by Ryan Sabalow
After almost four years of investigation, the state medical board moved Tuesday to revoke or suspend the license of a Redding doctor accused of having performed hundreds of unnecessary heart procedures.
In an accusation filed with California Attorney General Bill Lockyer, Dr. Fidel Realyvasquez Jr. is charged by the Medical Board of California with gross negligence stemming from bypass surgeries he performed on three patients in 2001 and 2002.
According to the accusation, Realyvasquez, the chief cardiac surgeon at what was then Redding Medical Center, operated on the patients -- ages 58, 52 and 76 -- without cause, based solely on diagnoses made by cardiology chief Dr. Chae Hyun Moon.
Moon, who also is under investigation by the state medical board, voluntarily agreed to stop practicing medicine in July 2003.
Moon, 58, is charged by the medical board with dozens of counts of gross negligence, incompetence, dishonesty and corruption, filing false or fraudulent claims, failure to maintain adequate records, and repeated negligent acts.
That investigation is ongoing.
Tuesday's accusation is that Realyvasquez, 57, performed the three coronary bypasses without verifying Moon's diagnoses.
The medical board's accusation reports each of the three surgeries in detail, using words like "failed to," "unnecessary" and "erroneous" to describe Moon's diagnoses and the following surgeries by Realyvasquez.
The accusations identified the patients by initials to protect their privacy.
In the case of the of the 58-year-old patient, identified as "E.G.," Realyvasquez performed a triple bypass coronary graft without checking to see that the patient could have been helped by a less invasive procedure, according to the filing.
In the second case, Moon told a 52-year-old woman in March 2002 she needed a coronary artery bypass graft surgery, the filing says. Moon suggested that if she didn't get one, "her grandchildren might find her dead," according to the accusation.
The accusation calls Moon's diagnosis of heart angiography a "misinterpretation" and says the patient had only "minor, if any, coronary artery disease."
In his examination of the patient, "Dr. Realyvasquez simply restated Dr. Moon's findings ... and obtained the patient's consent for the surgery," according the accusation.
The most serious allegation stems from the 76-year-old woman's surgery.
The accusation says she "suffered a major embolic stroke, from which she has not yet fully recovered" because of a four-vessel bypass Realyvasquez performed based on Moon's diagnosis.
Realyvasquez's Sacramento attorney, Malcolm Segal, said the medical board's claims are unfounded because his client simply was going off of test results given to him by another physician -- something every surgeon does.
"What (the accusation) seems to be saying is that no physician can rely upon any test report prepared by another physician on the case," Segal said. "I question then, does that mean that a surgeon has to repeat and personally do all the blood tests, repeat and personally do all the X-rays, repeat and redo every other test, even when, by training, that's not his responsibility?"
Saying that he had not seen the medical board's accusations, Moon's attorney, Matthew Jacobs of Sacramento, declined to comment on the allegations against Realyvasquez or Segal's statements.
Redding attorney Russell Reiner, who represents 345 patients who sued the doctors in civil court, said the final decision lies with the person holding the scalpel.
"It's the surgeon's ultimate responsibility to determine whether a person proceeds to surgery," Reiner said. "Realyvasquez failed in his responsibility."
Reiner said the medical board's accusation is "long overdue."
The complaint urges that Realyvasquez's license be revoked or suspended, and that he be forced to pay the costs of the investigation, future enforcement and probation.
Tuesday's filing is the latest chapter of the Redding Medical Center saga, which began in October 2002, when federal agents raided the hospital after tips from whistle-blowers.
Federal officials have been hashing out a settlement in that case since Nov. 15, when Moon and Realyvasquez came to a "global settlement" and agreed to pay prosecutors $1.4 million each.
A spokeswoman for the U.S. attorney's office in Sacramento said prosecutors have until June 2 to finalize that deal.
The settlement ended three years of criminal investigation.
No criminal charges were filed, and none of the doctors has admitted guilt.
In February, Realyvasquez and two other surgeons, Kent Brusett and Ricardo Javier Moreno-Cabral, were ordered to begin paying a $21 million civil settlement to 760 patients.
Moon and other cardiologists settled separate civil suits for $24 million nearly a year earlier.
Both doctors still live in Redding, their attorneys said.
Segal said his client has been "working on other matters related to medicine, including research."
Reporter Ryan Sabalow can be reached at 225-8344 or at email@example.com.