Sacramento pain doctor sues medical board over probation. ‘Putting my reputation in danger’

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A surgeon and owner of five Sacramento-area pain management clinics that see about 5,000 patients a month is suing the Medical Board of California, which placed his medical license on three years of probation.

Dr. Kayvan Haddadan is asking a Sacramento Superior Court judge to overturn the medical board’s “extreme discipline” against him, according to a filed petition for writ of administrative mandate.

In the legal action filed by Sacramento-based attorneys Brian Taylor and Ian McGlone on behalf of Haddadan, the attorneys argue that the ordered probation is based on two separate alleged simple acts of negligence; one that occurred over 10 years ago and another nearly nine years ago.

Haddadan, a pain management physician, is the president and medical director of Advanced Pain Diagnostic & Solutions, which he founded in 2012. The interventional pain management practice has clinics in Sacramento, Roseville, Davis, Folsom and Yuba City, with a surgery center in Rocklin.

Haddadan said the purpose of the state medical board is to keep patients safe. But he believes its discipline on him is unwarranted and can cause significant harm to his business.

“They’re making a big deal of almost nothing,” Haddadan said Monday in a phone interview with The Sacramento Bee. “Their intention is to get the physician in trouble.”

Last Wednesday, Judge Jennifer Rockwell granted Haddadan’s request to suspend the medical board’s discipline order of probation pending further review and judgment by the court on the surgeon’s petition seeking a reversal. The case will return to court July 22 for further proceedings.

On March 4, the Medical Board of California revoked Haddadan’s medical license but suspended that revocation pending successful completion of three years of probation. His medical practice would be allowed to continue during probation. The board’s discipline order went into effect April 3, before the Superior Court suspended that discipline last week.

The medical board hearing that led to Haddadan’s discipline was focused on two patients. One was 33-year-old woman with a history of chronic multiple joint problems, and the other was 49-year-old man with a long-standing history of knee and back pain, according to a Jan. 3 summary of the allegations and the hearing written by Administrative Law Judge Timothy Aspinwall.

Woman with chronic joint problems

The woman was previously diagnosed with osteoarthritis of both knees and hips, and she complained of whole-body pain for the three previous years. She had been prescribed methadone and diazepam. Haddadan agreed to take over her medical treatment and first saw the patient for chronic pain management on April 1, 2013.

Haddadan prescribed methadone and Valium, discussing with her in detail the treatment plan and explaining the risks and benefits of long-term opioid treatment for chronic pain. He saw her in his office each month with limited exceptions through at least 2020. He used point-of-care urine drug tests to monitor her compliance with her treatment plan, confirming those test results at an independent laboratory as needed.

A urine drug test on May 14, 2015, found nonprescribed methamphetamine in her system, according to Aspinwall’s written summary. In his clinical record, Haddadan wrote: “explained the treatment plan and patient nods for understanding. I am going to refill the medication without any additional refill. I will see the patient back in one month to evaluate the efficacy of the treatment...”

An independent lab test eight days later confirmed the presence of meth in her system. That May 22, 2015, lab test result report is included in the patient’s clinical records, but Haddadan did not separately record the test results in his clinical notes. His notes in subsequent office visits do not indicate that he spoke to her about either test that showed meth in her system.

On Oct. 22, 2015, Haddadan saw the patient in his office for a physical examination and medication management. Haddadan noted in his clinical record that a urine drug test at his office showed the patient was compliant with her medication regimen, including methadone, Xanax and Norco, according to the administrative law judge.

In his summary, Aspinwall wrote that Haddadan’s testimony that he did confront the patient about her positive meth test results was “not convincing,” and the evidence is clear the physician did not adequately note or address those test results that constitutes a departure from the standard of care; not an “extreme departure by exercising only scant care” as was alleged.

The administrative law judge noted that Haddadan continued to provide care for the patient by “keeping her close” and “practicing harm reduction.”

Man with knee and back pain

On March 20, 2014, Haddadan first saw a man with knee and back pain in his clinic following a referral from another treating physician. The following month, Haddadan prescribed pain medications including methadone for the man with complaints of persistent knee and back pain.

Haddadan testified that the patient was already on a high dose of 70 milligrams of methadone in March 2014, and he reduced the prescription to 60 milligrams. Haddadan said he still sees this patient, who is now on 20 milligrams of methadone per day.

Haddadan continued to treat the man nearly on a monthly basis through 2020, which included 60 to 70 milligrams of methadone per day during most if not all that time. The patient’s records do not reflect that Haddadan either ordered or reviewed an electrocardiogram (also known as an EKG test) for this patient, according to Aspinwall.

Haddadan testified that the patient told him his primary care physician had done an EKG test, and the test result was normal. He also said the patient did not have any irregular cardiac symptoms that would suggest a EKG was necessary, according to Aspinwall.

The administrative law judge determined that Haddadan committed a simple departure from the standard of care by failing to order an EKG test or review a recent EKG test of the patient when he began treating him with methadone.

California prosecutors

Haddadan’s attorneys argue in filed court documents that the medical board’s discipline is based on “two separate alleged simple acts of negligence,” one that occurred over 10 years ago and another nearly nine years ago. Taylor and McGlone also argue that the two unrelated acts did not result in any patient harm, and they are not the type of “repeated acts of negligence” to support the discipline.

The accusation of failing to order an EKG test was filed March 11, 2022, nearly eight years after he began treating him with methadone. The physician’s attorneys argued that the alleged conduct did not occur within seven years after the act, in accordance with the medical board’s code.

Haddadan told The Bee that the basis for the board’s discipline was “as trivial as that could be,” but the consequences to his medical practice can be far-reaching.

He said the probation can cause insurance companies to cancel contracts with his practice, because the fact he’s being monitored could have some thinking: “He may not be a good doctor.

“And that’s completely the opposite what it is.”

The physician also said harming his business could reduce the adequate access to pain management treatment in the region.

“They’re putting my reputation in danger,” Haddadan said of the discipline.

The California Attorney General’s Office is arguing against Haddadan in Sacramento Superior Court, asking the judge to uphold the state medical board’s discipline order.

In an opposition document filed April 9, Deputy Attorney General Megan O’Carroll wrote that Haddadan’s request to suspend the discipline order “minimizes the risk he posed to his patients, and makes assertions that are not supported by the record or the evidence.”

O’Carroll argued that case law has established that, in license discipline, repeated negligent acts require only there be two separate acts of negligence; they don’t need to be related or form a pattern. Haddadan continued to treat the patient with methadone through at least May 2020 without ordering an EKG, which is well within the board’s statutory period, the state prosecutor argued.

O’Carroll said whether either of these two patients were harmed is irrelevant because the medical board’s role is to prevent harm to patients in the future.

“Here, (Haddadan) was negligent in his care, the Board concluded that (Haddadan) has the potential to harm future patients,” O’Carroll argued in the court document. “The Board’s goal is to prevent harm to patients, not wait for it to occur.”

With the goal of protecting the public, the medical board adopted a penalty for Haddadan in accordance with the lower range of acceptable consequences under its disciplinary guidelines, state prosecutors argued.

This discipline would require Haddadan to serve three years of probation, take a medical record-keeping and prescribing practices course and have an objective physician in his same field review a portion of his charts four times a year, according to the Attorney General’s Office. State prosecutors said the goals is to confirm for the medical board that Haddadan is practicing medicine safely.

The state prosecutor argues that Haddadan has not shown a willingness to accept potential criticism of his practice or to consider whether additional training and monitoring would even be beneficial for his patients.

“If he were to succeed on this petition, the worst that would have occurred would be that he obtained additional professional education and had the insight of another colleague in his field having reviewed his patient charts for a few months,” O’Carroll wrote in her opposition document.

“It is difficult to see how this could be considered irreparable harm.”