Doctor appointed as medical board supervisor had been disciplined in New York, California
The Medical Board of California broke its own rules and appointed a doctor who had been disciplined by the board to oversee the practice of an obstetrician now accused of negligence in a patient death.
Antidote reviewed records from both the medical board investigation and the criminal investigation into the care that Dr. Andrew Rutland gave a Chinese immigrant who died in his office in October 2009. The records underscore lapses in physician discipline that persisted years after scores of government and media investigations.
Rutland lost his license in 2002 after The Orange County Register documented patient deaths and allegations of negligence. The medical board granted his request to have his license restored in 2007 and appointed a physician to supervise him: Dr. Christopher C. Dotson Jr. (New York License No. 083741, California License No. 19255).
Both Rutland and Dotson were graduates of Howard University, but that wasn't all they had in common.
The Medical Board of California had put Dotson on probation in 2000 after he was charged with gross negligence, incompetence and repeated acts of negligence in the care and treatment of two patients. The state of New York went even further, suspending Dotson's license.
Dotson was among the rarest of the rare, a doctor who had been reported to the medical board by his hospital. Hollywood Presbyterian Hospital in Los Angeles said Dotson had been negligent in the treatment of multiple patients. He lost his privileges to practice there.
One of Dotson's patients died following an abortion in February 1992. The board said that Dotson failed to adequately examine her and should have classified her case as high risk. Because he did not, the board said, the patient ended up bleeding severely from her uterus. Dotson was not prepared to respond. He did not have the right equipment, and he was not able to give her a blood transfusion quickly enough.
This may sound familiar. Rutland also is accused of negligence during an abortion and of failing to adequately examine the patient, Ying Chen. "Key information is missing from the patient's history such as height, weight and last menstrual period," the board wrote. "There is no record of the ultrasound examination."
The board said Rutland "failed to respond in a timely manner in performing appropriate resuscitative measures and obtaining the assistance of emergency personnel." He also failed to give her an oxygen mask and failed to call 911 quickly enough. Rutland has maintained throughout the medical board and criminal cases that he did nothing wrong in the treatment of Chen.
Might the similarities between their cases have made Dotson sympathetic to Rutland's plight?
The similarities don't stop there. Like Rutland, Dotson also has been sued multiple times by patients claiming injury or wrongful death.
In 2005, the week before Dotson's probation was set to expire, a 34-year-old attorney named Oriane Shevin visited Dotson's clinic, Eve Surgical Center in Los Angeles, according to records filed in Los Angeles County Superior Court. She was given RU-486, the two-stage abortion drug, and sent home. Shevin took the first part, mifepristone, orally on June 9, 2005, and inserted the misoprostol into her vagina on June 10. She developed a widespread infection and severe bleeding, dying on June 14 at Encino-Tarzana Regional Medical Center, court records show.
Dotson was sued on behalf of Shevin's two young children, and he, along with another doctor and the surgical center, settled the case on July 12, 2007.
Two months later, Rutland was given his license back, with restrictions, and Dotson, fresh out of probation, was given the job of overseeing Rutland's practice.
The board says Dotson's appointment was a mistake. Antidote asked the board on Thursday how it had picked Dotson and whether his disciplinary history was considered. The board's Public Information Officer Candis Cohen responded with a written statement on Tuesday:
Dr. Rutland submitted Dr. Dotson's name and Medical Board staff erred in approving him because of his disciplinary history. Our criteria does not permit any discipline by our board or cases pending at the Attorney General's Office. Probation staff is auditing all approved practice monitors to confirm that none has any previous discipline. If any are identified, they will immediately be terminated as a practice monitor. Thank you for bringing this matter to our attention.
Perhaps Dotson's history escaped the medical board's attention because his disciplinary record has been all but expunged from the Medical Board's Web site. The site says that he completed probation but does not provide any details about his case. Nor is there any mention of the settlement with Shevin's family. The board is supposed to be alerted by physicians if they pay a settlement above $30,000, and that information is supposed to be posted on the site.
If Dotson's appointment was, indeed, a mistake, it is a mistake with profound consequences. Dotson's opinion was one of only two medical opinions considered when Rutland went before a judge last month. Rutland was trying to make the case that this most recent patient death not prevent him from continuing to practice medicine. Rutland provided Dotson's assessment to Administrative Law Judge James Ahler as evidence that Rutland was performing within the standard of care. Here is the sum total of Dotson's assessment: one single-page letter.
The letter says that Dotson had reviewed 101 medical records for patients seen by Rutland at his offices in Chula Vista and Anaheim and at the Eden Surgical Center in Calabasas. In all cases, Dotson pronounced the files "adequately documented."
He says nothing about sitting in with Rutland on a consultation, watching him perform a procedure or talking with any of his patients. He also does not say anything about the medical records for Chen, the patient who died under Rutland's care. He does say the two of them had a nice chat about her, though.
Dr. Rutland and I discussed at length the tragic death of a patient by the name of Ying Chen who after the injection of a local anesthetic preparatory for the pregnancy termination suffered an anaphylactic reaction. In spite of appropriate resuscitation efforts, she succumbed in the hospital. In my opinion, Dr. Rutland is taking his probation very seriously and doing everything he can to more than meet the requisite requirements.
In the history of law enforcement, there must be a parole officer who had in the past served time for a crime. But the scenario has to be rare. In California, there are more than 100,000 physicians licensed to practice medicine. Would it really be too arduous for the medical board to find one without a disciplinary record to supervise a physician who is being disciplined?
After looking at Dotson's assessment of Rutland and the request from the medical board – the same medical board that had appointed Dotson – that Rutland temporarily be barred from practicing, Ahler, the administrative law judge, decided to allow Rutland to continue seeing patients. Like the medical histories of Dotson and Rutland, the judge's decision has an eerie echo to it.
In April 2002, Administrative Law Judge Ralph B. Dash evaluated a similar "interim suspension order" from the medical board and decided that the board had been investigating Rutland for more than three years and had not bothered to suspend his license. Why the rush?
''When doctors lose their licenses, they lose their livelihood,'' retired Deputy Attorney General M. Gayle Askren told the Orange County Register at the time. ''I think the administrative-law judges take this humanity issue to mind. Some of them will overemphasize this to the exclusion of the protection of the public.''
Dash allowed Rutland to practice in 2002 as long as he had another doctor in the room during surgeries. Rutland went on to deliver a baby, London Spencer Harrell, without another doctor in the room.
The Medical Board said that Harrell was in distress in the womb and should have been delivered by emergency C-section. Instead, Rutland continued to try for a vaginal birth, despite repeated requests for a C-section by the mother and by the delivery nurses. By the time Rutland gave up and performed a C-section, Harrell had suffered brain damage.
The Harrell case also had echoes. In 1999, Rutland had ignored pleas from another patient to have a C-section and instead twisted the neck of baby Jillian Broussard while pulling her out of the birth canal. She died from complications that resulted from a severed spine. Rutland admitted some measure of fault in order to settle that case with the medical board. He also settled his case with the Broussards, among the few plaintiffs to have at least a partial victory against Rutland.
Yet, 10 years later, Rutland continues to practice. He is now being investigated by the medical board for the fourth time.