22 23 24 25 26 27 28 EDMUND G, BROWN JR. Attomey General of California THOMAS S. LAZAR Supervising Deputy Attorney General ALEXANDRA, ALVAREZ Deputy Attorney General State Bar No. 187483 FILE D 110 West "A" Street, Suite 1100 San Diego, CA 92101 DEC 29 2009 P.O. Box 85266 San Diego, CA 92186-5266 OSTEOPATHIC MEDICAL BOARD Telephone: (619) 645-3141 eco Facsimile: (619) 645-2061 . Attorneys for Complainant BEFORE THE OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case Nos. 00-2008-002156 and 00-2008-002245 NOREEN A. BUMBY, D.O. 73255 El Paseo Palm Desert, CA 92260 ACCUSATION Osteopathic Surgeon Certificate No. 20A6441, Respondent. Complainant alleges: PARTIES 1. Donald J. Krpan, D.O. (Complainant) brings this Accusation solely in his official capacity as the Executive Director of the Osteopathic Medical Board of California, Department of Consumer Affairs, 2. On or about June 30, 1993, the Osteopathic Medical Board of California issued Osteopathic Surgeon Certificate No. 2086441 to Noreen A. Bumby, D.O. (Respondent). The Osteopathic Surgeon Certificate was in full force and effect at all times relevant to the charges brought herein and will expire on October 31, 2010, unless renewed, Mt Mt ‘AccusationJURISDICTION 3. This Accusation is brought before the Osteopathic Medical Board of California (Board), Department of Consumer Affairs, under the authority of the following laws. All section references are to the Business and Professions Cade unless otherwise indicated. 4, Section 3600 of the Code states that the law governing licentiates of the Osteopathic Medical Board of California is found in the Osteopathic Act and in Chapter 5 of Division 2, relating to medicine, 5. Section 3600-2 of the Code states: "The Osteopathic Medical Board of California shall enforce those portions of the Medical Practice Act identified as Article 12 (commencing with Section 2220), of Chapter 5 of Division 2 of the Business and Professions Coie, as now existing or hereafter amended, as to persons who hold certificates subject to the jurisdiction of the Osteopathic Medical Board of Californie, however, persons who elect to practice using the term or suffix ‘M.D.’ as provided in Section 2275 of the Business and Professions Code, as now existing or hereafter amended, shall not be subject to this section, and the Medical Board of California shall enforce the provisions of the article as to persons who make the election, After making the election, each person so clecting shall apply for renewal of his or her certificate to the Medical Board of California, and the Medical Board of California shall issue renewal certificates in the same manner as other renewal certificates are issued by it" 6. Section 2227 of the Code provides that a licensee who is found guilty under the Medical Practice Act may have his or her license revoked, suspended for a period not to exceed one year, placed on probation and required to pay the costs of probation monitoring, be publicly reprimanded, or have such other action taken in relation to discipline as the Division deems proper. au Mt ‘Aceusationwee ra aw een 7. Section 2234 of the Code states: "The Division of Medical Quality 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: "(@) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter. "(b) Gross negligence, "(© Repeated negligent acts. "(d) Incompetence. "(e) The commission of any act involving dishonesty or corruption which is substantially related to the qualifications, functions, or duties of @ physician and surgeon. "(® Any action or conduct which would have warranted the denial of a certificate, Section 2239 of the Code states: “(a) The use or prescribing for or administering to himself or herself, of any controlled substance; or the use of any of the dangerous drugs specified in Section 4022, or of alcoholic beverages, to the extent, or in such a manner as to be dangerous or injurious to the licensee, or to any other person or to the public, or to the extent that such use impairs the ability of the licensee to practice medicine safely or more than one misdemeanor or any felony involving the use, consumption, or self-administration of any of the substances referred to in this '” Unprofessional conduct under California Business and Professions Code scction 2234 is conduct which breaches the rules of ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical profession, and which demonstrates an unfitness to practice medicine. (Shea v. Board of Medical Quality Examiners (1978) 81 Cal.App.3d 564, 575.) ‘Accusationsection, or any combination thereof, constitutes unprofessional conduct, The record of the conviction is conclusive evidence of such unprofessional conduct. 9. Section 2264 of the Code states that the employing, directly or indirectly, the aiding, or the abetting of any unlicensed person or any suspended, revoked, or unlicensed practitioner to engage in the practice of medicine or any other mode of treating the sick or afflicted which requires a license to practice constitutes unprofessional conduet. 10. Section 2052 of the Code states: "(@) Notwithstanding Section 146, any person who practices or attempts to practice, or who advertises or holds himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as provided in this chapter [Chapter 5, the Medical Practice Act}, or without being authorized to perform the act pursuant to a certificate obtained in accordance with some other provision of law, is guilty of a public offense, punishable by a fine not exceeding ten thousand dollars ($10,000), by imprisonment in the state prison, by imprisonment in a county jail not exceeding one year, or by both the fine and either imprisonment, "() Any person who conspires with or aids or abets another to commit any act described in subdivision (2) is guilty of a public offense, subject to the punishment described in that subdivision, "(o) The remedy provided in this section shall not preclude any other remedy provided by law." 11, Section 2266 of the Code provides that the failure of a physician and surgeon to| maintain adequate and accurate records relating to the provision of ser s to their patients constitutes unprofessional conduct. aM ‘Accusation10 ul 12 13 14 16 7 18. 19 21 22 23 COST RECOVERY 12, Section 125.3 of the Code states, in pertinent part, that the Board may request the administrative law judge to direct a licentiate found to have committed a violation or violations of the licensing act to pay a sum not to exceed the reasonable costs of the investigation and enforcement of the case, FIRST CAUSE FOR DISCIPLINE (Gross Negligence) 13. Respondent has subjected her Osteopatiic Surgeon Certificate No. 20A6441 to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (b), of the Code, in the she has committed gross negligence in her care and treatment of the following patients, as more particularly alleged hereinafter: : Patient V.L. A. Patient V.L., a registered nurse who worked part-time at a hospital, sought treatment with respondent for anxiety and insomnia, Her first office visit with respondent was on or about July 19, 2006, Respondent's psychiatric consultation note for the July 19, 2006 visit did not contain a diagnosis or treatment plan. Respondent wrote patient V.L. a prescription for 90 pills of Restoril 15 mg, and three refills. The prescription indicated that patient V.L. was to take 1 to 3 pills at bedtime, Three months later, on or about October 20, 2006, respondent wrote patient V.L. a prescription for Restoril 7.5 mg, 1 pill as needed. The prescription indicated patient V.L. could refill as needed. B. On or about February 21, 2008, patient V.L. arrived at respondent's office| around 9:15 a.m. for a medication check. Before her appointment, she sat for a time in the waiting area, One of the other patients in the waiting area had a dog. When respondent came out to the waiting area, she bent down to pet the dog, In doing so, she lost her balance and fell backward. Patient V.L. had to catch respondent so that she would not fall, Patient V.L. asked respondent if she was all right to which respondent replied she Mt Accusationir 12 13 14 16 7 18 19 20 21 Mt was fine. Respondent returned to her office and her secretary, M.M., followed her. Pationt V.L. noticed that respondent was unsteady on her feet. C. Around 9:30 a.m,, patient V.L. went into respondent's office for her visit. Respondent told her, “Just a minute, I need to be still.” She then took a couple of minutes to gather herself, During that time, patient V.L. noticed that respondent was a bit disheveled; her blouse was half untucked and she appeared unkempt, Patient V.L. was concemed because respondent was normally very well groomed. Patient VL. noted that respondent's face was flushed and her eyes looked glassy. Respondent asked patient V.L. why she was there, Patient V.L. thought this was odd since she had gone to respondent for the same thing for the past year and a half, Patient V.L. gave.respondent a quick summary of her care and explained thet she needed a refill of her Restoril. Respondent attempted to fill out a prescription, but had trouble spelling Restoril. Patient V.L. had to spell the name of the drug for respondent, but respondent still wrote it incorreetly on the prescription. Patient V.L. sent the prescription to a mail-order pharmacy service and they ‘had to contact respondent to have the prescription corrected. D. After leaving respondent's office, patient V.L. spoke briefly with respondent's secretary, M.M. Patient V.L. noticed that M.M. was concerned about respondent's condition. MM. told patient V.L., “She'd better get into rehab or I'm going to close the office.” E, Patient V.L. did not smell alcohol, but opined that respondent was under the influence of alcohol because her symptoms were more consistent with alcohol intoxication than with drugs. She noticed respondent's pupils were rclatively normal in size and not pin points, as they would be with drugs. Patient V.L. is a registered nurse and is familiar with alcohol abuse, F. Respondent committed gross negligence in her care and treatment of patient V.L,, which included, but was not limited to, the following: (1) _ Practicing medicine and treating patient V.L. while intoxicated; ‘Accusationa (2) Failing to adequately chart the patient’s diagnosis, treatment plans, assessments of symptoms, monitoring of side effects, and the patient's response to treatment; (3) Prescribing a maximum dose of 45 mg Restoril per day in a sixty-nine year old woman; and (4) Failing to write a progress note for the February 21, 2008 visit. G. _Pationt L.M. was diagnosed with schizophrenia at age 54. She was referred to respondent by her therapist. Just prior to going to see respondent, patient L.M, had been an inpatient at Loma Linda University Behavioral Medicine Center (Loma Linda) for 15 days and discharged on medications, Patient L.M. was discharged from Loma Linda on Seroquel, Effexor, and Lamictal and was responding well to these medications. H. On or about December 20, 2007, patient L.M. saw respondent for her initial evaluation, K.D., patient L.M.’s ftiend and power of attorney, accompanied patient LM. to the office visit. Patient L.M. brought her paperwork from her psychiatric hospitalization for respondent's review, which detailed patient L.M.’s medications, Respondent glanced at the paperwork and gave them back to patient L.M. She diagnosed patient L.M. as “paranoid schizophrenia, schizoaffective.” Respondent did not chart whether patient L.M. had past symptoms of mood swings from depression and/or mania, Respondent wrote her a prescription for Abilify; however, she did not explain why she changed patient L.M.’s medication. K.D. recalled that respondent did not take a detailed history and that it was a short visit. I. Approximately one month later, patient L.M, went for a second visit. K.D. took patient L.M. to the office visit. Patient LM. told respondent that the Abilify was not working. Respondent switched her to another medication. There. is no documentation for this visit. “AccusationJ. In or about February 2008, patient L.M. went to respondent for another Visit. K.D. took patient LM. to the office visit. Patient LM. had one of the first appointments of the day, but she was not seen by respondent until approximately 11:00 am. When respondent came out to get patient L.M., she was staggering and had to hold the walls of the hallway to keep from falling down. Both patient L.M. and K.D. noticed that respondent's face was flushed. They followed respondent back into her office. Respondent tried to sit on the desk, but was having trouble balancing. She asked patient L.M, how the medication was working and patient L.M. indicated that it was not. Respondent then walked up to patient LLM, and began running her hands through patient L.M.’s hair. Respondent said, “You know me, I’m Noreen.” Both patient LLM. and K.D. were stunned by this. As respondent stumbled back around to the other side of her desk, her secretary M.M. came in and said, “That it for you today.” The secretary helped respondent sit down behind the desk. As patient L.M, and K.D. got up to leave, they heard M.M. say she was going to cancel the rest of respondent's appointments that day. Patient L.M. did not receive any prescriptions that day. There is no documentation for this visit, K. Respondent committed gross negligence in her care and treatment of patient L.M., which included, but was not limited to, the following: (1) Failing to spend approximately 50 minutes face to face with patient L.M. and failing to take a careful, detailed history at the December 20, 2007 initial visit; (2) Failing to carefully review patient’s psychiatric records from Loma Linda, copying the records, and placing them in patient L.M.'s chart; (3) Failing to write a progress note for the second visit; (4) Practicing medicine and treating patient L.M. while intoxicated during February 2008 visit; (5) Violating patient-physician boundaries by running her hands through patient L.M.'s hair while stating, “You know me, I'm Noreen;” and (6) Failing to write a progress note for the February 2008 visit. 8 ‘Accusation1 |} Patient A.W. 2 L. On or about May 1, 2008, the Board was contacted by a counselor, V.F. 3 who refers patients to respondent. V-F. reported that respondent had not been 4 communicating with her regarding her patients. V.F, also indicated that one of her patients told her she was treated by a student named “Gail” who is working on her 6 master’s degree in psychology. 7 M, _ V.F. stated that one of her patients, patient A.W., who had been treating 8 with respondent for approximately six to eight years, had a recent incident with 9 respondent which caused a crisis and resulted in the patient terminating her relationship 10 with respondent. Patient A.W. was almost hospitalized on April 24, 2008 after respondent ul refused to refill her prescription. Patient A.W. became so anxious that VF. feared she 12 Was a danger to herself or others. V.F. was able to refer the patient to another psychiatrist 13 and the crisis was managed and the patient was placed back on her medication, 4 N. _V.F. was also concerned because M.M., respondent's secretary, told 15 patient A.W. that respondent was not available for an appointment, but her “assistant 16 Gail” could see her. 7 ©. _V.F. had another patient, a retired firefighter, who also treated with 18 respondent. This patient has also reported to VF. that there is another person in 19 respondent's office who is seeing the patients. He told V.F. that at his last appointment, 20 he was scen by a woman named Gail for about ten minutes, and then respondent came in a at the end of the appointment and wrote out a seript for him, 22 P. _ V.P, called respondent's office because she became concerned about 23 ‘these reports by her patients. M.M. told V.F. that “Gail” was Gail E., a psychology intem| 24 or amaster’s student, She also reported that Gail E. takes over for respondent in the 25 afiemoons so that respondent could go home earlier. When V-F. later spoke directly to 26 respondent, respondent told her Gail B. is a certified alcohol and drug addiction counselor 27 ? Gail B. does not hold a Bachelor's Degree and is not licensed by any medical, ag || Psvchological, or nursing board whatsoever. 9 “Accusationut 12 B 14 15 16 7 18 19 20 22 23 25 26 27 28 (CADAC). Respondent told V-F. she did not know that Gail E, had been seeing any of her medication check patients, Q. Patient A.W. had known respondent for approximately eight years and had been a patient of respondent for six years of those cight. Respondent was treating her for bi-polar disorder and had, in the past, prescribed her multiple drugs, including Restoril, Klonopin, and Topamax. The progress notes contained in patient A.W.'s chart do not document whether medications were reviewed, whether interim histories were obtained regarding current symptoms, whether patient was responding to treatment, whether there were side-effects or adverse reaction to medication, and whether a mental status exam was: performed at each pharmacologic management visit. R. On or about February 11, 2008, respondent provided patient A.W. with a three month prescription for Klonopin, a medication that respondent had prescribed for many years for patient A.W. There is no documentation of the amount of pills prescribed, She had recently managed to reduce the dosage by half, Patient A.W. takes the Klonopin on somewhat of an as-needed basis, with a baseline dosage and an ability to take more if she feels she needs it. As such, there is always some variation to how long a prescription will last her. S. On or about April 24, 2008, patient A.W. called respondent's office for a refill of her Klonopin because she had run out one week early. When she called, she spoke with respondent's sceretary, M.M... Patient A.W. explained that she was having a severe depressive episode and had run out of the Klonopin one week early. She asked if respondent would authorize the refill at that time, Patient A.W. heard respondent in the background “screaming” that she would not give it to her a week early, Respondent yelled, “No, she can’t have it! What's the matter with her? Is she crazy?” Patient A.W. was shocked at respondent's reaction, Respondent refused to get on the telephone to discuss the problem with patient A.W. T. Patient A.W. had never run out of medication before or asked for an early refill. She is not drag-seeking and, in fact, had worked hard to reduce the number and 10 ‘AccusationAw LE dosages of psychotropic drugs she was taking. As a result of respondent's refusal to provide her a refill, patient A.W. ran out of her medication and was so upset by respondent's reaction that she immediately went into “crisis mode.” Patient A.W. ended up having to move in with her mother because she did not feel she could safely remain alone in her own home. She felt she was a danger to herself and even considered being hospitalized. V.F. was able to refer patient A.W. to another psychiatrist and got her an appointment for the following Monday. The new psychiatrist gave patient A.W. a prescription at that appointment. U. Patient A.W. also was troubled with another issue concerning respondent, She had an afternoon appointment scheduled with respondent, Patient A.W. called respondent's office to reschedule the appointment. M.M. told her that respondent was only seeing patients in the momings, but that she could have an appointment with respondent's “assistant.” When patient A.W. pointed out that her original appointment was for an aftemoon, M.M. informed her she was scheduled to see the assistant, Patient A.W. knew nothing about this, had never consented to treat with anyone other than respondent, and refused to do so. V. Respondent committed gross negligence in her care and treatment of patient A.W., which included, but was not limited to, the following: (1) Failing to maintain adequate and accurate medical records for patient A.W.’s pharmacologic management visits; (2) _ Refusing to refill patient A.W.’s prescription on or about April 24, 2008; and (3) Scheduling patient A.W. with respondent's assistant without her being told or consenting to see an assistant for follow up. Patient J.F. (Undercover Operation) W. On or about June 26, 2008, an undercover operation was conducted at respondent's office. At or about 10:30 a.m., Medical Board Investigator Erika George ‘went to respondent’s office posing as “patient LF.” “Patient J.P." was provided i ‘AccusationSoca rxauea paperwork to fill out, which included a questionnaire regarding the reasons for the visit. After a few minutes she was called into the back office by M.M. Gail E. was standing at the door next to M.M. Gail E, introduced herself to “patient J.F.” and told her she would bbe going over her information. Gail E. took “patient J.F.” to her office and went over the questionnaire and asked her questions. Gail B. asked “patient J.F.” the name of the city and state, but not the date. Gail B, asked “patient J.F.” what concems she was having. “Patient J.F.” told her that she was having trouble sleeping for the last six months because her father passed away. “Patient J.F.” explained to her that she was having nightmares that she had been diagnosed with cancer, She told Gail B, that her friends wanted her to talk to someone because she was drinking too much since her father passed away. “Patient J.F.” also told Gail B. that she would rather stay indoors, but goes out if friends call or come by. Gail E. told “patient J.F.” that she was having night terrors and that was not normal. Gail E. spent a total of nine minutes with “patient J.F.” X. Gail E, then excused herself and went into respondent’s office for approximately five minutes, Gail E. came back into her office and asked “patient J.P." to 0 to respondent's office, She introduced her to respondent and then explained to respondent the issues that “patient J.F.” was having. Gail E, told respondent that she thought that “patient J.P.” should be given Pristiq and Lunesta. “Patient JE.” asked Gail E. if those were medications she would normally recommend for her patients and she ‘tumed to respondent end said that it tends to work well for patients. During the interview, respondent told “patient J.P.” that “I was crazy when my dad died, [had panic attacks. ‘You know what, it’s been thirty-five years now and I’m still missing him.” Respondent also said, “You know what. I’m going to tell you something. When Ihad cancer times three-three times, you know what you leam and I think that was an epiphany forme. 'm sitting at the Kitchen table alone and I realize I may die, but you know what, it’s ok, cause what I’m going to do is I’m going to sleep and I’m going to die.” Gail E. left the office and returned to the room with a small plastic bag containing individually packaged medication. She showed “patient J.F.” the pills in her hand and told her that it was 12 ‘AccusationSc wera Lunesta and Pristiq. Gail E. gave “patient 1.F.” enough medication for three weeks. Gail E. indicated that “patient J.P.” should start off taking one before bed and if'she woke up in the middle of the night to take another one. Respondent then said “Try not to take the second pill if you can.” Gail E. agreed with respondent, but told “patient J.F.” that ifshe needed to take another one, then take it, Gail E. then told “patient J.P.” that she needed to slop drinking. She asked “patient J.F.” what she had been drinking. “Patient J.F." told Gail E, that she drank mixed drinks, Gail B. then said that “patient J.F.” really needed to stop drinking. Respondent told Gail E. that “patient J.F.” could have the next appointment with Gail E. Respondent and Gail B. gave “patient J.F.” a hug before she left her office, ‘They spent a total of eleven minutes with “patient J.P.” Although Geil B. checked ona check list on @ mental status exam form that serial sevens, proverb interpretation, and general knowledge tests were performed on “patient J.F.” and were within normal limits, these tests were not formally tested, Y. On or about July 24, 2008, “patient J.P.” retumed for a second undercover operation. After waiting approximately 10 minutes, Gail E. called “patient LF." into her office. Gail E. asked “patient J.F.” how she was doing on the medication that was given to her on the last visit. “Patient J.F.” told her that she was having some side effects fom the medication and had stopped taking it. Gail E. appeared to be upset and told “patient J.F.” that she needed to be taking the medication in order for Gail E, to evaluate her. “Patient J.F.” told Gail B, that the medication made her feel weird, Gail B. told “patient J.F.” that any medication will make her feel different when she first starts taking it, She said that “patient J.P.” needed to continue taking it for a few weeks before it will start working, Gail E. said that the Pristiq was the best medication out there and it hardly had any side effects. She said that Pristiq did not cause any damage to the brain or other organs, Z. Gail E, then started to go through “patient F.’s" medical records with het, She asked her if she was still having trouble sleeping. “Patient J.F.” informed Gail E, that the Lunesta had helped her sleep better, Gail E. then checked the medication listed B ‘Accusationul 12 13 a on “patient J.F.’s" records and took out a prescription pad from her desk. She wrote a refill for Lunesta on the pad. She put the prescription pad to the side of her desk. She then got up and walked to a cabinet in the comer of her office and pulled out sample packs of Pris She gave “patient J.P.” a month’s supply of Pristiq and a prescription card. Gail E. stated that the prescription card was good for $10 refills. She instructed “patient LF.” to take one Pristiq every morning at the same time, AA. Gail E, then sat down at her desk and asked “patient J.F.” ifshe had a support group or attended church. She also asked “patient J.F.” if wanted to do therapy, Gail E. asked if “patient J.P.” exercised and told her that hypertension and cholesterol ‘were common in African Americans and that it was important that she exercise. She asked “patient J.F.” how was her diet and “patient J.P.” told her that she had not been eating a lot lately. Gail E. stressed to “patient J.P.” how important it was for her to eat small meals regularly. She told her to eat 12 almonds and 12 blueberries everyday and to cat vegetables. BB. Gail E. told “patient J. to return in a month and was adamant about her taking the Pristiq. She got up from her desk and said she was going to have respondent sign the prescription. Gail E. told “patient J.F.” to follow her. Gail E. and “patient I.” walked into the back office and found respondent. Gail E, put the unsigned prescription in front of respondent and respondent signed the prescription. Gail E. asked the receptionist to schedule “patient J.P.” for another appointment in four weeks. Gail E, then tumed to “patient J.F.” and gave her a hug. Respondent also gave “patient JF.” a hug. CC. Respondent committed gross negligence in her care and treatment of “patient J.F.,” which included, but was not limited to, the following: MF ing to obtain and record a detailed alcohol and substance abuse history; (2) Failing to make further inquiry into whether “patient J.” was a candidate for AA, detoxification, or a chemical dependence program; 14 ‘AccusationMt Mt Wt (3) Failing to inquire at the follow-up visit on or about July 24, 2008, the nature and extent of “patient J.F.’s” drinking since the last session; (4) Failing to take a detailed history and document the presence or absence of| neurovegetative signs of depression during the initial evaluation and reviewing potential side effects and adverse reactions from the prescribed medications with “patient J (5) Failing to perform a formal mental status exam and document the results ‘on a patient who was complaining of confusion; (6) Recording mental status tests as performed when the tests were not formally done on “patient J.F.;” (7) Failing to spend a reasonable amount of time with “patient I.E.” during her initial evaluation, taking her own detailed history and charting it, asking “patient LF.” additional questions, and elaborating on and annotating the history taken by Gail E.; (8) Permitting Gail E. to make specific recommendations regarding psychopharmacology and relying on her recommendations; (9) Prescribing an antidepressant without taking a detailed history about neurovegetative signs of depression and without discussing potential side effects and adverse reactions of the antidepressant; (10) Failing to spend any time alone with “patient J.F.” during her initial evaluation; (11) Making statements disclosing her cancer and regarding dying; (12): Failing to meet with “patient .F.” during her July 24, 2008, pharmacologic management session and relying solely on Gail E.’s history gathering; and (13) Allowing Gail E, to write a refill for Lunesta for “patient J.P.” on a prescription for respondent's signature and dispensing a months supply of samples of Pristig, “Accusationul 12 13 14 15 16 W 18 19 20 21 23 24 26 27 28 SECOND CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 14, Respondent further has subjected her Osteopathic Surgeon Certificate No. 20A6441 to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (c), of the Code, in the she has committed repeated negligent acts in her care and treatment of patients V.L., A.W., LLM. and “I.F.,” as more particularly alleged hereafter: 15. Respondent committed repeated negligent acts in her care and treatment of patients V.L., LM. and “.F.,” which included, but was not limited to, the following: A. Paragraph 13, above, is hereby incorporated by reference as if fully set forth herein, Patient V.L. B. Reducing patient V.L.’s maximum dose of 45 mg to 7.5 mg per day of Restoril in a three months period. Patient L.M. C. Failing to explain or document the rationale or side-effects of the discontinuation of Seroquel, Effexor, and Lamictal and change to Abilify; and D. _ Failing to document whether patient L.M. had past symptoms of mood swings from depression and/or menia after diagnosing her as “paranoid schizophrenia, schizoaffective.” Patient “.P.” E, Failing to ask “patient J.F." the details as to the onset of the nightmares, the frequency of the nightmares, the content of the nightmares, and if she awakened screaming or in a panic; F. Failing to ask “patient J.F.” about the symptoms of her “anxiety” and panic, rather than assuming the patient knows what is meant by the term “anxiety;” G. Failing to ask “patient J.F.” the date when assessing her orientation; H. Failing to ask “patient J.P.” the nature and extent of her desire to stay indoors to rule-out agoraphobia; 16 ‘Accusation4 5 6 7 8 9 1. Failing to provide or refer “patient J.F.” for grief counseling; J. Failing to order lab work on “patient J.F.,” including a thyroid function test to rule out an endocrine cause of depression, a CBC, and a chemistry panel; K. Violating patient-physician boundary, by telling “patient J.F.” that “I was crazy when my dad died. Thad panic attacks. You know what, it’s been thirty-five years now and I’m still missing him;" L. Violating patient-physician boundaries by hugging “patient J-F.” during her initial evaluation; and M, Failing to make further inquiries as to what way Pristiq made “patient ‘E” feel “weird.” THIRD CAUSE FOR DISCIPLINE (Use of Alcoholic Beverages) 16. Respondent has further subjected her Osteopathic Surgeon Certificate No. 20A6441 to di iplinary action under sections 2227 and 2234, as defined by section 2239, subdivision (a), of the Code, in that she was used alcoholic beverages, to the extent, or in such a tanner as to be dangerous or injurious to herself or the public, and to the extent that such use impairs her ability to practice medicine safely, as more particularly alleged in paragraphs 13 through 15, above, and which are hereby incorporated by reference as if fully set forth herein, FOURTH CAUSE FOR DISCIPLINE (Aiding and Abetting the Unlicensed Practice of Medicine) 17. Respondent has further subjected her Osteopathic Surgeon Certificate No. 206441 to disciplinary action under sections 2227 and 2234, as defined by sections 2264 and 2052 of the Code, in that she aided and abetted Gail B, in the unlicensed practice of medicine, as more particularly alleged in paragraphs 13 through 15, above, and which are hereby incorporated by reference as if fully set forth herein, UW ul MW 17 Accusationow awa S 10 1 12 13 14 15 16 17 18 19 20 21 2 24 25 26 27 28 FIFTH CAUSE FOR DISCIPLINE (Failure to Maintain Adequate and Accurate Records) 18. Respondent has further subjected her Osteopathic Surgeon Certificate No. 20A6441 to disciplinary action under section 2234, as defined by section 2266, of the Code, in that she failed to maintain adequate and accurate records pertaining to services for her patients, as ‘more particularly alleged in paragraphs 13 through 15, above, which are hereby incorporated by reference as if fully set forth herein, SIXTH CAUSE FOR DISCIPLINE (Unprofessionat Conduct) 19, Respondent has further subjected her Osteopathic Surgeon Certificate No. 20A6441 to disciplinary action under sections 2227 and 2234, of the Code, in that she has engaged in conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical profession, and which Gemonstrates an unfitness to practice medicine, as more particularly alleged in paragraphs 13 through 18, above, which are hereby incorporated by reference as if fully set forth herein, a um Mt Mm ME a Mi ni mM ue a Mt ut 18 ‘Accusation10 i 12 13 14 15 16 7 18 19 20 21 22 PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Medical Board of California issue a decision: 1. Revoking or suspending Osteopathic Surgeon Certificate No, 2046441, issued to respondent Noreen A. Bumby, D.O.; 2, _ Ifplaced on probation, ordering respondent Noreen A. Bumby, D.O., to pay probation| monitoring costs; 3. Ordering respondent Noreen A. Bumby, D.O., to pay the Osteopathic Medical Board Of California the reasonable costs of the investigation and enforcement ofthis cese, pursuant fo Business and Professions Code section 125.3; and 4. Taking such other and further action as deemed necessary and prop: DATED: tembyn. 29,2005 DONALD J. KRP; Ex ecutive Director Osteopathic Medical Board of California Department of Consumer Affzirs State of California Complainant 'sD2009804953 accusation.if 19 ‘AccusationDECLARATION OF SERVICE BY CERTIFIED MAIL AND FIRST CLASS MAIL (Separate Mallings) In the Matter of the Accusation Against: Noreen A. Bumby, D.O. Case No: _00-2008-002156 and 00-2008-002245 |, the undersigned, declare that | am over 18 years of age and not a party to the within cause; my business address is 1300 National Drive, Suite 150, Sacramento, CA 95834. On December 29, 2009, | served the attached Accusation, Statement to Respondent, Request for Discovery, Notice of Defense (two copies) and copy of Government Code sections 11507.5, 11507.6 and 11507.7 by placing a true copy thereof enclosed in a sealed envelope as certified mail with postage thereon fully prepaid and return receipt requested, and another true copy of the Accusation, Statement to Respondent, Request for Discovery, Notice of Defense (Iwo copies) and copy of Government Gode sections 11507.5, 11507.6 and 11507.7 as enclosed in a second sealed envelope as first class mail with postage thereon fully prepaid, in the internal mail collection system at the Office of the Osteopathic Medical Board of California addressed as follows: NAME AND ADDRESS (certified and regular mail) Noreen A. Bumby, D.O. Certified Mail No. 73255 El Paseo #16 7008 1140 0001 8039 4413 Palm Desert, CA 92260 | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration was executed on December 29, 2009 at Sacramento, California Rebecca M. Burton és a Declarant Signature cc: Alexandra M. Alvarez, Deputy Attorney General