Anda di halaman 1dari 19

IN THE MATTER OF TRUMAN F. SOUDAH, Respondent License Number: D18966 M.D.

* * * *

BEFORE THE MARYLAND BOARD OF PHYSICIANS Case Number: 2001-0960

********************************************************************************************
CONSENT ORDER

On March 3, 2004, the Maryland Board of Physicians (the "Board"),1 charged Truman F. Soudah, M.D. (the "Respondent") (O.O.B. 08/22/47), License Number 018966, M.D. (the "Respondent") under the Maryland Medical Practice Act (the "Act"), Md. Health Occ. Code Ann. ("Health Occ.") 14-404(a) (2000).
Specifically, the Board charged the Respondent with the following provisions of

the Act under Health Occ. 14-404(a): (a) Subject to the hearing provisions of 14-405 of this subtitle, the Board, on the affirmative vote of a majority of the quorum,2 may reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the licensee:
(22) Fails to meet appropriate standards as determined by appropriate peer review for the delivery of quality medical and surgical care performed in an outpatient surgical facility, office, hospital, or any other location in this State;

(40)

Fails to keep adequate medical records as determined by appropriate peer review.

Pursuant to Maryland Laws 2003, Chapter 252, effective July 1, 2003, the former Board of
was renamed and reconstituted as the Maryland Board of

Physician Quality Assurance Physicians.


2

Effective July 1,2003, as a result of the legislative repeal and reenactment of Health Occ. 14has been changed to the affirmative vote of a majority of the

404(a), the voting requirement

quorum. See Maryland Laws 2003, Chapter 252.

FINDINGS OF FACT

I.

BACKGROUND

The Board finds the following: 1. At all times relevant to these charges, the Respondent was and is a physician licensed to practice medicine in the State of Maryland. He was initially licensed in Maryland on or about January 30, 1976, and his license is presently active. 2. At the time of the acts described herein, the Respondent was a physician engaged in the practice of obstetrics and gynecology at 9101 Franklin Square Drive, Suite 320, Baltimore, 21237. 3. On or about May 8,2001, the Board opened an investigation based on its receipt of a claim filed in the Health Claims Arbitration Office ("HCAO") by a pregnant patient who suffered a burn on her thigh secondary to spilled bichloracetic acid used by the Respondent to treat her abnormal Pap smear. 4. As part of its investigation, the Board requested that the Maryland State Medical Society ("MedChi") carry out a practice review focusing smears. on the Respondent's management MedChi assigned two of abnormal Pap obstetricianMaryland,

board-certified

gynecologists review.

(hereinafter the "peer reviewers") to perform the

Of the seven patients reviewed, the peer reviewers

concurred that the Respondent failed with regard to six patients to

keep adequate medical records. The reviewers also concurred that


the Respondent failed to meet appropriate standards for the

delivery patient. 5.

of quality medical

and surgical

care with regard to one

Based on its investigation,

the Board charged the Respondent and (40).

with

violating Health Occ. 14-404(a)(22) II. PATIENT RELATED PATIENT 1 FINDINGS OF FACT

6.

Patient 1 was a 29 year-old female patient on December 3, 1998, when she began seeing the Respondent for obstetrical care. She was 14 weeks pregnant.

7.

On December 21, 1998, the Respondent performed a Pap smear on Patient 1. The cytopathology results were reported as: lowgrade squamous intraepitheliallesion ("LGSIL") and the diagnosis

was mild dysplasia (CIN 1)3, HPV4-cell changes suggestive of


condyloma. for this The Respondent date. He wrote failed to document on the a progress report, note "for

cytopathology

colposcopy".

8.

Patient

1's

records

contained

an

undated

form

entitled,

"Colposcopic

Examination".

The Respondent indicated in his

response to the Board that he had performed the colposcopy on

CIN is an abbreviation for Cervicallntraepithelial Neoplasia. HPV is an abbreviation for Human Papilloma Virus.

January 13, 1999, but he failed to include this date in Patient 1's records.

9.

The Respondent failed to document whether he had taken any cervical biopsies, and if so, how many.

10.

The Respondent failed to document whether he visualized any cervical abnormalities colposcopically, other than "HPV".

11.

The Respondent failed to document whether he had done an


endocervical curettage ("EGG").

12. 13.

There was no biopsy report included in Patient 1's medical record. The Respondent failed to document his findings or a treatment plan for Patient 1.

14.

On an undated colposcopy follow-up documented that:

sheet, the Respondent

Patient had inadvertent touch of BGAcetic acid which caused burn medial side of Rt. Thigh ---Silvadene applied. Rx medical follow up. 15. 16. The Respondent failed to document any further patient follow-up.5 With regard to Patient 1, the Respondent failed to keep adequate medical records in violation of Health Occ. 14-404(a)(40) for reasons including in whole or in part, but not limited to: a. The Respondent's failure to include a date on the Golposcopic examination form; b. The Respondent's failure to document whether he took any cervical biopsies and if so, how many;
5

In a deposition regardinga civil claim regardingthis incident brought by Patient 1, the

Respondent indicated that he saw Patient 1 for a follow-up visit on January 18, 1999; there is no corresponding progress note in Patient 1's medical record.

c. The Respondent's failure to document any cervical abnormalities visualized colposcopically; d. The Respondent's failure to document whether he had done an endocervical curettage; e. The Respondent's failure to document his findings in a treatment plan for Patient 1; and f. The Respondent's failure to document any follow-up visits with Patient 1.
PATIENT 2

17.

Patient 2 was a 48 year-old female patient when she initially saw the Respondent for gynecologic care on July 31, 2001. The

Respondent performed a pelvic examination and a Pap smear. The pelvic examination revealed an enlarged uterus with possible fibroids. The Respondent ordered a pelvic, transvaginal and

abdominal ultrasound. 18. The results of the Pap smear were: Atypical squamous and endocervical cells of undetermined significance ("ASCUS"). A highgrade intraepithelial lesion ("HGSIL") cannot be excluded. ultrasound showed no definite abnormality. 19. The Respondent documented that a colposcopy was performed; the progress note however, was undated, although the specimen submission to the laboratory was dated as to when the biopsies were done. The colposcopy drawing was non-specific in that it only documented biopsy situs and potential abnormality along with the transformation zone. The documentation showed visualization of The

the entire transformation zone, however, there was no textual representations that the entire transformation zone was visualized.

20.

The Respondent two samples

documented

"CX6biopsy" showing graphically identified,

that

were taken and their location

but failed to

textually recite that two samples had been taken.

21.

The

Respondent

documented,

"?cx

dysplasia",

but

failed

to

document

any specific abnormalities

he had seen colposcopically.

22.

Patient 2's pathology report dated September 26, 2001 indicated the results of a cervical biopsy to be: exocervical mucosa with hyperkeratosis metaplasia and and endocervical mild mucosa koilocytotic with squamous The

associated

change.

Respondent wrote on the pathology report: "Repeat PAP next month". 23. The Respondent visualized no abnormalities in or near the

transformation zone, other than that indicated as U?GX dysplasia". In taking the biopsy of the suspected dysplasia, the Respondent included in the biopsy sample portions of the endocervical surface. The Respondent did not perform a separate additional samples of the endocervical surface. 24. The Respondent failed to keep adequate medical records in violation of Health Gee. 14-404(a)(40) for reasons including in whole or in part, but not limited to: a. The Respondent's failure to date the colposcopic examination form; b. The Respondent's failure to document whether he visualized Patient 2's cervical transformation zone;
6

EGG to obtain

Cx is an abbreviation for cervix.

c. The Respondent's failure to document the number of cervical biopsies taken; and/or d. The Respondent's failure to document any abnormalities he had visualized colposcopically.
PATIENT 3

25.

Patient 3 was a 21 year-old female patient when she began seeing the Respondent for gynecologic care on April 5, 2000. She had a history of a suction Dilatation and Curettage in August 1998. The Respondent documented that Patient 3 had an endometrial biopsy that was benign; he failed to include a date. The Respondent also noted that Patient 3 had a colposcopy that showed a history of HPV in "October". There was no year written.

26.

On April 26, 2000,7 the Respondent documented that Patient 3 had a "low grade" pap smear with "herpes" (the laboratory report indicated LGSIL and cellular changes consistent with herpes) and prescribed ValtrexB 500 mg. twice daily. The recommendation on the laboratory report was colposcopy and/or a repeat smear. The Respondent did not document a physical examination or treatment plan, other than "for colpos".

27.

On May 1, 2000, the Respondent documented "for colpos",9 and


prescribed Flagyl10 for "trich".11 Again, the Respondent failed to

7 8

The laboratory report indicated that the specimen was received on April 12, 2000. Valtrex is an antiviral drug used in the treatment of herpes. 9 Colpos is an abbreviation for Colposcopy. 10 Flagyl is an antibiotic. 11 Trich is an abbreviation for Trichomonas, a sexually transmitted parasitic infection.

document any physical examination findings or a treatment plan for Patient 3.


28.

On May 19, 2000, the Respondent performed a colposcopy and according to the pathology report, submitted three cervical biopsies
to the laboratory. The Respondent documented: "RIO HPV" and

checked off that he had visualized the transformation zone. The Respondent failed to clearly identify the biopsy sites on the diagram. The diagnosis from the laboratory was low-grade

squamous intraepithelial lesion (CIN I and associated koilocytic atypia consistent with HPV infection). The Respondent

documented on the laboratory report "LLETZ12 IV Sedation Week of 1ih 1:30 pm June".
29.

The Respondent performed a LLETZ on Patient 3 on June 12, 2000; the cone biopsy results showed that she had a HGSIL (CIN II-III) with negative margins, extensive HPV infection, acute and chronic cervicitis (mild to moderate) and Nabothian cysts.

30.

The Respondent performed a Pap smear on December 5, 2000 that was normal.

31.

The Respondent failed to keep adequate medical records for Patient 3 in violation of Health Occ. 14-404(a)(40) for reasons including in whole or in part, but not limited to: a. The Respondent's failure to adequately record dates significant to Patient 3's gynecologic history;

12

Large Loop Excision

of Transformation

Zone (type of Cervical

Cone Biopsy)

b. The Respondent's failure to adequately document physical examination and treatment plans on April 26 and May 1, 2000; and c. The Respondent's failure to adequately document Patient 3's Colposcopic examination on May 19, 2000.
PATIENT 4

32.

Patient 4 was a 22 year-old female patient when she began seeing the Respondent for prenatal care in April 2001. She had relocated from Texas and was six months pregnant. The Respondent

documented that her delivery of a male infant was "uneventful" on June 6, 2001. 33. The Respondent saw the patient post-partum on June 12, 2001 and failed to document any findings on physical examination. had laboratory (blood) studies drawn. 34. Patient 4 returned for a follow-up visit on July 31, 2001. Respondent performed a Pap smear. The Patient 4

The results were atypical The

squamous cells of undetermined significance ("ASCUS").


report further stated, "A high grade lesion cannot

be excluded".

The pathologist recommended colposcopy with tissue studies. The Respondent documented on the laboratory report, "for colposcopy". HPV typing was done and the results showed: "HPV DNA INTHIGH RISK DETECTED". progression ("HGSIL") to The results stated that the risk of Squamous is present. Intraepithelial The Lesion

High Grade cancer

or cervical

Respondent

documented on the laboratory report "for colposcopy".

35.

Ten months later, on May 1, 2002, the Respondent performed a repeat Pap smear and colposcopy on Patient 4.
document whether Patient 4's transformation

He failed to

zone was visualized he had

at 3600, how many cervical biopsies done an EGG. 36.

he took and whether

The Respondent failed to keep adequate medical records in violation of Health Gcc. 14-404(a)(40) for reasons including in whole or in part, but not limited to: a. The Respondent's failure to document any physical examination findings during Patient 4's initial post-partum visit on 6/12/01 ; b. The Respondent's failure to adequately document Patient 4's Golposcopic examination as outlined above; and c. The Respondent's failure to adequately document the reason for the 1O-month delay in performing Patient 4's colposcopy after receiving the results of her abnormal pap smear.

PATIENT 5

37.

Patient 5 was an 18 year-old patient when she saw the Respondent


for a gynecologic examination on July 25, 2001.13 Patient 5

complained of vaginal itching for one week.

The Respondent

performed a vaginal culture and a pap smear. He prescribed Flagyl for her. 38. The cytopathology report for Patient 5's July 25, 2001 pap smear indicated that, "satisfactory for evaluation but limited by lack of

13

Prior to this, it appears from her records that Patient 5 had seen another physician in the
practice for her gynecologic care.

Respondent's

10

pertinent clinical patient information". The results were an epithelial cell abnormality with rare atypical squamous cells of undetermined significance ("ASCUS") and the report further stated that a lowgrade squamous intraepithelial lesion ("LGSIL") cannot be

excluded. 39.

The Respondent also ordered HPV testing and the results showed that Patient 5 was at high or intermediate risk for one or more of several subtypes listed. The report further stated: Based on the current medical literature, the risk of progression to HSIL or cervical cancer is present. Consider follow-up with colposcopy and/or biopsy as clinically indicated.

40.

The

Respondent

documented

on

the

cytopathology

report,"Colposcopy in 2 weeks". He also documented, "will repeat in2w...". 41. On August 8,14the Respondent indicated that Patient 5's chlamydia culture was positive. He prescribed Zithromax and advised her to
be recultured examination 42. in two weeks. He failed to document findings. that he repeated a colposcopic

or any physical examination 25,15 the Respondent

On September

documented

the chlamydia culture. He again failed to document any follow-up regarding the colposcopy or any physical examination findings. He

14

The Respondent did not include a year, but based on the location of the notes in the chart, it The Respondent did not include a year, but based on the location of the notes in the chart, it

appeared to be 2001.
1

appeared to be 2001.

11

documented that "pt is under care of Dr. Y. per her mother". There is no indication in Dr. V's records that he saw Patient 5 for her
abnormal pap smear on July 25, 2001

or that he performed a

colposcopy.
43.

The Respondent failed to keep adequate

medical records in

violation of Health ace. 14-404(a)(40) for reasons including in whole or in part, but not limited to: a. The Respondent's failure to document any follow-up after Patient 5's abnormal pap smear including but not limited to a colposcopic examination; and b. The Respondent's failure to document any physical examination findings on August 8 or September 25, 2001.
PATIENT 6

44.

Patient 6 was a 22 year-old female when she began seeing the Respondent for Obstetrical care in 1995. Patient 6 had normal Pap smear results. In 1995 through 1997,

45.

On February 26, 1999, Patient 6's pap smear was reported as, "atypical squamous cells of undetermined significance ("ASCUS"), probably high grade squamous intraepithelial lesion ("HGSIL")". The pathologist's recommendation was to perform a colposcopy with tissue studies. The Respondent failed to document any office visit notes documenting a treatment plan.

46.

On March 26, 1999, the Respondent performed a colposcopic examination with biopsies. His colposcopic diagnosis was "mild to

12

mod[erate] dys[plasia] HPV mild", He failed to document whether he visualized the transformation zone, any colposcopic findings (such as cervical changes), whether he performed an endocervical curettage and how many biopsies he obtained. 47. The Respondent did not separately identify the cervical biopsies; they were received by the laboratory labeled as "cervix". pathology koilocytic dysplasia). 48. On April 14,16 the Respondent documented, "bichloracetic acid applied" on the colposcopic examination sheet. 49. With regard to Patient 6's care, the Respondent failed to keep adequate medical records in violation of Health Occ. 14report indicated that the specimen showed The focal

atypia suggestive

of HPV and noted CIN I (mild

404(a)(40) for reasons including in whole or in part, but not limited to: a. The Respondent's failure to document a treatment plan corresponding to Patient 6's February 26, 1999 pap smear; b. The Respondent's failure to document Patient 6's colposcopy as outlined above; and c. The Respondent's failure to document his rationale with regard to the bichloracetic acid treatment and any follow-up.

CONCLUSIONS

OF LAW

Based on the foregoing Findings of Fact, the Board concludes as a matter of law that the Respondent failed to keep adequate medical records as
16

The Respondent failed to document the year of treatment.

13

determined by appropriate
404(a)(40).

peer review, in violation of Health Occ. 14-

ORDER

;2vll day
case:

Based on the foregoing Findings of Fact and Conclusions of Law, it is this /' J
of L) J", ! '7

, 2004, by a quorum of the Board considering this

/
ORDERED that the Respondent's medical license in the State of Maryland be and is hereby REPRIMANDED; and be it further ORDERED that the Respondent shall be placed on PROBATION for a MINIMUM PERIOD OF ONE (1) year from the date the Board executes this Consent Order and shall continue until all of the following terms and conditions
are satisfied:

1.

SUPERVISION

A.

Within sixty (60) days of this Consent Order, the Respondent shall obtain approval from the Board for a gynecologic oncologist to supervise his colposcopic records. prior Board-approval The Respondent shall obtain oncologist supervisor

of the gynecologic

("Supervisor") before entering into any supervisory arrangement. As part of the approval process, the Respondent shall provide the Board with the curriculum requested by the vitae and any other information of the

Board regarding the qualifications

Supervisor submitted for approval;

14

B.

The Supervisor shall have no prior or current business, personal or financial relationship with the Respondent;

C.

The Respondent is responsible for ensuring that the Supervisor notify the Board in writing of his/her acceptance of the supervisory role with the Respondent;

D.

The Respondent shall provide to the Supervisor a copy of the charging document, Consent Order and other documents that the Board deems relevant;

E.

The supervision of the Respondent's colposcopic records shall occur on a monthly basis for a minimum of six (6) months. The

Respondent shall ensure that the Supervisor submit written reports to the Board on a bi-monthly basis. The Respondent shall have the sole responsibility for ensuring that the Supervisor submits the required bi-monthly reports to the Board in a timely manner; F. The Respondent may petition the Board for termination of the supervision of his colposcopic records after three (3) satisfactory reports are submitted to the Board, but in no event may the Respondent petition the Board prior to six (6) months from the date of this Consent Order. The Respondent shall not however, be

permitted to petition the Board for early termination of probation, but only of the supervisory condition as outlined in paragraph (E);

15

2.

EDUCATION

A.

The Respondent shall successfully complete a Board-approved comprehensive course in medical records documentation. Respondent shall submit the course description/syllabus Board prior to enrolling in the course, for approval. The to the

The Board

reserves the right to reject the course submitted for fulfillment of this condition, and may request additional information regarding the course. The Respondent shall successfully complete the course

and submit written verification of successful completion of the course no later than one (1) year from the date the Board executes this Consent Order; B. The Respondent shall successfully complete a Board-approved course in colposcopy. The Respondent shall submit the course

description/syllabus to the Board prior to enrolling in the course.


The Board reserves fulfillment the right to reject the course submitted for

of this condition, and may request additional

information

regarding the course. The Respondent shall successfully complete the course and submit written verification of successful completion of the course no later than one (1) year from the date the Board executes this Consent Order; C. The coursework in paragraphs 2A and 2B shall not count toward the mandatory Continuing Medical Education requirement for

maintenance of medical licensure;

16

3.

The Respondent shall practice according to the Maryland Medical Practice Act and in accordance with all applicable laws; and be it further ORDERED that any violation of the terms and/or conditions of this Order

shall be deemed a violation of probation and/or this Consent Order; and be it fu rther ORDERED that if the Respondent violates any of the terms and conditions of probation and/or this Consent Order, the Board, in its discretion, after notice and an opportunity for an evidentiary hearing before an Administrative Law Judge at the Office of Administrative Hearings if there is a genuine dispute as to the underlying material facts, or an opportunity for a show cause hearing before the Board otherwise, may impose any sanction which the Board may have imposed in this case under 14-404(a) and 14-405.1 of the Medical Practice Act, including a reprimand, probation, suspension, revocation and/or a monetary fine, said violation of probation being proved by a preponderance evidence; and be it further ORDERED that after the conclusion of the entire one (1) year period of PROBATION, the Respondent may file a written petition for termination of his probationary status without further conditions or restrictions, but only if the Respondent has satisfactorily complied with all conditions of this Consent Order, including all terms and conditions of probation, including the expiration of the one (1) year period of probation, and if there are no pending complaints regarding the Respondent before the Board; and be it further of the

17

ORDERED that the Respondent shall not petition the Board for early termination of his probationary period of the terms of this Consent Order; and be it further
ORDERED

that the Respondent shall be responsible for all costs

incurred in fulfilling the terms and conditions of this Consent Order and be it further ORDERED that this Consent Order shall be a PUBLIC DOCUMENT pursuant to Md. State Gov't Code Ann. 10-611 et seq. (1999 Repl. vol.)

-,

?~//cJf

Date

CONSENT

I, Truman F. Soudah, M.D, acknowledge that I have had the opportunity to consult with counsel before signing this document. By this Consent, I admit to

these allegations, and I agree and accept to be bound by the foregoing Consent Order and its conditions and restrictions. I waive any rights I may have had to contest the Findings of Fact and Conclusions of Law. I acknowledge the validity of this Consent Order as if entered into after the conclusion of a formal evidentiary hearing in which I would have had the right to counsel, to confront witnesses, to give testimony, to call witnesses on my own behalf, and to all other substantive and procedural protections as provided by

18

law. I acknowledge the legal authority and the jurisdiction of the Board to initiate these proceedings and to issue and enforce the Consent Order. I also affirm that I am waiving my right to appeal any adverse ruling of the Board that might have followed any such hearing. I sign this Consent Order after having had an opportunity to consult with counsel, without reservation, and I fully understand and comprehend the language, meaning and terms of this Consent Order. I voluntarily sign this Order and understand its meaning and effect.

1Date'

[~\ \)'-1
'

'(Nvt~,-,-~r~P/
Truman F. Soudah, M.D. (;/Z L

STATE OF MARYLAND GffY/COUNTY OF: '77fh/OJl

I HEREBY CERTIFY that on this

J t)'

day of

,,:-1 C L/ t{

, 20~

before me, a Notary Public of the State and County aforesaid/personally appeared Truman F. Soudah, M.D., and gave oath in due form of law that the foregoing Consent Order was his voluntary act and deed.
,,~S WITNESS, my hand and Notary Seal.
~~~~~~U~l';'~q..,

({tit/?

..~ ..' I. ... ";t- <:. ,:j 11 1f.. vo".. <S' ~, ..'" .0 :!: . f:>,. '-1f:>,i.- 0<' ~ r ': :00: 0 4-1r vs.('10 :cn: "
#.,

I"""~'!. x::.. ROB

..,...

IA

'~IJI!II~~

My commission

expires:

'

(7r ' '" YJ . "'.~ .~. "-oos < "~.. '1y '~;" ~ ., "."..' .,,~~.

~S\ :
~

co

("..f'Pfi

'1.14{,

I..~Sfi

0"

:'. :4..

cl"

~<.<::-"'v. u v,':
'

..."
\'"

:: ..
If

LOUNI'{

..\5.) ~'>; ~..'O<;

~.."

t.:

'IJ!'~~$~~@U~~%1!~~~"

Reviewed by:

Date

7(L/6'1
19

Anda mungkin juga menyukai