The medical license of an Anaheim anesthesiologist/pain-medicine specialist was placed on probation for five years due to negligence, repeated negligent acts and shoddy record keeping, according to the Medical Board of California.
During the probation period, which began on Friday, Dr. Edwin Samuel Kulubya cannot perform intravenous sedation for interventional pain procedures nor can he supervise physician assistants or advanced practice nurses, states the medical board order.
In July of 2013, Kulubya began seeing a 64-year-old woman who had been a patient of his partner at their Anaheim medical practice. She suffered from chronic pain, arthritis, obesity, hypertension, asthma and gout. About every month to three months through Oct. 13, 2014, Kulubya treated the patient through medication management, IV therapies and interventional procedures that included prescriptions of oxycodone for pain and the muscle relaxant Soma.
But medical board investigators say it was unclear from Kulubya’s notes whether the patient was progressing under his care and if the doctor incorporated “self-management approaches” like physical or psychological therapies in addition to his prescriptions of meds that included controlled substances. Investigators also found no evidence that Kulubya discussed with the patient the danger of addiction.
On Oct. 13, 2014, Kulubya performed an epidural steroid injection and injections of numbing agents into painful joints on the woman while she was under an IV sedation of Propofol, the powerful anesthetic that played a role in Michael Jackson’s death. The doctor’s notes indicate the woman was awake at the end of her procedure and the IV and monitors were removed.
Shortly thereafter she became unresponsive and went into cardiac arrest.
Kulubya’s notes detail the patient’s intraoperative vital signs—including blood pressure, pulse rate and oxygen saturation—and that paramedics arrived to rush her to Anaheim Regional Medical Center. But what was key to the medical board investigation was what those notes do not spell out, including: where the patient was when her heart stopped; who discovered she was unresponsive; how much Propofol had been administered to her; any detailed sedation record at all; whether a qualified independent person monitored the procedure; the identities of any other personnel who took care of her; and what had gone on before the operation and later in the recovery room.
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For the reasons above, the board concluded Kulubya had been grossly negligent, performed repeated negligent acts and failed to maintain adequate and accurate records. The board also took into consideration that it had disciplined Kulubya for the same reasons as well as incompetence in March of 2004, when his license was also placed on probation due to his treatment of five patients, including one who was prescribed Vicodin over the phone without seeing the doctor.
The '04 California case prompted medical boards in other states where Kulubya was licensed to practice to take actions of their own. Georgia issued a public reprimand and imposed a $2,500 fine, Kulubya’s license was suspended in Maryland and New York, and it was placed on probation in Pennsylvania, Michigan, North Carolina and Illinois. By that time, Kulubya was living in Texas, but it is unclear from online records whether the medical board in that state took any action.
Under the terms of Kulubya’s latest probation, which the doctor and his lawyer Jennifer L. Sturges accepted with their March signatures on a medical board document, he must: complete medical education, prescribing practices, record keeping and clinical assessment courses or programs; have his practice monitored by one or more licensed physicians; notify any hospitals or clinics where he has privileges of his probationary status; obey all laws; and submit quarterly progress reports.
Failure to comply with the probation conditions could launch the process to revoke or suspend Kulubya’s license.