by having

13 considered this matter.

14 14. The parties understand and agree that Portable Document Format (PDF) and facsimile

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copies of this Stipulated Settlement and Disciplinary Order, including Portable Document Format

(PDF) and facsimile signatures thereto, shall have the same force and effect as the originals.

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

the Board may, without further notice or formal proceeding, issue and enter the following

Disciplinary Order:

DISCIPLINARY ORDER

IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. A 39659 issued

to Respondent RA VI KANT GOGNA, M.D. (Respondent) is revoked. However, the revocation

is stayed and Respondent is placed on probation for three (3) years on the following terms and

conditions.

1. EDUCATION COURSE. Within 60 calendar days of the effective date of this

Decision, and for the first year of probation, Respondent shall submit to the Board or its designee

for its prior approval educational program(s) or course(s) which shall not be less than 40 hours

per year, for the first year of probation. The educational program(s) or course(s) shall be aimed at

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1 correcting any areas of deficient practice or knowledge and shall be Category I certified. The

2 educational program(s) or course(s) shall be at Respondent's expense and shall be in addition to

3 the Continuing Medical Education (CME) requirements for renewal of licensure. Following the

4 completion of each course, the Board or its designee may administer an examination to test

5 Respondent's knowledge of the course. Respondent shall provide proof of attendance for 65

6 hours of CME of which 40 hours were in satisfaction of this condition.

7 2. CLINICAL TRAINING PROGRAM. Within 60 calendar days of the effective date

8 of this Decision, Respondent shall enroll in a clinical training or educational program equivalent

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

1 O California - San Diego School of Medicine ("Program"). Respondent shall successfully complete

11 the Program not later than six (6) months after Respondent's initial enrollment unless the Board

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

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

14 day assessment of Respondent's physical and mental health; basic clinical and communication

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

16 Respondent's area of practice in which Respondent was alleged to be deficient, and at minimum,

17 a 40 hour program of clinical education in the area of practice in which Respondent was alleged

18 to be deficient and which takes into account data obtained from the assessment, Decision(s),

19 Accusation(s), and any other information that the Board or its designee deems relevant.

20 Respondent shall pay all expenses associated with the clinical training program.

21 Based on Respondent's performance and test results in the assessment and clinical

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

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

24 condition, treatment for any psychological condition, or anything else affecting Respondent's

25 practice of medicine. Respondent shall comply with Program recommendations.

26 At the completion of any additional educational or clinical training, Respondent shall

27 submit to and pass an examination. Determination as to whether Respondent successfully

28 completed the examination or successfully completed the program is solely within the program's

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jurisdiction.

2 If Respondent fails to enroll, participate in, or successfully complete the clinical training

3 program within the designated time period, Respondent shall receive a notification from the

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

5 so notified. The Respondent shall not resume the practice of medicine until enrollment or

6 participation in the outstanding portions of the clinical training program have been completed. If

7 the Respondent did not successfully complete the clinical training program, the Respondent shall

8 not resume the practice of medicine until a final decision has been rendered on the accusation

9 and/or a petition to revoke probation. The cessation of practice shall not apply to the reduction of

1 O the probationary time period.

11 3. MONITORING - PRACTICE/BILLING. Within 30 calendar days of the effective

12 date of this Decision, Respondent shall submit to the Board or its designee for prior approval as a

13 practice monitor(s), the name and qualifications of one or more licensed physicians and surgeons

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

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

16 personal relationship with Respondent, or other relationship that could reasonably be expected to

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

18 but not limited to any form of bartering, shall be in Respondent's field of practice, and must agree

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

20 The Board or its designee shall provide the approved monitor with copies of the Decision(s)

21 and Accusation(s), and a proposed monitoring plan. Within 15 calendar days of receipt of the

22 Decision(s), Accusation(s), and proposed monitoring plan, the monitor shall submit a signed

23 statement that the monitor has read the Decision(s) and Accusation(s), fully understands the role

24 of a monitor, and agrees or disagrees with the proposed monitoring plan. If the monitor disagrees

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

26 signed statement for approval by the Board or its designee.

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

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

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

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

3 If Respondent fails to obtain approval of a monitor within 60 calendar days of the effective

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

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

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

7 responsibility.

8 The monitor(s) shall submit a quarterly written report to the Board or its designee which

9 includes an evaluation of Respondent's performance, indicating whether Respondent's practices

1 o are within the standards of practice of medicine, and whether Respondent is practicing medicine

11 safely, billing appropriately or both. It shall be the sole responsibility of Respondent to ensure

12 that the monitor submits the quarterly written reports to the Board or its designee within 10

13 calendar days after the end of the preceding quarter.

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

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

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

17 15 calendar days. If Respondent fails to obtain approval of a replacement monitor within 60

18 calendar days of the resignation or unavailability of the monitor, Respondent shall receive a

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

20 calendar days after being so notified Respondent shall cease the practice of medicine until a

21 replacement monitor is approved and assumes monitoring responsibility.

22 In lieu of a monitor, Respondent may participate in a professional enhancement program

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

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

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

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

27 Respondent's expense during the term of probation.

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4. SOLO PRACTICE PROHIBITION. Respondent is prohibited from engaging in the

solo practice of medicine. Prohibited solo practice includes, but is not limited to, a practice

wnere: 1) Respondent merely shares office space with another physician but is not affiliated for

purposes of providing patient care, or 2) Respondent is the sole physician practitioner at that

location.

If Respondent fails to establish a practice with another physician or secure employment in

an appropriate practice setting within 60 calendar days of the effective date of this Decision,

Respondent shall receive a notification from the Board or its designee to cease the practice of

medicine within three (3) calendar days after being so notified. The Respondent shall not resume

practice until an appropriate practice setting is established.

If, during the course of the probation, the Respondent's practice setting changes and the

Respondent is no longer practicing in a setting in compliance with this Decision, the Respondent

shall notify the Board or its designee within 5 calendar days of the practice setting change. If

Respondent fails to establish a practice with another physician or secure employment in an

appropriate practice setting within 60 calendar days of the practice setting change, Respondent

shall receive a notification from th~ Board or its designee to cease the practice of medicine within

three (3) calendar days after being so notified. The Respondent shall not resume practice until an

appropriate practice setting is established.

5. NOTIFICATION. Within seven (7) days of the effective date of this Decision, the

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

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

Respondent, at any other facility where Respondent engages in the practice of medicine,

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

Executive Officer at every insurance carrier which extends malpractice insurance coverage to

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

calendar days.

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

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6. SUPERVISION OF PHYSICIAN ASSISTANTS. During probation, Respondent is

2 prohibited from supervising physician assistants outside of the hospital setting.

3 7. OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules

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

5 ordered criminal probation, payments, and other orders.

6 8. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations

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

8 compliance with all the conditions of probation.

9 Respondent shall submit quarterly declarations not later than 10 calendar days after the end

1 O of the preceding quarter.

11 9. GENERAL PROBATION REQUIREMENTS.

12 Compliance with Probation Unit

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

14 this Decision.

15 Address Changes

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

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

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

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

20 and Professions Code section 2021 (b ).

21 Place of Practice

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

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

24 facility.

25 License Renewal

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

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Travel or Residence Outside California

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

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

4 (30) calendar days.

5 In the event Respondent should leave the State of California to reside or to practice

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

7 departure and return.

8 10. INTERVIEW WITH THE BOARD OR ITS DESIGNEE. Respondent shall be

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

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

11 11. NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or

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

13 30 calendar days and within 15 calendar days of Respondent's return to practice. Non-practice is

14 defined as any period of time Respondent is not practicing medicine in California as defined in

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

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

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

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

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

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

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

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

23 months, Respondent shall successfully complete a clinical training program that meets the criteria

24 of Condition 18 of the current version of the Board's "Manual of Model Disciplinary Orders and

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

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

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

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

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

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

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

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

6 completion of probation. Upon successful completion of probation, Respondent's certificate shall

7 be fully restored.

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

9 of probation is a violation of probation. If Respondent violates probation in any respect, the

1 O Board, after giving Respondent notice and the opportunity to be heard, may revoke probation and

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

12 or an Interim Suspension Order is filed against Respondent during probation, the Board shall have

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

14 the matter is final.

15 14. LICENSE SURRENDER. Following the effective date of this Decision, if

16 Respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy

17 the terms and conditions of probation, Respondent may request to surrender his or her license.

18 The Board reserves the right to evaluate Respondent's request and to exercise its discretion in

1 9 determining whether or not to grant the request, or to take any other action deemed appropriate

20 and reasonable under the circumstances. Upon formal acceptance of the surrender, Respondent

21 shall within 15 calendar days deliver Respondent's wallet and wall certificate to the Board or its

22 designee and Respondent shall no longer practice medicine. Respondent will no longer be subject

23 to the terms and conditions of probation. If Respondent re-applies for a medical license, the

24 application shall be treated as a petition for reinstatement of a revoked certificate.

25 15. PROBATION MONITORING COSTS. Respondent shall pay the costs associated

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

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

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

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1 year.

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3 ACCEPTANCE

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

5 discussed it with my attorney, Paul R. Baleria. I understand the stipulation and the effect it will

6 have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Settlement and

7 Disciplinary Order voluntarily, knowingly, and intelligently, and agree·to be bound by the

8 Decision and Order of the Medical Board of California.

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DATED: RA VI KANT GOGNA, M.D. Respondent

14 I have read and fully discussed with Respondent RA VI KANT GOGNA, M.D. the terms

15 and conditions and other matters contained in the above Stipulated Settlement and Disciplinary

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Order. I approve its form and content.

DATED: S:-/-'7- / l( ~ L .

Paul R. Baleria ' Attorney for Respondent

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ENDORSEMENT

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3 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

4 submitted for consideration by the Medical Board of California.

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Respectfully submitted,

KAMALA D. HARRIS Attorney General of California ~ONESIII ..,

~l:f~AA;o~cx 7ra1 MARA FAUST ~

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Deputy Attorney General Attorneys for Complainant


Exhibit A

Accusation No. 02-2011-214299

KAMALA D. HARRIS f;\.ttorney General of California GAIL M. HEPPELL Supervising Deputy Attorney General State Bar No. 84134

1300 I Street, Suite 125 P.O. Box 944255 Sacramento, CA 94244-2550 Telephone: (916) 445-7376 Facsimile: (916) 327-2247

Attorneys for Complainant

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BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

10 In the Matter of the Accusation Against:

11 RA VI KANT GOGNA, M.D. 1205 E North St.

12 Manteca, CA 95336

13 Physician's and Surgeon's Certificate No. A 39659

Respondent.

Complainant alleges:

Case No. 02-2011-214299

ACCUSATION

PARTIES

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18 1. Linda K. Whitney (Complainant) brings this Accusation solely in her official capacity

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

20 2. On or about April 4, 1983, the Medical Board of California issued Physician's and

21 Surgeon's Certificate Number A 39659 to Ravi Kant Gogna, M.D. (Respondent). The Physician's

22 and Surgeon's Certificate was in full force and effect at all times relevant to the charges brought

23 herein and will expire on July 31, 2014, unless renewed.

24 JURISDICTION

25 3. This Accusation is brought before the Medical Board of California (Board),

26 Department of Consumer Affairs, under the authority of the following laws. All section

27 references are to the Business and Professions Code unless otherwise indicated.

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Accusation

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4. Section 2220 of the Code states:

Except as otherwise provided by law, the board may take action against all persons guilty of violating this chapter [Chapter 5, the Medical Practice Act]. The board shall enforce and administer this article as to physician and surgeon certificate holders, and the board shall have all the powers granted in this chapter for these purposes including, but not limited to:

(a) Investigating complaints from the public, from other licensees, from health care facilities, or from the board that a physician and surgeon may be guilty of unprofessional conduct. The board shall investigate the circumstances underlying any report received pursuant to Section 805 within 30 days to determine if an interim suspension order or temporary re·straining order should be issued. The board shall otherwise provide timely disposition of the reports received pursuant to Section 805. ·

5. 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, placed on probation and required to pay the costs of probation monitoring, or such other

action taken in relation to discipline as the board deems proper.

6. Section 2234 of the Code, states:

The board shall talce action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, tmprofessional conduct includes, but is not limited to, the following:

(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 om1ss1on 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.

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Accusation

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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.

FIRST CAUSE FOR DISCIPLINE

[Bus. & Prof.§ 2234(b)]

(Gross Negligence as to Patient A.P.)

Patient A.P. 1

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

1 O that Respondent was grossly negligent in his care, treatment and management of patient A.P. The

11 circumstances are as follows.

12 9. On or about November 16, 2010, A.P. a 31-year old female, presented to the

13 Emergency Depmtment of Kaiser Foundation Hospital in Modesto (hereinafter "Emergency

14 Department") with a chief complaint of syncope with a fall. The nursing notes mentioned that

15 A.P. complained of a "lump" on the back of her head. A.P.'s medical history included

16 hypertension, mitral valve regurgitation, tricuspid valve regurgitation, pulmonic valve

17 regurgitation, migraine, panic disorder, anxiety disorder and paroxysmal supraventricular

18 tachycardia2 ("SVT") A.P. was previously diagnosed with SVT.

19 10. Respondent's charting of A.P.'s history was as follows:

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Pt was upstairs in ICE-talking to a pt. She began to feel dizzy and then had a syncopal episode. When she came to-she was on the floor. Had a mild headache from her fall-but otherwise felt fine and alert. Has no other new sx since then.

23 11. Respondent's charting of his neurological examination stated: "Neurological:

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Negative for sensory change, focal weakness and seizures.''

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1 The patient's full name has been withheld to protect their privacy but it will be disclosed as part of discovery.

2 Supraventricular tachycardia is a rapid heart rate (tachycardia, or a heart rate above 100 beats per minute) that is caused by electrical impulses that originate above the heart's ventricles.

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Accusation

1 12. Respondent's charting failed to mention the presence or absence of symptoms or

2 signs prior to the syncopal episode. In addition, Respondent's charted physical examination

3 failed to mention whether a scalp examination was performed despite A.P. 's complaint of a

4 "lump" on her head. Further, Respondent's charted neurological examination did not include a

5 cranial nerve examination. Orthostatic vital signs3 were not taken,

6 13. Respondent diagnosed A.P. with syncope without evaluating the potential causes of

7 the syncopal episode when A.P. had cardiac risk factors with cardiac valvular abnormalities and a

8 history of SVT and the cause of A.P, 's syncopal episode could have been cardiac in nature.

9 14. Respondent failed to consider a cardio1ogical consult for A.P. and if available, failed

10 to compare A.P.'s existing EKG with any previous ones.

11 15. Respondent was grossly negligent in his care and treatment of patient A.P., including,

12 but not limited to the following:

13 a. Respondent failed to obtain a clear history of signs or symptoms prior to the syncopal

14 episode to assist in evaluating whether the cause of A.P. 's syncopal episode may have been

15 cardiac in nature, in light of A.P.'s medical history, as more fully set forth in paragraphs 10-15

16 above and incorporated by this reference as though set forth in full herein;

17 b. Respondent's neurological examination of A.P. failed to include a cranial nerve

18 examination and a scalp examination, as more fully set forth in paragraphs 10 - 15 above and

19 incorporated by this reference as though set forth in full herein;

20 c. Respondent failed to take and/or order orthostatic vital signs to be taken, as more

21 fully set forth in paragraphs 10 - 15 above and incorporated by this reference as though set forth

22 in full herein; and,

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d. Respondent failed to adequately evaluate the cause of AP. 's syncope through a

cardiac consultation or review of prior EK Gs to compare with the EKG taken during the

November 16, 2010 visit, as more fully set forth in paragraphs 10 - 15 above and incorporated by

this reference as though set forth in full herein.

3 Orthostatic vital signs are a series of vital signs of a patient taken while the patient is supine, then repeated with the patient sitting up then while standing.

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Accusation

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SECOND CAUSE FOR DISCIPLINE

[Bus. & Prof. §§ 2234 & 2266]

(Unprofessional Conduct - Failure to Maintain Adequate

and Accurate Medical Records as to Patient A.P.)

5 16. Respondent is subject to disciplinary action under sections 2234 and 2266 for

6 unprofessional conduct in that Respondent failed to maintain adequate and accurate medical

7 records for patient AP., as more fully set forth in. paragraphs 10 - 15 above and incorporated by

8 this reference as though set forth in full herein.

9 THIRD CAUSE FOR DISCIPLINE

10 [Bus. & Prof.§ 2234]

11 (Gross Negligence as to Patient L.A.)

12 Patient L.A.

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

14 that Respondent was grossly negligent in his care, treatment and management of patient L.A. The

15 circumstances are as follows.

16 18. On or about November 25, 2010, L.A., a 92-year old female presented to the

17 Emergency Department with complaints to the triage nurse of "discoloration of both feet, toes"

18 and a concern about taking Coumadin, an anticoagulant. Her vital signs were normal except for

19 mild bradycardia. L.A. did not complain of pain, numbness or tingling. The nursing note

20 mentioned that both legs were dark and discolored and bilateral discoloration of the toes.

21 19. Respondent's notes from his physical examination stated:

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Physical Exam Vitals reviewed. Constitutional: She appears well-developed and well-nourished. No distress. Musculoskeletal:

Bilateral feet Diffuse blanching redness over all toes. Skin normal Temp. Good sensation. Good pulses. Neurological: She is alert. She has normal reflexes.

5

Accusation

1 20. Respondent failed to chart examining L.A. 's calves for swelling or cords and

2 performing a capillary refill test of L.A.' s toes to determine if there is normal blood flow to

3 the tips of L.A.' s toes. Respondent did not chart whether there was increased warmth in

4 L.A. 's toes that could indicate an infection. Respondent did not chart examination of

5 L.A. 's heart or lungs.

6 21. Respondent's assessment was "skin discoloration --?early frostbite. No

7 evidence of infection." Respondent's plan of care was "home flu with PCP if no

8 improvement."

9 22. L.A. 's laboratory results were returned at 2117 hours on November 25, 2010,

1 O showing levels of Coumadin that exceeded the therapeutic value, requiring intervention.

11 Without intervention, a potential for significant bleeding existed.

12 23. L.A. was discharged at 0041 hours on November 26, 2010. Respondent's

13 discharge instructions did not include instructions to L.A. to address the elevated levels of

14 Coumadin by, for example, instructing L.A. to stop taking Coumadin for a day or

15 recommending that she be re-tested the following day. Respondent failed to take any steps

16 to address the elevated levels of Coumadin.

17 24. Respondent committed gross negligence in his care and treatment of patient L.A. by

18 failing to address and manage the elevated levels of Coru11adin, as more fully set forth in

19 paragraphs 19 - 24 above and incorporated by this reference as though set forth in full herein.

20 FOURTH CAUSE FOR DISCIPLINE

21 [Bus. & Prof.§§ 2234 & 2266]

22 (Unprofessional Conduct~ Failure to Maintain Adequate

23 • and Accurate Mcclical Records as to Patient L.A.)



26 records for patient L.A., as more fully set forth in paragraphs 18 - 24 above and incorporated by


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1 FIFTH CAUSE FOR DISCIPLINE

2 [Bus. & Prof. §§ 2234 & 2266]

3 (Unprofessional Conduct - Failure to Maintain Adequate

4 and Accurate Medical Records as to Patient T.S.)

5 Patient T.S.



8 records for patient T.S. The circumstances are as follows.

9 27. On or about November 15, 2010, patient T.S., a 55-year old female, presented to the

1 O Emergency Department after a shower door shattered and fell on her. T.S. described having a

11 headache before falling toward the shower door. She denied any loss of consciousness and

12 denied any head trauma. T.S. complained of muscle aches and pains. Her vital signs were

13 normal with reported continuous throbbing head pain rated as an "8" on a scale of "1 - 1 O." The

14 nursing assessment stated: "deep lac to left temportal [sic] area; lac superficial to left pinna;

15 small cuts to cheek; rt fingers; along rt elbow; bruising around left periorbital area."

16 28. Respondent's charting ofT.S.'s history was as follows:

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Lost her balance and fell in shower. The door shattered and fell on her. Sustained multiple lacerations. Happened couple hours ago. No LOC.

20 29. Respondent's notes from his physical examination stated, in part:

HENT: 2 cm jagged lac above left eyebrow.

Orbital rim OK. No injury to the globe.

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Eyes: Conjunctivae and extraocular motions are normal. Pupils are equal, round, and reactive to light.

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Neck: Normal range of motion. Neck supple. No thyromegaly present. Cardiovascular: Normal rate, regular rhythm and normal heart sounds ... Musculoskeletal: R Elbow-superficial laceration. full ROM. Neurological: She is alert and oriented. She has normal reflexes.

7

Accusation

1 30. Respondent's diagnosis and plan were as follows:

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A-Lacerations P -Facial laceration cleansed and sutured with 5-0 nylon. Suture removal in 7 days.

4 31. Respondent's charting failed to describe exploration of the laceration on T.S.'s face,

5 since glass was later discovered in T.S. 's laceration.

6 32. Respondent failed to maintain adequate and accurate medical records for patient T.S.,

7 including but not limited to the following:

8 a. Respondent failed to document that he inquired into the specifics of the headaches

9 experienced by T.S. before and.after the fall in order to determine if the headache contributed to

1 O the fall, as more fully set forth in paragraphs 28 - 32 above and incorporated by this reference as

11 though set forth in full herein;

12 b. Respondent failed to document performing and/or ordering another pain assessment

13 before discharging T.S., as more fully set forth in paragraphs 28 - 32 above and incorporated by

14 this reference as though set forth in full herein.;

15 c. Respondent failed to document examination of T.S. 's strength, head (for trauma),

16 extremities or back, as more fully set forth in paragraphs 28 - 32 above and incorporated by this

17 reference as though set forth in full herein; and,

18 d. Respondent failed to adequately describe the laceration on T.S.'s face and failed to

19 document exploration of the laceration for bony involvement or foreign body in that it was later

20 discovered that T.S. had retained glass in her laceration, as more fully set forth in paragraphs 28-

21 32 above and incorporated _by this reference as though set forth in full herein.

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Accusation

1 SIXTH CAUSE FOR DISCIPLINE

2 [Bus. & Prof. §§ 2234 & 2266]

3 (Unprofessional Conduct - Failure to Maintain Adequate

4 and Accurate Medical Records as to Patient K.M.)

5 Patient K.M.



8 records for patient K.M. The circumstances are as follows.

9 34. On or about November 22, 2010, patient K.M., a 55-year old male patient, presented

10 to the Emergency Department with complaints of high blood pressure recorded at home and

11 tingling in his left arm. K.M.'s blood pressure when taken in the Emergency Department at 0651

12 hours was 145/94, which decreased to 129/83 at 0742 hours. The nursing notes stated: "Pt c/o

13 high bp at home, was on his way to work and had left arm tingling and came to er. Pt states he

14 has been under a lot of stress lately. Denies CP [chest pain] or SOB [shortness of breath]."

15 35. K.M.'s medical history included peripheral nervous system disorder and

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hypertension. Respondent's physical examination of K.M. was charted as follows:

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Physical Exam Constitutional: He is oriented. He appears well-developed and well-nourished.

No distress. Eyes: Conjunctivae and extraocular motions are normal. Pupils are equal,

round, and reactive to light. Neck: Normal range of motion. Neck supple. No thyromegaly present. Cardiovascular: Normal rate, regular rhythm and normal heart sounds. Normal pulses. Pulmonary/Chest: Effort normal and breath sounds normal. No respiratory

distress. He has no wheezes.

Neurological: He is alert and oriented. He has normal reflexes. EKG - NSR. WNL.

25 36. Respondent diagnosed K.M. with hypertension. K.M. was discharged 1 hour and 12

26 minutes after his arrival. Respondent failed to address K.M. 's complaint of left arm tingling and

27 there is no documentation that he evaluated this complaint.

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Accusation

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37. Respondent failed to maintain adequate and accurate medical records for patient

I(M., including but not limited to the following:

a. Respondent failed to document information regarding how long K.M. had been

experiencing left arm tingling and whether K.M. continued to experience it while he was in the

Emergency Department, as more fully set forth in paragraphs 3 5 - 3 7 above and incorporated by

this reference as though set forth in full herein;

b. Respondent failed to document a neurological examination ofK.M.'s left arm, as

8 more fully set forth in paragraphs 35 - 37 above and incorporated by this reference as though set

9 forth in full herein; and,

10 c. Respondent failed to address K.M.'s left arm tingling in his discharge diagnosis and

11 failed to document that he evaluated this complaint, as more fully set forth in paragraphs 35 - 37

12 above and incorporated by this reference as though set forth in full herein.

13 SEVENTH CAUSE FOR DISCIPLINE

14 [Bus. & Prof.§ 2234(c)]

15 (Repeated Negligent Acts)

16 Patient V .R.

17 38. Respondent is subject to disciplinary action under section 2234, subdivision (c), of

18 the Code in that he committed repeated negligent acts.

19 39. On or about November 14, 2010, patient V.R., a 52-year old female, presented to the

20 Emergency Department after having consumed alcohol and taken "a handful ofMotrin."

21 According to the nursing assessment: "Pt and family were arguing saying that noone [sic] wants

22 her. Family stated that took a handful of 200mg Motrin ETOH use." V.R. stated she took 8

23 200mg Motrin for back, hip and knee pain. V.R. denied trying to harm herself. When V.R. was

24 interviewed further by the nursing staff, she stated was not trying to kill herself nor did she have

25 plans to hurt herself. V.R. stated she was drinking too much and got mad at her family.

26 40. V.R.'s vital signs were normal except for hypertension and tachycardia. Both later

27 normalized. V.R. complained of back pain, which she rated a "6" on a scale of"l - 10."

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Accusation

1 41. Respondent's physical examination notes were as follows:

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Physical Exam Vitals reviewed. Constitutional: She is oriented. She appears well-developed and wellnourished. No distress. Eyes: Conjunctivae and extraocular motions are normal. Pupils are equal, round, and reactive to light. Neck: Normal range of motion. Neck supple. No thyromegaly present. Cardiovascular: Normal rate, regular rhythm and normal heart sounds. Normal pulses. Pulmonary/Chest: Effort normal and breath sounds normal. No respiratory distress. She has no wheezes.

Neurological: She is alert and oriented. She has normal reflexes. Psychiatric: She has a normal mood and affect. Her behavior is normal.

11 42. V.R.'s laboratory tests were essentially normal except for mild anemia, elevated

12 blood alcohol level of .183, elevated glucose at 411 with a mildly elevated anion gap of 18 with

13 negative ketones. Respondent's assessment was: "l. Drug ingestion. No suicidal ideation.

14 2. Diabetes." His plan was to treat V.R. with IV fluids and insulin. V.R. was discharged home

15 with Metformin for hyperglycemia.

16 43. Respondent committed repeated negligent acts as follows:

17 a. Respondent committed negligence in his care, treatment and management ofV.R.,

18 including but not limited to the following:

19 i. Respondent fail~d to appropriately evaluate V.R.'s potential for self-harm such

20 as, for example, examining V.R. for evidence of previous attempts to harm herself and exploring

21 why V .R. took Motrin, as more fully set forth in paragraphs 40 - 43 above and incorporated by


23 ii. Respondent's diagnoses did not include alcohol intoxication, as more fully set

24 forth in paragraphs 40 - 43 above and incorporated by this reference as though set forth in full

25 herein.

26 iii. Respondent did not recommend planned follow up for V.R. to address her

27 emotional/potentially psychiatric problems, as more fully set forth in paragraphs 40 - 43 above

28 and incorporated by this reference as though set forth in full herein.

11

Accusation

b. Respondent committed negligence in his care and treatment of patient A.P.,

2 including, but was not limited to the following:

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1. Respondent failed to obtain a clear history of signs or symptoms prior to

syncope to assist in evaluating whether the cause of A.P.'s syncopal episode may have been

cardiac in nature, in light of A.P. 's history of cardiac abnormalities and SVT, as more fully set

forth in paragraphs 10 - 15 above and incorporated by this reference as though set forth in full

herein;

ii. Respondent's neurological examination of A.P. failed to include a cranial nerve

examination and a scalp examination, as more fully set forth in paragraphs 10 - 15 above and

incorporated by this reference as though set forth in full herein;

iii. Respondent failed to take and/or order orthostatic vital signs to be taken, as

more fully set forth in paragraphs 10 - 15 above and incorporated by this reference as though set

forth in full herein; and,

iv. Respondent failed to adequately evaluate the cause of A.P.'s syncope through,

for example, a cardiac consultation or review of prior EK Gs to compare with the EKG taken

during the November 16, 2010 visit, as more fully set forth in paragraphs 10 - 15 above and

incorporated by this reference as though set forth in full herein.

c. Respondent committed negligence in his care and treatment of patient L.A. by failing

19 to address and manage the elevated levels of Coumadin, as more fully set forth in paragraphs 19 -

20 24 above and incorporated by this reference as though set forth in full herein.

21 PRAYER

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

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

24 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 39659,

25 issued to Ravi Kant Gogna, M.D.;

26 2. Revoking, suspending or denying approval of Ravi Kant Gogna, M.D.'s authority to

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

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12

Accusation

1 3. Ordering Ravi Kant Gogna, M.D., if placed on probation, to pay the Medical Board ·

2 · of California the costs of probation monitoring; and,

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4. Taking such other and further action as deemed

5 DATED: May 17, 2013

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SA20!2107719

70696659.docx

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

13

Accusation

Documents

BEFORE THE MEDICAL BOARD OF CALIFORNIA ...4patientsafety.org/documents/Gogna, Ravi Kant 2014-08-01.pdfRAVI KANT GOGNA, M.D. OAHNo. 2013070282 7417 Spyglass Drive Modesto, CA 95356