Complainant Linda J. Bergmann, who as cause for disciplinary action, alleges:
1. Complainant is the Executive Director of the California State Board of Osteopathic Examiners ("Board") and makes and files this accusation solely in her official capacity.
2. On or about August 3, 1977, Osteopathic Physician and Surgeon License No. 20A 4160 was issued by the Board to David Steenblock, D.O. ("respondent"), and at all times relevant herein, said Osteopathic was, and currently is, in full force and effect.
3. This accusation is made in reference to the following statutes of the California Business and Professions Code ("Code"): Section 3600, a provision of the Osteopathic Act,
a. Stats. 1933, c. 399, p. 1298, § 3600, provides that the law governing licentiates of the Board is found in the Osteopathic Act and in Chapter 5 of Division II, §§ 2000 et seq. of the Code, relating to Medicine.
b. Section 3600-2, a provision of the Osteopathic Act, provides that the Board shall enforce those provisions of the Medical Practice Act identified as Articles 12, of Chapter 5 of Division II of the Code, as now existing or hereafter amended, as to persons who hold certificates subject to the jurisdiction of the Board.
c. Section 2227 provides that the Board may revoke, suspend for a period not to exceed one year, or place on probation, the license of any licensee who has been found guilty under the Medical Practice Act.
4. Section 2234 provides the Board shall take action against any licensee for unprofessional conduct which includes but is not limited to the following:
"(b) Gross negligence.
"(c) Repeated negligent acts.
5. On or about September 6, 1988, this thirteen-year-old patient went to respondent's medical office with a complaint of "emotional diarrhea", "all day small meals-slow weight gain", and coated tongue and corner lips cracked". The patient was examined briefly and several tests were ordered.
On or about September 7, 1988, the patient completed a detailed health questionnaire. The health questionnaire stated the patient had three bowel movements per day, had bad breath, had nervous stomach, was sensitive to cold and was abused from birth until she was adopted when she was eight-years-old.
On or about September 12, 1988, the patient made a return visit. On this visit, it was noted that patient's diarrhea was extremely worse, the patient "had to go almost every 10 minutes", and the problem was life-threatening. It was also noted that the patient's father had colitis and that the patient bled around the rectum from irritation.
On or about September 13, 1988, the patient made a return visit. On this visit, it was noted the patient was small and cachectic; that the patient's mouth was totally covered with white plaque of candida, and that the patient had "clubbing of all fingernails". Thereafter, the patient made one additional visit in September 1988, and one visit in October 1988.
The patient was next seen on January 16, 1989, when respondent prescribed Vitaplex, Zinc, GTF, Sialex and Nizoral. On the January 17, 1989 visit, respondent ordered a barium enema. Thereafter the patient made one more visit in January 1989, and two visits in early February 1989.
On or about February 4, 1989, the patient was admitted to Children's Hospital of Orange County and after a number of surgical operations, the patient died on or about June 20, 1989.
6. Respondent David A. Steenblock is guilty of gross negligence in violation of Business and Professions Code section 2234(b) with respect to the care and treatment he rendered to Ariann W. for the following reasons:
a. Respondent failed to recognize advanced illness in an adolescent;
b. Respondent failed to refer patient with an advanced illness to an appropriate specialist;
c. Respondent failed to diagnose the actual cause for the patient's advanced anemia;
d. Respondent failed to treat in a timely fashion a patient with an advanced illness;
e. Respondent.failed to warn a patient of the possible side effects of injectable iron.
7 . Respondent David A. Steenblock is guilty of incompetence in violation of section 2234(d) of the Code with respect to the care and treatment he rendered to patient Ariann W. for the following reasons.
- a. Complainant realleges each and every allegation set forth in paragraph 6 above;
- b. Respondent failed to complete physical examination and to direct the physical examination to appropriate organ system;
- c. Respondent failed to correlate physical findings with patient complaints;
- d. Respondent failed to document physical findings on a patient's chart;
- e. Respondent used unrecognized therapies in the treatment of a patient with an advanced illness.
8. Respondent David A. Steenblock is guilty of repeated negligent acts in violation of section 2234(c) by virtue of each matter set forth in paragraphs 6 and 7 above.
Patient James C.
9. In May of 1986, James C. became a patient of respondent David A. Steenblock. He was seen several times between May and September 1986.
On September 12, 1986, respondent performed a colonoscopy on James C. The colonoscopy extended to the cecum. The only documentation in the chart with respect to the colonoscopy is that it was performed. Respondent made no record as to whether anesthesia was administered, or what the patient's vital signs were during the procedure. There was no documentation as to the type of instrument used or how the patient tolerated the procedure.
The patient record for James C. indicates administration of "IV therapy" on September 25, 29; October 1, 3, 9, 10, 13, 16, 20, 23, and 24, 1986. There is no documentation in the patient's chart as to the purpose of the IV therapy, nor. any diagnosis justifying its use.
The patient record for James C. indicates the administration of cortical extract for a complaint of fatigue. There is no documentation in the patient's chart of any adrenal insufficiency.
10. Respondent David A. Steenblock was guilty of committing repeated acts of negligence in violation of Business and Professions Code section 2234(c), in his treatment of James C. for the following reasons:
- a) Respondent failed to administer anesthesia in connection with a colonoscopy to the cecum, or alternatively failed to keep any record of the administration of such anesthesia;
- b) Respondent failed to document adequately the type of instrument used for colonoscopy, the type of anesthesia, if any, or the vital sings of the patient during the procedure;
- c) Respondent administered IV therapy without documentation as to the purpose of that IV therapy or the diagnosis which justified its use;
- d) Respondent administered adrenal cortical extract when there was no documentation of adrenal insufficiency.
11. Respondent David A. Steenblock is guilty of incompetence in violation of Business and Professions Code section 2234(d) by virtue of each matter set forth in paragraph 9 above.
WHEREFORE, complainant requests that the Board hold a hearing on the matters alleged herein, and that following said hearing, the Board issue a decision:
DATED: August 19, 1993
Linda J. Bergman
Board of Osteopathic Examiners State of California
Linda J. Bergmann, Executive Director of the Board of Osteopathic Examiners of the State of California, by and through her attorney, Daniel E. Lungren, Attorney General of the State of California, by Samuel K. Hammond, Deputy Attorney General, and David Steenblock, D.O. ("respondent"), by and through his attorney William H. Moore, Jr. Esq., hereby stipulate as follows:
1. The Board of Osteopathic Examiners, ("Board") acquired jurisdiction over respondent by reason of the following:
A. Respondent was duly served with a copy of the Amended Accusation, Statement to Respondent, Request for Discovery, Form Notice of Defense and copies of Government Code sections 11507.5, 11507.6 and 11507.7 as required by section 11503 and 11~05, and respondent timely filed a Notice of Defense within the time allowed by section 11506 of the code.
B. Respondent has received and read the Amended Accusation which is presently on file as Case No. 91-1, before the Board. Respondent understands the nature of the charges alleged in the Amended Accusation and that the charges and allegations constitute cause for imposing discipline upon respondent's license to practice osteopathic medicine which was issued by the Board.
2. Respondent and his counsel are aware of each of respondent's rights, including the right to a hearing on the charges and allegations, the right to confront and cross-examine witnesses who would testify against respondent, the right to present evidence in his favor and call witnesses on his behalf, or to testify himself, his right to contest the charges and allegations, and other rights which are accorded to respondent pursuant to the California Administrative Procedure Act (Gov. Code, § 11500 et seq.), including the right to seek reconsideration, review by the superior court, and appellate review.
3. Respondent freely and voluntarily waives each and every one of the rights set forth in paragraph 2.
4. Respondent understands that in signing this stipulation rather than contesting the Amended Accusation, he is enabling the Board of Osteopathic Examiners of the State of California to issue the following order without further process.
5. Admissions made by respondent herein are for purposes of rhis proceeding, for any other disciplinary proceedings by the Board, and for any petition for reinstatement, reduction of penalty, or application for relicensure, and shall have no force or effect in any other case or proceeding. In the event this settlement is not adopted by the Board, the stipulation will not become effective and may not be used for any purpose.
6. Respondent neither admits nor denies the allegations in Amended Accusation No. 91-1, but for the purposes of this stipulation and for no other purpose, respondent agrees he is in violation of sections 2234(b) and 2234(d) of the Code as alleged in Amended Accusation No. 91~1 in that, he failed to adequately document his examinations and treatment in the charts of patients Ariann W. and James C., and that he failed to warn the family of patient Ariann W. about the possible side effects of the iron injectable medication.
7 . Based upon the foregoing, it is stipulated and agreed that the Board may issue the following as its decision In this case.
IT IS HEREBY ORDERED that Osteopathic number 20A 4160 issued to David Steenblock, D.O. is suspended for nine (9) months. However, the suspension is stayed and respondent is placed on probation for five (5) years on the following terms and conditions:
1. Respondent shall complete a course in pharmacology. The course shall be taken at an institution of respondent's choosing subject to the approval of the Board. The course shall be completed within 12 months of the effective date of this decision and order. This course shall be in addition to the Continuing Medical Education requirements for re-licensure. Following the completion of the course, the Board or its designee may administer an examination to test respondent's knowledge of the course.
2. Respondent shall complete 40 hours of courses in medical
charting. The course may be courses offered by the School of
Osteopathy or by a medical school recognized by the Board. The
courses may also be workshops offered by the American Osteopathic
Association or the American Medical Association or their subsidiaries.
The courses shall be completed on or before December 31, 1994.
This courses shall be in addition to the Continuing Medical Education requirements for re-licensure.
3. Respondent shall complete a course in ethics. The course
shall be taken at an institution of respondent's choosing subject
to the approval of the Board.
The course shall be completed within 12 months of the effective date of the this decision and order This course shall be in addition to the Continuing Medical Education requirements for re-licensure.
4. Respondent shall reimburse the Board for its investigation and prosecution costs in the amount of $10,000. Payment of the costs may be made by monthly installments provided the entire $10,000 is paid on or before August 31, 1996.
5. Respondent shall obey all federal, state and local rules governing the practice of medicine in California.
6. Respondent shall submit quarterly declaration under penalty of perjury on forms provided by the Board, stating whether there has been compliance with all the conditions of probation.
7. Respondent shall comply with the Board's probation surveillance program.
8. Respondent shall appear in person for interviews with the Board's medical consultants upon request at various intervals and with reasonable notice. The identity of the consultants shall be mutually agreeable to both the Board and respondent.
9. In the event respondent should leave California to reside or to practice outside the State, respondent must notify the Board in writing of the dates of departure and return. Periods of residency or practice outside California will not apply to the reduction of. this probationary period.
10. If respondent violates probation in any respect, the Board may revoke probation and carry out the disciplinary order that was stayed after giving respondent notice and the opportunity to be heard.
If an Accusation and/or Petition to Revoke Probation is filed against respondent during probation, the Board shall have continuing jurisdiction until the matter is final, and the period of probation shall be extended until the matter is final. Upon successful completion of probation, respondent's certificate will be fully restored.
11. When respondent fully complies with the above terms, the matter of Accusation No. 91-1 shall be deemed finally concluded and closed in its entirety.
I concur in the stipulation and order.
DANIEL E. LUNGREN, Attorney General of the State of California
Samuel K. Hammond Deputy Attorney General
Attorneys for Complainant
William H. Moore, Jr.
Attorney for Respondent
I have carefully read and fully understand the stipulation and order set forth above. I have discussed the terms and conditions set .forth in the stipulation and order with my attorney William H. Moore, Esq. I understand that in signing this stipulation I am waiving my right to a hearing on the charges set forth in the Accusation on file in this matter. I further understand that in signing this stipulation the Board shall enter the foregoing order placing certain requirements, restrictions and limitations on my right to practice osteopathic medicine in the State of California.
DAVID STEENBLOCK, D.O.
The foregoing Stipulation and Order, in No. 91-1, is hereby adopted as the Order of the Osteopathic Medical Board of California. An effective date of March 21, 1994 has been assigned to this Decision and Order.
Made this 21st day of March, 1994.
FOR THE OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
RICHARD T. PITTS, D.O., PRESIDENT