Marc R. Rose, M.D. Surrenders California Medical License
Stephen Barrett, M.D.
In 2014, the Medical Board of California charged ophthalmologist Marc R. Rose, who operates the OC Medical Center and South Coast Laser Center in Costa Mesa, California, with prescribing medical marijuana without adequately evaluating patients. The accusation document (shown below) states:
- California law permits marijuana to be obtained if recommended by a physician "who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief."
- After receiving complaints, the board sent two investigators to the OC Medical Center wearing concealed audio and video recording devices. They were taken to a room to communicate by computer video link with Dr. Rose, who was located elsewhere.
- Both undercover investigators described having headaches that had not been medically diagnosed and did not provide a legitimate basis for the use of medical marijuana.
- Practice standards for drug prescriptions require that the physician perform and record the patient's history, an appropriate examination, a treatment plan, and informed consent, including discussion of side effects.
- Rose merely interviewed the investigators via Skype, one for about three minutes and the other for less than two minutes, after which a clinic receptionist handed each a one-year recommendation that Rose had pre-signed.
- Rose created medical records that falsely stated that each had undergone a physical examination with no abnormal findings.
The complaint, which charges Rose with negligent and dishonest conduct, concluded that "Dr. Rose made no effort to ensure adequate treatment of these two patients. He simply gave them the paper they wanted and sent them on their way." The now-defunct South Coast Laser Web site stated that Rose "specializes in eye health and anti-aging medicine." Rose's 1998 book Save Your Sight!: Natural Ways to Prevent and Reverse Macular Degeneration, contains a wide array of dubious advice about dietary supplements.
KAMALA D. HARRIS
Attorney General of California
ROBERT McKIM BELL
Supervising Deputy Attorney General
CINDY M. LOPEZ
Deputy Attorney General
State Bar No. 119988
300 South Spring Street, Suite 1702
Los Angeles, California 90013
Telephone: (213) 897-2556
Facsimile: (213) 897-9395
Attorneys for Complainant
MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against:
MARC RICHARD ROSE, M.D.
3420 Bristol Street, Suite 700
Physician's and Surgeon's Certificate C 37054,
Case No. 8002013001445
1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official capacity as the Executive Director of the Medical Board of California, Department of Consumer Affairs.
2. On or about July 26, 1976, the Medical Board of California issued Physician's and Surgeon's Certificate Number C 37054 to Marc Richard Rose, M.D. (Respondent). That license was in full force and effect at all times relevant to the charges brought herein and will expire on September 30, 2014, unless renewed.
3. This Accusation is brought before the 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 Code ("Code") unless otherwise indicated.
4. Section 2220 of the Code provides that the Medical Board of California may take action against all persons guilty of violating the Medical Practice Act of California.
5. Section 2227 of the Code provides that a licensee who is found guilty under the Medical Practice Act may have his or her license revoked, suspended for a period not to exceed one year, placed on probation and required to pay the costs of probation monitoring, or such other action taken in relation to discipline as the Division1 deems proper.
1Business and Professions Code section 2002, as amended and effective January 1, 2008, provides that, unless otherwise expressly provided, the term "board" as used in the State Medical Practice Act (Bus. & Prof. Code § 2000, et seq.) means the Medical Board of California, and references to the Division of Medical Quality and Division of Licensing in the Act or any other provision of law shall be deemed to refer to the Board.
6. Section 2234 of the Code, states:
"The board shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following:
"(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter.
"(b) Gross negligence.
"(c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts.
"(1) An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act.
"(2) When the standard of care requires a change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph (1), including, but not limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care.
"(e) The commission of any act involving dishonesty or corruption which is substantially related to the qualifications, functions, or duties of a physician and surgeon.
"(f) Any action or conduct which would have warranted the denial of a certificate.
"(g) The practice of medicine from this state into another state or country without meeting the legal requirements of that state or country for the practice of medicine. Section 2314 shall not apply to this subdivision. This subdivision shall become operative upon the implementation of the proposed registration program described in Section 2052.5.
"(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and participate in an interview scheduled by the mutual agreement of the certificate holder and the board. This subdivision shall only apply to a certificate holder who is the subject of an investigation by the board."
7. Section 2238 of the Code states:
A violation of any federal statute or federal regulation or any of the statutes or regulations of this state regulating dangerous drugs or controlled substances constitutes unprofessional conduct.
8. Section 2242, subdivision (a) of the Code states:
"(a) Prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022 without an appropriate prior examination and a medical indication, constitutes unprofessional conduct.
9. Section 2261 of the Code states:
Knowingly making or signing any certificate or other document directly or indirectly related to the practice of medicine or podiatry which falsely represents the existence or nonexistence of a state of facts, constitutes unprofessional conduct.
10. Section 2266 of the Code states: The failure of a physician and surgeon to maintain adequate and accurate records relating to the provision of services to their patients constitutes unprofessional conduct.
11. Health and Safety Code section 1362.5 provides as follows:
"(a) This section shall be known and may be cited as the Compassionate Use Act of 19962 "(6)(1) The people of the State of California hereby find and declare that the purposes of the Compassionate Use Act of 1996 are as follows:
"(A) To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief.
"(B) To ensure that patients and their primary care-givers who obtain and use marijuana for medical purposes upon the recommendation of a physician are not subject to criminal prosecution or sanction.
"(C), To encourage the federal and state governments to implement a plan to provide for the safe and affordable distribution of marijuana to all patients in medical need of marijuana.
"(2) Nothing in this section shall be construed to supersede legislation prohibiting persons from engaging in conduct that endangers others, nor to condone the diversion of marijuana for nonmedical purposes.
"(c) Notwithstanding any other provision of law: no physician in this state shall be punished, or denied any right or privilege, for having recommended marijuana to a patient for medical purposes.
"(d) Section 11357, relating to the possession of marijuana, and Section 11358, relating to the cultivation of marijuana, shall not apply to a patient, or to a patient's primary caregiver, who possesses or cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.
"(e) For the purposes of this section, "primary care-giver" means the individual designated by the person exempted under this section who has consistently assumed responsibility for the housing, health, or safety of that person."
2The Compassionate Use Act was added to California law in 1996 by means of an initiative known as Proposition 215, and became effective on November 6, 1996.
12. Health and Safety Code section 11362.7, subdivision (a) provides that "'Attending physician' means an individual who possesses a license in good standing to practice medicine or osteopathy issued by the Medical Board of California or the Osteopathic Medical Board of California and who has taken responsibility for an aspect of the medical care, treatment, diagnosis, counseling, or referral of a patient and who has conducted a medical examination of that patient before recording in the patient's medical record the physician's assessment of whether the patient has a serious medical condition and whether the medical use of marijuana is appropriate. "
13. Health and Safety Code section 11362.7, subdivision (h) provides that "'Serious medical condition' means all of the following medical conditions: (I) Acquired immune deficiency syndrome (AIDS); (2) Anorexia.; (3) Arthritis; (4) Cachexia; (5) Cancer; (6) Chronic pain; (7) Glaucoma; (8) Migraine; (9) Persistent muscle spasms, including, but not limited to, spasms associated with multiple sclerosis; (10) Seizures, including, but not limited to, seizures associated with epilepsy; (11) Severe nausea; (12) Any other chronic or persistent medical symptom that either: (A) Substantially limits the ability of the person to conduct one or more major life activities as defined in the Americans with Disabilities Act of 1990 (Public Law 101- 336). (B) If not alleviated, may cause serious harm to the patient's safety or physical or mental health."
FACTUAL ALLEGATIONS COMMON TO ALL CHARGES
14. Having received complaints, the Medical Board enforcement staff commenced an investigation of the OC Medical Center ("the clinic"), a facility in Anaheim, California operated by the Respondent.
15. In the course of the investigation, Medical Board Investigator G. posed under the pseudonym of Mr. David John Le ("Mr. Le"). On August 17, 2012, Investigator G. presented to OC Medical Center, complaining of a new-onset headache. After a brief interview by computer video link, he was issued a one-year recommendation for medical marijuana. On October 10, 2012, Medical Board Investigator D. performed the same exercise with the same results, using the pseudonym of Mr. Woody Glenn Daniels ("Mr. Daniels"). Both officers were equipped with a video/audio recording device and transmitter.
PATIENT SUMMARY, INVESTIGATOR G. ("MR. LE")
16. On August 17, 2012, Investigator G. presented to the Clinic. He completed documentation regarding his medical history. He was taken to a room where he communicated by computer video link with Dr. Rose, who was elsewhere.
17. Investigator G. Reported to Dr. Rose that he had recently developed headaches, for which he was taking acetaminophen and ibuprofen, without having seen a physician in the previous five years. He indicated that he had a frontal headache. He reported that he had never used marijuana. A brief social and surgical history was taken. He was asked if he had diabetes or high blood pressure. No review of systems was taken. No physical examination was performed. The entire interaction with Dr. Rose took approximately three minutes.
18. The receptionist then gave him a recommendation valid for one year for the use of medical marijuana, signed by Dr. Rose.
19. Medical records received from Dr. Rose for this patient include a single-page progress note. That note documents a brief history, without a neurological, otolaryngological, or psychiatric review of systems. It indicates that a physical examination was done, including specifically that HEENT (Head, Eyes, Ears, Nose, and Throat), pulmonary, cardiovascular, GI (gastrointestinal), extremities, musculoskeletal, and skin examinations were all normal. Neurological examination is documented as "oriented x 3." It indicates Investigator G's "use" as "occ." The assessment includes "insomnia" and "chronic pain - head."
20. There is a form with a variety of check-boxes for symptoms that was completed by Investigator G. It indicates only headache. No other boxes are checked. It indicates that the headaches have been present for three weeks and are caused by "stress." It indicates that the headaches occur daily. There is a section in the medical record labeled "Disclosures and Conditions" in which Investigator G. initialed boxes that indicate that he acknowledges, among other things, that he will provide Dr. Rose with medical records, that he will obtain medical follow-up with an unspecified primary physician, and that he understands the "side effects" of medical marijuana use. Those adverse effects are listed in medical language, and include such things as "nystagmus," "altered libido," "abnormal ova," and so on. The form contains the affirmation "that I have a serious medical condition that adversely affects my quality of life."
21. According to the recording device carried by Investigator G., he entered the office at 13:14:49. He entered the examination room 7 and began to speak with Dr. Rose at 13:31 :44. He was asked a series of rapid- fire questions. He was asked whether he had a tension or migraine headache. He asked what those terms meant. Dr. Rose pantomimed something off screen and Investigator G. picked one or the other type of headache. He was asked no additional questions about his headache. He stated specifically that he had never used marijuana before. No attempt was made to make any kind of formal visual examination whatsoever. Neither the risks nor the benefits of medical marijuana use were discussed. There was no discussion of seeing any physician under any subsequent circumstances. The interview terminated at 13:33:39, and he left the building at 13:36:50. The total time of the interaction between Investigator G. and Dr. Rose was one minute and fifty-five seconds.
PATIENT SUMMARY, INVESTIGATOR D. ("MR. DANIELS")
22. On October 10, 2012, Investigator D. presented to OC Medical Center. He was registered and completed documentation regarding his medical history. He was taken to a room where he communicated by computer video link with Dr. Rose, who again was not present. He was only briefly able to see the image of a man on the computer screen. The remainder of the interview was audio only. A brief social history was taken. He was asked whether he had diabetes or high blood pressure. A surgical history was taken. He reported his only medication as occasional aspirin. He reported not having seen a physician for one year. Investigator D. reported a history of increasingly severe right-sided retro-orbital headache, of recent onset. A brief psychiatric, musculoskeletal and gastroenterological review of symptoms was performed. No neurological review of systems was performed. No physical examination was performed. The entire interaction with Dr. Rose took approximately three minutes. Upon departing, the receptionist then gave him a recommendation valid for one year for the use of medical marijuana, signed by Dr. Rose.
23. Medical records for this incident later received from Dr. Rose include a single-page progress note. That note documents a brief history, without a neurological, otolaryngological, or psychiatric review of systems. The history is "tension headaches and right cluster headaches, stress, anxiety, insomnia, uses medical marijuana once or twice a day." It indicates that a physical examination was done, including specifically that HEENT, pulmonary, cardiovascular, GI, extremities, musculoskeletal, and skin examinations were all normal. Neurological examination is documented as "oriented x 3." The Assessment includes "tension headache + R cluster headache, anxiety, stress, insomnia" and "chronic pain - headache."
24. There is a form with a variety of check-boxes for symptoms that was completed by Investigator D. It indicates only headache. No other boxes are checked. It indicates that the headaches are "recurrent bad headaches" of unknown cause with an onset about a month prior to the visit and have been more severe for about a week. The same "Disclosures and Conditions" form initialed by Investigator G. is also in Investigator D.'s record.
25. Investigator D. entered Dr. Rose's office at 14:05:38 and began to speak with Dr. Rose at 14:14:39. He was asked a series of rapid-fire questions. He indicated that his headaches had been "really bad lately." No specific questions were asked regarding associated symptoms or events. No attempt was made to make any kind of formal visual examination whatsoever. Neither the risks nor the benefits of medical marijuana use were discussed. There was no discussion of seeing any physician under any subsequent circumstances. The interview terminated at 14:17:16, and he left the building at 14:19:23. The total time of the interaction between Investigator D. and Dr. Rose was two minutes and thirty seven seconds.
STANDARD OF PRACTICE
26. The standard of medical practice in California is to recommend medical marijuana only when it is clinically indicated, and only as part of a rational treatment plan that has specific, identifiable goals. The standard of medical practice in California is to document all aspects of the process of evaluation and management that support the decision to recommend medical marijuana. That standard of practice is expressed in a written policy by the Medical Board, as well as a matter of usual community standards of practice. The Board has outlined the specific standard of practice regarding the recommendation of medical marijuana, which was adopted by the full Board on May 7, 2004.3 The text from that standard is identical to the general standard of practice just outlined: "These accepted standards are the same as any reasonable and prudent physician would follow when recommending or approving any other medication, and include the following:
- History and an appropriate prior examination of the patient.
- Development of a treatment plan with objectives.
- Provision of informed consent including a discussion of side effects.
- Periodic review of the treatment's efficacy.
- Consultation, as necessary.
- Proper record keeping that supports the decision to recommend the use of medical marijuana.
27. The standard of practice outlined by the Medical Board reserves medical marijuana for the treatment of "seriously ill Californians." It states that the physician "should determine that medical marijuana use is not masking an acute or treatable progressive condition, or that such use will lead to a worsening of the patient's condition." It states that the physician "must determine that the risk/benefit ratio of medical marijuana is as good, or better, than other medications that could be used for that individual patient." Further, it mandates that "a physician who is not the primary treating physician may still recommend medical marijuana. . . . however, it is incumbent upon that physician to consult with the patient's primary treating physician or obtain the appropriate patient records to confirm the patient's underlying diagnosis and prior treatment history." Finally, it stipulates that "recommendations should be limited to the time necessary to appropriately monitor the patient."
28. The issue of what conditions are serious enough to warrant the recommendation of medical marijuana is also a matter of both community standards of practice and written policy. The original 1996 code which allowed the recommendation of medical marijuana to seriously ill Californians was clarified and expanded in 2004. There is a list of eleven specific serious conditions4 plus "Any other chronic or persistent medical symptom that either: (a) Substantially limits the ability of the person to conduct one or more major life activities as defined in the Americans with Disabilities Act of 1990 (Public Law 101-336) or (b) If not alleviated, may cause serious harm to the patient's safety or physical or mental health." In order for the recommendation of marijuana by a physician in California to adhere to the standard of practice, a patient must have such a condition. That is, the standard of practice in California is to reserve the recommendation of marijuana for patients who are seriously ill and whose illness is not effectively controlled by other established treatments. It is the standard of practice that marijuana use is not to be recommended for minor medical problems or for problems that can be controlled by other methods.
4The eleven specific serious conditions are: Acquired immune deficiency syndrome [AIDS], anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, persistent muscle spasms, including, but not limited to spasms associated with multiple sclerosis, seizures, including, but not limited to seizures associated with epilepsy, and severe nausea.
29. In neither patient was a history documented in any meaningful way. History includes the timing, character, and severity of the complaint. It includes associated symptoms, palliating and provoking factors. It includes relevant review of systems. For headache of recent onset, the history should include specific inquiry into associated symptoms of stiff neck, photophobia, phonophobia, nausea, vomiting, numbness, tingling, loss of coordination, fever, chills, sweats, and so on. Those questions were not asked of either patient. The only history that was taken was that each patient reported severe headache.
30. Neither patient was examined, apart from brief physical observation.
31. The Respondent spent one minute and fifty five seconds with one patient and two minutes and thirty seven seconds with the other. During that time, he recorded a brief history and made a quick assessment that each man would benefit from a recommendation for the use of medical marijuana. He then documented that he performed an eight-system physical examination.5
5The eight systems are: HEENT, cardiovascular, pulmonary, gastrointestinal, extremities, musculoskeletal, skin, and neurological examinations.
32. A HEENT examination requires, as the name implies, detailed examination of the head, eyes, ears, nose, and throat. It requires the use of at least an otoscope and usually an ophthalmoscope.
33. Cardiovascular examination requires the palpation of pulses and the use of a stethoscope to auscultate heart and lung sounds.
34. Pulmonary examination requires an assessment of respiratory effort, auscultation of the lungs, and percussion of the chest.
35. Gastroenterological examination requires observation of the unclothed abdominal wall, auscultation of bowel sounds, and palpation of the abdomen.
36. Musculoskeletal examination requires manipulation of the joints and spine.
37. Extremity examination requires at the least an evaluation for clubbing, cyanosis, and edema.
38. Skin examination requires observation and palpation of unclothed skin.
39. Neurological examination requires careful assessment of cranial and spinal nerve function.
40. Dr. Rose did not ask either man to state the place, date, or circumstance. It is therefore not possible for him to know whether either man was oriented or to what degree.
41. In neither case was a plan of care developed. Dr. Rose simply issued a recommendation for the use of medical marijuana for one year, without condition and without giving either man the opportunity (or requiring them) to come back for reevaluating to assess the efficacy of treatment.
42. Informed consent was provided to neither patient. Informed consent is a process in which risks and benefits of a proposed therapy are discussed, questions are solicited and answered, and the physician determines that the patient wishes to proceed with the proposed therapy. Informed refusal, of course, would be when the patient considers the risk: benefit ratio to be unacceptable and declines the procedure. In order for informed consent to be obtained, the physician must be cognizant of the risks involved in the proposed therapy and communicate those risks to the patient. Informed consent is an active process and requires physician input. It does not consist simply of initialing boxes on a form that has not been explained in detail.
43. The Respondent failed to discuss the risks and benefits of medical marijuana with either patient.
44. The medical records in these two cases are inadequate to support the decision to recommend the use of medical marijuana at all, and are in no way sufficient to recommend its use for a year. The assessment in each record is sparse and inaccurate. There is no discussion of possible alternative treatments in the medical record. There is no indication that Dr. Rose even considered evaluation and management of headache beyond over-the-counter medication before recommending marijuana use. For example, the assessment of Investigator G. includes insomnia and chronic headache. But Investigator G. did not have "chronic" pain; his headache was of recent onset. When interviewed, Dr. Rose stated repeatedly that Investigator G. was using medical cannabis for relief of his headaches. However, that is not true: during his evaluation, Investigator G. denied ever having used marijuana.
45. The assessment of Investigator D. included both tension and cluster headache, chronic headache, anxiety, stress, and insomnia. However, Investigator D. specifically denied stress during the examination. He did not, contrary to Dr. Rose's claim, that he had cluster headache. He just said he had a "really bad headache." In any case, his headache was not chronic, it was acute.
46. In short, Dr. Rose simply wrote down whatever diagnoses came to mind, without regard to documentation in the medical record.
47. When questioned, Dr. Rose explicitly acknowledged that neither patient was seriously ill. Neither patient was documented to have a significant degree of disability. Neither had a persistent problem that limited their ability to conduct one or more major life activity. In fact, DI Rose didn't even ask questions of either man about the degree of their suffering or what their suffering prevented them from doing.
48. Marijuana is a potent centrally-acting drug with negative effects on concentration and memory and sometimes-potent analgesic effect, capable of masking the symptoms of serious illnesses, for example, tuberculosis meningitis or untreated extreme hypertension, until it results in catastrophic brain damage.
49. Dr. Rose made no effort to ensure adequate treatment of these two patients. He simply gave them the paper they wanted and sent them on their way.
FIRST CAUSE FOR DISCIPLINE
50. Respondent is subject to disciplinary action under section 2234, subdivision (b) for gross negligence. The circumstances are as follows:
51. Complainant hereby realleges the allegation in paragraphs 14 through 49 as though fully set forth at this point, and alleges that it was an extreme departure from the standard of practice for the Respondent:
- to fail to document a sufficient history to justify the recommendation of medical marijuana;
- to fail to document a sufficient history to conclude that the headache was of innocent etiology;
- to fail to develop and document a rational plan of care that included re-evaluation and re-assessment of the efficacy of treatment;
- to fail to establish which specific physician would be responsible for proactive monitoring of that plan to fail to provide informed consent;
- to recommend medical marijuana use for a period of one year;
- to fail to document the degree of disability of the patients;
- to recommend medical marijuana use for men whom Dr. Rose thought not to be "seriously ill";
- to exclude serious underlying pathology that might be responsible for the new onset of headache;
- to fail to take steps to prevent the use of marijuana from masking the existence and progression of serious underlying pathology;
- to fail to undertake a detailed neurological evaluation for a patient with new onset headache, and to later argue that such an evaluation could not be done in the setting of an office visit;
- to fail to have vital signs taken when undertaking to evaluate and manage a new acute medical complaint, particularly when that complaint is headache.
52. Telehealth - It is the standard of practice in California, when using telehealth technologies (previously called telemedicine)6, that verbal consent from the patient be obtained and documented in the patient's medical record. California Business and Professions Code 2290.5 specifically provides that the failure to do so shall constitute unprofessional conduct. It is the standard of practice to document clearly in the medical record which visits, or which part of a particular visit, are performed or augmented using telehealth. In general terms, the standards of practice for telehealth are otherwise identical to the standards of practice for face-to-face medicine. That is, telehealth does not excuse any incomplete or substandard practice.
6California Business and Professions Code 2290.5 defines Telehealth as the delivery of health care services via information and communication technologies. Its use is discussed on the Medical Board web site at: www.mbc.ca.gov/licensees/telehealth.aspx
53. Dr. Rose did not clearly mark either of the two patient charts as being the product of an evaluation by video conference over the Internet. He reports that he marked both charts "0-C", but such a marking does not make the nature of the visit evident to an otherwise uninformed reviewer. In the cases at hand, the standard of practice required that Dr. Rose perform a detailed physical examination. Practicing telehealth without a professional standing by with the patient ready to perform whatever physical examination maneuver was required rendered the care provided by telehealth ineffective. The Respondent performed evaluations for the purpose of recommending medical marijuana by Skype7 fails to conform to the standard of practice that demands that the quality of care cannot be degraded by the use of telecommunication technology. As a medical marijuana recommendation is specifically to be used for people who are seriously ill, it is not possible to provide high quality care to seriously ill patients without being able to examine them.
7Skype is a video calling program that uses the Internet to transmit two-way video and audio.
A. It was an extreme departure from the standard of practice to fail to clearly mark both chart notes as the product of telehealth;
B. It was an extreme and potentially life-threatening departure from the standard of practice to undertake to use Internet video conferencing to evaluate and treat seriously ill patients without the presence of a licensed professional physically present with the patients in question.
54. Honesty - It is the standard of practice in California for physicians to be honest and forthright in their dealings with patients, with each other, and with various regulatory bodies.
55. That standard is a matter of law, tradition, and principle. Probably the most widely accepted guide to physician ethics is the AMA's Code of Medical Ethics. 5 1 Item two of the introductory section, Principles of Medical Ethics, states: "A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities."
56. The Respondent was dishonest when he documented that he performed physical examinations that he never performed; when he falsely claimed that Investigator G. had said that he used medical marijuana; and when he attempted to mislead Medical Board investigators by falsely implying that the examinations were in person.
A. It was an extreme departure from the standard of practice to document physical examinations that were never done;
B. It was an extreme departure from the standard of practice to falsely claim that Investigator G. said that he used medical marijuana.
C. It was an extreme departure from the standard of practice to send pre-signed recommendations for medical marijuana to the OC Medical Center;
D. It was an extreme departure from the standard of practice to feign ignorance of that departure during the interview with the Board.
E. It was an extreme departure from the standard of practice for the Respondent to offer misleading testimony about his use of telehealth in his interview with the Board.
SECOND CAUSE FOR DISCIPLINE
57. By reason of the facts set forth above in the First Cause for Discipline, Respondent is subject to disciplinary action under section 2261 of the Code for knowingly making or signing a certificate or other document related to the practice of medicine which falsely represents the existence or non-existence of a state of facts.
THIRD CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Patient Records)
58. By reason of the facts set forth above in in the First Cause for Discipline, Respondent is subject to disciplinary action under section 2266 of the Code for failure to maintain adequate and accurate records relating to the provision of patient services.
FOURTH CAUSE FOR DISCIPLINE
(Prescribing Without Good Faith Prior Examination & Medical Indication)
By reasons of the facts set forth above in in the First Cause for Discipline, Respondent is subject to disciplinary action under section 2242, subdivision (a) of the Code for prescribing, dispensing or furnishing dangerous drugs without a good faith prior examination and medical indication. The circumstances are as follows:
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 Physician's and Surgeon's Certificate Number C 37054, issued to Marc Richard Rose, M.D.
2. Revoking, suspending or denying approval of his authority to supervise physician assistants, pursuant to section 3527 of the Code;
3. Ordering him to pay the Medical Board of California, if placed on probation, the costs of probation monitoring; and
4. Taking such other and further action as deemed necessary and proper.
DATED: August 12, 2014
Medical Board of California
Department of Consumer Affairs
State of California
This page was revised on June 25, 2016.