CAlif: Tenet-Redding Doctors Keep Licenses

[NRSKarenRN, BSN, RN]

Medical Board fails to win the suspension of two heart physicians at a Tenet Healthcare facility.

By David Streitfeld

Times Staff Writer

November 14 2002

http://www.latimes.com/business/printedition/la-fi-tenet14nov14,0,640726.story?coll=la%2Dheadlines%2Dpe%2Dbusiness

Two doctors who are under investigation for allegedly performing unnecessary operations at Tenet Healthcare Corp.'s Redding Medical Center got to keep their licenses Wednesday.

Shasta County Superior Court Judge Monica Marlow ruled that the California Medical Board's evidence against cardiologist Chae Hyun Moon and heart surgeon Fidel Realyvasquez was insufficient to stop them from practicing.

"She sent a message that these kinds of proceedings cannot and should not be based on innuendo, hearsay and double hearsay," said William Warne, Moon's lawyer.

Realyvasquez lawyer Robert H. Zimmerman said the board "fired a dud."

The board had sought temporary restraining orders in the wake of an FBI investigation of the doctors' work, which burst into public view two weeks ago after agents raided Redding Medical and carted away boxes of patient files. The FBI is probing alleged Medicare fraud, but the Medical Board was seeking the suspensions solely on public safety grounds.

"The judge didn't like the evidence we had," said Dave Thornton, the board's chief of enforcement. "But based on the nature of the allegations, and the potential for more operations that are unnecessary and put patients at risk, we felt we had to move quickly."

He added that the board would continue its investigation. "We need to reevaluate what we have and what more we need in order to get some kind of interim restriction or suspension of these licenses."

The investigation has proved to be a big headache for Santa Barbara-based Tenet, which also is having its Medicare billing practices audited by the federal government. Neither the doctors nor Tenet has been charged with any crime.

It is very rare for the Medical Board to seek either a temporary restraining order or an interim suspension order, which is a similar proceeding. Only three restraining orders and 23 suspension orders were granted during the board's last fiscal year.

To make its case, the Medical Board used the 67-page FBI affidavit as well as a declaration by Vincent Yap, chief of cardiology for Kaiser Permanente Medical Group in Richmond.

"It is my strong professional opinion that neither Dr. Moon nor Dr. Realyvasquez can safely practice medicine, and each poses a threat to patients," Yap said, adding that both had committed "acts of dishonesty or corruption."

But Moon's lawyer, Warne, said the affidavit relied on anonymous witnesses. "We can only guess at what these witnesses would say if they had to swear under oath to the 'facts' as they know them." He called Yap's declaration "disingenuous" and "a house of cards" because, except for one patient file that the doctor independently reviewed, he was basing all his conclusions on the affidavit.

The judge's rejection of the affidavit means that it is likely to receive widespread critical examination. Indeed, at least one of the claims in the affidavit appeared to weaken under a minimal amount of scrutiny.

Moon is quoted as bragging to a reluctant heart patient that he had studied at Stanford under Dr. Yak, an inventor of an intravascular ultrasound imaging technique called IVUS. The patient then tells the nurse "that if Moon studied under Yak," he wanted Yak to review his records.

"A short time later," the affidavit continues, "the nurse returned and said that he had telephoned Stanford and that they had never heard of a Dr. Yak."

The patient asked the nurse to seek out Moon for clarification. Moon then changed his statement, telling the nurse that "Yak was not a doctor but instead was a technician." The patient, understandably, "felt as though Moon had just lied to him."

The incident is cited as an example of what the FBI and the Medical Board describe as the doctors' approach to patients. Moon and Realyvasquez "were able to carry out their scheme by lying and/or misleading and in some cases scaring patients," the board wrote in its court petition.

But there is a doctor at Stanford named Paul Yock, and he did invent IVUS. Moon was a pioneer in the use of IVUS, and according to court papers took a continuing legal education course at Stanford in it. Yock didn't return calls for comment.

On Wednesday, neither of the doctors was present in court. Warne said that as of early evening, he hadn't talked to his client. Moon "was busy treating patients," the lawyer said. "We talked to his wife, who was elated."

Zimmerman said Realyvasquez was "obviously relieved." He noted that the reaction to the judge's ruling from the doctors' supporters in the courtroom "was a spontaneous roar of approval, like someone had just scored a touchdown in the local high school football game."

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