"My vision is to create and share a meaningful and healthy life," reads Dr. Christopher Holden's "professional statement" for an online service that matches patients with physicians. "Imagine your life with higher standards, less clutter, less debt, less stress and less discontent."
Unfortunately, the Orange family medicine doctor could not live up to his vision for a 46-year-old woman with uterine cancer, according to court documents filed by the Medical Board of California, which placed Holden's license to practice in the state on probation for three years effective last Friday, March 24.
The discipline stems from Holden being "grossly negligent" in his care for the patient identified only as "T.P.," according to the Medical Board. Her symptoms should have led the doctor to first exam her for uterine cancer before finding a basis to rule that out in favor of a diagnosis of something more benign, found the board, which notes he pretty much did the complete opposite. He never did diagnose the disease.
Since at least 2008, Holden saw T.P. at her home because she suffered from agoraphobia. It was early in these visits that she complained of vaginal bleeding, which Holden chalked up to her transitioning to menopause. However, he performed no tests to confirm his suspicions, with her Sept. 27, 2008, chart only noting a “change in periods” without stipulating the amount of bleeding or whether T.P. should be sent for a gynecological exam, the board points out. Holden diagnosed menometrorrhagia—heavy bleeding with prolonged and/or irregular menstrual periods—and prescribed a thyroid-stimulating hormone.
Irregular menses are included in the medical record for T.P.’s Jan. 27, 2009, follow-up exam. Holden called for thyroid testing again, a female hormonal panel and neurotransmitter testing, although the Medical Board found he never documented whether those labs were completed.
“On March 21, 2009, [Holden] diagnoses T.P. with piriformis syndrome,” states the board in reference to a condition where a muscle in the buttocks region spasms and causes pain, “but there is no history and no pertinent exam recorded.”
Nine days later, T.P. was placed on iron medication for anemia, with Holden noting in her chart that her hypothyroidism was “overcorrected.” He also increased her thyroid medication and noted to check her labs in three months. “At this point, the TSH [amount of thyroid-stimulating hormone in the blood] is 0.01,” the board states. “There is a span of two years before TSH is checked again. T.P.’s TSH never normalizes while under the care of [Holden].”
During a February 2010 examination, T.P. complained of increased bleeding, which Holden indicated was secondary to stress. On July 23 of that year, he diagnosed her with microcytic anemia—usually an indication of an iron deficiency—but the board found he performed no rectal exam. Holden also diagnosed T.P. with a yeast infection in her intestines, but he did not state a basis for this conclusion in the history of present illness or in his exam, according to the board.
T.P.’s hemoglobin dropped dramatically in November 2010, as compared to the July visit, but all that was recommended for her was more iron. Holden told the board he advised the patient to see a gynecologist but no referral is documented in his records.
Noting T.P. was pale on Jan. 24, 2011, Holden ordered another complete blood count test. On Oct. 10, 2011, he stated she had seen a gynecologist and a PAP smear and ultrasound were planned, but for T.P.’s next appointment a month later Holden did not follow up on whether she indeed saw the specialist. She had not, the board found. This time, Holden charted that T.P. had non-cancerous growths in her uterus.
Holden did not see T.P. on March 4, 2012, but he wrote in her chart that she was anemic and had low blood pressure and needed a transfusion. T.P. left Holden a message a week later saying she was still anemic and had been to the emergency room. The doctor did not indicate he planned to see his patient in light of this.
The last time Holden did see T.P. was on April 5, 2012, when he noted she had received a blood transfusion at Orange Coast Memorial Medical Center and was planning to go to a gynecologist for a possible procedure to treat abnormal uterine bleeding.
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Twelve days later, a gynecologist could not perform a PAP smear nor a biopsy due to significant vaginal bleeding. That doctor suspected T.P. had cervical cancer, which was confirmed a month later.
According to the board's findings—which Holden and his attorneys Dennis K. Ames and Zarah B. Maginot accepted based on their signatures dated Jan. 3 on court documents—the doctor had been grossly and repeatedly negligent when it came to T.P.'s care and had done a poor job of keeping records.
Under the terms of the probation, Holden must obey all laws, refrain from supervising physician assistants, submit quarterly progress reports to the board, complete medical education and record-keeping courses and notify hospitals and other facilities where he has privileges of his probationary status.
Holden, who attended UC Irvine's medical school, writes near the end of his professional statement on the Zocdoc referral website with: "Imagine cultivating your passion until you cannot bare a day without pursuing it." Assuming his passion remains treating patients, he had better comply by the conditions of his probation if he wants to keep pursuing it. Failure to do so could result in board proceedings to revoke Holden’s license to practice medicine in California.