Grafilo v. Cohanshohet

243 Cal. Rptr. 3d 807, 32 Cal. App. 5th 428
CourtCalifornia Court of Appeal, 5th District
DecidedJanuary 22, 2019
DocketB285193
StatusPublished
Cited by9 cases

This text of 243 Cal. Rptr. 3d 807 (Grafilo v. Cohanshohet) is published on Counsel Stack Legal Research, covering California Court of Appeal, 5th District primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Grafilo v. Cohanshohet, 243 Cal. Rptr. 3d 807, 32 Cal. App. 5th 428 (Cal. Ct. App. 2019).

Opinion

BIGELOW, P. J.

*430Dr. 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 *431to 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 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 *809tecum 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 *432partnership 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 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 (20 mg) 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, 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 *810combination 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 *433regular 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.

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 ).

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Bluebook (online)
243 Cal. Rptr. 3d 807, 32 Cal. App. 5th 428, Counsel Stack Legal Research, https://law.counselstack.com/opinion/grafilo-v-cohanshohet-calctapp5d-2019.