2 California doctors accused of gross negligence for excessive opiate prescriptions

The Medical Board of California has recommended that two Pasadena doctors have their licenses revoked or suspended after determining the pair negligently prescribed painkillers and other dangerous drugs to patients and failed to maintain proper medical records.

Dr. Robert D. Siew and Dr. Elisa Cuellar Alvarado both practice internal medicine at  Huntington Hospital — Siew since 1995 and Alvarado since 2008, according to the hospital’s website. The two also are affiliated with The Californian skilled nursing facility, which changed ownership in April and has since become the target of a state Department of Health and Human Services investigation surrounding complaints of negligence involving three patients.

“We are aware that a complaint was made to (Department of Health and Human Services), and we are fully cooperating with them,” said Brandon Bales, administrator of The Californian, in an email. He said Siew has served as medical director at The Californian for more than a decade and Alvarado joined the facility’s Quality Assurance Committee in April.

Bales, however, did not respond to a request for comment regarding the findings on both Siew and Alvarado from the Medical Board investigations.

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The Medical Board issued its nine-page petition to revoke or suspend Alvarado’s medical license on April 4; a 19-page petition on Siew was issued on Jan. 25. A hearing for Siew has been scheduled before a panel of judges with the state Office of Administrative Hearings later this year, but no hearing has yet been scheduled for Alvarado, Medical Board spokesperson Alexandria Schembra said in an email.

Meanwhile, Siew and Alvarado continue to practice medicine. Neither responded to requests for comment.

In an email, Huntington Health spokesperson Dorey Huston said Siew and Alvarado are private, independent physicians in the Pasadena area who are on Huntington Hospital’s medical staff. She could not say whether any of the patients noted in the Medical Board investigations were patients at Huntington Hospital, an affiliate of Cedars-Sinai.

“Due to privacy laws, we are unable to comment about matters before the California Medical Board other than to say that we respect the board’s process,” Huston said.

Siew allegations

In its petition, the Medical Board accuses Siew of gross negligence, repeated negligent acts, excessive prescribing of dangerous drugs, failure to maintain adequate and accurate medical records and failure to consult with a state database to review patients’ controlled substance history before prescribing them controlled substances.

The alleged negligent acts involved six patients Siew treated from 2013 through 2022.

In one case, Siew admitted prescribing the use of Percocet six times a day, for more than a year, to an 86-year-old patient for chronic knee pain, back pain and other ailments. He never contacted the patient’s prior physician, and only took the word of his patient and his son, according to the petition.

Siew also failed to keep appropriate records on his patient for pain and medication management.

“Despite prescribing controlled substances on a continuous basis to this patient, (Siew) did not have a written opiate contact with the patient, as (Siew) indicated that was ‘not necessary,’ ” according to the petition.

From July 2015 through March 2022, Siew filled out more than 200 prescriptions for a 73-year-old female patient he was treating for various ailments, including breast cancer, chronic pain syndrome, depression and post-traumatic stress disorder.

Siew, according to the Medical Board, prescribed the patient opioids, benzodiazepines and sedatives — fentanyl, Percocet, Ambien and diazepam, among other drugs. But he failed to keep records of his patient’s response to the prescribed medications and how they affected her pain.

“This constituted an extreme departure from the standard of care as it related to the prescribing of controlled substances, including both opioids and benzodiazepines, which can cause dangerous interactions,” according to the Medical Board petition.

Alvarado allegations

The Medical Board accuses Alvarado of gross negligence, repeated negligent acts and failure to maintain adequate and accurate records involving two patients she treated from 2017 through 2021.

One of her patients, a 46-year-old woman treated from 2017 through 2021 for chronic low back pain, progressive degenerative disc disease, inflammatory arthritis and anxiety, was prescribed Vicodin and Xanax.

Alvarado, however, did not properly note the patient’s anxiety and progress on her medical chart, nor did she document other medications that had been tried before prescribing the same patient alprazolam, a benzodiazepine that was prescribed in combination with hydrocodone, or Vicodin, an opiate, according to the Medical Board.

Alvarado admitted to Medical Board representatives she did not have a signed medication management agreement for the patient, even though she had been prescribing the patient opioids for years.

From October 2017 through 2021, Alvarado treated a 71-year-old man for chronic leg pain due to restless leg syndrome. Along with Tylenol with codeine, Alvarado prescribed 50-milligram tablets of the opiate Tramadol, with daily dosages of eight times per day — above the Federal Drug Administration’s recommended daily dose of 300 milligrams a day for patients age 65 or older, according to the Medical Board.

The Medical Board noted that initial therapies for restless leg syndrome should include gabapentinoids, which are anti-convulsant medications used to treat partial seizures, neuropathic pain and restless leg syndrome.

“Severe cases sometimes require the use of a benzodiazepine, but opioids are not generally used in treating restless leg syndrome,” according to the petition.

Alvarado, according to the Medical Board, was also aware her patient had been prescribed Adderall, a stimulant, by his psychiatrist, concluding that, during the course of his treatment, he had been taking an amphetamine, two opioids and two benzodiazepines.

“The combination of these controlled substances increases the potential risk of sedation, addiction and seizures,” according to the petition.

Californian investigation

It was also unclear whether any of the patients cited in the Medical Board investigations were patients at The Californian, which, according to Bales, has served the local community for more than 50 years, providing nursing and rehabilitation care to Pasadena residents.

Investigators with the state Department of Health and Human Services were alerted to the skilled nursing facility for an inspection last month in response to four complaints involving patients falling and not being properly monitored, and failure by nursing staff to respond to patient call lights.

During their May 7 inspection, investigators concluded nursing staff failed to properly respond to one patient’s call light. The patient subsequently told investigators he usually had to wait at least 30 minutes to an hour before staff answered his call, according to a report dated May 31.

State investigators also determined Californian nursing staff failed to ensure patient safety in preventing falls after two patients, both documented fall risks, fell and required treatment at Huntington Hospital.

One of those patients was Weslie Hofland, 87, who was admitted to The Californian on April 22 after suffering a fall at Arcadia Gardens Retirement Hotel, where he resides. Three days later, he suffered a fall at The Californian and was taken to Huntington Hospital, where was treated for an injured right hand and received sutures for a scalp laceration, according to hospital records and the state’s investigation report.

Despite requests by Hofland’s family and his doctor to have floor mats put down and Hofland’s bed lowered to help prevent falls, it was never done, and Hofland suffered another fall on May 4. A nurse found Hofland on the floor near his bed.

“He was on the ground. He had shallow breathing, and he was just staring off,” said Hofland’s primary care doctor, David Dang, in a telephone interview on Friday, June 7. “He did not know where he was. He wasn’t answering questions, just blank stares.”

Hofland was again taken to Huntington Hospital and treated for a golf ball-size hematoma above his right eye, hospital records show.

Samuel Beckerman, the emergency room doctor at Huntington Hospital, subsequently filed a complaint with the state, as did Hofland’s daughter, Natalie Hofland. It triggered the state probe now underway.

Natalie Hofland has since retained a lawyer.