XAVIER BECERRA Attorney General of California MATTHEWM Roy... · XAVIER BECERRA Attorney General of...
Transcript of XAVIER BECERRA Attorney General of California MATTHEWM Roy... · XAVIER BECERRA Attorney General of...
XAVIER BECERRA Attorney General of California
2 MATTHEWM.DAVIS Supervising Deputy Attorney General
3 MARTIN W. HAGAN Deputy Attorney General
4 State Bar No. 155553 600 West Broadway, Suite 1800
5 San Diego, CA 92101 P .0. Box 85266
6 San Diego, CA 92186-5266 Telephone: (619) 738-9405
7 Facsimile: (619) 645-2061
8 Attorneys/or Complainant
9
10
11
12
BEFORE THE
13
14
15
16
MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against:
Roy Cass Springer, M.D. 6280 Jackson Drive, Suite 8 San Diego, CA 92119-3436
Case No. 800-2017-032022
ACCUSATION
17 Physician's and Surgeon's Certificate No. A 23489,
18
19
20
Respondent.
PARTIES
21 1. Christine J. Lally (Complainant) brings this Accusation solely in her official capacity
22 as the Interim Executive Director of the Medical Board of California, Department of Consumer
23 Affairs (Board).
24 2. On or about September 5, 1969, the Medical Board issued Physician's and Surgeon's
25 Certificate Number A 23489 to Roy Cass Springer, M.D. (Respondent). The Physician's and
26 Surgeon's Certificate was in full force and effect at all times relevant to the charges brought
27 herein and will expire on December 31, 2021, unless renewed.
28 I I I I
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
JURISDICTION
2 3. This Accusation is brought before the Board, under the authority of the following
3 laws. All section references are to the Business and Professions Code (Code) unless otherwise
4 indicated;
5 4. Section 2227 of the Code states:
6 (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
7 Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in accordance with the
8 provisions of this chapter:
9 (1) Have his or her license revoked upon order of the board.
10 (2) Have his or her right to practice suspended for a period not to exceed one year upon order of the board.
11 (3) Be placed on probation and be required to pay the costs of probation
12 monitoring upon order of the board.
13 (4) Be publicly reprimanded by the board. The public reprimand may include a requirement that the licensee complete relevant educational courses approved by the
14 board.
15 (5) Have any other action taken in relation to discipline as part of an order of
16 probation, as the board or an administrative law judge may deem proper.
(b) Any matter heard pursuant to subdivision (a), except for warning letters, 17 medical review or advisory conferences, professional competency examinations,
continuing education activities, and cost reimbursement associated therewith that are 18 agreed to with the board and successfully completed by the licensee, or other matters
made confidential or privileged by existing law, is deemed public, and shall be made 19 available to the public by the board pursuant to Section 803.1.
20 STATUTORY PROVISIONS·
21 5. Section 2234 of the Code, states:
22 The board shall take action against any licensee who is charged with unprofessional conduct. In addition to-other provisions of this article, unprofessional
23 conduct includes, but is not limited to, the following:
24 (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 .
.25 (b) Gross negligence.
26 (c) Repeated negligent acts. To be repeated, there must be two or more
27 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
28 repeated negligent acts.
2
ROY CASS SPRINGER, M.D. -ACCUSATION NO. 800-2017-032022
2
(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 3 omission that constitutes the negligent act described in paragraph (I), including, but
not limited to, a reevaluation of the diagnosis or a change in treatment, and the 4 licensee's conduct departs from the applicable standard of care, each departure
constitutes a separate and distinct breach of the standard of care. 5
6 (f) Any action or conduct which would have warrnnted the denial of a
7 ceriificate.
8
9 6. Section 725 of the Code states:
10 (a) Repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering of drugs or treatment, repeated acts of clearly excessive use of
11 diagnostic procedures, or repeated acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of the community of licensees is
12 unprofessional conduct for a physician and surgeon, dentist, podiatrist, psychologist, physical therapist, chiropractor, optometrist, speech-language
13 pathologist, or audiologist.
14 (b) Any person who engages in repeated acts of clearly excessive prescribing or administering of drugs or treatment is guilty of a misdemeanor and shall be
15 punished by a fine of not less than one hundred dollars ($100) nor more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days nor
16 more than 180 days, or by both that fine and imprisonment.
17 (c) A practitioner who has a medical basis for prescribing, furnishing,· dispensing, or administering dangerous drugs or prescription controlled substances
18 shall not be subject to disciplinary action or prosecution under this section.
19 (d) No physician and surgeon shall be subject to disciplinary action pursuant
20
21
to this section for treating intractable pain in compliance with Section 2241.5.
7. Section 2266 of the Code states: The failure of a physician and surgeon to maintain
22 adequate and accurate records relating to the provision of services to their patients constitutes
23 unprofessional conduct.
24 I I I I
25 II I I
26 I I I I
27 II I I
28 II I I
3
ROY CASS SPRINGER, M.D. -ACCUSATION NO. 800-2017-032022
FIRST CAUSE FOR DISCIPLINE
2 (Gross Negligence)
3 8. Respondent is subject to disciplinary action under sections 2227 and 2234, as defined
4 by section 2234, subdivision (b), of the Code, in that he committed gross negligence in his care
5 and treatment of Patients A and B, as more particularly alleged hereinafter:
6 PATIENT A 1
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
9. On or about December 16, 2013, Respondent had his first visit with Patient A, a then-
29-year-old-male and family member.2 According to Respondent's chart note, Patient A's chief
complaint was "back pain improved, but had spasm on 12/15." Muscle tightness and L4-5 and
positive straight leg test was noted. Respondent's assessment was "acute low back pain" and the
plan was listed as "Rx Norco3 #30."
II II
1 The patients referenced in this Accusation are designated as "Patient A," Patient B," and "Patient C" in order to maintain and protect their privacy. ·
2 The AMA Code of Medical Ethics states, "[i]n general, physicians should not treat themselves or their own family members" except for limited circumstances which includes "emergency settings or isolated settings where there is no other qualified physician available" or "for short-term, minor problems." As recognized by the AMA, "[t]reating a family member poses several challenges including, but not limited to, professional objectivity, patient autonomy and informed consent." (AMA Code of Medical Ethics Opinion 1.2.1.)
3 Hydrocodone APAP (Vicodin®, Lortab® and Norco®) is a combination of hydrocodone bitartrate and acetaminophen which was formerly a Schedule III controlled substance pursuant to Health and Safety Code section 11056, subdivision (e), and a dangerous drug pursuant to Business and Professions Code section.4022. On August 22, 2014, the DEA published a final rule rescheduling hydrocodone combination products to schedule II of the Controlled Substances Act, which became effective October 6, 2014. Schedule II controlled substances are substances that have a currently accepted medical use in the United States, but also have a high potential for abuse, and the abuse of which may lead to severe psychological or physical dependence. When properly prescribed and indicated, hydrocodone combination products are used for the treatment of moderate to severe pain. In addition to the potential for psychological and physical dependence there is also the risk of respiratory depression, which is increased, when hydrocodone combination products are used with other central nervous system (CNS) depressants and acute liver failure from excessive acetaminophen, which has resulted in black box warnings being issued by the Federal Drug Administration (FDA). The FDA black box warnings included, among other things, that "Concomitant use of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death" and that "Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with use of the acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen containing product." ·
4
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-20 I 7-032022
10. During the period of on or about January 1, 2014, through December 31, 2014,
2 Patient A had eight visits with Respondent which took place on January 16, January 27, March
3 27, May 14, June 28, September 18, November 26, and December 23, 2014. During this time,
4 Patient A's problems were generally documented as including, but not limited to, left shoulder
5 pain, back pain and occasional muscle spasm. On January 3, Respondent's Physician Assistant
6 Certified (P.A.C.) J.K. issued two prescriptions for controlled substances without any supporting
7 medical documentation. On January 6, another physician in Respondent's clinic, most likely Dr.
8 S.G.,4 had an office visit with Patient A because "Dr. Springer [was] out of town." Thereafter,
9 Patient A's dose ofhydrocodone/APAP (Norco) was increased without sufficient examination,
1 O history, and/Or adequate documentation. During 2014, Respondent's chart notes were cursory
11 and routinely failed to adequately document, among other things, prior treatment, detailed
12 histories, physical examinations, detailed assessments and treatment plans for presenting
13 problems, detailed analysis of pain and effect on quality of life, informed consent for the
14 controlled substances being prescribed, adequate risk screening measures,5 and/or specific and
15 complete information for the controlled substances being prescribed. According to the CURES6
16 repo1t for Patient A, the following prescriptions for controlled substances were filled for Patient A
17 . during2014:
18
19
20
21
22
23
24
25
26
27.
28
II II
II II
4 The chart note for January 6, 2014, did not identify the examining physician. However, a prescription was issued by Dr. S.G. to Patient A on that date.
5 Risk screening measures include, but are not limited to, obtaining adequate histories on such items as mental health, drug use, alcohol use, and any other conditions or diagnoses which may be contraindicated for the controlled substances being prescribed, pain management agreements, pill counting, toxicology screening, opioid risk screening tools or checklists, and periodic review of available prescription drug monitoring programs. Risk screening measures are designed to address aberrant drug behavior including, but not limited to, misuse and/or diversion of the controlled substances being prescribed.
6 CURES is California's prescription drug monitoring program which tracks Schedule II, III and IV controlled substance prescriptions that are dispensed in California. One of the explicit purposes of the CURES database is to assist "law enforcement and regulatory agencies in their efforts to control the diversion and resultant abuse of Schedule II, Schedule Ill, and Schedule IV controlled substances." (Health & Saf.Code, § 11165, subd. (a).)
5
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-20 I 7-032022
2
3
4
5
6
7
8
9
10
1 I
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Date Filled Drug Name Strength Quantity Days Prescriber
01-03-20 I 4 Hydrocodone/ AP AP 10/325 mg 90 30 PAC (J.K.)
01-03-2014 Carisoprodol7 350 mg 90 30 PAC (J.K.)
01-06-2014 Hydrocodone/ AP AP 10/325 mg 20 05 Dr. S.G.
01-29-2014 Hydrocodone/ AP AP 10/325 mg 40 10 Respondent
01-29-2014 Hydrocodone/ APAP 10/325 mg 120 30 Respondent
02-26-2014 Hydrocodone/ APAP 10/325 mg 120 30 Respondent
02-26-2014 Hydrocodone/ AP AP 10/325 mg 40 10 Respondent
03-24-2014 Hydrocodone/ AP AP 10/325 mg 40 10 Respondent
03-25-2014 Hydrocodone/ AP AP 10/325 mg 120 30 Respondent
04-21-2014 Hydrocodone/ APAP 10/325 mg 120 30 Respondent
04-21-2014 Hydrocodone/ AP AP 10/325 mg 40 10 Respondent
05-16-2014 Hydrocodone/ AP AP 10/325 mg 160 26 Respondent
06-10-2014 Hydrocodone/ APAP 10/325 mg 160 26 Respondent
07-05-2014 Hydrocodone/ AP AP 10/325 mg 160 26 Responqent
07-29-2014 Hydrocodone/ APAP 10/325 mg 160 26 Respondent
08-25-2014 · Hydrocodone/APAP . 10/325 mg 160 26 Respondent
09-19-2014 Hydrocodone/ AP AP 10/325 mg 160 27 Respondent
10-15-2014 Hydrocodone/ AP AP 10/325 mg 160 26 Respondent
11-26-2014 Hydrocodone/ AP AP 10/325 mg 95 15 Respondent
12-24-2014 Hydrocodone/ APAP 10/325 mg 90 15 Respondent
7 Carisoprodol (Soma®) is a Schedule IV controlled substance pursuant to Health and s p
afety Code section 11057, subdivision (d), and a dangerous drug pursuant to Business and rofessions Code section 4022. When properly prescribed and indicated, it is used for the short-
erm treatment of acute and painful musculoskeletal conditions. Soma® is commonly used by t t A I
hose who abuse opioids to potentiate the euphoric effect of opioids, to create a better "high." ccording to the DEA, Office of Diversion Control, "[c]arisoprodol abuse has escalated in the
ast decade in the United States. According to Diversion Drug Trends, published by the DEA on he trends in diversion of controlled and noncontrolled pharmaceuticals, carisoprodol is a
c ommonly diverted drug.
6
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-20 I 7-032022
11. During the period of on or about January 1, 2015, through December 31, 2015,
atient A had twelve visits with Respondent which took place on February 20, March 18, April 1, 2 p
3 A pril 22, May 18, June 1, June 15, July 20, September 15, November 14, December 11, and
4 D ecember 21, 2015. During this time, Patient A's problems were generally documented as
5 ncluding, but not limited to, spasm, ankle sprain (documented on April I), and dental infection
6 ( documented on December 21 ). In general, Respondent's chatt notes were cursory and routinely
7 fi ailed to adequately document, among other things, prior treatment, detailed histories, physical
8 e xaminations, detailed assessments and treatment plans for presenting problems, detailed analysis
9 0 f pain and effect on quality of life, informed consent for the controlled substances being
10 p rescribed, adequate risk screening measures, and/or specific and complete information for the
11 c ontrolled substances being prescribed. During this period of time, Patient A's morphine
12 e quivalency doses were as high as 136 milligrams per day. According to the CURES report for
13 p
14 2
15
atient A, the following prescriptions for controlled substances were filled for Patient A during
16
17
18
19
20
21
22
23
24
25
26
27
28
015:
Date Filled
01-24-2015
03-04-2015
04-01-2015
04-23-2015
05-18-2015
06-01-2015
06-15-2015
07-20-2015
08-20-2015
09-15-2015
10-06-2015
10-22-2015
Drug Name Strength Quantity Days Prescriber
Hydrocodone/ APAP 10/325 mg 90 30 Respondent
Hydrocodone/ AP AP 10/325 mg 40 06 Respondent
Hydrocodone/ AP AP 10/325 mg 120 30 Respondent
Hydrocodone/ APAP 10/325 mg 150 25 Respondent
Hydrocodone/ APAP 10/325 mg 120 30 Respondent
Hydrocodone/ AP AP 10/325 mg 30 05 Respondent
Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
Hydrocodone/ AP AP 10/325 mg 100 17 Respondent
Hydrocodone/ AP AP 10/325 mg 105 17 Respondent
Hydrocodone/ AP AP 10/325 mg 115 19 Respondent
Hydrocodone/ APAP 10/325 mg 105 17 Respondent
Hydrocodone/ APAP 10/325 mg 120 20 Respondent
7
ROY CASS SPRINGER M.D. - ACCUSATION NO. 800-2017-032022
2
3
4
Date Filled
11-16-2015
12-11-2015
12-22-2015
Drug Name Strength
Hydrocodone/ APAP 10/325 mg
Hydrocodone/ APAP 10/325 mg
Hydrocodone/APAP 10/325 mg
Quantity Days Prescriber
120 20 Respondent
150 25 Respondent
80 13 Respondent
5 12. During the period of on or about January 1, 2016, through December 31, 2016,
6 Patient A had six visits with Respondent which took place on February 1, April 13, May 9, May
7 31, June 29, and November 22, 2016. During this time, Patient A's problems were generally
8 documented as including, but not limited to, tooth pain, low back spasms, and left sciatica. On
9 May 31, Respondent noted left-sided sciatica but failed to document urinary or bowel symptoms,
10 perinea) sensation, or anal wink, and he failed to exclude cauda equina syndrome.8 On June 29,
11 there was notation to "See specialist (pain) soon [and] Arrange for MRI." On July 13, Patient A
12 was seen by Dr. B.W., physical medicine and pain management, who recommended Norco
13 10/325 mg q.i.d., continued stretching, consider MRI, consider physical therapy and continue
14 current plan. During this time, Patient A's problems were generally documented as including, but
15 not limited to, left shoulder pain, back pain and occasional muscle spasm. In general,
16 Respondent's chart notes were cursory and routinely failed to adequately document, among other
17 things, prior treatment, detailed histories, physical examinations, detailed assessments and
18 treatment plans for presenting problems, detailed analysis of pain and effect on quality of life,
19 nfonned consent for the controlled substances being prescribed, adequate risk screening
20 measures, and/or specific and complete infonnation for the controlled substances being
21 prescribed. There was no documentation for the prescription from Physician Assistant H.H.
22 which was filled on August 18, 2016. There was no documentation for the prescriptions from Dr.
23 B.L., which were filled on September 12, October 18, and December 17, 2016. During this
24 period of time, Patient A's morphine equivalency doses were approximately 60 milligrams per
25 day. According to the CURES report for Patient A, the following prescriptions for controlled
26 substances were filled for Patient A during 2016:
27
28 8 Cauda equina syndrome is a neurological emergency created by compression of the
distal spinal column which if untreated and unrecognized can lead to paralysis.
8
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Date Filled Drug Name Strength Quantity Days Prescriber
01-09-2016 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
02-01-2016 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
02-27-2016 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
03-21-2016 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
04-15-2016 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
05- i'o-2016 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
06-04-2016 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
06-30-2016 Hydrocodone/APAP 10/325 mg 150 25 Respondent
07-26-2016 Hydrocodone/ APAP 10/325 mg 150 25 Dr. B.W.
08-18-2016 Hydrocodone/ APAP 10/325 mg 150 25 P.A. (H.H.)
09-12-2016 Hydrocodone/ APAP 10/325 mg 150 25 Or. B.L.9
10-18-2016 Hydrocodone/ AP AP 10/325 mg 150 25 Dr. B.L.
11-23-2016 Hydrocodone/APAP 10/325 mg 150 25 Respondent
12-17-2016 Hydrocodone/ AP AP 10/325 mg 150 25 Dr. B.L.
13. During the period of on or about January I, 2017, through December 31, 2017,
p atient A had seventeen visits with Respondent or Respondent's colleague, Dr. B.L., which took
lace on February 23 (Dr. B.L. visit), April 27 (Dr. B.L. visit), June 12 (Dr. B.L. visit), June 23, p
J uly 3 (Dr. B.L. visit), July 17, August 8, September 11, September 30, October 2, October 20,
0 ctober 27, November 14, November 27, December 9, December 14, and December 21, 2017.
D uring this time, Patient A's problems were generally documented as including, but not limited
t o, low back pain, right ankle pain, and back spasms (unchanged). Respondent's chart note of
A ugust 8, indicated "no longer seeing B.L. (pill mill) 10- no referrals ever done or suggested"
s d
9 Patient A filled prescriptions from Dr. B.L., who worked with Respondent, on eptember 12, October 18, and December 17, 2016, which had no corresponding medical record ocumentation.
10 The chart notes indicates that Respondent and Dr. B.L. both worked at the Center for amily Health which was owned by Respondent. Respondent's "pill mill" reference is ironic F
c onsidering that Respondent subsequently issued numerous similar prescriptions of
9
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
with a notation to "Use Oxy for severe pain" and, in regard to referrals, "MRI and PT soon." On
2 August 8, Patient A had a MRI with the "impression" reported as "straightening of normal
3 ordotic curvature, compatible with muscle spasm." On August 11, Patient A had a rehabilitation
4 evaluation where physical therapy was recommended. During this time, Patient A's problems
5 were generally documented as including, but not limited to, left shoulder pain, back pain and
6 occasional muscle spasm. In general, Respondent's chart notes were cursory and routinely failed
7 o adequately document, among other things, prior treatment, detailed histories, physical
8 examinations, detailed assessments and treatment plans for presenting problems, detailed analysis
9 of pain and effect on quality of life, informed consent for the controlled substances being
IO prescribed, adequate risk screening measures, and/or specific and complete information for the
11 controlled substances being prescribed. During this period of time, Patient A's morphine
12 equivalency dose exceeded 90 mg per day. 11 According to the CURES report for Patient A, the
13 following prescriptions for controlled substances were filled for Patient A during 2017:
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Date Filled Drug Name Strength Quantity Days Prescriber
01-10-2017 Hydrocodone/APAP 10/325 mg 150 25 Dr. B.L.
02-02-2017 Hydrocodone/ APAP I 0/325 mg 150 25 Dr. B.L.
02-24-2017 Hydrocodone/ APAP I 0/325 mg 150 25 Respondent
03-20-2017 Hydrocodone/APAP 10/325 mg 150 25 Dr. B.L.
04-04-2017 Hydrocodone/ AP AP I 0/325 mg 150 25 Dr. B.L.
hydrocodone/APAP (Norco) 10/325 mg (#150) and later added Oxycodone/APAP (Percocet) which actually increased the overall morphine equivalency dosage for Patient A, and put him at greater risk of, among other things, psychological or physical dependence, respiratory depression, overdose, and/or death.
11 On March 18, 2016, the Centers for Disease Control and Prevention (CDC) issued its Guideline for Prescribing Opioids for Chronic Pain. One of the recommendations was that 'When opioids are started, clinicians should prescribe the lowest effective dose. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when increasing dosage [greater than] 50 [MED/day], and should avoid increasing to [greater than] 90 [MED/day] or carefully justify a decision to titrate dosage to [greater than 90 [MED/day]." Additionally, the American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine (hereinafter collectively referred to as "Academies") note that extreme caution is necessary when a patient is receiving over 90-100 MED/day.
10
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
I .
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Date Filled Drug Name Strength Quantity Days. Prescriber
04-28-2017 Hydrocodone/ AP AP 10/325 mg 150 25 Dr. B.L.
05-22-2017 Hydrocodone/ APAP 10/325 mg 150 25 Dr. B.L.
06-15-2017 Hydrocodone/ APAP 10/325 mg 150 25 Dr. B.L.
07-03-2017 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
07-23-2017 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
08-08-2017 Oxycodone/APAP12 10/325 mg 50 10 Respondent
08-17-2017 Hydrocodone/ AP AP 10/325 mg 150 15 Respondent
08-28-2017 Oxycodone/ APAP 10/325 mg 50 07 Respondent
09-12-2017 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
09-12-2017 Oxycodone/ APAP 10/325 mg 40 10 Respondent
09-30-2017 Oxycodone/ AP AP 10/325 mg 40 20 Respondent
10-09-2017 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
10-20-2017 Oxycodone/ AP AP 10/325 mg 50 15 Respondent
10-27-2017 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
11-08-2017 Oxycodone/ AP AP 10/325 mg 45 11 Respondent
11-27-2017 Oxycodone/ AP AP 10/325 mg 50 13 Respondent ,
12-10-2017 Oxycodone/APAP 10/325 mg 50 12 Respondent
12-15-2017 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
12-21-2017 Oxycodone/ APAP 10/325 mg 80 30 Respondent
14. During the period of on or about January 1, 2018, through December 31, 2018,
p atient A had fifteen visits with Respondent which took place on January 11, February 3, March
12 Oxycodone/APAP [acetaminophen] (Percocet®), an opioid analgesic, is a Schedule II ontro1led substance pursuant to Health and Safety Code section 11055, subdivision (b ), and a c
d p T A
angerous drug pursuant to Business and Professions Code section 4022. When properly rescribed and indicated, it is used for the management of moderate to moderately severe pain. he Drug Enforcement Administration has identified oxycodone, as a drug of abuse. (Drugs of buse, A DEA Resource Guide (2011 Edition), at p. 41.) The Federal Drug Administration has
ssued a black box warning for Percocet® which warns about, among other things, addiction, a buse and misuse, and the possibility of "life-threatening respiratory distress."
11
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
3, April 18, May 14, June 6, July 1, July 17, July 26, August 18, September 12, October 4, 2
2 N ovember 19, December 6, and December 14, 2018. During this time, Patient A's problems
3 w ere generally documented as including, but not limited to, left shoulder pain, back pain and
4 0 ccasional muscle spasm. On March 23, Respondent charted that Patient A was "using less
5 N orco" which was inaccurate. 13 In general, Respondent's chart notes were cursory and routinely
6 fi ailed to adequately document, among other things, prior treatment, detailed histories, physical
7 e xaminations, detailed assessments and treatment plans for presenting problems, detailed analysis
8 0 f pain and effect on quality cif life, informed consent for the controlled substances being
9 p rescribed, adequate risk screening measures, and/or specific and complete information for the
10 .c ontrolled substances being prescribed. During this time, Patient A's problems were generally
11 d ocumented as including, but not limited to, low back pain ·and back spasms. During this period
12 0 f time, Patient A's morphine equivalency dose exceeded 90 mg per day. According to the
13 c URES repo11 for Patient A, the following prescriptions for controlled substances were filled for
14 p
15
16
17
18
19
20
21
22
23
24
25
26
27 h
atient A during 2018:
Date Filled Drug Name Strength Quantity Days Prescriber
01-07-2018 Oxycodone/ APAP 10/325 mg 50 15 Respondent
01-12-2018 Hydrocodone/ AP AP 10/325 mg 150 30 Respondent
02-05-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
03-02-2018 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
03-27-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
04-18-2018 Hydrocodone/ AP AP 10/325 mg 150 30 Respondent
05-14-2018 Hydrocodone/ AP AP 10/325 mg 150 30 Respondent
06-06-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
07-02-2018 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
13 According to the CURES report for Patient A, he continued to fill prescriptions of ydrocodone/ APAP (Norco) in 2018 in the range of 5-6 tabs per days (which he consistently
28 eceived in 2017) and filled a prescription for Norco 10/325 mg (# 150- 20 day supply) on July 26, r
2 018, which represented 7.5 tabs per day.
12
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Date Filled Drug Name Strength Quantity Days Prescriber
07-17-2018 Oxycodone/ APAP 10/325 mg 50 12 Respondent
07-26-2018 Hydrocodone/ AP AP 10/325 mg 150 20 Respondent
08-20-2018 Hydrocodone/ APAP 10/325 mg 150 25 Respondent
09-12-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
10-04-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
10-24-2018 Tramadol 14 50 mg 120 30 Respondent
10-26-2018 Oxycodone/ AP AP 10/325 mg 60 10 Respondent
10-29-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
11-19-2018 Oxycodone/ APAP 10/325 mg 60 10 Respondent
12-06-2018 Oxycodone/ APAP 10/325 mg 70 14 Respondent
12-14-2018 Hydrocodone/ AP AP 10/325 mg 150 25 Respondent
12-24-2018 Oxycodone/ AP AP 10/325 mg 80 15 Respondent
15. On or about January 9, 2019, Respondent documented persistent back pain of unclear
e tiology, minimal success with physical therapy, "[u]ses hydrocodone and occasional
0 xycodone," with a review of symptoms. A comprehensive physical exam was documented
w hich included a questionable genital exam and questionable clinical breast exam including lack
0 f dimpling. 15 A back examination was not documented.
14 Tramadol Hydrochloride (Ultram®, Ultracet®), an opioid analgesic, is a Schedule IV ontrolled substance pursuant to Health and Safety Code section 11057, subdivision (d), and a c
d p a
angerous drug pursuant to Business and Professions Code section 4022. When properly rescribed and indicated, it is used for the treatment of moderate to severe pain. The FDA-pproved labeling under the Drug Abuse and Dependence section warns, among other things, that '[t]ramadol hydrochloride may induce psychic and physical dependence ... Dependence and buse, including drug-seeking behavior and taking illicit actions to obtain the drug are not limited o those patients with prior history of opioid dependence. The risk in patients with substance
a t a t d n
buse has been observed to be higher. Tramadol hydrochloride is associated with craving and olerance development. Withdrawal symptoms may occur if tramadol hydrochloride is iscontinued abruptly." According to the DEA, "[t]ramadol is most commonly abused by arcotic addicts, chronic pain patients, and health professionals."
15 A comprehensive clinical breast examination with comments about the absence of asses and dimpling is appropriate for a routine health care maintenance examination of an adult
emale patient, which is not typically done on a male patient such as Patient A, absent specific m fl c omplaints regarding his breasts or unless he had atypical gynecomastia (enlargement of a man's
13
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
16. Respondent committed gross negligence in his care and treatment of Patient A which
included, but was not limited to, the following:
II II
(a) Respondent undertook treatment and continued treatment of a family
member, Patient A, over an extended period of time, which included, but
was not limited to, issuing numerous prescriptions of controlled
substances and failing to actively pursue or consider other conditions or
diagnoses including, but not limited to, comorbid depression and anxiety
and/or cauda equina syndrome;
(b) Respondent repeatedly prescribed controlled substances to Patient A, a
family member, without adequately obtaining, providing and/or
documenting, among other things, prior treatment, detailed histories,
physical examinations, detailed assessments and treatment plans for
presenting problems, detailed analysis of pain and effect on quality of life,
informed consent for the controlled substances being prescribed, adequate
risk screening measures, and/or specific and complete information for the
controlled substances being prescribed;
(c) Respondent failed to document why Physician Assistant J.K. prescribed a
higher dose of hydrocodone/APAP (Norco) and issued a prescription for
carisoprodol (Soma) on or about January 3, 2014;
(d) Respondent repeatedly prescribed opiates in excessive doses which
increased the risk of harm to Patient A;
(e) Respondent failed to carefully coordinate and/or document any
coordination of care with Dr. B.L.; and
(f) Respondent inaccurately charted that Patient A was "using less Norco" on
March 23, 2018.
breasts usually due to hormone imbalance or hormone therapy). Similarly, the performance of a genital examination on one's family member is not something that would typically be done in such a clinical setting.
14
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-20 I 7-032022
PATIENT B
2 17. On or about September 2, 2014, Respondent had his first documented visit with
3 Patient B, a then-31-year-old-female and family member, which took place nearly eight months
4 after he began prescribing controlled substances to Patient B. According to Respondent's chart
5 note, Patient B's chief complaint was "severe spine/back pain from a rear impact motor vehicle
6 accident in 201 O." The subjective section of the chart note indicated, among other things, "Now:
7 sudden onset of LBP [low back pain] I may be from yoga exercising." Respondent documented a
8 checkbox physical examination which was normal except for the back area with no further details
9 provided. The documented assessment was "Low back spasm" and his plan was "will try
1 O occasional] Norco for pain ... may need [muscle] relaxant." Respondent prescribed Norco
11 (hydrocodone/ APAP) 10/325 mg (# 160) one tablet every four hours as needed for pain.
I 2 I 8. Respondent had one more documented office visit with Patient B which took place on
13 October 29, 2014. According to_ Respondent's chart note, Patient B reported that she was "Doing
14 better [with] Less pain/spasm" and that she had a muscle spasm episode "but now resolved."
I 5 Respondent documented a checkbox physical examination which was normal for cardiac,
I 6 extremities, neurological and abnonnal for back indicating "80-90 [percent with] pain." The plan
I 7 was to continue exercising and stretching and to prescribe "Norco# 160 but use only sparingly"
18 with no strength documented in the chart note. A copy of the handwritten prescription was
19 ncluded as part of the certified medical records. During the course of2014, Respondent
20 ncreased the risk of harm to Patient B in increasing her morphine equivalency dose from I 5 mg
21 per day to 61 .5 mg per day while concurrently prescribing Soma (carisoprodol) 350 mg.
22 According to the CURES report for Patient B, the following prescriptions for controlled
23
24
25
26
27
is
s ubstances were filled for Patient B during 2014:
Date Filled Drug Name Strength Quantity Days
01-13-2014 Hydrocodone/ APAP 5/325 mg 90 30
01-13-2014 Carisoprodol 350 mg 90 30
02-10-20 I 4 Hydrocodone/ APAP 5/325 mg 90 30
15
ROY CASS SPRINGER, M.D. -ACCUSATION NO. 800-2017-032022
Prescriber
Respondent
Respondent
Respondent
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Date Filled Drug Name Strength Quantity Days Prescriber
02-10-2014 Carisoprodol 350 mg 90 30 Respondent
03-10-2014 Hydrocodone/ APAP 5/325 mg 90 30 Respondent
03-10-2014 Carisoprodol 350 mg 90 30 Respondent
04-07-2014 Hydrocodone/ APAP 5/325 mg 90 30 Respondent
04-07-2014 Carisoprodol 350 mg 90 30 Respondent
05-07-2014 Hydrocodone/APAP 7.5/325 mg 120 30 Respondent
05-07-2014 Carisoprodol 350 mg 90 30 Respondent
06-05-2014 Hydrocodone/ APAP 7.5/325 mg 120 30 Respondent
06-05-2014 Carisoprodol 350 mg 90 30 Respondent
07-02-2014 Hydrocodone/ AP AP 7.5/325 mg 120 30 Respondent
07-05-2014 Carisoprodol 350 mg 90 30 Respondent
08-01-2014 Hydrocodone/ AP AP 7.5/325 mg 120 30 Respondent
08-01-2014 Carisoprodol 350 mg 90 30 Respondent
08-30-2014 Carisoprodol 350 mg 90 30 Respondent
09-02-2014 Hydrocodone/ AP AP 10/325 mg 160 26 Respondent
09-27-2014 Hydrocodone/ AP AP 10/325 mg 160 26 Respondent
10-27-2014 Hydrocodone/ AP AP 10/325 mg 160 26 Respondent
19. Respondent committed gross negligence in his care and treatment of Patient B which
ncluded, but was not limited to, the following:
(a) Respondent undertook treatment and continued treatment of a family
member, Patient B, over an extended period of time, which included, but
was not limited to issuing numerous prescriptions of controlled
substances;
(b) Respondent repeatedly prescribed controlled substances to Patient B, a
family member, without conducting any good faith examinations;
I /II
16
ROY CASS SPRINGER, M.D. - A CCU SA TION NO. 800-2017-032022
(c) Respondent repeatedly prescribed controlled substances to Patient B, a
2 family member, without adequately obtaining, providing and/or
3 documenting, among other things, prior treatment, detailed histories,
4 physical examinations, detailed assessments and treatment plans for
5 presenting problems, detailed analysis of pain and effect on quality of life,
6 informed consent for the controlled substances being prescribed, adequate
7 risk screening measures, and/or specific and complete information for the
8 controlled substances being prescribed;
9 (d) Respondent prescribed controlled substances without adequately assessing
1 O the effectiveness of such treatment;
11 (e) Respondent repeatedly prescribed Soma (carisoprodol) over an extended
12 period of time without adequately documenting why it was necessary, safe
13 and effective to do so; and
14 (f) Respondent repeatedly increased the risk of harm to Patient B by
15 prescribing Soma (carisoprodol) in combination with escalating doses of
16 Norco (hydrocodone/ APAP).
17 SECOND CAUSE FOR DISCIPLINE
18 (Repeated Negligent Acts)
19 20. Respondent is further subject to disciplinary action under sections 2227 and 2234, as
20 defined by section 2234, subdivision (c), of the Code, in that he committed repeated negligent
21 acts in his care and treatment of Patients A, B, and C, as more particularly alleged herein:
22 PATIENT A
23 21. Respondent committed repeated negligent acts in his care and treatment of Patient A
24 which included, but was not limited to, the following:
25 (a) Paragraphs 9 through 16, above, are hereby incorporated by reference as if
26 fully set forth herein;
27 (b) Respondent undertook treatment and continued treatment of a family
28 member, Patient A, over an extended period of time, which included, but
17
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
was not limited to, issuing numerous prescriptions of controlled
2 substances, and failing to actively pursue or consider other conditions or
3 diagnoses including, but not limited to, comorbid depression and anxiety
4 and/or cauda equina syndrome;
5 (c) Respondent repeatedly prescribed controlled substances to Patient A, a
6 family member, without adequately obtaining, providing and/or
7 documenting, among other things, prior treatment, detailed histories,
8 physical examinations, detailed assessments and treatment plans for
9 presenting problems, detailed analysis of pain and effect on quality of life,
IO informed consent for the controlled substances being prescribed, adequate
11 risk screening measures, and/or specific and complete information for the
12 controlled substances being prescribed;
13 (d) Respondent failed to document why Physician Assistant K.K. prescribed a
14 higher dose ofhydrocodone/APAP (Norco) and issued a prescription for
15 carisoprodol (Soma) on or about January 3, 2014;
16 (e) Respondent repeatedly prescribed opiates in excessive doses which
17 increased the risk of harm to Patient A;
18 (f) Respondent failed to carefully coordinate and/or document any
19 coordination of care with Dr. B.L.; and
20 (g) Respondent inaccurately charted that Patient A was "using less Norco" on
21 March23,2018.
22 PATIENTB
23 22. Respondent committed repeated negligent acts in his care and treatment of Patient B
24 which included, but was not limited to, the following:
25 (a) Paragraphs 17 through 19 above, are hereby incorporated by reference as
26 if fully set forth herein;
27 (b) Respondent undertook treatment and continued treatment of a family
28 member, Patient B, over an extended period of time, which included, but
18
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-20 I 7-032022
was not limited to issuing numerous prescriptions of controlled
2 substances;
3 (c) Respondent repeatedly prescribed controlled substances to Patient B, a
4 family member, without conducting any good faith examinations;
5 (d) Respondent repeatedly prescribed controlled substances to Patient B, a
6 family member, without adequately obtaining, providing and/or
7 documenting, among other things, prior treatment, detailed histories,
8 physical examinations, detailed assessments and treatment plans for
9 presenting problems, detailed analysis of pain and effect on quality of life,
1 O informed consent for the controlled substances being prescribed, adequate
11 risk screening measures, and/or specific and complete information for the
12 controlled substances being prescribed;
13 (e) Respondent prescribed controlled substances without adequately assessing
14 the effectiveness of such treatment;
15 (I) Respondent repeatedly prescribed Soma (carisoprodol) over an extended
16 period of time without adequately documenting why it was necessary, safe
17 and effective to do so; and
18 (g) Respondent repeatedly increased the risk of harm to Patient B by
19 prescribing Soma (carisoprodol) in combination with escalating doses of
20 Norco (hydrocodone/ APAP).
21 PATIENT C
22 23. Patient C was a long-term female patient of Respondent's with a multitude of medical
23
24
25
26
27
28
problems. 16 During the period of on or about January 1, 2014 (when Patient C was 52-years-old)
through December 31, 2014, Patient C had eight visits with Respondent which took place on
January 8, March 3, April 30, May 27, June 30, August 25, October 22, and December 15, 2014.
During this time, Patient C's problems were generally documented as includin_g, but not limited
16 Respondent was unable to recall specifically when he first started treating Patient C but estimated it was sometime between 2005 and 2008. According to Respondent, the earlier medical records were not available because they had been destroyed.
19
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
to, right shoulder pain and lower back pain. In general, Respondent's chart notes were cursory
and routinely failed to adequately document, among other things, prior treatment, detailed
histories, physical examinations, detailed assessments and treatment plans for presenting
problems, detailed analysis of pain and effect on quality of life, informed consent for the
controlled substances being prescribed, adequate risk screening measures, and/or specific and
complete information for the controlled substances being prescribed. According to the CURES
report for patient C, she filled numerous prescriptions from Respondent in 2014 for various
controlled substances including, but not limited to, phentermine, 17 OxyContin, morphine sulfate, 18
modafinal, 19 and lorazepam.20
17 Phentermine HCL (Lonamin®, Fastin®, Adipex®), an anorectic, is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision (f), and a dangerous drug pursuant to Business and Professions Code sect'ion 4022. When properly prescribed and indicated phentermine HCL is used as a short term adjunct in a regiment of weight reduction based on exercise, behavioral modification, and caloric restriction. According to the DEA fact sheet for anorectic drugs, phentermine can produce amphetamine-like effects and is frequently encountered on the illicit market.
18 Morphine sulfate (MS Contin®), an opioid analgesic, is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (e), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of pain that is severe enough to require daily, around-theclock, long-term opioid treatment and for which alternative treatment options are inadequate. The Drug Enforcement Administration has identified oxycodone, as a drug of abuse. (Drugs of Abuse, A DEA Resource Guide (2011 Edition), at p. 40.) The Federal Drug Administration has issued a black box warning for MS Cantin® which warns about, among other things, addiction, abuse and misuse, and the possibility of life-threatening respiratory distress. The warning also cautions about the risks associated with concomitant use of MS Cantin® with benzodiazepines or other central nervous system (CNS) depressants.
19 Modafinil (Provigil®, Alertec®, Modavigil®) is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision ( d), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated it is used to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive s.leep apnea, or shift work disorder.
20 Lorazepam (Ativan®), a benzodiazepine, is a centrally acting hypnotic-sedative that is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision (d), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of anxiety disorders or for the short term relief of anxiety or anxiety associated with depressive symptoms. Concomitant use of lorazepam with opioids "may result in profound sedation, respiratory depression, coma, and death." The Drug Enforcement Administration (DEA) has identified benzodiazepines, such as lorazepam, as a drug of abuse. (Drugs of Abuse, DEA Resource Guide (2011 Edition), at p. 53.) The FDA has issued a black box warning indicating that concomitant use oflorazepam with opioids "may 1:esult in profound sedation, respiratory depression, coma, and death."
20
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
24. During the period of on or about January 1, 2015, through December 31, 2015,
2 Patient Chad seven visits with Respondent which took place on February 9, March 30, April 27,
3 June 24, August 25, October 14, and December 9, 2015. During this time, Patient C's problems
4 were generally documented as including, but not limited to, neuropathy, shoulder pain, ankle
5 pain, chest congestion, asymmetrical breasts, and vertigo. In general, Respondent's chart notes
6 were cursory and routinely failed to adequately document, among other things, prior treatment,
7 detailed histories, physical examinations; detailed assessments and treatment plans for presenting
8 problems, detailed analysis of pain and effect on quality of life, informed consent for the
9 controlled substances being prescribed, adequate risk screening measures, and/or specific and
1 O complete information for the controlled substances being prescribed. According to the CURES
11 report for patient C, she filled numerous prescriptions from Respondent in 2015 for various
12 controlled substances including, but not limited to, phentermine, OxyContin, morphine sulfate,
13 modafinal, and lorazepam. Respondent's physician assistant, under Respondent's supervision,
14 also issued five prescriptions for Patient C without documentation for the prescriptions.21
15 25. During the period of on or about January 1, 2016, through December 31, 2016,
16
17
18
19
20
21
22
23
24
25
26
27
28
Patient Chad seven visits with Respondent which took place on February 3, March 28, May 18,
July 12, September 14, October 13, and November 9, 2016. During this time, Patient C's
problems were generally documented as including, but not limited to, shoulder pain,
asymmetrical breasts, and narcolepsy. Neurologic, orthopedic and breast surgery consultations
were referenced in the medical records. On July 12, a right shoulder X-ray showed a humeral
head deformity and possible subluxation (paiiial dislocation of the shoulder joint). On November
23, Patient C was seen by a neurologist who performed an EKG/NCV study with diagnoses for
right brachia! plexopathy (a form of peripheral neuropathy) most likely from prior radiation
therapy and carpal tunnel syndrome. In general, Respondent's chart notes were cursory and
routinely failed to adequately document, among other things, prior treatment, detailed histories,
physical examinations, detailed assessments and treatment plans for presenting problems, detailed
21 According to the CURES report, Physician Assistant H.H issued prescriptions for OxyContin, morphine sulfate and/or phentermine on April 3, April 14, April 20, May 11, and May 19, 2015.
21
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
analysis of pain and effect on quality of life, informed consent for the controlled substances being
2 prescribed, adequate risk screening measures, and/or specific and complete information for the
3 controlled substances befog prescribed. According to the CURES report for patient C, she filled
4 numerous prescriptions from Respondent in 2016 for various controlled substances including, but
5 not limited to, phentermine, OxyContin, morphine sulfate, modafinal, and lorazepam.
6 26. During the period of on or about January 1, 2017, through December 31, 2017,
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Patient Chad seven visits with Respondent which took place on January 3, February 22, April 4,
May 16, June 27, July 25, and November 20, 2017. During this time, Patient C's problems were
generally documented as including, but not limited to, shoulder pain, weight loss, diarrhea, face
rash, and falls. Patient C was hospitalized from March 9 through March 15, with family reporting
altered mentation. During the hospital admission, concern was raised regarding misuse of
prescribed drugs. Patient C was discharged with Megace (appetite stimulant) added, phentennine
discontinued, and morphine dosage reduced. On November 20, Respondent documented "[follow
up] from healthcare center' discharge (without any further details on the specifics) and noted in the
History of Present Illness section of his chaii note that Patient C was "Off of the opioids" and that
she was "Thinking of getting a medical marijuana card to replace other medications." In general,
Respondent's chart notes were cursory and routinely failed to adequately document, among other
things, prior treatment, detailed histories, physical examinations, detailed assessments and
treatment plans for presenting problems, detailed analysis of pain and effect on quality of life,
informed consent for the controlled substances being prescribed, adequate risk screening
measures, and/or specific and complete information for the controlled substances being
prescribed. According to the CURES report for patient C, she filled numerous prescriptions from
Respondent in 2017 for various controlled substances including, but not limited to, phentermine
(last filled on July 19), OxyContin (last filled on June 28), morphine sulfate (last prescription
from Respondent filled on August 2), modafinal (last prescription from Respondent filled on July
25), lorazepam (last filled on August 15), temazepam22 (first filled on September 1), and tramadol
22 Temazepam (Restoril®), a benzodiazepine, is a centrally acting hypnotic-sedative that is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057,
22
ROY CASS SPRINGER, M.D. -ACCUSATION NO. 800-2017-032022
(first prescription from Respondent filled on November 22).
2 27. During the period of on or about January 1, 2018, through December 31, 2018,
3 Patient C had six visits with Respondent which took place on January 24, March 26 (nurse
4 practitioner visit), April 9, August 20, October 30, and November 26, 2018. During this time,
5 Patient C's problems were generally documented as including, but not limited to, back pain,
6 injury to ankle, and heart palp_ations. In general, Respondent's chart notes were cursory and
7 routinely failed to adequately document, among other things, prior treatment, detailed histories,
8 physical examinations, detailed assessments and treatment plans for presenting problems, detailed
9 analysis of pain and effect on quality of life, informed consent for the controlled substances being
1 O prescribed, adequate risk screening measures, and/or specific and complete information for the
11 controlled substances being prescribed. According to the CURES report for patient C, she filled
12 numerous prescriptions from Respondent in 2018 for various controlled substances including, but
13 not limited to, temazepam, tramadol, hydrocodone/APAP, and OxyContin (resumed prescription
14 from Respondent beginning November 2).
15 28. Respondent committed repeated negligent acts in his care and treatment of Patient C
16 which included, but was not limited to, the following:
17 (a) Respondent repeatedly failed to adequately document physical
18 examinations for the treatment he provided;
I 9 (b) Respondent repeatedly failed to adequately document histories for the
20 treatment he provided;
21 (c) Respondent repeatedly failed to adequately document necessary and
22 specific information for the therapies he provided and/or the controlled
23 substances being prescribed;
24
25
26
27
28
subdivision (d), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used to treat seizure disorders and panic disorders. Concomitant use oftemazepam with opioids "may result in profound sedation, respiratory depression, coma, and death." The Drug Enforcement Administration (DEA} has identified benzodiazepines, such as temazepam, as drug of abuse. (Drugs of Abuse, DEA Resource Guide (2011 Edition), at p. 53.) The FDA has issued a black box warning indicating that concomitant use of temazapam with opioids "may result in profound sedation, respiratory depression, coma, and death."
23
ROY CASS SPRINGER, M.D. - ACCUSATION NO. 800-2017-032022
2
3
4
5
6
7
8
9
IO
11
12
13
14
15
16
(d) Respondent repeatedly failed to adequately document his rationale for
prescribing two long acting opiates;
(e) Respondent repeatedly failed to adequately document his rationale for
prescribing benzodiazepines concurrently with the opiates he was
prescribing;
(1) Respondent failed to adequately document the care and treatment that was
provided by his physician assistant including, but not limited to, the
prescriptions issued by the physician assistant in 2015;
(g) Respondent failed to adequately document the circumstances of Patient
C's hospital admission in March 2017 and her changes in treatment,
including the discontinuation and/or tapering of controlled substances
shortly thereafter; and
(h) Respondent failed to adequately document his rationale for discontinuing
lorazepam and substituting temazepam in August and September 2017.
THIRD CAUSE FOR DISCIPLINE
(Repeated Acts of Clearly Excessive Prescribing)
17 29. Respondent is further subject to disciplinary action under sections 2227 and 2234, as
18' defined by section 725, of the Code, in that he has committed repeated acts of clearly excessive
I 9 prescribing of drugs or treatment to Patient A as determined by the standard of the community of
20 physicians, as more particularly alleged in paragraphs 9 through 16, above, which are hereby
21 incorporated by reference and realleged as if fully set forth herein.
22 FOURTH CAUSE FOR DISCIPLINE
23 (Failure to Maintain Adequate and Accurate Records)
24 30. Respondent is further subject to disciplinary action under sections 2227 and
25 2234, as defined by section 2266, of the Code, in that he failed to maintain adequate and
26 accurate records in his care and treatment of Patients A, B, and C, as more particularly
27 alleged in paragraphs 9 through 28, above, which are hereby incorporated by reference
28 and realleged as if fully set forth herein.
24
ROY CASS SPRINGER, M.D. -ACCUSATION NO. 800-2017-032022
PRAYER
2 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,
3 and that following the hearing, the Medical Board of Califomia issue a decision:
4 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 23489,
5 issued to Respondent Roy Cass Springer, M.D.;
6
7
8
2. Revoking, suspending or denying approval of Respondent Roy Cass Springer, M.D.'s
authority to supervise physician assistan,t§~d advanced practice nurses; :,~~ ·:
3. Ordering Respondent Roy Cass Springer, M.D., if placed on probation, to pay the
9 Board the costs of probation monitoring; and
iO
11
12
13
14
15
16
4.
DATED:
Taking such other and further action as deemed necessary and proper.
APR 2 2 2020 --------
17 SD2020700552
18
19
20
21
22
23
24
25
26
27
28
82265269 .docx
25
ROY CASS SPRINGER, M.D. -ACCUSATION NO. 800-2017-032022