BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

BAKHTIAR MOUSSAZADEH, M.D.

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Case No. 17-2012-226761

Physician 1 s and Surgeon 1 s Certificate No. A 10861

Respondent

OAH No. 2015050327

DECISION

The attached Proposed Decision is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00p.m. on April22, 2016.

IT IS SO ORDERED March 23, 2016.

MEDICAL BOARD OF CALIFORNIA

By:/.1;; . ..,At;.... , ,MU mvard Krauss, M.D., Chair

Panel B

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against: Case No. 17-2012-226761

BAKHTIAR MOUSSAZADEH, M.D., OAH No. 2015050327

Physician and Surgeon's Certificate No. Al0861,

Respondent.

PROPOSED DECISION

This matter was heard by LaurieR. Pearlman, Administrative Law Judge (AU) with the Office of Administrative Hearings (OAH), on December 14- 16, 2015, in Los Angeles, California. Complainant was represented by E.A. Jones III, Supervising Deputy Attorney General. Bakhtiar Moussazadeh, M.D. (Respondent) was present and was represented by Laura C. McLennan, attorney at law.

Oral and documentary evidence was received, and argument was heard. The record closed, and the matter was submitted for decision on December 17, 2015.

FACTUAL FINDINGS

1. On January 21, 2015, an Accusation was filed against Respondent in this matter by Complainant Kimberly Kirchmeyer in her official capacity as the Executive Director of the Medical Board of California (Board), Department of Consumer Affairs.

2(a). On June 30, 2009, the Board issued Physician and Surgeon's Certificate Number A108651 to Respondent. Respondent's Certificate was in full force and effect at all relevant times, and has been renewed through March 31, 2017.

2 (b). The Accusation and all other statutorily required documents were properly served on Respondent on January 21, 2015. Respondent timely filed his Notice of Defense contesting the Accusation, and this matter ensued.

3. Respondent, who graduated from UCLA with a B.S. degree, attended medical school outside of the United States from 2001 to 2006. He interned in New York from 2006 to 2007. Between 2007 and 2010, Respondent was in an anesthesiology residency at Cedars-

Sinai Medical Center in Los Angeles (Cedars-Sinai). From 2010 through 2011, Respondent participated in a pain management fellowship at Cedars-Sinai. On April 15, 2011, Respondent became board-certified in anesthesiology by the American Board of Medical Specialties. From August 2012 to 2013, Respondent participated in an anesthesia fellowship program at Cedars-Sinai, providing anesthesia in liver tr.ansplant cases.

4. On August 26,2010, Respondent's two brothers, Pirooz Moussazadeh, age 27, and Shahriar Moussazadeh, age 38, were shot to death as the victims of a botched robbery. Respondent comes from a very tight-knit family, and has no other siblings.

5. On November 19, 2011, while preparing to provide anesthesia for a surgical case at Cedars-Sinai, at or around midnight, Respondent insufflated1 sevoflurane2

through a gauze pad. Respondent repeated this conduct (insufflating the gas during the preparation for a case) eight or nine times in the next two to three weeks. The effect on him was one of disassociation which lasted 30 to 45 seconds. He stated that the use was dangerous, but that the concentration or potency he used was not potentially life-threatening.

6. On December 5, 2011, while preparing an anesthesia case around 7:00a.m., Respondent spilled sevoflurane and wiped it up with gauze. Instead of disposing of the gauze, he placed it over his nose and insufflated the gas. An attending physician observed the behavior and reported it. Respondent subsequently took a leave of absence from Cedars­Sinai, effective December 8, 2011.

7. Respondent began therapy with Ronit Davidyan, a Licensed Clinical Social Worker, in early December 2011. Respondent saw Davidyan for therapy approximately once a week until February 2012. Thereafter, he saw her every month or two until January 2013.

8. On December 16, 2011, Respondent underwent an addiction outpatient evaluation by Itai Danovitch, M.D., a psychiatrist. She noted that Respondent acknowledged the first use, and admitted doing it again eight or nine times after that. Dr. Danovitch

1 Insufflation is the act of blowing something (e.g., a medicinal substance) into a body cavity, such as the mouth or nostrils.

= Sevoflurane, a halogenated general inhalation anesthetic drug, is indicated for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery. Facilities for maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitation must be immediately available. Since the level of anesthesia may be altered rapidly, only vaporizers producing predictable concentrations of sevoflurane should be used. Sevoflurane is a dangerous drug within the meaning of Business and Professions Code (Code) section 4022.

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indicated that Respondent met the criteria for complicated bereavement. She stated, that though she did not see evidence of dependence," ... the episode certainly meets the criteria for abuse and places him at high risk for future substance dependence, particularly given his occupational hazard." Her diagnosis was "Chronic adjustment disorder (complicated bereavement); Inhalant abuse, no dependence." (Exh. 7, p. 82.)

9. Respondent sought to return to work at Cedars-Sinai on March 1, 2012. On March 28, 2012, Dr. Danovitch wrote a referral letter recommending that Respondent continue weekly therapy with Ronit Davidyan for a two year period.

10. Respondent contacted the Pacific Assistance Group (PAG) on May 1, 2012, in order to participate in its monitoring program; he started a random drug-testing program3 and entered a peer support group with PAG.

11. Before returning from his leave of absence, Respondent signed a behavioral contract with Cedars-Sinai on May 12, 2012, in which he agreed to abstain from the use of alcohol and mood-altering drugs, and to continue therapy with a psychiatrist.

12. On June 8, 2012, a fitness for duty report was produced by Michel A. Sucher, M.D. Dr. Sucher reported that Respondent was deeply affected by the deaths of his brothers, and attributed his conduct to his failure to deal with the bereavement issues related to the murder of his two brothers in 2010. Dr. Sucher stated that Respondent admitted using anesthetic gas, in or around November 2011, which resulted in "a good feeling." According to Dr. Sucher, when Respondent used the gas a second time he was observed and sent home. This led to his leave of absence. After discussing Respondent's progress with his therapist, Dr. Danovitch, and others, Dr. Sucher concluded that Respondent was fit for duty, so long as he abstained from drugs, underwent random drug testing, obtained a worksite monitor, and continued therapy with Dr. Danovitch.

13. Respondent was authorized to return to work by letter dated June 29, 2012. He signed a revised behavioral contract on June 29, 2012.

14. By letter dated July 10,2012, Respondent's request to return to Cedars-Sinai from the leave of absence was granted, effective August 3, 2012. Respondent met with his psychiatrist, Dr. Danovitch, on July 31, 2012. She noted that with respect to his inhalant abuse, he was in early remission, was continuing therapy with a therapist, was undergoing drug screening with PAG, and was psychiatrically stable. Dr. Danovitch strongly

l Biological fluid testing of Respondent was negative for controlled substances on January 6, 2012, January 22, 2012, February 7, 2012, March 14, 2012, April 12, 2012, and May 24, 2012.

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recommended that Respondent continue with psychotherapy once a week for the next two years.

15. On September 4, 2012, after returning to Cedars-Sinai from the leave of absence, Respondent again insufflated sevoflurane. An individual observed Respondent's behavior in the operating room, and reported it. Respondent denied drug use when questioned by his superiors, but later that evening admitted it to his PAG monitor, who reported it to the hospital.

16. Respondent requested a second leave of absence from Cedars-Sinai on September 6, 2012, which was granted on September 14, 2012.

17. On September 20, 2012, Cedars-Sinai filed a report pursuant to Code section 805, advising the Medical Board that Respondent had taken a leave of absence after an investigation of his behavior had been started.

18. On September 24, 2012, Respondent entered a four-day program for evaluation and stabilization of his drug abuse situation at the Mission Hospital Chemical Dependency Program in Laguna Beach. He was discharged into a 30-day residential program at Northbound Treatment Services (NTS), where he received counseling and participated in group therapy sessions. Respondent completed his time at NTS on October 27, 2012. Respondent was fully compliant with the program at NTS.

19. On December 6, 2012, Edward Kaufman, M.D., Medical Director of NTS, stated that for Respondent to return to work he needed to be substantially more involved in AA meetings, start random urine testing, establish a program with his sponsor, and obtain a work site monitor.

Respondent's Evidence

20. Respondent is 38 years-old. He has a wife and two young children for whom he provides the sole financial support. Respondent was a highly-respected and exemplary anesthesiology resident. He was awarded prestigious anesthesiology fellowships at Cedars­Sinai in pain management and liver transplant. However, on August 26, 2010, his life changed in an instant when his only two siblings were brutally murdered at home.

21. After his brothers' murders, Respondent was tasked with identifying their remains. He was haunted by disturbing memories of this highly traumatic experience. He was eventually diagnosed with post-traumatic stress disorder. Rather than deal with these disturbing memories, and his devastating feelings of loss and despair, Respondent believed it was his duty to be a pillar of strength for his parents and extended family. In counseling, he learned how to deal with his loss and how to begin to heal from this trauma. Respondent has

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developed effective coping mechanisms. These include sharing his feelings, participating in psychotherapy and support groups, working with his sponsor, and accepting emotional support from his wife and others. He feels that he has obtained the tools needed to allow him to fully heal from the loss of his brothers. His wife and young children are strong motivation for his continued recovery.

22. Respondent first abused sevoflurane on November 19, 2011, shortly after his murdered brother's birthday. His abuse of sevoflurane in September 2012 occurred close to the religious anniversary of his brothers' murders. In therapy, Respondent was told that his actions were cries for help, and that he clearly intended to be caught.

23. Within days of beginning his leave of absence in the fall of 2012, Respondent began intensive therapy. He voluntarily was admitted as an inpatient at Mission Hospital Chemical Dependency Program from September 24 to 28, 2012. On the day of discharge from Mission Hospital, Respondent was admitted for extended inpatient therapy for an additional 30 days, both in a group, and as an individual, at NTS. On September 24, 2012, he began to attend regular self-help meetings. Respondent continues to attend 12-step meetings two to three times per week.

24. Respondent enrolled in a Trauma Recovery Group at Newport Wellness Center from October 8 through November 7, 2012.

25. On November 5, 2012, Respondent signed a contract with California Physicians Health Program (CPHP) under the supervision of Dr. Sucher. Dr. Sucher specializes in working with physicians dealing with drug addiction, and other related problems. While with CPHP, Respondent underwent evaluation, therapy and randomized drug screenings, all of which were negative.

26. After extensive therapy, Respondent and his therapists concluded that he could safely resume the practice of anesthesia. Respondent last inhaled sevoflurane nearly three­and-a-half years ago, in September 2012. He has remained substance-free since that time, with the sole exception of prescription narcotic analgesics following two shoulder surgeries in 2015. After both surgeries, Respondent weaned himself from pain medication sooner than expected by his surgeon.

27. With the support and assistance of former Board president, Ronald Wender, M.D., Respondent actively began to seek employment as an anesthesiologist in spring 2013. In August 2013, he was hired by Upland Anesthesia Medical Group (now known as Allied Anesthesia Medial Group), after undergoing a meticulous vetting process. He has worked with Allied Anesthesia without a single problem for nearly two and a half years. When he applied to Upland/Allied Anesthesia, Respondent was completely forthright about his incidents of sevoflurane abuse in 2011 and 2012 at Cedars Sinai, and made no effort to hide

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or mm1m1ze it. As part of his employment, he willingly agreed to undergo random toxicology screening. Without a single exception, these random drug screenings have been negative.

28. Since August 2013, Respondent has been successfully working full-time as a staff anesthesiologist at St. Mary's Medical Center in Apple Valley, where he is held in high esteem by his professional colleagues. St. Mary's has retained the right to randomly drug test respondent as part of granting him hospital privileges.

29. To further verify that he is fit, from a psychiatric perspective, to practice anesthesia without any oversight, proctoring, or monitoring, Respondent underwent an independent psychiatric evaluation by Timothy Pylko, M.D., on July 28, 2015. Dr. Pylko's professional practice focuses primarily on patients dealing with addictive personalities and the problems related thereto, as well as the underlying causes for their addictive behavior. Dr. Pylko testified credibly at hearing, and submitted a report. He interviewed Respondent and found him to be completely free of any anxiety or depressive symptoms. Dr. Pylko was particularly impressed by the psychological growth Respondent demonstrated in his therapy and in his commitment to sobriety. Dr. Pylko did not find Respondent to have any severe addictive behaviors. He believes that Respondent's abuse of sevoflurane was an attempt to deal with the anxiety, depression, and overwhelming dysphoria which followed the death of his brothers. It is Dr. Pylko' s professional opinion that Respondent is not at risk of recurrence for any of his prior maladaptive behaviors. Dr. Pylko sees no evidence of any risk to the general public should Respondent be allowed to practice fully and independently.

30(a). On September 18, 2015, Dr. Sucher, with the CPHP, also conducted a thorough evaluation of Respondent. Dr. Sucher testified credibly at the hearing, and submitted a report. He found Respondent to be in full compliance with CPHP requirements. Each of Respondent's urine drug screens has been negative. Respondent demonstrates "a high quality of sobriety" and has a strong recovery program in place. Dr. Sucher feels that Respondent's prognosis for ongoing successful recovery is excellent, and believes that there are no safety issues regarding his practice of medicine.

30(b ). If Respondent were to receive a Public Letter of Reprimand, in lieu of probation, Respondent has committed to participating in ongoing monitoring with CPHP and Dr. Sucher. This would include monitoring, randomized drug testing, and therapy (as recommended by CPHP and memorialized in writing through a contract between CPHP and Respondent.) Respondent understands that any significant failure to comply with the requirements of CPHP would be reported immediately to the Board, and would have serious repercussions.

31. Respondent did not deny the facts upon which the Accusation is based. He asserts that there is no purpose to be served by imposing discipline at this point in time. Respondent believes that he has taken all necessary measures to recover from his devastating

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loss and has demonstrated over the past two-and-a-half years that his practice of medicine poses no risk to the public. Aside from the isolated abuse of sevoflurane in 2011 and 2012, he has successfully practiced anesthesia without incident. Respondent has been told that if he were to be placed on probation, he would lose his job with Allied Anesthesia Medial Group because he would not be able to retain his hospital privileges, would be unable to receive insurance reimbursement for his services, and would be unable to obtain malpractice insurance. As a result, he would be foreclosed from the practice of anesthesiology, which he loves because it enables him to help people during a highly stressful period.

32. Respondent submitted numerous letters of support from professional colleagues, sobriety sponsors, his treating orthopedic surgeon, and family members. Each of them is fully aware of his incidents of sevoflurane abuse and this disciplinary proceeding. The writers praise Respondent for his compassion, skills as a physician, exemplary work ethic, commitment to his family, and consistent emotional equilibrium.

LEGAL CONCLUSIONS

1. Code section 2227 provides that a licensee who is found to be in violation of 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 may be publicly reprimanded.

2. Code section 2234 provides that the board shall take action against any licensee who is charged with unprofessional conduct.

3. Code section 2239 provides that unprofessional conduct includes self-administering any dangerous drug specified in Code section 4022,4 in such a manner as to be dangerous or injurious to the licensee, to any other person, or to the public, or to the extent that such use impaired his ability to practice medicine safely.

4. Cause exists to discipline Respondent's physician's and surgeon's certificate, pursuant to Code section 2239, in that Complainant established, by clear and convincing evidence, that Respondent used a dangerous drug to the extent, or in such a manner as to be dangerous or injurious to himself, or to any other person or to the public, or to the extent that such use impaired his ability to practice medicine safely, as set forth in Factual Findings 1-19.

Ill 5. Cause exists to discipline Respondent's physician's and surgeon's certificate,

4 A dangerous drug is one that requires a prescription.

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pursuant to Code section 2239 in that Complainant established, by clear and convincing evidence, that Respondent engaged in unprofessional conduct, as set forth in Factual Findings 1-19.

Analysis re: Level of Discipline

6(a). Complainant established that cause for discipline exists, and the Board must acknowledge, to both the public and the medical community, that the acts and omissions of Respondent were not in compliance with the Business and Profession Code. The remaining question is the nature of the discipline to be imposed against Respondent's certificate for his violations.

6(b). Complainant argues that the Uniform Standards for Substance-Abusing Licensees (Uniform Standards) (Cal. Code Regs., tit. 16, § 1361, et seq.), which took effect on July 1, 2015, are mandatory and must be implemented, without any discretion to deviate therefrom. At hearing, Respondent asserted that since the incidents at issue in this proceeding occurred in 2011 and 2012, almost three years before the Uniform Standards took effect, their application herein would be retroactive, and therefore, improper. Both contentions lack merit. Application of the Uniform Standards in this matter would not constitute a retroactive

application. (See Bradley v. School Bd. of Richmond, 416 U.S. 696, 711.) Nor has Complainant established that the ALJ lacks any discretion whatsoever to deviate therefrom. In fact, Code section 2227 provides a range of disciplinary measures from which to choose, in order to protect the public and to aid in rehabilitating the licensee, who has established that he is no longer a substance abuser:s

Section 1361, subdivision (a), of the Uniform Standards states that in reaching a decision on a disciplinary action, deviation from the disciplinary guidelines is appropriate where the Board, in its discretion, determines that the presence of mitigating factors warrants such a deviation.

6(c). Code section 2229, provides, in pertinent part:

(a) Protection of the public shall be the highest priority for the Division of Medical Quality, ... and administrative law judges of the Medical Quality Hearing Panel in exercising their disciplinary authority.

(b) In exercising his or her disciplinary authority an administrative law

5 In Complainant's BriefRe: Retroactivity of the Uniform Standards, Complainant concedes that "the Uniform Standards did not substantively change the discretion the Board has under Business and Professions Code section 2227 to discipline physicians." (Brief, 2:12-3:2.)

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judge of the Medical Quality Hearing Panel, [or] the division, ... shall, wherever possible, take action that is calculated to aid in the rehabilitation of the licensee ...

6(d). Code section 2227, subdivision (a), provides:

(a) A licensee whose matter has been heard by an administrative law judge of the Medical Quality Hearing Panel as designated in Section 11371 of the Government Code, ... and who is found guilty, or who has entered into a stipulation for disciplinary action with the division, may, in accordance with the provisions of this chapter:

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

(2) Have his or her right to practice suspended for a period not to exceed one year upon order of the division.

(3) Be placed on probation and be required to pay the costs of probation monitoring upon order of the division.

( 4) Be publicly reprimanded by the division.

(5) Have any other action taken in relation to discipline as part of an order of probation, as the division or an administrative law judge may deem proper.

[Emphasis added.]

6( e). Protection of the public is the primary purpose of the Board, not punishment of the licensee. Under the unusual circumstances presented here, subjecting Respondent to a term of probation would be harsh and unduly punitive. Rather than aiding his rehabilitation, it would effectively end his career as an anesthesiologist. Respondent's use of sevoflurane in 2011 and 2012 was aberrant and isolated behavior, occasioned by the severe emotional trauma stemming from the murder of his only two siblings. The passage of time since his brothers' murders appears to have allowed a degree of healing for his intense grief.

Respondent established significant mitigation and rehabilitation, as set forth in Factual Findings 20-32. He demonstrated sustained compliance with a recovery program. Respondent established consistent and sustained participation in activities which promote and support recovery, including drug-testing, on-going therapy, and support meetings. Respondent has accepted full responsibility for his actions and has worked diligently to achieve and maintain his recovery. Significantly, he is no longer a substance abusing

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licensee; he has maintained his sobriety for nearly three-and-a-half years. Respondent has successfully worked as an anesthesiologist without incident for nearly two-and-a-half years. His employment contract with Allied Anesthesia Medical Group requires him to undergo random drug testing, as does the hospital where he has privileges. Moreover, Respondent has committed to entering into a contract with CPHP and Dr. Sucher for monitoring, randomized drug testing, and therapy. Any significant failure to comply with the requirements of CPHP would be reported immediately to the Board. All of these factors provide effective public protection, without ending Respondent's career.

6(f). Given the foregoing, a public reprimand will best protect the public without imposing overly harsh and punitive discipline on Respondent. Issuance of a letter of reprimand would be public discipline, which would provide appropriate notice to patients and the public. License revocation or suspension would be strictly punitive, and the probation conditions set forth in the disciplinary guidelines (e.g., evaluations, notice to employer, biological fluid testing, and group support meetings) would duplicate the actions Respondent has already taken.

ORDER

Respondent is hereby reprimanded under Business and Professions Code section 2227, subdivision (a)(4).

DATED: January 13, 2016

LAURIE R. PEARLMAN Administrative Law Judge Office of Administrative Hearings

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FILED

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KAMALA D. HARRIS STATE OF CALIFORNIA

MEDIC.AL BOARD OF CALIFORNIA Attorney General of California E. A. JONES III Supervising Deputy Attorney General State Bar No. 71375

SA~RJ\M~N~~d~ 20.15.. B't~~ ? \. " NAL YST

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California Department of Justice 300 So. Spring Street, Suite 1702 Los Angeles, CA 90013 Telephone: (213) 897-2543 Facsimile: (213) 897-9395

Attorneys for Complainant

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

BAKHTIAR MOUSSAZADEH, M.D.

1236 Wellesley Ave., Apt. #6 Los Angeles, California 90025

Case No. 17-2012-226761

ACCUSATION

13 Physician's & Surgeon's Certificate A108651,

14 Respondent.

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16 Complainant alleges:

17 PARTIES

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

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

20 Affairs.

21 2. On June 30, 2009, the Medical Board of California issued Physician's and Surgeon's

22 Certificate number Al08651 to Bakhtiar Moussazadeh, M.D. (Respondent). That license was in

23 full force and effect at all times relevant to the charges brought herein and will expire on March

24 31, 2015, unless renewed.

25 JURISDICTION

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

27 authority of the following laws. All section references are to the Business and Professions Code

28 ("Code") unless otherwise indicated.

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Accusation

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 other

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

5 5. Section 2234 of the Code, states:

6 "The board shall take action against any licensee who is charged with unprofessional

7 conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not

8 limited to, the following:

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

10 violation of, or conspiring to violate any provision of this chapter.

11 "(b) Gross negligence.

12 "(c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or

13 omissions. An initial negligent act or omission followed by a separate and distinct departure from

14 the applicable standard of care shall constitute repeated negligent acts.

15 "(1) An initial negligent diagnosis followed by an act or omission medically appropriate

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

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

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

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

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

21 standard of care.

22 "(d) Incompetence.

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

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

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

26 "(g) The practice of medicine from this state into another state or country without meeting

27 the legal requirements of that state or country for the practice of medicine. Section 2314 shall not

28 apply to this subdivision. This subdivision shall become operative upon the implementation of the

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Accusation

1 proposed registration program described in Section 2052.5.

2 "(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and

3 participate in an interview scheduled by the mutual agreement of the certificate holder and the

4 board. This subdivision shall only apply to a certificate holder who is the subject of an

5 investigation by the board."

6 6. Section 2239 of the Code states:

7 "(a) The use or prescribing for or administering to himself or herself, of any controlled

8 substance; or the use of any of the dangerous drugs specified in Section 4022, or of alcoholic

9 beverages, to the extent, or in such a manner as to be dangerous or injurious to the licensee, or to

10 any other person or to the public, or to the extent that such use impairs the ability of the licensee

11 to practice medicine safely or more than one misdemeanor or any felony involving the use,

12 consumption, or self-administration of any of the substances referred to in this section, or any

13 combination thereof, constitutes unprofessional conduct. The record of the conviction is

14 conclusive evidence of such unprofessional conduct.

15 "(b) A plea or verdict of guilty or a conviction following a plea of nolo contendere is

16 deemed to be a conviction within the meaning of this section. The Division of Medical Quality

17 may order discipline of the licensee in accordance with Section 2227 or the Division of Licensing

18 may order the denial of the license when the time for appeal has elapsed or the judgment of

19 conviction has been affirmed on appeal or when an order granting probation is made suspending

20 imposition of sentence, irrespective of a subsequent order under the provisions of Section 1203.4

21 of the Penal Code allowing such person to withdraw his or her plea of guilty and to enter a plea of

22 not guilty, or setting aside the verdict of guilty, or dismissing the accusation, complaint,

23 information, or indictment."

24 FIRST CAUSE FOR DISCIPLINE

25 (Abuse of Drugs)

26 7. Respondent is subject to disciplinary action under section 2239 of the Code in that

27 Respondent used a dangerous drug to the extent, or in such a manner as to be dangerous or

28 injurious to himself, or to any other person or to the public, or to the extent that such use impaired

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Accusation

1 his ability to practice medicine safely. The circumstances are as follows:

2 8. Between 2007 and 2010, Respondent was in an anesthesiology residency at Cedars-

3 Sinai Medical Center. From 2010 through 2011, Respondent participated in a pain management

4 fellowship at Cedars- Sinai Medical Center. From 2011 to 2013, Respondent participated in an

5 anesthesia fellowship program providing anesthesia in liver transplant cases.

6 9. In or around November 2011, while providing anesthesia during a surgical case at

7 Cedars- Sinai Medical Center, at or around midnight, Respondent insufflated sevoflurane1

8 through a gauze pad.

9 10. In or around December 2011, while preparing an anesthesia case around 7:00a.m. in

10 the morning, Respondent spilled sevoflurane. He wiped it up with gauze. Instead of disposing of

11 the gauze, he placed it over his nose and insufflated the gas. An attending physician observed the

12 behavior and reported it. Respondent subsequently admitted to insufflating sevoflurane on up to

13 eight or nine occasions during preparation for providing anesthesia in surgical cases. Respondent

14 subsequently took a leave of absence from Cedars- Sinai Medical Center.

15 11. On or about September 4, 2012, after returning from the leave of absence, Respondent

16 again insufflated sevoflurane. An individual observed Respondent's behavior immediately after

17 and reported it. Respondent subsequently took another leave of absence from Cedars - Sinai

18 Medical Center.

19 SECOND CAUSE FOR DISCIPLINE

20 (Unprofessional Conduct)

21 12. Respondent is subject to disciplinary action under section 2234 of the Code in that he

22 engaged in unprofessional conduct. The circumstances are as follows:

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1 Sevoflurane, a halogenated general inhalation anesthetic drug, is indicated for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery. Sevoflurane should be administered only by persons trained in the administration of general anesthesia. Facilities for maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitation must be immediately available. Since the level of anesthesia may be altered rapidly, only vaporizers producing predictable concentrations of sevoflurane should be used. Sevoflurane is a dangerous drug within the meaning of Business and Professions Code section 4022.

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Accusation

1 13. The facts and circumstance alleged in paragraphs 8 through 11 above are incorporated

2 here as if fully set forth.

3 PRAYER

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

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

6 1. Revoking or suspending Physician's and Surgeon's Certificate Number A108651,

7 issued to Bakhtiar Moussazadeh, M.D.;

8 2. Revoking, suspending or denying approval of his authority to supervise physician

9 assistants, pursuant to section 3527 of the Code;

10 3. Ordering him to pay the Medical Board of California, if placed on probation, the costs

11 of probation monitoring; and

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

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DATED: January 21, 2015

LA2014613146 61461932.doc

Executive · ctor Medical Board of California Department of Consumer Affairs State of California

Complainant

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Accusation