Grafilo v. Cohanshohet ( 2019 )


Menu:
  • Filed 1/22/19; Certified for Publication 2/21/19 (order attached)
    IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
    SECOND APPELLATE DISTRICT
    DIVISION EIGHT
    DEAN GRAFILO, as Director, etc.,                               B285193
    Plaintiff and Respondent,                              (Los Angeles County
    Super. Ct. No. BS169143)
    v.
    KAMYAR COHANSHOHET,
    Defendant and Appellant;
    MEDICAL BOARD OF CALIFORNIA,
    Real Party in Interest and
    Respondent.
    APPEAL from an order of the Superior Court of Los
    Angeles County. Michelle Williams Court and Joseph R. Kalin,
    Judges. Reversed.
    Fenton Law Group, Benjamin J. Fenton, Dennis E. Lee and
    Alexandra De Rivera for Defendant and Appellant.
    No appearance for Plaintiff and Respondent.
    Xavier Becerra, Attorney General, Gloria L. Castro,
    Assistant Attorney General, Judith L. Alvarado and Tan N. Tran
    Deputy Attorneys General for Real Party in Interest and
    Respondent, Medical Board of California.
    _____________________________
    Dr. Kamyar Cohanshohet appeals from the superior court’s
    order to produce the medical records of five of his patients in
    connection with an investigation into his prescription of
    controlled substances to these patients. Because the state has
    failed to demonstrate good cause to obtain these records, we
    reverse the order.
    PROCEDURAL BACKGROUND
    The Investigation
    In 2014, the Medical Board of California (the Board)
    received an anonymous complaint alleging Dr. Cohanshohet
    “prescribes huge quantities of narcotics to patients without giving
    exams, tests, x-rays or even bloodwork. A loved one went to this
    doctor and is now in rehab. Not once did this doctor examine
    him, look at charts. He only went by a complaint of pain and
    started prescribing narcotics at $400 a visit every two weeks.
    He is in partnership with a pharmacy in his building.”
    An investigator for the Board obtained a report from the
    Controlled Substance Utilization Review and Evaluation System
    (CURES), a database maintained by the California Department
    of Justice. The CURES report for Dr. Cohanshohet shows the
    Schedule II, III, and IV controlled substances prescribed by him
    to patients between July 27, 2014 and July 27, 2015.
    Dr. Shoaib Naqvi works as a medical consultant for the
    Health Quality Investigation Unit of the Department of
    Consumer Affairs. He identified five patients who were
    prescribed dosages of opioids that were possibly in excess of the
    2
    recommended amount. These five patients were notified of the
    investigation and asked to sign releases for their medical records.
    They refused. As a result, subpoenas duces tecum were served on
    June 30, 2016, for the medical records of patients C.B., L.P.,
    M.D., C.S., and R.V. for the time period between July 27, 2014
    and July 27, 2015. The patients were informed when the
    subpoenas were issued and advised of their right to object.
    Dr. Cohanshohet refused to comply with the subpoena, asserting
    his patients’ right to privacy.
    The Petition
    The Board subsequently filed a petition in the superior
    court for an order compelling the production of the medical
    records requested and for Dr. Cohanshohet’s testimony.
    In support of its petition to compel compliance of the subpoenas,
    the Board submitted the declarations of its investigator and
    Dr. Naqvi. The investigator’s declaration sets forth the impetus
    for the Board’s investigation: an anonymous complaint that
    Dr. Cohanshohet overprescribed opioids to one patient without
    conducting an examination or screening of him or her.
    The anonymous complaint also alleged Dr. Cohanshohet was in
    partnership with the pharmacy in his building. The investigator
    further described the sequence of events leading to the petition,
    including obtaining the CURES report for Dr. Naqvi’s review,
    attempting to obtain consent from the patients, and
    Dr. Cohanshohet’s refusal to comply with the subpoenas.
    Dr. Naqvi documented his role and his conclusions from
    reviewing Dr. Cohanshohet’s CURES report. He explained he is
    tasked with reviewing questionable medical and surgical
    practices of physicians licensed by the Board. Thus, he
    maintains familiarity with the standard of medical practice in the
    3
    state of California. Dr. Naqvi then in general terms explained
    the different classes of controlled substances, their potential for
    abuse, side effects, indicated use, and the standard of care for
    prescribing these substances. He also provided details of 11
    specific drugs prescribed by Dr. Cohanshohet, nine of which are
    used to treat pain. The remaining two are used to treat anxiety,
    insomnia, or muscle spasms and seizures.
    Dr. Naqvi further explained that morphine is used as the
    basis for a comparison of pain treatments to determine if the
    patient’s opioid dosage is excessive. He stated that knowing the
    morphine equivalent dosing (MED) is useful to evaluate different
    types of opioids and to convert from one opioid to another. Opioid
    dosing may be considered excessive if the MED level exceeds 100
    mg per day. Dr. Naqvi noted an MED of greater than 100 mg per
    day “puts the patient at added risk for overdose and death.” The
    standard of care requires that the prescriber inform the patient of
    potential risks and benefits of the drug. The patient must then
    provide informed consent, including being notified that death is a
    potential risk, when opioid dosing exceeds 100 mg MED per day.
    Dr. Naqvi opined that good cause existed to believe that a
    violation of the Medical Practice Act (Bus. & Prof. Code, § 2000,
    et seq.) may have been committed by Dr. Cohanshohet. Dr.
    Naqvi identified five patients who were prescribed controlled
    substances in a manner that appeared to deviate from the
    standard of care for prescribing these drugs.
    Patient C.B. regularly received 90–120 (20mg) oxycodone
    HCL tablets along with 30 (20 mg) oxymorphone HCL tablets and
    30 (10 mg) Valium tablets each month from July 27, 2014 to
    January 5, 2016. Based on this information, C.B. may have
    taken three tablets of oxycodone, one tablet of oxymorphone HCL,
    4
    and one tablet of Valium a day, totaling at least 150 mg MED per
    day. Dr. Naqvi noted the sedative effects of opioids are further
    aggravated by the use of Valium, resulting in a combination that
    has a “very real possibility of sedation to the point of respiratory
    arrest.” He concluded a review of C.B.’s medical record is
    necessary to confirm that an appropriate examination was done
    before prescribing this medication regimen, that regular
    assessments of the efficacy and effects of the treatment regimen
    were conducted and documented, and that the appropriate
    monitoring measures were performed.
    Likewise, patient M.D. regularly received 90 (30 mg)
    oxycodone HCL tablets, 30 (4 mg) hydromorphone HCL tablets,
    30 (10 mg) Valium tablets, and 60 (350 mg) carisoprodal tablets
    (a muscle relaxant) each month from July 27, 2014 to July 27,
    2015. According to Dr. Naqvi, this would appear to indicate three
    tablets of oxycodone, one tablet of hydromorphone HCL, two
    tablets of carispotrodal, and one tablet of Valium were taken each
    day, resulting in at least 106 mg MED. This treatment regimen
    also presented the very real possibility of sedation to the point of
    respiratory arrest.
    Patient L.P. regularly received 20–220 (10 mg) hydrocodone
    bitartrate-acetaminophen with 30–45 (350 mg) carispotrodal each
    month during the relevant time period, indicating the patient
    took five tablets of hydrocodone bitartrate-acetaminophen and
    one or two tablets of carisoprodal daily. This combination
    appeared equivalent to a minimum of 75 mg MED.
    Patient C.S. received prescriptions for 60–120 (10 mg)
    OxyContin tablets, 120–240 (325 mg–10 mg) Norco tablets, and
    30–90 (10 mg) benzodiazepine or related drug (such as Valium,
    clonazepam, or temazepam, indicating 105–125 mg MED per day.
    5
    Patient V.R. received 120–150 (15 mg–20 mg) oxycodone
    HCL tablets with 20–60 benzodiazepine or related drugs (Valium
    (10 mg), Ambien, or Zaleplon). This would indicate four to five
    tablets of Oxycodone and one tablet of Valium along with a
    sleeping pill per day, resulting in 60–75 mg MED.
    The prescriptions for L.P., C.S., and V.R. carried risks
    similar to those of patients C.B. and M.D. On this basis,
    Dr. Naqvi concluded these five patients may have received
    excessive amounts of opioids as compared to the recommended
    dosage. Dr. Naqvi explained the records are necessary to
    determine whether Dr. Cohanshohet performed an examination
    and screening of those patients, received informed consent,
    regularly assessed the efficacy and effects of the treatment
    regimen, and monitored those patients.
    The Opposition
    Four of the five patients submitted declarations objecting to
    the petition. Dr. Cohanshohet also opposed the petition,
    asserting the Board lacked good cause to justify the intrusion into
    his patients’ privacy. He asserted in a declaration that he
    completed hundreds of hours of post-graduate training in pain
    management and palliative care and that some of his patients
    suffer from pain associated with acute injuries while others seek
    active cancer treatment, palliative care, or end-of-life care.
    In addition, he proffered the declaration of Dr. Jack Berger,
    a physician certified in anesthesiology and who teaches pain
    medicine and pain management at USC. Dr. Berger reviewed
    Dr. Naqvi’s declaration. He agreed that physicians who prescribe
    controlled substances to treat pain are required to complete a
    medical history and physical examination, diagnose the problem,
    inform the patient of any risks, and write a treatment plan which
    6
    states the objectives, proposed treatments, and justifications for
    the medications selected. He explained one of the primary
    functions of a pain management specialist is to monitor and
    guard against patient misuse and abuse of controlled substances
    such as opioids.
    However, Dr. Berger challenged Dr. Naqvi’s reliance on the
    CDC prescribing guidelines which were merely recommendations
    for primary care clinicians who are prescribing opioids for chronic
    pain outside of active cancer treatment, palliative care, and end-
    of-life care. These guidelines were not in effect at the time the
    patients in question were treated. He further contested
    Dr. Naqvi’s conclusions as to each patient. Dr. Berger argued
    that a dosage greater than 100 mg MED does not automatically
    violate the standard of care, so long as the patient’s informed
    consent was obtained. He found there was no reason to suspect
    Dr. Cohanshohet failed to perform a proper examination, obtain
    informed consent, or review the risks and benefits of higher
    dosage opioid therapy with the patient. He also opined that
    nonopioid alternatives would have presented similar risk of
    serious side effects, like morbidity.
    The Order
    The Hon. Joseph Kalin presided over the hearing on the
    Board’s petition. After argument, he stated he would take the
    matter under submission and issue a ruling in “the next day or
    two.” The Board served a notice of ruling a few weeks later
    indicating its petition had been granted, but no order was
    attached. Dr. Cohanshohet objected to the notice, arguing he
    received no communication from the trial court about its ruling.
    A different trial judge, the Hon. Michelle Williams Court,
    informed the parties at a later status conference that she spoke
    7
    with Judge Kalin, and he confirmed he granted the petition.
    Dr. Cohanshohet timely appealed.
    Although Dr. Cohanshohet questions whether an order was
    ever issued, the parties are proceeding on the assumption a
    ruling was made. Indeed, the record is sufficient to demonstrate
    the superior court granted the petition and ordered Dr.
    Cohanshohet to produce the requested records. Therefore,
    we will treat the appeal as one from an appealable judgment.
    (Dana Point Safe Harbor Collective v. Superior Court (2010)
    
    51 Cal.4th 1
    , 11–13 [order compelling compliance with
    administrative subpoena is appealable final judgment].)
    DISCUSSION
    Dr. Cohanshohet contends the state’s interest in his
    patients’ medical records is insufficient to overcome their right to
    privacy. He argues the Board lacks authority to issue subpoenas
    for records of noncomplaining patients. In addition, the Board
    has failed to pursue less intrusive means of investigation.
    Finally, Dr. Cohanshohet argues the Board has failed to establish
    good cause for its investigation because the records sought have
    not been shown to be material or relevant to the investigation.
    We are not persuaded the Board has demonstrated good
    cause to require Dr. Cohanshohet to produce the five patients’
    records. Accordingly, we reverse the trial court’s order. In doing
    so, we need not address Dr. Cohanshohet’s other grounds for
    reversal.
    I.     The Medical Board
    The Board is a unit of the Department of Consumer
    Affairs.1 (Bus. & Prof. Code, § 101, subd. (b).) It is tasked with
    1     Although the director of Consumer Affairs is the plaintiff
    and respondent in this matter, the Board is the real party in
    8
    protecting the public against incompetent, impaired, or negligent
    physicians. To accomplish this task, the Board is authorized to
    investigate complaints from the public that a physician may be
    guilty of unprofessional conduct. (Bus. & Prof. Code, § 2220,
    subd. (a).) A physician may only prescribe controlled substances
    when he holds a good faith belief that it is required for a patient’s
    ailment, and only in a quantity and for a length of time that is
    reasonably necessary. (Health & Saf. Code, § 11210.) A violation
    of this provision constitutes unprofessional conduct (Bus. & Prof.
    Code, § 2238), and subjects the violator to disciplinary action by
    the Board (Bus. & Prof. Code, § 2234).
    The Board’s investigators have the status of peace officers
    (Bus. & Prof. Code, § 160), and possess a wide range of
    investigative powers, such as the power to issue subpoenas for
    the appearance of a witness or for the production of documents
    (Gov. Code, § 11181, subds. (a) & (e)). The Board is authorized to
    issue a subpoena in “any inquiry [or] investigation” (Gov. Code,
    § 11181, subd. (e)), and may do so for purely investigative
    purposes; it is not necessary that a formal accusation be on file or
    a formal adjudicative hearing be pending. (Arnett v. Dal Cielo
    (1996) 
    14 Cal.4th 4
    , 8; Brovelli v. Superior Court (1961) 
    56 Cal.2d 524
    , 528.)
    If a party refuses to comply with the administrative
    subpoena, the Board may petition the superior court for an
    order compelling compliance. (Gov. Code, §§ 11186–11187.) “If it
    appears to the court that the subpoena was regularly
    issued . . . by the head of the department, the court shall enter an
    order that the person appear before the officer named in the
    interest and we refer to it as the petitioner in this opinion rather
    than the Department of Consumer Affairs.
    9
    subpoena at the time and place fixed in the order and testify or
    produce and permit the inspection and copying of the required
    papers or other items described in subdivision (e) of Section
    11181 as required . . . . Upon failure to obey the order, the person
    shall be dealt with as for contempt of court.” (Gov. Code,
    § 11188.)
    II.   Standard of Review
    The question of whether a subpoena meets the
    constitutional standards for enforcement is a question of law to
    be reviewed de novo. (Fett v. Medical Bd. of California (2016)
    
    245 Cal.App.4th 211
    , 216 (Fett); Millan v. Restaurant Enterprises
    Group, Inc. (1993) 
    14 Cal.App.4th 477
    , 485.) The superior court’s
    factual findings regarding whether the Board established good
    cause to intrude on the patients’ privacy rights are reviewed
    under the substantial evidence standard. (Fett, supra, 245
    Cal.App.4th at p. 216.)
    III. Privacy Law in California
    The state Constitution expressly grants Californians a
    right of privacy, which extends to their medical records.
    (Cal. Const., art. I, § 1.) As one court put it: “The state of a
    person’s gastro-intestinal tract is as much entitled to privacy
    from unauthorized public or bureaucratic snooping as is that
    person’s bank account, the contents of his library or his
    membership in the NAACP.” (Board of Medical Quality
    Assurance v. Gherardini (1979) 
    93 Cal.App.3d 669
    , 679
    (Gherardini).)
    In Hill v. National Collegiate Athletic Assn. (1994)
    
    7 Cal.4th 1
    , 35 (Hill), the California Supreme Court established a
    framework for evaluating potential invasions of privacy.
    The party asserting a privacy right must establish a legally
    10
    protected privacy interest, an objectively reasonable expectation
    of privacy in the given circumstances, and a threatened intrusion
    that is serious. (Id. at pp. 35–37.) The party seeking information
    may raise in response whatever legitimate and important
    countervailing interests disclosure serves, while the party
    seeking protection may identify feasible alternatives that serve
    the same interests or protective measures that would diminish
    the loss of privacy. A court must then balance these competing
    considerations. (Id. at pp. 37–40.)
    Additionally, good cause is required to be shown when the
    state seeks to invade an individual’s privacy rights through an
    administrative subpoena seeking his or her medical records.
    (Gherardini, supra, 93 Cal.App.3d at p. 681; Wood v. Superior
    Court (1985) 
    166 Cal.App.3d 1138
    , 1141–1143 (Wood).)2 Good
    cause “ ‘calls for a factual exposition of a reasonable ground for
    the sought order.’ ” (Gherardini, supra, at p. 681 quoting Waters
    v. Superior Court (1962) 
    58 Cal.2d 885
    , 893.)
    In Wood, the Board issued administrative subpoenas for
    the medical records of 52 patients under the care of two different
    physicians because it suspected the physicians were over-
    prescribing certain Schedule II drugs. In support of the
    subpoenas, the Board submitted declarations from its
    investigators that stated they had obtained copies of the two
    2     The Supreme Court disapproved Wood and Gherardini to
    the extent they hold that a compelling interest must always be
    shown when an individual’s privacy rights are implicated, rather
    than employ a balancing analysis under Hill. (Williams v.
    Superior Court (2017) 
    3 Cal.5th 531
    , 556–557, fn. 8.) Because the
    high court did not overrule Wood and Gherardini on any other
    ground, we continue to rely on these cases for their good cause
    analysis and for other propositions.
    11
    doctors’ Schedule II drug prescriptions from various pharmacies.
    One investigator reported a pharmacist had told her he believed
    a particular patient was receiving an excessive dose of Demerol.
    The Board’s medical consultant opined that there existed a
    “ ‘definite possibility of excessive prescribing of controlled drug
    substances’ ” and that the medical records should be obtained to
    determine whether appropriate medical conditions existed to
    warrant the prescriptions. (Wood, supra, 166 Cal.App.3d at
    p. 1142.)
    The court concluded the Board’s showing was insufficient to
    warrant a demand for the complete medical records of the
    patients, because it included records of medical issues unrelated
    to the prescription of the controlled substances. (Wood, supra,
    166 Cal.App.3d at p. 1149.) The court further stated, “Here we
    have some facts about the prescriptions and the conclusions of
    board personnel that they are suspicious but no mediating facts
    revealing why the conclusion is warranted. The board has made
    no evidentiary showing of how often physicians similarly-situated
    to petitioners might prescribe these drugs. Alternatively, the
    board has made no showing of the likelihood that the
    prescriptions could have been properly issued, given what is
    known of the circumstances of issuance. Absent this information
    the trial court has no means by which to gauge the likelihood
    that the records sought will reveal physician misconduct.
    Without this there can be no independent judicial assessment of
    good cause. The judicial function of assessing cause [citation]
    cannot be abdicated by deferring to the bare conclusions of board
    personnel.” (Id. at p. 1150, italics omitted.)
    In Bearman v. Superior Court (2004) 
    117 Cal.App.4th 463
    (Bearman), a doctor prescribed marijuana to his patient to treat
    12
    migraines and attention deficit disorder. The doctor provided the
    patient with a letter certifying the patient was under his medical
    care and, having evaluated the medical risks and benefits of
    cannabis use with the patient, the doctor approved his use of
    cannabis for the relief of pain and nausea of migraines and
    decreasing the frequency and intensity. The doctor further stated
    the approval for medicinal cannabis would not require a repeat
    visit until November or December 2001, effectively providing an
    expiration date for the prescription. (Id. at p. 467.)
    On April 10, 2001, park rangers discovered pipes and
    marijuana among the patient’s possessions. The patient
    presented the letter to the rangers. Believing the doctor was
    possibly violating the law and medical ethics by exceeding his
    scope of practice, one of the park rangers sent a copy of the letter
    to the Board and asked for “ ‘appropriate actions.’ ” (Bearman,
    supra, at pp. 467–468.) An investigation was initiated and the
    Board issued an administrative subpoena for the patient’s
    records after the patient refused to consent to the disclosure.
    (Id. at p. 468.)
    The trial court granted the Board’s petition to compel
    compliance, but on appeal, the court found an absence of good
    cause for disclosure of the patient’s records. The court concluded
    the supporting declarations by the Board “are nothing more than
    speculations, unsupported suspicions, and conclusory statements
    drawn solely from [the doctor’s] letter to [his patient] and the
    simple fact he recommended the use of marijuana.” (Bearman,
    supra, at p. 471.) There were no facts suggesting the doctor was
    negligent in his patient’s treatment, or that he prescribed
    marijuana for improper reasons. (Ibid.)
    13
    Similarly, in Gherardini, the investigator’s declaration was
    insufficient because it “set[] forth no facts, no showing of
    relevance or materiality of the medical records of these five
    specified patients to the general charge of gross negligence and/or
    incompetence of the licensee-doctor.” (Gherardini, supra, 93
    Cal.App.3d at p. 681.)
    By contrast, the court in Cross v. Superior Court (2017) 
    11 Cal.App.5th 305
     (Cross) found good cause for an order compelling
    compliance with subpoenas for the medical records of three
    patients. There, the Board subpoenaed a psychiatrist’s patient
    records to investigate an allegation that she improperly
    prescribed controlled substances to three people. (Id. at p. 310.)
    The psychiatrist refused to produce the records, invoking the
    psychotherapist-patient privilege and the patients’ right to
    privacy. (Ibid.)
    The Department of Consumer Affairs filed a petition to
    compel compliance with the subpoenas, which was granted.
    On appeal, the court concluded the patients had a state
    constitutional right to privacy that protects information
    contained in their medical records. (Cross, supra, 11 Cal.App.5th
    at p. 325.) Nevertheless, it found compelling the state’s interest
    in investigating whether a doctor prescribed excessive or
    improper amounts of controlled substances. (Id. at p. 327.)
    The court found unpersuasive the psychiatrist’s contention
    that there was no compelling interest in her particular case
    because the facts and declarations relied upon by the Board did
    not justify its investigation. (Cross, supra, 11 Cal.App.5th at
    p. 328.) Specifically, the psychiatrist argued the Board’s expert
    was not competent to demonstrate it had good cause to
    investigate her prescribing practices because the expert was an
    14
    internist rather than a specialist in psychiatry. The court found
    the trial court did not abuse its discretion to conclude the Board’s
    expert was qualified to competently render an opinion on the
    subject. (Id. at p. 327.)
    Good cause was shown where the Board’s medical
    consultant “opined on the nature and properties of the drugs
    prescribed, their potential complications, and the precautions
    that should be taken by a physician who prescribes the
    medications.” (Cross, supra, 11 Cal.App.5th at p. 327.) In
    particular, the Board’s expert believed the three patients in
    question, all women who were likely postmenopausal, may be at
    increased risk for coronary artery disease complications, which
    could be exacerbated by use of the prescribed stimulants. (Id. at
    p. 315.) The psychiatrist also prescribed high doses of Adderall, a
    drug predominately used to treat attention deficit hyperactivity
    disorder (ADHD) and narcolepsy. The psychiatrist prescribed
    Adderall to one patient at a dosage level that was three times the
    maximum recommended dosage for treatment of ADHD and in
    excess of the recommended dosage for treatment of narcolepsy.
    (Id. at pp. 312–313.)
    Good cause was further shown by the investigator’s
    declaration that one of the purported patients denied she was
    ever treated by the psychiatrist. Additionally, the psychiatrist
    had been disciplined by the Texas Medical Board for improperly
    prescribing sleep medication to a close family member. (Cross,
    supra, 11 Cal.App.5th at p. 328.)
    15
    IV.   The Board Has Failed to Demonstrate Good Cause
    Dr. Cohanshohet challenges the basis for the subpoenas,
    contending good cause is lacking to order compliance of the
    subpoenas. We agree the Board has failed to demonstrate good
    cause.
    Applying the guidance provided by Wood, Bearman, and
    Cross, we conclude Dr. Naqvi’s declaration is insufficient to show
    good cause to compel compliance of the subpoenas at issue. Good
    cause requires something more than the mere fact that a
    specialist in pain medication prescribed doses slightly greater
    than 100 MED to three patients and two others received
    prescriptions for drugs which, used in combination, resulted in
    increased sedative effects.
    As in Bearman, there are no facts suggesting Dr.
    Cohanshohet was negligent in treating his patients or that he
    prescribed controlled substances without meeting the standard of
    care. Given that Dr. Cohanshohet is a pain management
    specialist who sometimes treats patients seeking active cancer
    treatment, palliative care, and end-of-life care, it is reasonable to
    assume at least some of his patients would require treatment for
    pain that would exceed the recommended dose. Indeed, there is
    no indication how many patients Dr. Cohanshohet treats in total
    and what percentage the five patients at issue comprise that
    total.
    As in Wood, the Board has made no evidentiary showing of
    how often similarly-situated physicians who specialize in pain
    treatment might prescribe these drugs. Neither has the Board
    made any showing of the likelihood that the prescriptions could
    have been properly issued, given what is known of Dr.
    Cohanshohet’s practice. Instead, Dr. Berger identified instances
    16
    where his prescribing patterns would have been appropriate.
    Specifically, Dr. Berger indicated that the CDC’s prescribing
    recommendations, relied upon by Dr. Naqvi, do not apply in cases
    involving “active cancer treatment, palliative care, and end-of-life
    care.” Dr. Naqvi failed to discuss these circumstances in his
    declaration.
    This is in contrast to the supporting evidence in Cross,
    which provided much greater detail as to why the drugs
    prescribed posed a greater risk to the three patients identified as
    opposed to a patient who was not a postmenopausal woman.
    In addition, one of the patients in Cross received doses that
    equaled three times the maximum recommended dose. Another
    patient denied she had been treated by the psychiatrist and the
    psychiatrist had been previously disciplined by the Texas Medical
    Board for improper prescription practices. (Cross, supra, 11
    Cal.App.5th at pp. 312–315.) Cross presented a much greater
    showing of good cause to compel compliance of the subpoenas.
    The Attorney General contends the consumer complaint,
    “which alleged the exact concerns identified in Dr. Naqvi’s
    declaration,” provides the additional evidence necessary to
    constitute good cause. We are not persuaded an anonymous
    complaint which provides scant detail, particularly about who
    and when the prescriptions were written, constitutes substantial
    evidence of good cause. Indeed, we are skeptical the complaint
    bolsters Dr. Naqvi’s suspicions, given that Dr. Naqvi was induced
    to look through the CURES report for improper prescriptions of
    opioids because of the complaint. Thus, it may be the case that
    Dr. Naqvi looked through the CURES report to justify the
    allegations in the anonymous complaint.
    17
    DISPOSITION
    The order to comply with the challenged subpoenas is
    reversed and the trial court is directed to issue a new order
    denying the petition. Dr. Cohanshohet is awarded his costs on
    appeal.
    BIGELOW, P. J.
    We concur:
    GRIMES, J.
    STRATTON, J.
    18
    Filed 2/21/19
    CERTIFIED FOR PUBLICATION
    IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
    SECOND APPELLATE DISTRICT
    DIVISION EIGHT
    DEAN GRAFILO, as Director, etc.,                B285193
    Plaintiff and Respondent,                (Los Angeles County
    Super. Ct. No. BS169143)
    v.
    ORDER CERTIFYING
    KAMYAR COHANSHOHET,                             PUBLICATION
    Defendant and Appellant;                  [No change in the judgment]
    MEDICAL BOARD OF CALIFORNIA,
    Real Party in Interest and
    Respondent.
    THE COURT:
    The opinion in the above entitled matter was filed on
    January 22, 2019, was not certified for publication in the Official
    Reports. For good cause it now appears that the opinion should
    be published in the Official Reports and it is so ordered.
    ____________________________________________________________
    BIGELOW, P. J.          GRIMES, J.          STRATTON, J.
    

Document Info

Docket Number: B285193

Filed Date: 2/21/2019

Precedential Status: Precedential

Modified Date: 2/21/2019