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BEFORE THE MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
In the Matter of the Accusation Against: )
Anil Krishnakumar Gandhi, M.D.
Physician's and Surgeon's Certificate No. A 30411
Respondent
) ) ) ) ) ) ) )
Case No. 06-2011-217567
DECISION AND ORDER
The attached Stipulated Settlement and Disciplinary Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.
This Decision shall become effective at 5:00p.m. on March 11, 2016.
IT IS SO ORDERED: February 12, 2016.
MEDICAL BOARD OF CALIFORNIA
Panel A
KAMALA D. HARRIS Attorney General of California
2 ROBERT MCKIM BELL Supervising Deputy Attorney General
3 COLLEEN M. McGURRIN Deputy Attorney General
4 State Bar Number 147250 300 South Spring Street, Suite 1702
5 Los Angeles, California 90013 Telephone: (213) 620-2511
6 Facsimile: (213) 897-93 95 Attorneys for Complainant
7 BEFORE THE
8 MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS
9 STATE OF CALIFORNIA
10 In the Matter of the Accusation Against:
ANIL KRISHNAKUMAR GANDHI, M.D. 17100 Norwalk Blvd, Ste. 111 Cerritos, California 90703
Physician's and Surgeon's Certificate Number A 30411
Respondent.
Case No. 06-2011-217567
OAH No. 2014090549
STIPULATED SETTLEMENT AND DISCIPLINARY ORDER
IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above-
entitled proceedings that the following matters are true:
PARTIES
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19 1. Kimberly Kirchmeyer ("Complainant") is the Executive Director of the Medical
20 Board of California. She brought this action solely in her official capacity and is represented in
21 this matter by Kamala D. Harris, Attorney General ofthe State of California, by Colleen M.
22 McGurrin, Deputy Attorney General.
23 2. ANIL KRISHNAKUMAR GANDHI, M.D. ("Respondent") is represented in this
24 proceeding by attorney Fredric J. Greenblatt, whose address is 22151 Ventura Blvd., Suite 200,
25 Woodland Hills, California 91364-1600.
26 3. On or about August 30, 1976, the Medical Board of California issued Physician's and
27 Surgeon's Certificate Number A30411 to Respondent. Said Certificate was in full force and
28 effect at all times relevant to the charges brought in Accusation No. 06-2011-217567 and will
STIPULATED SETTLEMENT (06-2011-217567)
1 expire on July 31, 2016, unless renewed.
2 JURISDICTION
3 4. Accusation No. 06-2011-217567 was filed before the Medical Board of California
4 (Board), Department of Consumer Affairs, and is currently pending against Respondent. The
5 Accusation and all other statutorily required documents were properly served on Respondent on
6 June 24, 2014. Respondent timely filed his Notice of Defense contesting the Accusation.
7 5. A copy of Accusation No. 06-2011-217567 is attached as exhibit A and incorporated
8 herein by reference.
9 ADVISEMENT AND WAIVERS
10 6. Respondent has carefully read, fully discussed with counsel, and understands the
11 charges and allegations in Accusation No. 06-2011-217567. Respondent has also carefully read,
12 fully discussed with counsel, and understands the effects of this Stipulated Settlement and
13 Disciplinary Order.
14 7. Respondent is fully aware of his legal rights in this matter, including the right to a
15 hearing on the charges and allegations in the Accusation; the right to be represented by counsel at
16 his own expense; the right to confront and cross-examine the witnesses against him; the right to
17 present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel
18 the attendance of witnesses and the production of documents; the right to reconsideration and
19 court review of an adverse decision; and all other rights accorded by the California
20 Administrative Procedure Act and other applicable laws.
21 8. Respondent freely, voluntarily, knowingly, and intelligently waives and gives up each
22 and every right set forth above.
23 CULPABILITY
24 9. Respondent understands and agrees that the charges and allegations in Accusation
25 No. 06-2011-217567, if proven at a hearing, constitute cause for imposing discipline upon his
26 Physician's and Surgeon's Certificate.
27 10. For the purpose of resolving the Accusation without the expense and uncertainty of
28 further proceedings, Respondent agrees that, at a hearing, Complainant could establish a prima
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STIPULATED SETTLEMENT (06-20 11-217567)
facie factual basis for the charges alleged in paragraph 35 B through J in the First Cause for
2 Discipline, the Third Cause for Discipline and the Fourth Cause for Discipline as alleged in the
3 Accusation, and that Respondent hereby gives up his right to contest those charges.
4 11. Respondent agrees that if he ever petitions for early termination or modification of
5 probation, or if the Board ever petitions for revocation of probation, all of the charges and
6 allegations contained in Accusation No. 06-2011-217567, as specified in paragraph 10 above,
7 shall be deemed true, correct and fully admitted by respondent for purposes of that proceeding or
8 any other licensing proceeding involving respondent in the State of California."
9 12. Respondent agrees that his Physician's and Surgeon's Certificate is subject to
10 discipline and he agrees to be bound by the Board's probationary terms as set forth in the
11 Disciplinary Order below.
12 CONTINGENCY
13 13. This stipulation shall be subject to approval by the Medical Board of California.
14 Respondent understands and agrees that counsel for Complainant and the staff of the Medical
15 Board of California may communicate directly with the Board regarding this stipulation and
16 settlement, without notice to or participation by Respondent or his counsel. By signing the
17 stipulation, Respondent understands and agrees that he may not withdraw his agreement or seek
18 to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails
19 to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary
20 Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal
21 action between the parties, and the Board shall not be disqualified from further action by having
22 considered this matter.
23 14. The parties understand and agree that Portable Document Format (PDF) and facsimile
24 copies ofthis Stipulated Settlement and Disciplinary Order, including Portable Document Format
25 (PDF) and facsimile signatures thereto, shall have the same force and effect as the originals.
26 15. In consideration of the foregoing admissions and stipulations, the parties agree that
27 the Board may, without further notice or formal proceeding, issue and enter the following
28 Disciplinary Order:
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STIPULATED SETTLEMENT (06-2011-217567)
DISCIPLINARY ORDER
2 IT IS HEREBY ORDERED that Respondent ANIL KRISHNAKUMAR GANDHI, M.D.
3 shall provide appropriate referrals of HIV and/or AIDS patients to other physicians or facilities.
4 IT IS HEREBY FURTHER ORDERED that Physician's and Surgeon's Certificate Number
5 A 30411 issued to Respondent ANIL KRISHNAKUMAR GANDHI, M.D. is revoked. However,
6 the revocation is stayed and Respondent is placed on probation for three (3) years on the
7 following terms and conditions.
8 1. MEDICAL RECORD KEEPING COURSE. Within 60 calendar days ofthe effective
9 date of this Decision, Respondent shall enroll in a course in medical record keeping equivalent to
1 0 the Medical Record Keeping Course offered by the Physician Assessment and Clinical Education
11 Program, University of California, San Diego School of Medicine (Program), approved in
12 advance by the Board or its designee. Respondent shall provide the program with any information
13 and documents that the Program may deem pertinent. Respondent shall participate in and
14 successfully complete the classroom component of the course not later than six (6) months after
15 Respondent's initial enrollment. Respondent shall successfully complete any other component of
16 the course within one ( 1) year of enrollment. The medical record keeping course shall be at
17 Respondent's expense and shall be in addition to the Continuing Medical Education (CME)
18 requirements for renewal of licensure.
19 A medical record keeping course taken after the acts that gave rise to the charges in the
20 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board
21 or its designee, be accepted towards the fulfillment of this condition if the course would have
22 been approved by the Board or its designee had the course been taken after the effective date of
23 this Decision.
24 Respondent shall submit a certification of successful completion to the Board or its
25 designee not later than 15 calendar days after successfully completing the course, or not later than
26 15 calendar days after the effective date of the Decision, whichever is later.
27 2. CLINICAL TRAINING PROGRAM. Within 60 calendar days of the effective date
28 of this Decision, Respondent shall enroll in a clinical training or educational program equivalent
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STIPULATED SETTLEMENT (06-2011-217567)
to the Physician Assessment and Clinical Education Program (PACE) offered at the University of
2 California- San Diego School of Medicine ("Program"). Respondent shall successfully complete
3 the Program not later than six (6) months after Respondent's initial enrollment unless the Board
4 or its designee agrees in writing to an extension of that time.
5 The Program shall consist of a Comprehensive Assessment program comprised of a two-
6 day assessment of Respondent's physical and mental health; basic clinical and communication
7 skills common to all clinicians; and medical knowledge, skill and judgment pertaining to
8 Respondent's area of practice in which Respondent was alleged to be deficient, and at minimum,
9 a 40 hour program of clinical education in the area of practice in which Respondent was alleged
10 to be deficient and which takes into account data obtained from the assessment, Decision(s),
11 Accusation(s), and any other information that the Board or its designee deems relevant.
12 Respondent shall pay all expenses associated with the clinical training program.
13 Based on Respondent's performance and test results in the assessment and clinical
14 education, the Program will advise the Board or its designee of its recommendation(s) for the
15 scope and length of any additional educational or clinical training, treatment for any medical
16 condition, treatment for any psychological condition, or anything else affecting Respondent's
17 practice of medicine. Respondent shall comply with Program recommendations.
18 At the completion of any additional educational or clinical training, Respondent shall
19 submit to and pass an examination. Determination as to whether Respondent successfully
20 completed the examination or successfully completed the program is solely within the program's
21 jurisdiction.
22 If Respondent fails to enroll, participate in, or successfully complete the clinical training
23 program within the designated time period, Respondent shall receive a notification from the
24 Board or its designee to cease the practice of medicine within three (3) calendar days after being
25 so notified. The Respondent shall not resume the practice of medicine until enrollment or
26 participation in the outstanding portions of the clinical training program have been completed. If
27 the Respondent did not successfully complete the clinical training program, the Respondent shall
28 not resume the practice of medicine until a final decision has been rendered on the accusation
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and/or a petition to revoke probation. The cessation of practice shall not apply to the reduction of
the probationary time period.
3. PROHIBITED PRACTICE OF PERFORMING BREAST REDUCTION OR
MASTOPEXY PROCEDURES. During probation, Respondent is prohibited from performing
breast reductions and mastopexy procedures. After the effective date of this Decision, all new
patients must be provided notification that the Respondent is prohibited from performing breast
reductions and mastopexy procedure at the time of their initial appointment. All existing patient
must be provided this notification if the patient inquires about the prohibited procedures.
Respondent shall maintain a log of all patients to whom the required oral notification was
made. The log shall contain the: I) patient's name, address and phone number; patient's medical
record number, if available; 3) the full name ofthe person making the notification; 4) the date the
notification was made; and 5) a description of the notification given. Respondent shall keep this
log in a separate file or ledger, in chronological order, shall make the log available for immediate
inspection and copying on the premises at all times during business hours by the Board or its
designee, and shall retain the log for the entire term of probation.
4. EDUCATIONAL COURSE IN THE SUBJECT AREA OF HIV/AIDS: Within 60
17 calendar days of the effective date of this Decision, Respondent shall enroll in a one-day 8-hour
18 educational course in the subject area of HIV I AIDS, approved in advance by the Board or its
19 designee. Respondent shall provide the course with any information and documents that the
20 Program may deem pertinent. Respondent shall participate in and successfully complete the
21 course not later than six (6) months after Respondent's initial enrollment. The HIV I AIDS course
22 shall be at Respondent's expense and shall be in addition to the Continuing Medical Education
23 (CME) requirements for renewal of licensure.
24 An educational course in HIV I AIDS taken after the acts that gave rise to the charges in the
25 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board
26 or its designee, be accepted towards the fulfillment ofthis condition if the course would have
27 been approved by the Board or its designee had the course been taken after the effective date of
28 this Decision.
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Respondent shall submit a certification of successful completion to the Board or its
designee not later than 15 calendar days after successfully completing the course, or not later than
15 calendar days after the effective date of the Decision, whichever is later.
5. NOTIFICATION. Within seven (7) days ofthe effective date ofthis 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
6. SUPERVISION OF PHYSICIAN ASSISTANTS. During probation, Respondent is
prohibited from supervising physician assistants
7. OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules
governing the practice of medicine in California and remain in full compliance with any court
ordered criminal probation, payments, and other orders.
8. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations
19 under penalty of perjury on forms provided by the Board, stating whether there has been
20 compliance with all the conditions of probation.
21 Respondent shall submit quarterly declarations not later than 10 calendar days after the end
22 of the preceding quarter.
23 9. GENERAL PROBATION REQUIREMENTS.
24 Compliance with Probation Unit
25 Respondent shall comply with the Board's probation unit and all terms and conditions of
26 this Decision.
27 Address Changes
28 Respondent shall, at all times, keep the Board informed of Respondent's business and
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STIPULATED SETTLEMENT (06-20 11-217567)
1 residence addresses, email address (if available), and telephone number. Changes of such
2 addresses shall be immediately communicated in writing to the Board or its designee. Under no
3 circumstances shall a post office box serve as an address of record, except as allowed by Business
4 and Professions Code section 2021 (b).
5 Place of Practice
6 Respondent shall not engage in the practice of medicine in Respondent's or patient's place
7 of residence, unless the patient resides in a skilled nursing facility or other similar licensed
8 facility.
9 License Renewal
10 Respondent shall maintain a current and renewed California physician's and surgeon's
11 license.
12 Travel or Residence Outside California
13 Respondent shall immediately inform the Board or its designee, in writing, of travel to any
14 areas outside the jurisdiction of California which lasts, or is contemplated to last, more than thirty
15 (30) calendar days.
16 In the event Respondent should leave the State of California to reside or to practice
17 Respondent shall notify the Board or its designee in writing 30 calendar days prior to the dates of
18 departure and return.
19 10. INTERVIEW WITH THE BOARD OR ITS DESIGNEE. Respondent shall be
20 available in person upon request for interviews either at Respondent's place of business or at the
21 probation unit office, with or without prior notice throughout the term of probation.
22 11. NON-PRACTICE WHILE ON PROBATION. Respondent shall notify the Board or
23 its designee in writing within 15 calendar days of any periods of non-practice lasting more than
24 30 calendar days and within 15 calendar days of Respondent's return to practice. Non-practice is
25 defined as any period of time Respondent is not practicing medicine in California as defined in
26 Business and Professions Code sections 2051 and 2052 for at least 40 hours in a calendar month
27 in direct patient care, clinical activity or teaching, or other activity as approved by the Board. All
28 time spent in an intensive training program which has been approved by the Board or its designee
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STIPULATED SETTLEMENT (06-20 11-217567)
shall not be considered non-practice. Practicing medicine in another state of the United States or
2 Federal jurisdiction while on probation with the medical licensing authority of that state or
3 jurisdiction shall not be considered non-practice. A Board-ordered suspension of practice shall
4 not be considered as a period of non-practice.
5 In the event Respondent's period of non-practice while on probation exceeds 18 calendar
6 months, Respondent shall successfully complete a clinical training program that meets the criteria
7 of Condition 18 of the current version of the Board's "Manual of Model Disciplinary Orders and
8 Disciplinary Guidelines" prior to resuming the practice of medicine.
9 Respondent's period of non-practice while on probation shall not exceed two (2) years.
10 Periods of non-practice will not apply to the reduction of the probationary term.
11 Periods of non-practice will relieve Respondent of the responsibility to comply with the
12 probationary terms and conditions with the exception of this condition and the following terms
13 and conditions of probation: Obey All Laws; and General Probation Requirements.
14 12. COMPLETION OF PROBATION. Respondent shall comply with all financial
15 obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the
16 completion of probation. Upon successful completion of probation, Respondent's certificate shall
17 be fully restored.
18 13. VIOLATION OF PROBATION. Failure to fully comply with any term or condition
19 of probation is a violation of probation. If Respondent violates probation in any respect, the
20 Board, after giving Respondent notice and the opportunity to be heard, may revoke probation and
21 carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke Probation,
22 or an Interim Suspension Order is filed against Respondent during probation, the Board shall have
23 continuing jurisdiction until the matter is final, and the period of probation shall be extended until
24 the matter is final.
25 14. LICENSE SURRENDER. Following the effective date of this Decision, if
26 Respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy
27 the terms and conditions of probation, Respondent may request to surrender his or her license.
28 The Board reserves the right to evaluate Respondent's request and to exercise its discretion in
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STIPULATED SETTLEMENT (06-20 11-217567)
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determining whether or not to grant the request, or to take any other action deemed appropriate
and reasonable under the circumstances. Upon formal acceptance of the surrender, Respondent
shall within 15 calendar days deliver Respondent's w&llet and wall certificate to the Board or its
designee and Respondent shall no longer practice medicine. Respondent will no longer be subject
to the terms and conditions of probation. If Respondent re-applies for a medical license, the
application shall be treated as a petition for reinstatement of a revoked certificate.
7 15. PROBATION MONITORING COSTS. Respondent shall pay the costs associated
8 with probation monitoring each and every year of probation, as designated by the Board, which
9 may be adjusted on an annual basis. Such costs shall be payable to the Medical Board of
10 California and delivered to the Board or its designee no later than January 31 of each calendar
II year.
12 AC~EPTANCE
13 I have carefully read the above Stipulated Settlement and Disciplinary Order and have fully
14 discussed it with my attorney, Fredric J. Greenblatt. I understand the stipulation and the effect it
15 will have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Settlement and
16 Disciplinary Order freely, voluntarily, knowingly, and intelligently, and agree to be bound by the
17 Decision and Order of the Medical Board ofCalifornia.
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DATED: ::2/l) Jl~ ANIL KRJSHNAKUMAR GANDHI, M.D. Respondent
I have read and fully discussed with Respondent ANI GANDHI,
23 M.D. the terms and conditions and other matters con
14 Disciplinary Order. I approve its fonn and content.
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26 DATED:
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STIPULATED SETTLEMENT (06-2011-217567)
The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully
2 submitted for consideration by the Medical Board of California.
3 Dated: · ~/·./· .J(
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LA2013610856 61791543.docx
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Respectfully submitted,
KAMALA D. HARRIS Attorney General of California ROBERT MCKIM J3ELL Supervising Deputy Attorney General
'j \ I L I : / '---~ . ): t ,l ._ tt( ,\ ... I --~. COLLEEN M. McGURRIN Deputy Attorney General Attorneysfor Complainant
STIPULATED SETTLEMENT (06-20 I I -2 I 7567)
Exhibit A
Accusation No. 06-2011-217567
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KAMALA D. HARRIS Attorney General of California ROBERT MCKIM BELL Supervising Deputy Attorney General COLLEEN M. McGURRrN Deputy Attorney General State Bar Number 147250
300 South Spring Street, Suite 1702 Los Angeles, California 90013 Telephone: (213) 620-2511 Facsimile: (213) 897-9395
Attorneys for Complainant
BEFORE THE 8 MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS 9 STATE OF CALIFORNIA
10 In the Matter of the Accusation Against:
11 ANIL KRISHNAKUMAR GANDHI, M.D.
12
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17100 Norwalk Boulevard, Suite 111 Cerritos, California 90703
14 Physician's and Surgeon's Certificate A 30411,
15 Respondent.
16
17 Complainant alleges:
Case No. 06-2011-217567
ACCUSATION
18 PARTIES
19 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official
20 capacity as the Executive Director ofthe Medical Board of California (Board).
21 2. On August 30, 1976, the Board issued Physician's and Surgeon's Certificate number
22 A 30411 to Ani! Krishnakumar Gandhi, M.D. (Respondent). That license was in full force and
23 effect at all times relevant to the charges brought herein and will expire on July 31, 2014, unless
24 renewed.
25 JURISDICTION
26 3. This Accusation is brought before the Board under the authority of the following
27 laws. All section references are to the Business and Professions Code (Code) unless otherwise
28 indicated.
Accusation
4. Section 2004 of the Code states, in pertinent part:
2 "The board shall have the responsibility for the following:
3 "(a) The enforcement ofthe disciplinary ... provisions of the Medical Practice Act.
4 "(b) The administration and hearing of disciplinary actions.
5 "(c) Carrying out disciplinary actions appropriate to findings made by a panel or an
6 administrative lavv judge.
7 "(d) Suspending, revoking, or otherwise limiting certificates after the conclusion of
8 disciplinary actions.
9 "(e) Reviewing the quality of medical practice carried out by physician and surgeon
10 certificate holders under the jurisdiction of the board.
11 "(f) ... (i)."
12 5. Section 2220 of the Code states, in pertinent part:
13 " ... the Division of Medical Quality1 may take action against all persons guilty of violating
14 this chapter [Chapter 5, the Medical Practice Act]. The division shall enforce and administer this
15 article as to physician and surgeon certificate holders, and the division shall have all the powers
16 granted in this chapter for these purposes including, but not limited to:
17 "(a) Investigating complaints from the public, from other licensees, from health care
18 facilities, or from a division of the board that a physician and surgeon may be guilty of
19 unprofessional conduct. ... "
20 "(b) Investigating the circumstances of practice of any physician and surgeon where there
21 have been any judgments, settlements, or arbitration awards requiring the physician and surgeon
22 or his or her professional liability insurer to pay an amount in damages in excess of a cumulative
23 total ofthirty thousand dollars ($30,000) with respect to any claim that injury or damage was
24 proximately caused by the physician's and surgeon's error, negligence, or omission.
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1 California Business and Professions Code section 2002, as amended and effective January 1, 2008,
provides that, unless otherwise expressly provided, the term "board" as used in the State Medical Practices Act (Bus. & Prof. Code § 2000, et seq.) means the "Medical Board of California," and references to the "Division of Medical Quality" and ''Division of Licensing" in the Act or any other provision oflaw shall be deemed to refer to the Board.
2
Accusation
"(c) Investigating the nature and causes of injuries from cases which shall be reported of a
2 high number of judgments, settlements, or arbitration awards against a physician and surgeon."
3 6. Section 2230.5 of the Code states, in pertinent part, that any accusation filed against a
4 licensee pursuant to Section 11503 of the Government Code shall be filed within three years after
5 the board, or a division thereof, discovers the act or omission alleged as the ground for
6 disciplinary action, or within seven years after the act or omission alleged as the ground for
7 disciplinary action occurs, whichever occurs first.
8 7. Section 2227 ofthe Code states:
9 "(a) A licensee whose matter has been heard by an administrative law judge of the Medical
10 Quality Hearing Panel as designated in Section 11371 ofthe Government Code, or whose default
11 has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary
12 action with the board, may, in accordance with the provisions ofthis chapter:
13 "(1) Have his or her license revoked upon order of the board.
14 "(2) Have his or her right to practice suspended for a period not to exceed one year upon
15 order of the board.
16 "(3) Be placed on probation and be required to pay the costs of probation monitoring upon
17 order ofthe board.
18 "(4) Be publicly reprimanded by the board. The public reprimand may include a
19 requirement that the licensee complete relevant educational courses approved by the board.
20 "(5) Have any other action taken in relation to discipline as part of an order of probation, as
21 the board or an administrative law judge may deem proper.
22 "(b) Any matter heard pursuant to subdivision (a), except for warning letters, medical
23 review or advisory conferences, professional competency examinations, continuing education
24 activities, and cost reimbursement associated therewith that are agreed to with the board and
25 successfully completed by the licensee, or other matters made confidential or privileged by
26 existing law, is deemed public, and shall be made available to the public by the board pursuant to
27 Section 803.1."
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8. Section 2234 of the Code, states, in pertinent part:
"The board shall take action against any licensee who is charged with unprofessional
conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not
limited to, the following:
"(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the
violation of, or conspiring to violate any provision of this chapter.
"(b) Gross negligence.
"(c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or
omissions. An initial negligent act or omission followed by a separate and distinct departure from
the applicable standard of care shall constitute repeated negligent acts.
"( 1) An initial negligent diagnosis followed by an act or omission medically appropriate
for that negligent diagnosis of the patient shall constitute a single negligent act.
"(2) When the standard of care requires a change in the diagnosis, act, or omission that
constitutes the negligent act described in paragraph (1 ), including, but not limited to, a
reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the
applicable standard of care, each departure constitutes a separate and distinct breach of the
standard of care.
"(d) Incompetence.
"(e) .... "
"(f) Any action or conduct which would have warranted the denial of a certificate.
"(g) ... (h)."
9. Section 2259.7 ofthe Code states:
"The Medical Board of California shall adopt extraction and postoperative care standards in
regard to body liposuction procedures performed by a physician and surgeon outside a general
acute care hospital, as defined in Section 1250 of the Health and Safety Code. In adopting those
regulations, the Medical Board of California shall take into account the most current clinical and
scientific information available. A violation ofthese extraction and postoperative care standards
shall constitute unprofessional conduct."
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Accusation
10. California Code of Regulations, Title 16, Section 1356.6 states, in pertinent part:
2 "(a) " ....
3 "(b) The following standards apply to any liposuction procedure not required ... to be
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performed in a general acute-care hospital or a setting specified in Health and Safety code Section
1248.1:
"(1) .... (2)."
"(3) Monitoring. The following monitoring shall be available for volumes greater than
8 150 and less than 2,000 cubic centimeters oftotal aspirate .... :"
9 (A) Pulse oximeter
10 (B) Blood pressure (by manual or automatic means)
11 (C) Fluid loss and replacement monitoring and recording
12 (D) Electrocardiogram
13 "( 4) Records. Records shall be maintained in the manner necessary to meet the standard
14 of practice and shall include sufficient information to determine the quantities of drugs and fluids
15 infused and the volume of fat, fluid and supranatant extracted and the nature and duration of any
16 other surgical procedures performed during the same session as the liposuction procedure."
17 "(5) .... "
18 11. Section 2266 of the Code states: "The failure of a physician and surgeon to maintain
19 adequate and accurate records relating to the provision of services to their patients constitutes
20 unprofessional conduct."
21 12. Section 125.6 of the Code states, in pertinent part:
22 "(a)(l) ... every person who holds a license under the provisions of this code is subject to
23 disciplinary action under the disciplinary provision of this code applicable to that person, if
24 because of any characteristic listed or defined in subdivision (b) or (e) of Section 51 ofthe Civil
25 Code, he ... refuses to performed the licensed activity ... or if, because of any characteristic
26 listed or defined in subdivision (b) or (e) of Section 51 ofthe Civil Code, he ... makes any
27 discrimination, or restriction in the performance ofthe licensed activity.
28 "(2) ... (4)."
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Accusation
"(b)(l) ... (2)."
2 "(c)(l)."
3 "(2) 'License,' as used in this section, includes 'certificate,' .... "
4 OTHER CODE SECTIONS
5 13. Section 51 of the Civil Code states, in pertinent part:
6 "(a) This section shall be known, and may be cited, as the Unruh Civil Rights Act.
7 "(b) All person within the jurisdiction of this state are free and equal, and no matter what
8 their ... medical condition ... are entitled to the full and equal accommodations, advantages,
9 facilities, privileges, or services in all business establishments of every kind whatsoever."
10 14. Section 1250 ofthe Health and Safety Code states, in pertinent part: "As used in this
11 chapter, "health facility" means any facility, place, or building that is organized, maintained, and
12 operated for the diagnosis, care, prevention, and treatment of human illness, physical or mental ..
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14 FIRST CAUSE FOR DISCIPLINE
15 (Repeated Negligent Acts)
16 15. Respondent is subject to disciplinary action under Business and Professions Code
17 section 2234, subdivision (c), in that he committed repeated negligent acts in his care and
18 treatment of patient P .L? The circumstances are as follows:
19 16. On or about July 27, 2007, patient P.L., a then forty-three year old Spanish speaking
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female, presented to the Wildwood Surgical Group (WSG)3 for a breast reduction consultation to
reduce her cup size from a "D" cup to a "C". At that time, P.L. completed an "Adult Health
History" questionnaire, but failed to indicate if she had a family history of breast cancer. The
questionnaire did not ask for any prior mammogram information. Respondent measured the
distance between the patient's clavicles and nipples, and noted the distance to be 31 inches apart.
2 For privacy, the patient in the Accusation will be identified by their first and last initials. The full name
will be disclosed to Respondent upon timely request for discovery pursuant to Government Code section 11507.6.
3 At the time ofthe patient's care and treatment, WSG was a solo practice of cosmetic surgery and
Respondent was the sole owner, operator, and only physician in the Group. Respondent subsequently changed the name of his facility to "Fountain of Youth."
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Accusation
It is unclear if Respondent conducted a physical exam of the patient's breasts that day, as there is
2 no documentation of the results of any physical examination being performed.
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17. On or about October 2, 2007, P.L. again presented to WSG to schedule the breast
reduction procedure. At that time, P.L. was seen by "Lorna," Respondent's Physician's Assistant
(hereafter, "Lorna"). Lorna provided the patient with a series of forms4 to sign including a
"Consent for Breast Implant Surgery." The consent mentions capsular contracture, implant size
and type, "rejection" or "extrusion", implant rupture, and numerous other items which have no
relevance to either breast reduction procedures or mastopexy. 5 There are no references in the
consent regarding the expectations or complications specific to breast reductions or mastopexy,
including the devascularization of nipple-areola complex (NAC).6 P.L. initialed the consent, but
did not sign or date it. Lorna completed the "Breast Augmentation Preparation Check List"
(Check List) which included Respondent's AIDS Policy, requiring all patients to undergo an
AIDS test prior to treatment. The Check List also required patients to have a pregnancy test prior
to surgery, but did not require a baseline mammogram for patients over 40 years old.
Although P.L. had presented for a breast reduction surgery and a breast lift, the consent
form, the history and evaluation form, the pre-operative checklist, the pre-operative history and
physical, the pre and post surgical instructions, the preoperative planning, the day of surgery
information and procedure documents all relate to breast implant or augmentation.7 It is unclear
if Respondent saw or physically examined the patient that day, as he failed to document any
4 On that visit, the patient was given the following forms in English: "Consent for Breast Implant Surgery";
Consent for Local Anesthesia"; "Our AIDS Policy for YOUR PROTECTION"; '"Procedure; Augmentation Mammoplasty'·; "Copies of Medical Records"; "Day of Breast Augmentation Surgery''; Cost Procedure and Deposit Receipt"; "Photographs Release Form"; Patient Advisement and Acknowledgement"; "Breast Augmentation PreOperative Checklist"; '·Notice of Privacy Practices"; and the following forms in Spanish: "Physician and Patient Arbitration Contract''; "Consent to Treatment, Payment, and other Health Services"; "Instructions before Your Surgery Breast Implants"; "Breast Implant Post-Operative Instructions"; "Important Information"; and "Complications."
5 Mastopexy is a cosmetic surgical procedure to lift the breasts.
6 The nipple areola complex, commonly abbreviated as NAC, is the primary landmark of the breast, which
contains 15-20 lobes of compound areolar glands, each lobe resembling a bunch of grapes on a long stalk and a widespread drainage system of lymph vessels. Numerous arteries supply blood to the NAC with the internal thoracic arteries supplying a constantly reliable source. The nipple contains connective tissue, smooth muscle, 15-20 lactiferous (milk) ducts, and many nerve endings. The areola is the dark area around the nipple.
7 In a Progress Note, dated October 2, 2007. PA Lorna wrote: "Pt is aware that all signed documents are for
breast lift are the same as Breast Augmentation as well as complications which were used for Pre-Op."
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Accusation
examination in the chart.
2 18. On or about December 17,2007, P.L. presented to Respondent for the breast
3 reduction and breast lift procedures. Respondent again measured the distance between the
4 patient's clavicle and nipples and recorded the distances in the "Breast Implant Surgery
5 Preoperative Planning" form and progress note as: right breast 30.5 centimeters (em); and the left
6 breast 30 em. These measurements differed from Respondent's previously recorded
7 measurements, however, Respondent failed to explain the discrepancy in the chart. Respondent
8 estimated that 300 ccs of total fat would be aspirated during the liposuction procedure. In the
9 progress note, Respondent wrote "Discussed with patient," however, he failed to document what
10 he discussed with the patient.
11 A. Prior to performing the procedures, Respondent failed to inquire if the patient, who
12 was forty-three years old, ever had a baseline mammogram, and ifthere were any abnormalities.
13 Respondent also failed to inquire ifthe patient had a family history of breast cancer. Respondent
14 performed "Liposuction8- Breast reduction Both Breasts" using a local tumescent anesthesia, 9
15 however, the patient was never provided with written consents for the "liposuction" or the
16 "vertical mammoplasty breast lift." Respondent noted, in his liposuction operative report, that
17 "350 cc of liquid and fat" was removed. However, in a progress note it is documented that "300
18 cc" had been aspirated during the liposuction. The "Anesthesia and Operative Records,"
19 however, reflects that "300 millimeters (ml)" were aspirated from each breast. Respondent failed
20 to clarify and explain this discrepancy in the patient's chart. Additionally, Respondent failed to
21 mention, in his operative report, where the tumescent infiltration and subsequent liposuction were
22 performed in relation to the NAC pedicle.
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B. Immediately after the liposuction procedure, Respondent performed a "Vertical
Mammoplasty Breast lift," however, Respondent failed to document: a description of how the
8 Liposuction, also known as lipoplasty or suction-assisted lipectomy, is a cosmetic procedure performed to
remove unwanted fat deposits from under the skin. The fat is permanently removed from under the skin with a suction device. The average amount of fat removed is about a liter or a quart. It is not intended to remove large quantities of fac.
9 Tumescent anesthesia is the administration of a dilute local infiltration anesthetic (lidocaine) though the
use of large volumes of fluid.
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Accusation
procedure was actually performed; what type of pedicle was used for the NAC; and how much
2 the NAC's were lifted. From Respondent's operative report and the additional records in the
3 patient's chart, it is difficult to determine what actually occurred during the breast lift procedure.
4 19. On or about December 19, 2007, P.L. presented for her first post-operative
5 appointment. At that time, Respondent documented "wound ok, minimal bruising, nipple and
6 areola look ok." The chart documents that "PHOTOS" were taken, however, there are no
7 photographs taken of the patient for this visit.
8 20. On or about December 21, 2007, P.L. was seen for a follow-up visit. At that time,
9 she was noted to be doing well with some bruising and swelling. Respondent ordered that the
10 patient should continue taking ciprofloxacin, an oral antibiotic, and added 500 mgs of intra
11 venous (IV) cerftriaxone 10 for three days even though there was no documented evidence of an
12 infection in the patient's chart. The chart documents that "PHOTOS" were taken, however, there
13 were no photographs in the patient's chart taken on this visit.
14 21. Thereafter, P.L. was seen on December 22, and 23,2007, and was noted to be doing
15 well with some bruising. The chart again documents that "PHOTOS" were taken, however, there
16 were no photographs in the patient's chart taken on this visit.
17 22. On or about December 24, 2007, P.L. was again seen for a follow-up visit. At that
18 time, it was noted that the patient's "nipple and areola appears and feels stiff and dark," however,
19 the chart failed to specify which breast was affected. This finding was not recorded the previous
20 day as the patient was noted to be doing well, was healing and had no erythema (redness). No
21 further actions were taken by Respondent at this time, and the patient was instructed to return in
22 two days. The chart documents that "PHOTOS" were taken, however, there were no photographs
23 in the patient's chart taken on this visit.
24 23. On or about December 26, 2007, P.L. returned and was noted to be "doing good, less
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bruising with swelling." The staple was removed from the right breast and she was instructed to
return in two days to have the staple removed from her left breast. There is no documentation of
1° Ceftriaxone is an antibiotic used to treat many kinds of bacterial infections, including severe or lifethreatening forms such as meningitis.
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Accusation
the condition or appearance of the patient's nipples or areola on this visit despite having been
2 noted to be "stiff and dark" two days earlier. Respondent told the Board, during an interview,
3 that he examined the patient's nipples and areola that day, but failed to document it. The chart
4 documents that "PHOTOS" were taken, however, there were no photographs in the patient's chart
5 taken on this visit.
6 24. On or about December 28, 2007, P.L. returned and was noted to be "doing well, less
7 bruising with swelling." There is, however, no documentation ofthe condition or appearance of
8 the patient's nipples or areola on this visit. The chart documents that "PHOTOS" were taken,
9 however, there were no photographs in the patient's chart taken on this visit.
10 25. On or about December 31, 2007, P.L. returned for a follow-up visit and it was noted
11 that the patient's "Areola and nipple appears black and stiff and is necrotic." Respondent
12 recommended that both the patient's nipples and areola be excised and grafted. The patient was
13 also noted to have a "hematoma," however, there is no further description as to its size, location
14 or other characteristics. Although the chart documents that "PHOTOS" were taken, however,
15 there were no photographs in the patient's chart taken on this visit. The patient was scheduled for
16 the bilateral excisions and a full thickness skin grafting on January 3, 2008.
17 26. On or about January 2, 2008, Respondent saw the patient and noted that her nipple
18 and areola appear dark and appears to be dead tissue.
19 27. On or about January 3, 2008, P .L. presented to Respondent for the bilateral excision
20 of her areola and nipples with a full thickness skin graft. The "Breast Augmentation Pre-
21 Operative History and Physical" documents that the patient had no "prior liposuction." The
22 "Preoperative & Postoperative Care Record" documents that a "consent" was signed, however,
23 there are no consent forms for the nipple areola excision nor the full thickness skin grafting
24 procedures performed that day.
25 A. Respondent performed the procedures and documented that the necrotic areola and
26 nipple tissue was "parchment like." Respondent then utilized a full thickness graft from the
27 patient's lower abdomen to graft to the excised areas. Respondent, however, failed to record in
28 his operative report whether the full thickness grafts were applied to a recipient bed of dermis,
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Accusation
subcutaneous tissue, or breast tissue. This information would have significant implications for
2 the patient's options for potential future nipple reconstruction. The information, however,
3 contained in the narrative portion of the operative report makes it difficult to ascertain what
4 actually occurred during the procedures.
5 B. The chart contains another operative report entitled "Tumescent Liposuction
6 Operative Report" for "Areola revision." This report, however, is for a liposuction procedure and
7 states "After signing informed consent, ... Intravenous access was started in a peripheral vein"
8 and "liposuction of the selected areas was carried out .... " Respondent told the Board during an
9 interview that he doesn't use intravenous access and no liposuction had been performed that day.
10 28. On or about February 15, 2008, P.L. presented for another procedure. Respondent
11 documented that he performed a "Creating Nipple like appearance" operation. This, however,
12 makes no sense as an operative procedure. In the report, Respondent failed to provide a
13 comprehensive description of the operative plans, the operative procedures itself and the end
14 results of the procedure. Additionally, the information contained in the body ofthe report makes
15 it difficult to ascertain exactly what occurred during the procedure. Further, the "Preoperative &
16 Postoperative Care Record" and the "Tumescent Liposuction Pre-Op Orders" both document that
17 a "consent" was signed, however, there is no signed consent for the procedure performed on this
18 visit in the chart. Further, no liposuction had been performed that day.
19 29. On or about March 17, 2008, P.L. returned and complained that her left breast was
20 larger than the right. Respondent recommended that the patient undergo further liposuction of her
21 left breast.
22 30. On or about March 21, 2008, the patient returned for the further liposuction of her left
23 breast. Respondent's pre and post-operative diagnosis was "obesity, patient desire ofliposuction
24 both breast areas," however, the "Op Done" portion of the report states "Liposuction Left Breast
25 areas." Respondent noted, in the "Op. procedure" narrative portion of the report, that the "Right
26 side was tackled first." The right side, however, was not the intended area of concern.
27 Respondent failed to document any procedure performed on the patient's left breast that day.
28 Additionally, the information contained in the body of the report makes it difficult to ascertain
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Accusation
exactly what was done during the procedure.
2 The ·'Liposuction Pre-Operative History and Physical" documents that the patient had no
3 prior liposuction or complications with previous surgeries. The "Liposuction Pre-Operation
4 Clearance" form documents that a letter of medical clearance was obtained, however, there is no
5 such letter in the patient's chart. The "Preoperative & Postoperative Care Record," the
6 "Tumescent Liposuction Pre-Op Orders" and the "Liposuction Pre-Operation Clearance" all note
7 that a "consent" was signed, however, there is no consent form for the procedure performed on
8 the patient this day.
9 31. On or about April15, 2008, P.L. again presented to Respondent and expressed
10 concern about the size difference between her breast.
11 32. On or about May 16, 2008, the patient returned again and was still unhappy with the
12 asymmetry of her breasts. Respondent recommended further liposuction of her left breast.
13 33. On or about May 23, 2008, P.L. presented for the further liposuction of her left breast.
14 The "Preoperative & Postoperative Care Record," the "Tumescent Liposuction Pre-Op Orders,"
15 and the "Breast Augmentation Pre-Operative Clearance" forms all document that a "consent" was
16 signed, however, there is no signed consent for the procedure performed on this visit. In his
17 operative report, Respondent documents the pre and post-operative diagnosis as "obesity, patient
18 desire of liposuction Both Breast Areas," however, the "Op Done" portion ofthe report states
19 "Liposuction Left Breast area." Respondent documents, in the "Op. procedure" narrative portion
20 of the report, that the "Left side was tackled first," but fails to mention any procedure performed
21 on the patient's right breast that day. Additionally, the information contained in the body of the
22 report makes it difficult to ascertain exactly what was done during the procedure.
23 34. On or about June 2, 2008, the patient again presented to Respondent for a follow up
24 visit. At that time, Respondent recommended that the patient have cosmetic tattooing of the
25 areola and nipples. The patient declined the recommendation. This was the patient's last visit
26 with Respondent.
27 35. Respondent committed repeated negligent acts when he:
28 A. Failed to conduct an appropriate pre-operative screening, including failing to
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Accusation
ascertain if the patient had a family history of breast cancer, had a baseline mammogram prior to
2 surgery and any abnormalities noted, and if the patient did not have a baseline mammogram to
3 order her to have a mammogram prior to performing the elective procedures;
4 B. Failed to obtain informed consent prior to the December 17, 2007 liposuction and
5 breast lift procedures;
6 C. Failed to document the condition and appearance of the patient's nipple and areola on
7 December 26, 2007;
8 D. Failed to assess and document the condition and appearance of the patient's nipple
9 and areola on the December 28, 2007 visit;
10 E. Failed to obtain informed consent prior to the January 3, 2008 nipple and areola
11 excisions and full thickness grafting procedures;
12 F. Failed to obtain informed consent prior to the February 15, 2008 "creating nipple like
13 appearance" operation;
14 G. Failed to obtain informed consent prior to the March 21, 2008 liposuction procedure;
15 H. Failed to obtain informed consent prior to the May 23, 2008 liposuction procedure;
16 I. Repeatedly failed to record accurate, complete and detailed operative reports fully
17 describing the operative plan, operative procedure and results;
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J. Repeatedly failed to maintain adequate, complete and accurate records.
SECOND CAUSE FOR DISCIPLINE
(Lack of Knowledge)
21 36. Respondent is subject to disciplinary action under section 2234, subdivision (d), in
22 that he showed a lack of knowledge in his care and treatment of patient P.L. The circumstances
23 are as follows:
24 37. Paragraphs 16 through 34, inclusive, above are incorporated herein by reference as if
25 fully set forth
26 3 8. On or about May 8, 2013, Respondent was interviewed by the Board regarding his care
27 and treatment ofP.L. and the resulting complications. During the interview, Respondent told the
28 Board that he initially believed the patient's complications was due to a simultaneous, bilateral,
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Accusation
symmetrical infections, however, Respondent failed to send the excised tissue for pathology
2 analysis to confirm his hypothesis. After some discussion during the interview, Respondent
3 thought the problem may have been from an inadequate blood supply, but was still "confused" as
4 to what could have lead to the complication. Respondent, however, failed to consider one ofthe
5 universal components of essentially all mastopexies, which is raising the NAC. Critical to this
6 step is planning and defining the vascular pedicle on which the NAC will be based, in order to
7 preserve it's viability. Had Respondent been aware ofthe underlying principles of mastopexies
8 he should have planned out and described the type of pedicle he intended to use. Additionally,
9 Respondent would have changed his planned course of action by either not performing the
10 simultaneous liposuction at that time, or by performing it differently to avoid traumatizing the
11 NAC pedicle. Further, Respondent would have been more careful with the application of
12 compressive dressings to avoid undue pressure. Finally, once the early signs ofNAC ischemia
13 were noted post-operatively, namely on December 24, 2007, Respondent should have removed
14 the peri-areola sutures to decrease any potential tension of the complex and its blood supply.
15 THIRD CAUSE FOR DISCIPLINE
16 (Unlawful Discrimination)
17 39. Respondent is subject to disciplinary action under Business and Professions Code
18 Section 125.6 in that he engages in the unlawful discrimination of patients with Acquired Immune
19 Deficiency Syndrome (AIDS). The circumstances are as follows:
20 40. During Respondent's interview with the Board regarding his care and treatment of
21 P.L., Respondent's AIDS policy was discussed. This policy requires all patients to undergo an
22 AIDS test prior to receiving treatment from Respondent. Respondent told the Board that if a
23 patient tests positive with the HIV virus he will not treat them. Respondent further told the Board
24 that he would not refer the patient to another physician because that "would be criminal" as the
25 new doctor would be "in danger."
26 I I I
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FOURTH CAUSE FOR DISCIPLINE
2 (Failure to Maintain Accurate and Adequate Records)
3 41. Respondent is subject to disciplinary action under section 2266, 2259.7 and
4 California Code of Regulations, Title 16, Section 1356.6, subdivision (b)(4), in that he failed to
5 maintain accurate and adequate records in his care and treatment of patient P.L. The
6 circumstances are as follows:
7 42. Paragraphs 16 through 34, inclusive, above are incorporated herein by reference as if
8 fully set forth.
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10 PRAYER
11 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,
12 and that following the hearing, the Medical Board of California issue a decision:
13 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 30411,
14 issued to Ani! Krishnakumar Gandhi, M.D.
15 2. Revoking, suspending or denying approval of his authority to supervise physician's
16 assistants, pursuant to section 3527 ofthe Code;
17 3. Ordering Respondent to pay the Medical Board of California the costs of probation
18 monitoring, if placed on probation; and
19 4. Taking such other and further action as deemed necessary and proper.
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21 DATED: June 24, 2014
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LA2013610856 61298680.docx
Interim Executive Director Medical Board of California Department of Consumer Affairs State of California
Complainant
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