before the medical board of california department of ...4patientsafety.org/documents/hjortsvang,...

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation and Petition to Revoke Probation Against:

) ) ) )

ERICK WARREN HJORTSV ANG, M.D.) Case No. 800-2014-003642

Physician's and Surgeon's Certificate No. A 79589

Respondent

) ) ) ) )

DECISION AND ORDER

On November 16, 2016, a Decision became effective wherein Respondent, Erick Warren Hjortsvang, M.D., was ordered to complete a medical record keeping course, prior to being publically reprimanded pursuant to Business and Professions Code section 2227, subdivision (a)(4). On January 30, 2017, the Medical Board of California notified the Respondent that he fully complied with the terms and conditions of the Decision. In accordance with the Decision, Respondent's Physician's and Surgeon's Certificate No. A 79589 was publically reprimanded on January 30, 2017.

MEDICAL BOARD OF CALIFORNIA

Dev Gnanadev, M.D. President




) ) ) )

ERICK WARREN HJORTSV ANG, M.D.)


Respondent

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DECISION

Case No. 800-2014-003642

OAH No. 2016030088

The attached Proposed Decision is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00 p.m. on November 16, 2016.

IT IS SO ORDERED October 17, 2016.





ERICK HJORTSV ANG, M.D.,

Physician and Surgeon's Certificate No. A79589

Respondent.

Case No. 800-2014-003642

OAH No. 2016030088

PROPOSED DECISION

Administrative Law Judge Ruth S. Astle, State of California, Office of Administrative Hearings, heard this matter in Oakland, California, on August 22, 24 and 25, 2016.

Joshua M. Templet, Deputy Attorney General, represented complainant.

Respondent Erick Hjortsvang, M.D., was present and was represented by Gregory Abrams, Attorney at Law.

The matter was submitted on August 25, 2016.

FACTUAL FINDINGS

1. Complainant Kimberly Kirchmeyer made this accusation in her official capacity as the Executive Director of the Medical Board of California (Board).

2. On June 26, 2002, the Board issued Physician and Surgeon's Ce1iificate Number A79589 to Erick Hjortsvang, M.D. (respondent). The certificate was in full force and effect at all times relevant to the charges brought against him in this accusation and petition to revoke probation and will expire on June 30, 2018, unless renewed.

. 3. In a disciplinary action against respondent the Board issued a decision, effective October 30, 2013, in which respondent's certificate was revoked. However, the revocation was stayed and respondent was placed on probation for a period of five years with certain terms and conditions. Respondent's probation was tolled for 17 months until July 6, 2015, because he was unemployed. As of the date of this hearing, respondent has three years and seven months of probation to complete. Respondent has met all the terms and conditions of his probation to date including attending and successfully completing PACE, additional continuing medical education, and a practice monitor.

4. Respondent is a hematologist-oncologist. His previous discipline by the Board \\'.as based on a Stipulation and Order in 2013, as a result of his chemotherapy treatment of a cancer patient with Methotrexate in 2010.

5. Beginning in July 2013, respondent started chemotherapy treatment of a cancer patient (patient A). The patient, a male of 56 years of age, presented with a six-month history of a left neck mass and three years of progressive back pain. Later that month, the patient was diagnosed with Stage III Hodgkin's lymphoma, nodular sclerosis. Respondent started the patient on a standard chemotherapy protocol on July 24, 2013, with Adriamycin, bleomycin, vinblastine, and dacarbaxine. Respondent did not document obtaining informed consent from the patient for the chemotherapy, including the use of bleomycin and the risks of lung injury from this drug.

6. Bleomycin is a key component of curative chemotherapy regiments used to treat curable cancers, such as Hodgkin's lymphoma. Its use may cause bleomycin-induced lung injury, including life-threatening interstitial pulmonary fibrosis.

7. Respondent noted that the patient complained of new symptoms on his September 30, 2013 visit, including a persistent cough for two weeks. The patient received another cycle of chemotherapy, including bleomycin, on October 4, 2013.

8. From October 18, 2013 to October 21, 2013, the patient was hospitalized and treated for presumptive pneumonia. A progress note entered by respondent on October 21, 2013, noted that a high-resolution CT scan revealed abnormal changes in the patient's radiologic appearance. The high-resolution CT scan on October 20, 2013, demonstrated interstitial fibrosis with areas of patchy ground-glass density.

9. The patient returned home and had an increased dry cough. He presented to the emergency department on October 28, 2013, with dyspnea. He was found to be tachypneic but not hypoxic. A chest x-ray showed low lung volumes and extensive bilateral lung opacities, indicating worsening interstitial fibrosis. The patient was admitted to the intensive care unit for further treatment. His condition continued to deteriorate, and he died on November 19, 2013. The Death Summary reported that the patient had bleomycin lung toxicity with severe acute respiratory distress syndrome.

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10. It was not established by clear and convincing evidence that respondent ignored signs of possible pulmonary toxicity from bleomycin. Respondent consulted a pulmonary specialist who recommended the patient be treated for an infection first. Complainant's expert testified that respondent's actions constituted a simple departure from the standard of practice. However, he based his opinion on facts that were not established including that the patient was short of breath early in the treatment and that respondent did not consider bleomycin toxicity, which was clearly not the case.

Respondent's expert was persuasive. He testified that at every stage respondent acted within the standard of practice and based on the clinical facts including no shortness of breath, the low dose of bleomycin given to the patient, the recommendations of the pulmonary specialist, and the results of the early x-rays and CT Scan. He opined that, respondent's treatment of the patient was appropriate.

11. At the time of the October 4, 2013, chemotherapy treatment, the patient had a cough for over two weeks. The patient reported he had been exposed to whooping cough. He did not suffer from shortness of breath. A PET/CT exam taken on October 2, 2013, was not abnormal.

12. Respondent did not fail to consider bleomycin toxicity. It was considered by respondent as possibility, but infection was more likely. Respondent, with consultation with others, decided infection was more likely and treated the patient accordingly. The use of. corticosteroids is contra-indicated for an infection. It was within the standard of care to treat the patient for infection before deciding to treat the patient for bleomycin toxicity. The patient had received a very small amount of bleomycin and less than 1 % of patients suffer from bleomycin toxicity with the small amount administered to him.

13. Respondent admits that he did not record in his medical records that the patient and his family were informed of the dangerous risks of the use of this chemotherapy treatment, including potentially lethal bleomycin toxicity. It was established that respondent failed to maintain adequate and accurate records. Respondent claims he did tell them, but failed to document it.

14. Respondent is presently employed at PCR Oncology in Pismo Beach, California (PCR). He works with and for David L. Palchak, M.D. He started working with Dr. Palchak July 5, 2015. Dr. Palchak also acts as respondent's practice monitor. PCR has a good error prevention protocol, which respondent follows carefully. Dr. Plachak consults closely with respondent and finds respondent to be an excellent diagnostician and treating physician. He has been working with respondent on what he calls "chaii clutter" and is satisfied with respondent's progress. Dr. Palchak finds respondent pays attention to detail.

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LEGAL CONCLUSIONS

1. By reason of the matters set forth in Factual Findings 3 through 12, cause for disciplinary action and revocation of probation does not exist pursuant to Business and Professions Code section 2234, subdivision (c) (repeated negligent acts). It was not established by clear and convincing evidence through expert testimony that there were two or more negligent acts or omissions.

2. By reason of the matters set forth in Finding 13, cause for disciplinary action exists pursuant to Business and Professions Code section 2266 (failure to maintain adequate and accurate records). Respondent had not completed the probationary conditions when this matter occurred. It would not be appropriate to revoke his probation based on his failure to keep adequate medical records. Taking a record keeping course is sufficient to address this issue.

3. The matters set forth in Factual Finding 14, have been considered in making the following order. Complainant has requested that the probation be revoked and reinstated on the same terms and conditions for 5 years. Under all the circumstances including the amount of time remaining on his probation, and the failure to establish repeated acts of negligence, a letter of reprimand is the appropriate level of discipline based on the Factual Findings set forth above in this matter.

ORDER

1. Respondent's probation in Case No. 12-2011-215456 shall not be revoked and shall continue as ordered September 30, 2013 and effective October 30, 2013.

2. Physician and Surgeon's Certificate No. A79589 issued to respondent Erick Hjortsvang, M.D., shall by way of a letter from the Medical Board of California be publicly reprimanded. This Decision can serve as the Public Letter of Reprimand, provided, however, that the public reprimand is conditioned on respondent's compliance with the following conditions precedent:

Medical Record Keeping Course

a. Within 60 calendar days of the effective date of this Decision, respondent shall enroll in a course in medical record keeping equivalent to the Medical Record Keeping Course offered by the Physician Assessment and Clinical Education Program, University of California, San Diego School of Medicine (Program), approved in advance by the Board or its designee. Respondent shall provide the Program with any information and documents that the Program may deem pertinent. Respondent shall participate in and successfully complete the classroom component of the course not later than six (6) months after

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respondent's initial enrollment. Respondent shall successfully complete any other component of the course within one (1) year of enrollment. The medical record keeping course shall be at respondent's expense and shall be in addition to the CME requirements for renewal of licensure.

DATED: September 20, 2016

RUTHS. ASTLE Administrative Law Judge Office of Administrative Hearings

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KAMALA D. HARRIS Attorney General of California JANE ZACK SIMON Supervising Deputy Attorney General JOSHUA M. TEMPLET Deputy Attorney General State Bar No. 267098

455 Golden Gate A venue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 703-5529 Facsimile: (415) 703-5480 E-mail: [email protected]

Attorneys/or Complainant


DEPARTMENT OF CONSUMER AFFAIRS ST A TE OF CALIFORNIA

Physician's and Surgeon's Certificate No. A79589,

Respondent.

Complainant alleges:

PARTIES

1. Kimberly Kirchmeyer (Complainant) brings this Accusation and Petition to Revoke

Probation solely in her official capacity as the Executive Director of the Medical Board of

California, Department of Consumer Affairs (Board).

2. On or about June 26, 2002, the Medical Board issued Physician's and Surgeon's

Certificate Number A 79589 to Erick Hjortsvang, M.D. (Respondent). The certificate was in full

force and effect at all times relevant to the charges brought herein and will expire on June 30,

2016, unless renewed.

(ERICK HJORTSVANG, M.D.) ACCUSATION AND PET. TO REVOKE PROBATION NO. 800-2014-003642

3. In a disciplinary action entitled "In the Matter of the Accusation Against Erick

2 Hjortsvang, M.D.," Case No. 12-2011-215456, the Board issued a decision, effective October 30,

3 2013, in which Respondent's Physician's and Surgeon's Certificate was revoked. However, the

4 revocation was stayed and Respondent's certificate was placed on probation for a period of five

5 (5) years with certain terms and conditions. A copy of that decision is attached as Exhibit A and

6 incorporated herein by reference.

7 JURISDICTION

8 4. This Accusation and Petition to Revoke Probation is brought before the Board, under

9 the authority of the following laws. All section references are to the Business and Professions

1 O Code unless otherwise indicated.

11 5. Section 2004 of the Code provides that the Board shall have the responsibility for the

12 enforcement of the disciplinary and criminal provisions of the Medical Practice Act.

13 6. Section 2227 of the Code provides that a licensee who is found guilty under the

14 Medical Practice Act may have his or her license revoked, suspended for a period not to exceed

15 one year, placed on probation and required to pay the costs of probation monitoring, or such other

16 action taken in relation to discipline as the Board deems proper.

17 7. Section 2228 of the Code states:

18 The authority of the board ... to discipline a licensee by placing him or her on probation includes, but is not limited to, the following:

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(a) Requiring the licensee to obtain additional professional training and to pass an examination upon the completion of the training. The examination may be written or oral, or both, and may be a practical or clinical examination, or both, at the option of the board or the administrative law judge.

(b) Requiring the licensee to submit to a complete diagnostic examination by one or more physicians and surgeons appointed by the board. If an examination is ordered, the board shall receive and consider any other report of a complete diagnostic examination given by one or more physicians and surgeons of the licensee's choice.

( c) Restricting or limiting the extent, scope, or type of practice of the licensee, including requiring notice to applicable patients that the licensee is unable to perform the indicated treatment, where appropriate.

( d) Providing the option of alternative community service in cases other than violations relating to quality of care.

8. Section 2234 of the Code states:

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(ERICK IIJORTSVANG, M.D.) ACCUSATION AND PET. TO REVOKE PROBATION NO. 800-2014-003642

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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.

( 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.

9. 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.

BACKGROUND

10. Erick Hjortsvang, M.D. (Respondent) is a hematologist-oncologist. Respondent was

previously disciplined by the Board in 2013, based on his chemotherapy treatment of a cancer

patient in 2010.

11. At issue in the present case is Respondent's chemotherapy treatment of another of his

cancer patients, Patient A 1 ("Patient A" or "the patient''), beginning in July 2013. The patient, a

male of 56 years of age, presented with a six-month history of a left neck mass and three years of

progressive back pain. Later that month, the patient was diagnosed with Stage ITI Hodgkin's

lymphoma, nodular sclerosis. Respondent started the patient on a standard chemotherapy protocol

on July 24, 2013 with adriamycin, bleomycin, vinblastine, and dacarbazine. Respondent did not

1 The patient's name has been withheld to protect patient privacy.

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(ERICK J-l.JORTSV ANG, M.D.) ACCUSATION AND PET. TO REVOKE PROBATION NO. 800-2014-003642

document obtaining informed consent from the patient for the chemotherapy, including the use of

2 bleomycin and its attendant risks of lung injury.

3 12. Bleomycin is a key component of curative chemotherapy regiments used to treat

4 curable cancers, such as Hodgkin's lymphoma. Its use may cause bleomycin-induced lung injury,

5 including life-threatening interstitial pulmonary fibrosis in up to ten percent of patients receiving

6 the drug.

7 13. Respondent noted that the patient complained of new symptoms on his September 30,

8 2013 visit, including a persistent cough for two weeks.

9 14. The patient received another cycle of chemotherapy, including bleomycin, on

10 October 4, 2013.

11 15. The patient was admitted from October 18, 2013 until October 21, 2013 and was

12 treated for presumptive pneumonia. A progress note entered by Respondent on October 21, 2013

13 stated that a chest x-ray and a CT scan revealed changes in the patient's radiologic appearance. A

14 chest x-ray taken on or about October 18, 2013 showed bi basilar airspace disease, and a high-

15 resolution CT scan taken on or about October 20, 2013 showed interstitial fibrosis with areas of

16 patchy ground glass density, consistent with bleomycin toxicity.

17 16. The patient returned home and had gradual progressive shortness of breath and an

18 increased dry cough. He presented to the emergency department on or about October 28, 2013

19 with dyspnea. He was found to be tachypneic but not hypoxic. A chest x-ray showed low lung

20 volumes and extensive bilateral lung opacities, indicating worsening interstitial fibrosis,

21 consistent with bleomycin toxicity. The patient was admitted to the intensive care unit for further

22 treatment. His condition continued to deteriorate, and he died on or about November 19, 2013.

23 The Death Summary reported that the patient had bleomycin lung toxicity with severe acute

24 respiratory distress syndrome (ARDS).

25 CAUSE FOR DISCIPLINE

26 (Unprofessional Conduct: Repeated Negligent Acts)

27 17. Respondent Erick Hjortsvang, M.D. is subject to disciplinary action under Business

28 and Professions Code section 2334, subdivisions (a) (violation of Medical Practice Act) and (c)

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(ERICK HJORTSV ANG, M.D.) ACCUSATION AND PET. TO REVOKE PROBATION NO. 800-2014-003642

(repeated negligent acts), and section 2266 (failure to maintain adequate records), in that he failed

2 to appropriately and timely evaluate, diagnose, and/or treat bleomycin toxicity to Patient A's

3 lungs and failed to document obtaining informed consent for administration of bleomycin.

4 18. Respondent ignored signs of possible pulmonary toxicity from bleomycin that

5 warranted further evaluation with pulmonary function tests, high-resolution CT scans, and/or

6 pulmonary consultation. Instead, Respondent proceeded to administer an additional dose of

7 bleomycin.

8 19. At the time of his October 4, 2013 chemotherapy treatment, the patient had suffered

9 from shortness of breath and a cough for over two weeks, and there was no radiographic or other

1 O clinical evidence of a cause for his symptoms. In addition, a PET/CT exam taken on or about

11 October 2, 2013 was abnormal and showed mild diffuse lung uptake, which was not present on

12 prior July 2013 PET/CT exam, and which was suggestive of new lung toxicities. Despite these

13 new pulmonary findings indicating possible bleomycin toxicity, Respondent did not order a

14 pulmonary function test or a chest x-ray to rule out bleomycin toxicity before proceeding with an

15 additional chemotherapy treatment on October 4, 2013.

16 20. Further, after the high-resolution CT scan on October 20, 2013 demonstrated

17 interstitial fibrosis with areas of patchy ground glass density consistent with bleomycin toxicity,

18 Respondent failed to consider and carryout a therapy directed at bleomycin toxicity. The patient

19 should have been promptly started on steroids. Corticosteroids have been the mainstay of

20 intervention for bleomycin toxicity and have been found to be more successful earlier in the

21 evolution of the process.

22 21. In addition, Respondent failed to inform the patient of the dangerous risks of his

23 chemotherapy treatment, including potentially lethal bleomycin toxicity.

24 22. Respondent's conduct constitutes multiple simple departures from the standard of

25 care and a failure to maintain adequate and accurate records.

26 CAUSE TO REVOKE PROBATION

27 23. As stated above, a previous Accusation was filed before the Board in Case No. 12-

28 2011-215456, alleging that Respondent had engaged in multiple departures from the standard of

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(ERICK HJORTSVANG, M.D.) ACCUSATION AND PET. TO REVOKE PROBATION NO. 800-2014-003642

care, including repeated negligent acts, gross negligence, and incompetence, in violation of the

2 Medical Practice Act. The Board and Respondent thereafter entered into a stipulated settlement,

3 by which Respondent agreed that his certificate would be placed on probation with terms and

4 conditions. The stipulated settlement provided that failure to fully comply with any term or

5 condition of probation, including the requirement that Respondent obey all laws, would be a

6 violation of his settlement agreement and would authorize the Board to carry out the disciplinary

7 order that was stayed.

8 24. Respondent is guilty of unprofessional conduct and his probation is subject to

9 revocation based upon his violations of the Medical Practice Act, as set forth above in the Cause

1 O for Disciplinary Action.

11 PRAYER

12 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,

13 and that following the hearing, the Medical Board of California issue a decision:

14 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 79589,

15 issued to Erick Hjortsvang, M.D.;

16 2. Revoking the probation that was granted by the Board in Case No. 12-2011-215456

17 and imposing the disciplinary order that was stayed, thereby revoking Physician's and Surgeon's

18 Certificate No. A 79589 issued to Erick Hjortsvang, M.D.;

19 3. Revoking, suspending or denying approval of Erick Hjortsvang, M.D.'s authority to

20 supervise physician assistants, pursuant to section 3527 of the Code;

21 4. Ordering Erick Hjortsvang, M.D., if placed on further probation, to pay the Board the

22 costs of probation monitoring; and

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5. Taking such other and further action

July 13, 2015

SF2015401572

Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant

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(ERICK I IJORTSV ANG. M.D.) ACCUSATION AND PET. TO REVOKE PROBATION NO. 800-2014-003642

EXHIBIT A



In the Matter of the Accusation Against:

Erick 1-ljortsvang, M.D.


Respondent

) ) ) ) ) ) ) ) ) ) _____________ )

Case No. 12~2011 -215456

DECISION

The attaclwd Stipulated Settlement and Disciplinary Order is hcrchy amended, pursuant to Government Code section 11517(c)(2)(c) to correct technical or minor changes that do not affect the factual or legal basis of the proposed decision. The proposed decision is amended as follows:

1. Pngc 1- the heading of "Case No. 16-201.1-215456" is stricken and replaced with 11 Case No. 12-2011-215456".

The Stipulated Settlement and Disciplinary Order as amended is hereby accepted and adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, Stntc of California.

This Dec.is ion shall become effective at 5:00 p.m. on OcJ_q_bcl' 30, 2013.

lT IS SO ORDERED: September 30, 2013.

lVfEDICAL BOARD 01~ CALIFORNIA I do hereby certify that t.hiti document tf.1."i 'Ltue ~~w c~rrect: copy of fhe ~·igi.ooJ -0u .fUt Ju iltfs

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KAMALA D. HARRIS Attorney General of California JOSE R. GUERRERO Supervising Deputy Attorney General JANE ZACK SIMON Deputy Attorney General [SBN 116564]

455 Golden Gate Avenue) Suite 11000 San Francisco, CA 94102-7004 Telepho;-ic: (415) 703-5544 Fax: (4 J 5) 703-5480 E-mail: [email protected]_,_gov_

Attorneys/or Complainant Medical Board ofCal{fornia



ln the Matter of the Accusation Against:

ERICK H.JORTSV ANG. M.D. Kaiser Foundation Hospital 99 Monticello Road San Rafael, CA 94903

Physician's and Surgeon's Certificate No. A79589

----~-~--------R_e_s_pondent.J

Case No. 16-2011~215456

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

TT IS HEREBY STIPULATED AND AGREED by and between the parties to the

above-entitled proceedings that the following matters arc true:

1. KiIT1berly Kirchmeyer (Complainant) is the Interim Executive Director of

21 the Mcdicnl BMrd of California and is the complainant herein. This action hl:is been <1t all times

21 brought and maintained solely in the official capacity or the Ivledical Board's Executive Director,

2J who is represented in this matter by Kamala D. Harris, Attorney General of Lhc State of

24 California, by Jane Zack Simon, Deputy Attorney General.

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26 I 11

27 I II

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\[--·--· --·--·--~--------·St1-.p-u-la-t~dSettl~~;~t-a_n_d Disciplinary Order (·l-6-)--2-0-11---2-15456)

2. Erick IIjorstvang, M.D. (Respondent) is represented by Kenneth L.

2 Freeman, Law Offices of Kenneth L. Freeman, 4: 04 - 24th Street, Box 770, San Francisco, CA

3 94114.

4 3. On June 26, 2002, the Medical Board of California issued Physician's and

5 Surgeon's Certificate No. A79589 to Respondent. Said certificate is renewed and current with an

6 expiration date of June 30, 2014.

7 4. Accusation No. 16-2011-215456 (Accusation) was duly filed before the

8 Medical Board of California (Board), and is currently pending against Respondent. The

9 Accusation and all other statutorily required documents were properly served on Respondent. A

1 O copy of the Accusation is attached as Exhibit A.

l 1 5. Respondent has carefully read, discussed with counsel, and understands the

12 charges and allegations in the Accusation. Respondent bas also care folly read, discussed \vith

1 J counsel, and understands the effects of this Stipulated Settlement and Disciplinary Order

l 4 (Stipulation.)

l 5 G. Respondent is fully aware of his legal rights in this matter, including the

16 right to a bearing on the charges and allegations !n the Acc(1sation; the right to be represented by

17 counsel a~ his own expense; the right to confront and cross-examine the witnesses against him;

18 the rtght to present evidence mid to testify on his own behnlf; the right to the issuance of

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subpoenas to compel the attendance of witnesses and the production of documents; the right to

20 reconsideration and court review of an adverse decision; and all other rights accorded by the

21 Califomia Administrative Procedure Act and other applicable lmvs.

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7. For the purpose of resolving the charges and allegations in the Accusation,

without the expense and uncertair.ty of further proceedings, Respondent agrees that the charges

ancl allegations in the Accusation, if proven ut a hearing, constitute cause for imposing discipline

upon his Physician's and Surgeon's cerlific.ate and he agrees to be bound by the Board's

imposition o:! discipline as set forth in the Disciplinary Order belovv.

8. The cldmissions made by Respondent are only for the purpo~cs of

this proc.:eeding or any other proceedings in which the Medical Board of California or other

2 ~·-···------~-~~-----·------"---------·-------..---~-----~- ---------------------

Stipulated Setllement and Disciplinary Order (16-2011-215456)

profossional licensing agency is involved, rmd shall not be admissible in any other criminal or

2 civil proceedings.

3 9. This Stipulation shall be subject to the approval of the Board.

11 Eespondcnt understands and agrees that Board staff and counsel for Complainant may

5 communicate directly with the Board regarding this Stipulation, without notice to or participation

6 by Respondent or his counsel. If the Board fails to adopt this Stipulation as its Order in this

7 matter, the Stipulation shall be of no force or effect; it shall be inadmissible in any legal action

8 between the parties; and the Board shall not be disqualified from further ac·jon in this matter by

9 virtue of its consideration of this Stipulation. Respondent also understands and n.grees that he will

l O not oe able to withdraw or modify this Stiptilation while it is before the Board for consideration.

11 10. The patties understand and agree tl1at facsimile or electronic copies of this

l 2 Stip~ilalecl Settlement and Disciplinary Order, including facsimile or electronic signatures thereto,

13 shall have the same force and effect as lhe originals.

14 11. Jn consideration of the foregoing admissions aJld stipulations, the parties

15 agree that the Board may, without further notice or formal procccc\ing, issue and enter the

16 following Dlsciplinary Order:

J 7 DlSCIPLINARY ORDER

J 8 IT IS HEREBY ORDERJ2D that Physician's and Smgeon's Certificate number

19 A 79589 issued to Respondent Eric.k Hjorlsvang, M.D. is revoked. However, the revocation is

20 stayed and Respondent is placed on probation for five (5) years on the following terms and

?.1 conditions.

22 ' ;, Clinical Training Program: Within 60 calendar days of the effective date of

23 this Decision, Respondent shall enroll in a c.linical training or educational program equivalent to

24 the Phys:cian Assessment and Clinical Educa:ion Progn.m1 (PACE) offered at the University of

25 Cali fornil', - San Diego School of Medicine (Program). Respondent shall successfully complete

26 the Program not later than six (6) months after Respondent's initial enrollment unless the Board

27 or its cksignee agrees in writing to an extension of that time. The Program shall consist or a

28 Co1:1prchcns i ve Assessment pro gram comprised of a two-day assessment of Respondent's

j - -·--·---~- ··~······~--~--------·-·-----·

Stipulated Settle1nent and Disciplinary Ordc!' (16-2011-215456)

physical and r:1cntal health; basic clinical and cornrnunication skills common to all clinicians; and

2 medical knowledge, skill and judgment pertaining to Respondent's area of practice in which

3 Respondent was alleged to be deficient, and at minimum, a 40 hour program of clinical education

4 in the area of practice in \vhich Respondent was alleged to be deficient and which takes into

5 account data obtained from the asscilsment, Dccision(s), Accusation(s), and any other information

6 that the Board or its designee deems relevant. Respondent shall pay all expenses associated with

7 the clinical training program.

8 Based on Respondent's performance and test results in the assessment and clinical

9 education, the Program will advise the Board or its designce of its recommcndation(s) for the

l 0 scope and length of any additional educational or clinical training, treatment for any medical

11 condition, treatment for any psychological condition, or anything else affecting Respondent's

12 prac1.icc o[ medicine. Respondent shnll comply with Program rccomrncndat!ons. /\t the

13 completion of any additional educational or clinical training, Respondent shall submit to and pass

14 an examination. Determination as to whether Respondent successfully completed the

15 examination or successfully completed the program is solely within the program's jurisdiction.

16 If Respondent fails to enroll, participate in, or successfully complete the clinical training

17 program within the designated time period, Respondent shall receive a notification from the

18 Board or its dcsigncc to cease the practice of medicine within three (3) calendar days after being

19 so notified. Respondent shall not resume the practice of medicine until enrollment or

20 participation in the outstanding portions of the clinical training program have been complcled. If

2 l Respondent does not s\.1ccessfully complete the cllnical training program, l~csponc\cnt shall not

22 resume the practice of medicine until a final decision has been rendered on the Accusation and/or

23 a Petition to Revoke Probation. The cessation of practice shall not apply to the reduction of the

24 probationary time period.

25 Practice Monitor: Within 30 calendar days of tl1e effective date of lhis

26 Decision, Respondent shall subrnit to the Board or its dcsignce for prior approval as n practice,

27 monitor, the name and qualif1cations of one or r:1orc licensed physicians ad surgeons wl1osc

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Stipulated Settlement and Disciplinary Order (16·-2011-215456)

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licenses are valid 0nd in good standing, and who are prererably American Board of Medical

Specialties (ABMS) certified. A monitor shall have no prior or current business or personal

relationship with Respondent, or other relationship 1.hat could reasonably be expecLed to

cornpmrnise the ability of the monitor to render fair and un'Jiased reports to the Board, including

but not 1 irnited to any form of bartering, shall be in Respondent's field of practice, and must agree

to serve as Respondent's monitor, Respondent shall pay all monitoring costs. The Board or its

clesignce shall provide the approved monitor with copies of the Decision and Accusation, and a

proposed monitoring plan. Within 15 calendar days of receipt of tbe Decisio:1, Accusation, and

proposed monitoring plan, the monitor shall submit a signed statement that the monitor has read

the Decision and Accusation, fully understands the role of a monitor, and agrees or disagrees with

the proposed monitoring plan. If the monitor disagrees with the proposed monitoring plan, the

mo11i~or shnll submit a revised rnoniloring p\m1 with the signed stntcrncnL for approval by the

Board or its designce.

Within 60 calendar days of the effective date of this Decision, and continuing throughout

probation, Respondent's prnGtice shall be monitored by the approved monitor. Respondent shall

make all records available for immediate inspection and copying on the premises by the monitor

at all times during business hours and shall retain the records for the entire term of pm bat ion.

If Respondent fails to obtain approval of a monitor within 60 calendar days of the.

effective date or this Decision, Respondent shall receive a notification from the Board or its

designcc to cease the practice of medicine within three (3) calendar clays after being so notified,

Respondent shnll cease tlic practice of rncrJic!nc un\il a monitor is ::1pproved to provide monitoring

responsibiti ty.

The rnonilor shall submit a quarterly written report to the Board or its dcsignce which

includes an evaluation of Respondent's performance, indicating whether Respondent\ practices

arc within the standards of' practice of medicine, and whether Respondent is practicing medicine

26 safely. It shall be the sole responsibility of Respondent to ensure that the monitor submits the

27 ' quarlerly written reports to the Board or its designee \Ni thin \ 0 calendar days after tbc encl of the

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---------···---· ··--· --~- --- -· Stipulated Settleme1{t a1~dD-i-sciplinary Order (16-201 J-iis4_5_6)-

preceding qumler.

2 If the monitor resigns or is no longer available, Respondent shall, within 5 calendar days

3 of such resignation or unavailability, submit to t:he Board or its designee, for prior approval, the

4 name and qualifcations of a replacement r:lonitor who will be assuming that responsibility within

5 15 calernh1r days. If Respondent fails lo obtain approval of a replacement monitor within 60

6 calendar days of the resignation or unavai !ability of the monitor, Respondent shall receive. a

7 notification from the Board or its dcsignee to cease the practice of medicine within three (3)

8 c~alendar days after being so notified. Respondent shall cease the practice of medicine until a

9 replacement monitor is approved and assumes monitoring responsibility.

10 In lieu of a monitOl', Respondent may participate in a professional enhancement program

11 .equivalent to the one offered by the Physician Assessment and Clinical Education Program at the

12 Un ivcrsity of California, San Diego School of Ivr cdicine, that incl udcs, at rnin irnum, qi:11.rtcrly

13 chart review, semi-annual practice assessment, and semi-annual review of professional growth

14 and cducalion. Respondent shall participate in the professional enhancement program at

15 Respondent's expense during the term of probation.

16 3. Solo Practice Prohibition: Respondent is prohibited frorn engaging in the solo

17 practice of medicine. Prohibited solo prnctice includes, but is not limited to, a practice where: J)

18 Respondent merely shares office space with another physician but is not affiliated for purposes of

19 providing patient care, or 2) Respondent is the sole physician practitioner at that location.

20 JC Respondent fails to establish a practice with another physician or secure cmployrmmt in an

) 1 appropriate practice setting within GO cnknclm days of the effective date of this Decision,

22 Respondent shall receive £\notification from Lhe BoaTd or its designee to cease the practice of

23 medicine within three (3) calendar days after being so notified. Respondent shall not resume

24 practice until an appropriate practic.z; setting is established. lf~ during the course of probation,

25 Respondent's practice :;ettinG changes and Respondent is no longer practicing in a setting in

26 complia:1cc ·with thi;; Decision, Respondent shall notify the Board or its designcc within 5

27 calendar days of the praclice setting change. lf Respondent fails to establish a practice with

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6 I Stipulated Settlement and Disciplinary Order ( 16-2011-215456) ;

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, another physician or secure employment in an appropriate practice setting within 60 calendar

2 days of tbe pract[ce setting change, Respondent shall receive a notification from the Board or its

1 designee to cease the practice of medicine within three (3) calendar days after being so notified.

4 Respondent shall not resume practice until an appropriate practice setting is established.

5 4. Education Course: Within 60 calendar days of the effective date of this

6 Decision, and on an annual basis for the first three (3) years of probation, Respondent shall

7 subrnit to the Board or its designce for its prior approva1 educational program(s) or course(s)

8 which shall not be less than 25 hours per year. The ed'Jcational program(s) or course(s) shall be

9 ' aimed at correcting any meas of deficient practice or lmowledge and shall be Category I eertified.

l 0 The educational program(s) or course(s) shall be at Respondent's expense and shall be in addition

l J to the Continuing Medical Education (CME) requirements for renewal of licensure. Following the

12 completion of each comsc, the Board or its designee may administer an examination to test

1 J Respondent's knowledge of the course. Respondent shall provlde proof of attendance for the

14 coursework taken in satisfaction of this condition.

1.5 ), Notification: Within seven (7) days of the effective date of this Decision,

16 Respondent shall provide a true copy of' this Decision and Accusation to the Chief of Staff or the

17 Chief Executive Officer at every hospital where privileges or membership arc extended to

18 Respondent, at any other facility where Respondent engages in the pract!ce of medicine,

19 incL1ding all physician and locum tenens registries or other similar agencies, and to the Chief

20 Executive Officer at every insurance carrier which extends malpractice insurance coverage to

21 ' Rcspund::.nt. Respondent shnll submit proof of compliance lo the Board or its dcsignec within 15

22 calendar days. This condition shall apply to any cbange(s) in hospitals, olhcr facilities or

23 insurance carrier.

24 6. Supervision of Phvsician Assistants: During probation, Respondent is

25 prohibited from supervising physician assistants.

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7. Obey All Laws: Respondent shall obey all federal, state and local laws,

2 all rules governing the practice of medicine in California and remain in full compliance with any

J court ordered criminal probation, payments, and other orders.

4 8. Quarterly Declarations: Respondent shall submit quarlerly

S dcclaratiorn under penalty of pe1jury on forms provided by the Board, stating whether there has

6 been compliance with all the conditions of probation. H.espondcnt shall submit quarlcrly

7 declarations not later than 10 calendar days after the end of the preceding quarter.

8 9. General Probation Requirements: Respondent shall comply and

9 cooperate with the Board's probation ·"mit and all terms and condit1ons of this Decision.

I 0 Respondent shal 1, at all times, keep the Board informed of Respondent's business and residence

I l addresses, enuiil address (if available), and telephone nurnber. Changes of such addresses slrnll he

12 irnrncdiatcly comn:unicalcd in writing to the Board or its clcsignec. Under no circlllmtances shall

13 a post office box serve as an address of record, except as allowed by Business and Professions

14 Code section 202l(b). Respondent shall not engage in the practice of medicine in Respondent's

15 o:- a patient's p\ace of residence, unless the patient resides in a skillc.d nursing facility or other

16 similar licensed facility. Respondent shall main:ain a current and renewed California physician's

17 and surgeon's license. Respondent shall immediately inform the Board or its dcsignee, in writing,

l 8 of travel to any areas outside the jurisdiction of Californja which lasts, or is contemplated to last,

l 9 more than thirty (30) calendar days. In the event Respondent should leave the State of California

20 to reside or to practice Respondent shall notify the Board or its clesignee in writing 30 calendar

21 days prior to the elates of dcpnrture and r(,;turn.

22 10. Intcrvic·w with the Board or its Dcsigncc: Respondent shall be

23 available in person upon request for interviews either at Respondent's place of business o; at the

24 probation unit office, with or without prior notice throughout the term of probation.

25 11. Non-JJractice While on rrobation: Respondent shall notify the Board

26 or its designcc in writing within 1 S calendar days of any periods of non·practice lasting more

27 than 30 calendar days and within 15 calendar days of Respondent's return to practice. Non-

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----------- . ----------__________ ,, _____ -.. ----------·-- Stipul~ted S;Wemcnt and Disciplinary Order ( 16-2011-215456)

practice is defined as any period of' time Respondent is not practicing medicine in California as

2 defined in Dusiness and Professions Code sections 2051 and 2052 for at least 40 hours in a

3 calendar month in direct patient care, clinical activity or leaching, or otl1er activity as approved by

4 the Board. All lime spent in an intensive training program which has been approved by the Board

5 or its designee shall not be considered non-practice. Practicing medicine in another state of' the

6 United States or Federal jurisdiction while on probation with the medical licensing authority of

7 :hat state or jurisdiction shall not be considered non-practice. A Board~ordered suspension of

8 practice shall not he considered as a period of non-practice. In the event Respondent's period of

9 non-practice while on probation exceeds 18 calendar months, Respondent shall successfully

10 complete a cllnical training program that meets the criteria of the clinical training program

l l described in the version of the Board's "Manual of Model Disciplinary Orders and Disciplinary

l?. Ouiclclines" that is in effect at the time, prior to resuming the practice of medicine. Respondent's

13 period of non-practice while on probation shall not exceed two (2) years. Periods of non-practice

14 \Vil! not apply to the reduction of the probationary term. Periods of non-practice will relieve

15 respondent of the responsibility to comply with the probationary terms and conditions with the

16 exception of this condition and Lhe following tenTlS and conditions of probation: Obey All Laws;

17 and General Probation Reql1irGrnents.

18 12. Completion of Prolrnti<m: Respondent shall comply with all financial

19 obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the

20 completion of probation. Upon successful completion of probation, Respondent's certificate shall

21 be fully restored.

22 13. Violation of Probation: Failure to fully comply with any term or

23 condition of pro balion is a viola ti on of probation. 1f Respondent violates probation in any respect,

24 the Board, after giving Respondent notice and the opportunity to be heard, may revoke probation

25 and cHrry out tbe disciplinary order that wa.s stayed. If an Accusation, Petition to Revoke

26 Probation, or an Interim Suspension Order is filed against Respondent during probation, the

2 7 Board shal 1 have continuing jurisdiction until the matter is final, and the period of probation shall ' I

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be extended until the mf:lttcr is final.

2 14. License Surrender: Follow1ng the effective date ol'this Decision, if

3 Respondent ceases prnctictng clue to n;1Jrcrnent or herihh reasons or is otherwise unable to satisfy

4 the terms nnd conditions of probation, Respondent may request to surrender his license. The

5 Board reserves the right to evaluate Respondent's request and tn exercise its discretion in

6 clelcrmin\ng whether or not to grant the request, or to take any other. action deemed appropriate

7 zmd rcnsonnbk under the circumstnnces. Upon formal ncceptnncc of the .surrender, Respondent

8 shall within J 5 culcndm clc1ys deliver his wallet and \Vall ccrtllkate to the Bonrcl or its designee

9 and Respondent shall no .longer pnicticc medidnc. Respondent will no longer be subject to the

10 terms and conditions of probation. If Respondent re-applies for a medical license, the appl.ication

.11 shaJ l be treated as :1 petition for reinstatement of a revoked certificate.

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15. Erobn.tion !Vfonitol'ing CQ.§.!fil Respondent shall Pf\Y the costs

asso0iated with probation monitoring each and every year of probation. as designated by the

Board, which nre currently set at $'.1,999,00, hut rrrny be adjusted on a.n annual basis. Such costs

shall be payable to the Medical Board of California and delivered to the Hoard or its dc::;ignee no

later than January 31 of each calendar year.

ACCEPTANCE

l have cmcfolly read the Stipulnled Settlement and Disciplinary Order. l undcrstand tht.:

Stipulation and the effect it will hnvo on my Physician's and Surgeon's Certificate. I enter into

this Stipulated Settlement and Disciplinary Order voluntarily, knowingly, and ~ntclligcntly, and

agree to be bmrncl by the Dec:ision and Ord tr of the MedlcBl Board of Cnliforn~a.

DATED: ~ j <;•' ) '2 '0 \ -i. ("-! ' I c ....................... L ... ____ Efuil1<~1Ji1P%t;-~i6

Respondem

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APPROVAL

I have read and fully discussed with Respondent, Erick Hjorstvang, M.D. the termR and

conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order. 1

I approve its form and c.ontent.

DATED: _j=-f-(~ ~

__ Z-~------....... KEiNNETH L. FREEMAN Law Offices of Kem1eth L. Freeman

Attorney.for Re;.,pondent

ENDORSEMENT

T'.1e foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully

S\~bmittcd for consideration by the \1eclirnl Board of California.

Dated: >j J \L-\ \7j ----·~·~ ---- ------~- ----- K;\M/\LA D. E-lARR[S

Attorney General of California \~ " ,·

.-~·~~ ( ~··~ ( 1 JAN Z/1tK S MON ~tty A't o ncy Gcnernl

Attorneys.for Complainant

~--------11 ______ ~-----··-·· ·-1 Stipulated Settlement and Disciplinary Order ( l 6-20 l l -215456) j

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K1\MA:.,A 0. HARRIS Attorney General of California .Josi·: R. Gu1m1i.ERO Supervising Deputy Attorney General JAN!::'. ZACI<. SIMON Deputy Attorney General [SBN 1165641

455 (}olden Gate A venue, Suite 1J000 San Francisco, CA 94 l 02-7004 Telephone: (415) 703-5544 Fax: ( 415) 703-5480 E-mni l: J_~nez,~1ck. si tT1011(g}_doj.cc1. goy_

A/torneysj(H' Complainant Medical Board ofCal(f'ornia

FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA SAC~_JSN1To.J111 ~ I s L20 L3 HY:....;.LY:ff-h.~ ANALYST

REFOiillTHE MEDICAL BOARD OF CALIFORNIA


ln the Matter of the Accusation Age.inst:

ERICK l-UORTSV ANG, M.D. KAISER FOUNDATION HOSPITAL

99 MONTICELJ) RO/\D

SAN RMM'.L, CA 94903

PHYSICIAN'S AND SURGEON'S CERTIFICATE

No. A 79589

Complainant alleges:

Case No. 12-2011-215456

J\CCllSATION

1. Lindn K. Whitney (Complainant) brings this Accusation solely in her official

capacity as the Executive Director of the Medical Board of California, Department of Consumer

Affairs.

On Ju:1e 26, 2002, the Medical Board of California issued Physician's and

Surgcor1·s Certificate Number A 79589 to Erick Hjortsvang, M.D. (Respondent). Said c;erliftcate

is renewed and current, with an expiration date of June 30, 2014.

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--------- ____ I 1\cc~1sation Case No. \2-20! t-'.2154561

JURISDJCTJON

2 3. This Accusation is brought before the Medical Board of California 1 (Board),

! Deparlrnent of Consumer Affairs, under the authority of the following laws. All section 3

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refere:1ces are to the Business and Professions Code unless otherwise indicated.

A. Section 2227 of the Code provides that a licensee who is founc~

guilty under the Medical Practice Act may have his or her license revoked or

suspended for a period not to exceed one year; or the licensee may be placed on

probation und may be required to pay the costs of probation monitoring or may

have such other action taken in relation to discipline as the Division deems proper.

B. Section 2234 of the Code provides that the Medical Board shall

take acdon 8.gainst any licensee who is charged with unprofessional conduct.

Unprofessional conduct inclndes, b~1t is not limited to:

(a) Violating or attcmpUng to violate, directly or indirectly,

assisting ir: or abetting the violation of, or conspiring to violate, any

provision of this chapter [Chapter 5, the Medical Practice Act]

(b)

(c)

(d)

Gross negligence

Repeated negligent acts

Incompetence

FIRST CAUSE FOR DISCIPLINE

Pnticnt B.W.

Respondent is subject lo disciplinary action under scnions

sections 2234(b) [gross negligence], and/or [negligence] ancl/o;' 2234(d) [incompetence] of the

Code based on his care and treatment of Patient B.W.2.

5, Palicnt B.W. was~ 9 years old when she sought medical treatment for

----·------26 1 The terms "Board" and "Division of Medical Quality'' mean the Medi ca\ Board of

California. 27 2 The patient is identified by initial to protect privacy.

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leg pain. Within weeks, she was diagnosed with a high grade osteosarcoma of' the tibia in her left

leg. She was referred to Respondent, a medical oncologist al Kaiser Permanante in San Rafael,

California.

6. Respondent first saw B.W. on May 6, 2010. Respondent has explained

that while B. W. was an adult, her cuncer was cousidered pediatric. There was no pediatric

' oncologist on the 1:1eclical staff at the Kaiser Santa Rosa facility, and Respondent undertook to 6

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treat B.W. Respondent's chart note for the May 6 visit indicates that he discussed the case with

an oncologic surgeon, as well as a ;1ccliatric oncologist from a different Kaiser facility. In

consultation \Vith the pediatric oncologist, a treatment protocol (Prntocol) d.eveloped by the

Children's Oncology Group was selected. The Protocol was sent to Respondent by the pediatric

oncologist.

7. Respondent was unfamiliar with the cmnplcx trea:mcnt Protocol used in

this case. The Protocol consisted of the use of sevcrnl different chemotherapeutic agents, followed

hy surgery, with sti l1 more chemotherapy after the surgery. One of the chemotherapy agents used

in the Protocol was Mcthotrexatc, administered at a high dose. Methotrcxatc is a cancer drug

whicl1 essentially kills cells by inhibiting the synthesis of DNA and RNA. Methotrexate is known

to kill some of the patient's normal cells and lissues, including bone ma.now and gastrointestinal

mucosa, particularly when aun:inistcred at high doses. Toe toxic side effects of Mcthotrexale can

be reversed by administering Leucovorin, which serves as an antidote to Methotrexate toxicity.

This process is known <lS ''Leucovorin Rescue." The Protocol utilized for B .W.'s cancer treatment

contained explicit instructions nnd do~ne;c information for cnreful rind precise monitoring of

Mcthotrcxate levels, as well as the appropriate timing and dosages for Leucovorin Rescue

therapy. Jn particular, the Protocol required the continuation of Lcucovorin until the patient's

Methotrexate level has been reduced to a specific level, and it set forth the appropriate dose of

Leucovorin to be used in response to Methotrexate levels at specific points in the treatment.

8. · B.W. began her cbemothernpy treatment in May, 2010. Between June and '

Septcm ber 2010, B. W. received inpa:ien1 Mcthotrexate/Lcucovorir1 therapy on four separate

occasions. Over the course of the Methot:·exale lre<:~trnent, Respondent p;·err.aturely discontinued

~--- -----·------------------------------·---Accusation Case Ne. l?.-2011-2!5456

Lcucovorin Rescue, and discharged B.W. from the hospital with Methotrexate levels exceeding

2 that dictated by the Protocol. In July, a chemotherapy dose was cancelled after B.W, developed

3 mouth sores, ci rash, and difficulty swallovving. On July 26, 2010, B.W. underwent surgery for

4 tumor removal and knee replacement. On September 6, 20 l 0, she was admitted for resumption of

5 Methotrexate/Lcucovorin treatment. Her Methotrexate levels during her hospital slay were qui le

6 high; however, Respondent failed to adjust the dose of Leukovorin in accordance with the

7 Protocol. On September l 0, 2010, Respondent ordered Leucovorin dlscontinued, and B.W. was

8 clischa:·ged with a Mcthotrcxate level in excess of that allowed by the Protocol, a fever and low

9 white blood count.

10 9. On September 12, B.W. presented to the emergency room with a :-;evere

1: skin rash rJ1d blistering, fever, a critically low wl1ite blood count and diarrhea. She was admitted

12 to the lnlensive Cl:lrc Unll. Over the c,uursc or several weeks, B,W. was aggressively treated by

13 Respondent and a number of other physicians. Her condition continued to deteriorate and she died

14 onOctoberJ,2010.

l 5 10. Respondent com;:nitted the following acts or omissio:-is in his care and

lG treatrnenl of Patient B.W.:

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/\, Respondent treated B.W. using a complex Protocol which was unfamiliar

to him, without taking the steps necessary to learn and understand the details of the

Protocol, and/or without obtaining sufficient consultation or oversight of his

tre£\tment plnn.

B. Respondent foiled to adhere to '.he Protocol, and in particular, failed lo

adequately monitor and responc! to h\gh levels of Melhotrexate and lo treat his

patient with appropriate and sufficient Leucovo1'ln Rescue therapy.

C, Respondent lacked adequate knowledge, skill or ability regarding

Melhotrexatc, its pharmacology and clinical use, and in particular, its use in high

closes.

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D. Respondent failed to recognize, appreciate or respond to symptoms of

Methotrexale toxicity when B.W, presented with symptoms in July, 201 Cl, and

when she was hospiLalizccl on September 12, 20 l 0.

PRAYER

WHEREFORE, Complainant requests that a hearing be held on the matters herein

alleged, and th2,1 following the hearing, the Board issue a decision:

l. Revoking or suspending Physicinn's and Surgeon's Certificate Number

8 /\79589 is.sued to Erick Hjortsvang, M.D.;

9 " L, Ordering Respondent Lo pay probation costs in the event that he is placed

1 0 on probatlon;

11 3. Revoklng, suspendhg, or clcr~ying approval of Respondent's authority to

12 supervise physician assistants; and

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4. Taking such other and further action as deemed necessary and proper.

Dated: !\' J s 2013 :18 y .. ' -

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before the medical board of california department of ...4patientsafety.org/documents/hjortsvang,...

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