Moheet v. Bd. of Regis. for Healing Arts

• Decision Date: 07 December 2004
• Docket Number: No. WD 63543.,WD 63543.
• Parties: Abdul MOHEET, M.D., Appellant, v. STATE BOARD OF REGISTRATION FOR the HEALING ARTS, Respondent.
• Court: Missouri Court of Appeals

154 S.W.3d 393

Abdul MOHEET, M.D., Appellant, v. STATE BOARD OF REGISTRATION FOR the HEALING ARTS, Respondent.

No. WD 63543.

Missouri Court of Appeals, Western District.

December 7, 2004.

As Modified February 1, 2005.

Motion for Rehearing and/or Transfer to Supreme Court Denied February 1, 2005.

Application for Transfer Denied March 1, 2005.

William L. Davis, St. Louis, MO, for appellant.

Daniel Neal McPherson, Jefferson City, MO, for respondent.

Before JAMES M. SMART, JR., P.J., JOSEPH M. ELLIS, and LISA WHITE HARDWICK, JJ.

JAMES M. SMART, JR., Judge.

Abdul Moheet, M.D., appeals the decision of the Administrative Hearing Commission in which it found cause to discipline his medical license by subjecting it to a public reprimand. We affirm the Commission's decision.

Factual and Procedural Background

Appellant Abdul Moheet, M.D., was licensed by the State Board of Registration for the Healing Arts as a physician and surgeon in 1986. In January 2001, the Board filed a complaint with the Administrative Hearing Commission seeking a determination that Dr. Moheet's physician license was subject to discipline. The complaint arose out of Dr. Moheet's emergency-room treatment of a patient, referred to as "J.D.," in January 1995.

First Emergency Room Visit

On January 20, 1995, J.D., a forty-year-old male suffering from high blood pressure, felt a sudden and severe headache while driving. Soon after he returned home, he asked his son, Jason, to call an ambulance. When the paramedics arrived, they took J.D.'s history, which included hypertension (high blood pressure), and a list of J.D.'s medications, one of which was to treat the hypertension. They noted that J.D.'s chief complaints were a headache and neck spasms. Jason notified his mother, J.D.'s wife, at her work.

Because of J.D.'s neck pain, the paramedics put a cervical collar on him and secured him to a spinal board. They took his blood pressure three times between 3:59 and 4:30 p.m. and gave him nitroglycerine to lower his blood pressure. His blood pressure was high, ranging from 200/120 to 170/130. After delivering J.D. to the emergency room, the paramedics remained there for about fifty minutes. They gave a verbal report to an unidentified nurse. It is unclear what happened to their written report at this point.

The nurse manager of the emergency department, Douglas Bouldin, R.N., was waiting to perform triage on J.D. when he arrived. Bouldin filled in an Emergency Room Record form (the "E.R. form") with J.D.'s vital signs. J.D.'s blood pressure was 170/130 at 4:50 p.m. Bouldin also recorded J.D.'s medications. He wrote on the form, "Cervical neck pain & [headache]." Bouldin passed the E.R. form to the nurse assigned to J.D.'s room, Darlene Brooks.

J.D.'s wife gave Nurse Brooks J.D.'s medical history, which in addition to high blood pressure, included depression, alcoholism, and left arm numbness. She also told the nurse that J.D. had not been taking his blood pressure medicine. Brooks examined and questioned J.D. and wrote her findings on the E.R. form. J.D. told her that while driving, he had a "charlie horse," causing a severe headache. He could not hold his head up without pain and could not turn his head. He also complained of pain and numbness around his left wrist and elbow. Brooks did not take J.D.'s blood pressure.

Dr. Moheet was on duty in the emergency room that day. At 5:05 p.m., Dr. Moheet began examining and taking a history from J.D. He observed that J.D. was lying on a backboard in a cervical collar, holding onto the side rails of the gurney, clenching his teeth, and going into spasms. When asked why he was in the emergency room, J.D. responded that he was having neck pain that radiated into the back part of his head. Dr. Moheet asked J.D. if he had hurt himself, and he said that he fell while sledding in the snow (referring to an incident the previous day when sledding with his children). He complained of numbness in the left arm. Dr. Moheet was hampered in taking J.D.'s medical history because J.D. was unhappy with the questions and repeatedly requested pain medication.

Dr. Moheet checked J.D.'s breathing, pulse, lung sounds, and abdomen. He then did a neurological check, which included checking his ability to feel sensations. J.D. had decreased sensation in the thumb, outer forearm, middle finger, and on the inner side of the left hand. To Dr. Moheet, these sensory changes suggested radiculopathy (nerve impingement due to a cervical disc problem). J.D. was given an injection for pain. Dr. Moheet sent J.D. for x-rays. Although J.D. had informed the nurse of a sudden onset of head pain, Dr. Moheet did not order a CAT scan of the head. J.D.'s reflexes were normal. When it was determined that J.D. did not have a neck fracture, the collar, cushion, and backboard were removed, and he was returned to the emergency room.

At 6:40 p.m., Dr. Moheet again examined J.D. and checked his neurological responses. At this time, J.D., who was sitting up on the gurney, told Dr. Moheet that he was feeling 50% better. Dr. Moheet told J.D. of his diagnosis of a C-6 radiculopathy (pinched sixth nerve) on the left side. He told J.D. that the x-ray was negative and that he was being discharged with a muscle relaxant and an anti-inflammatory painkiller. J.D.'s wife asked whether those medications would cause a problem with J.D.'s blood pressure. Dr. Moheet said they would not. Dr. Moheet did not consider this mention of blood pressure to be a reason to further examine J.D. He testified at the hearing that the primary care physician handles blood pressure maintenance and most cases do not become emergency room situations. At 7:00 p.m., J.D. was given a soft collar for his neck and released to go home.

Dr. Moheet later charted his findings for J.D. based on his notes. Dr. Moheet did not know J.D.'s blood pressure when he treated him and did not review the ambulance records or the E.R. form. Dr. Moheet expected his nurses to inform him of any abnormalities in the patient's vital signs. J.D. did not inform Dr. Moheet that he had high blood pressure nor did he mention that he had stopped taking his medication.

Second Emergency Room Visit

At approximately 6:30 the next morning, J.D.'s wife found J.D. unconscious on the bedroom floor and could not revive him. An ambulance crew responded and took J.D.'s blood pressure four times between 7:16 and 7:50 a.m. The readings were extremely high: 220/120; 200/128; 210/118; and 228/108. The ambulance crew gave J.D. a drug for hypertension and took him to the hospital.

At the hospital, Dr. Michael F. Boland, a neurosurgeon, was informed by emergency room personnel that J.D. had an abnormal CAT scan, was comatose, and needed emergency neuro-surgical treatment. Dr. Boland diagnosed a spontaneous intraventricular hemorrhage in the fourth ventricle of his brain (a hemorrhagic stroke). The blood from the hemorrhage had clotted and blocked the flow of spinal fluid. The excess fluid in his brain built up tremendous pressure, causing him to lapse into a coma. Dr. Boland believed that J.D. had suffered the hemorrhage during the afternoon of January 20, 1995, and that he would have stopped bleeding by the time he arrived at the emergency room that previous day.

Dr. Boland told J.D.'s wife that J.D. needed an emergency procedure to avoid imminent death. His wife authorized the procedure. The procedure was performed in the emergency department due to the urgency. J.D. spent a week in neuro-intensive care, a week in a step-down area, and a week on a rehabilitation floor. At the time of the hearing, J.D. was deceased, having died the previous March. There is no evidence that the cause of his death (an intra-abdominal hemorrhage) was related to the 1995 stroke.

Hemorrhagic Stroke

According to Dr. Boland, intraventricular hemorrhages of the brain are relatively rare, and most symptoms are not evident until the bleeding has been going on for a period of hours. The patient often has a headache and neck pain. The blood pressure can be elevated or remain normal. However, complaints of a headache with neck pain but without a stiff neck, nausea, and vomiting, is not a typical presentation. Unlike other types of strokes, the patient may show no neurological deficit because there is no destruction of brain tissue. According to Dr. Boland, a CAT scan on January 20th would have revealed the hemorrhage in J.D.'s brain.

Proceedings Before the Commission and the Circuit Court

In January 2001, the Board filed its complaint against Dr. Moheet. The complaint alleged, inter alia, that cause exists to discipline Dr. Moheet's license pursuant to section 334.100.2(5), RSMo. 2000,¹ which allows the Board to file a complaint for the following cause:

Any conduct or practice which is or might be harmful or dangerous to the mental or physical health of a patient ...; or incompetency, gross negligence or repeated negligence in the performance of the functions or duties of any profession licensed or regulated by this chapter.

After a hearing, the Commission found cause to discipline Dr. Moheet's license based on "gross negligence" and "conduct that might have been harmful or dangerous to the physical health of a patient." The Board thereafter issued a public reprimand to Dr. Moheet's license.

On judicial review, the Cole County Circuit Court affirmed the Commission's findings of facts and conclusions of law and the disciplinary order. Dr. Moheet now appeals to this court.

Standard of Review

On appeal, we review the Commission's decision, rather than that of the trial court. State Bd. of Registration for Healing Arts v. McDonagh, 123 S.W.3d 146, 152 (Mo. banc 2003). For purposes of review, the Commission's action and the Board's order are "treated as one decision." Dorman v. State Bd. of Registration for Healing Arts, 62 S.W.3d 446, 453 (Mo.App.2001) (citing § 621.145). The decision is presumed valid, and the attacking party has the burden of...