The bad doctor is in.
The bad doctor is in.
Matt Coker

State Probes Doctors Joseph Efe Imarah and Ruth Annette Schack

Medical Board of California discipline could be coming for a Newport Beach psychiatrist accused of over-prescribing medications and laboratory testing for a 30-year-old man and an Irvine anesthesiologist who allegedly sent an 84-year-old woman home without outpatient surgery due to heart irregularities—but did not consult a cardiologist.

She died of heart failure that same day.

Kimberly Kirchmeyer, the medical board's executive director, says in an accusation filed Nov. 14 that Dr. Joseph Efe Imarah's treatment of the female patient identified only as "E.S." constituted gross negligence, repeated negligent acts and general unprofessional conduct.

E.S. had a medical history that included cancer, diastolic heart failure, hypertension, chronic obstructive pulmonary disease, chronic kidney disease and hypothyroidism when she went to a Kaiser Permanente outpatient surgery center the morning of March 24, 2014, to have her breast implants removed.

There to provide anesthesia services, Imarah found E.S. appeared alert and in no distress during pre-operation procedures, although he did note her heart rate was low. Imarah then had her hooked up to an EKG, which came back at 10:26:38 a.m. with a reading of "sinus rhythm, third degree avb" (atrioventricular block) and then, at 10:27:11 a.m., "sinus rhythm with a complete heart block" and a heart rate at 40 beats per minute.

Based on her condition, Imarah cancelled the procedure and sent E.S. home—without calling for a cardiology consultation first, according to Kirchmeyer. He did mark in his notes at 10:43 a.m. that he advised E.S. to see a cardiologist. She was discharged seven minutes later. Within a few hours of arriving home, she had turned blue. Paramedics were called, but she died that afternoon. Her cause of death was listed as cardiac arrest, diastolic heart failure and hypertension.

On April 4, 2014, a Kaiser cardiologist reviewed pre-op EKG tracings and, that same day, a message was left on the voicemail of E.S., who was by then no more, urging her to immediately get to an emergency room because of her EKG results. Her heart blockage was noted in Kaiser records from that day.

The second case concerns Dr. Ruth Annette Schack, who has been a practicing psychiatrist for nearly 30 years. A man identified only as "A.K." saw Schack repeatedly from Jan. 3, 2002, through May 13, 2013. Over that span, Schack at various times diagnosed him with anxiety, depression, insomnia, panic disorder, grogginess, low testosterone and being "decompensated," which means his mental health was deteriorating.

Schack began psychotherapy sessions that would continue with A.K. weekly and then monthly and then bi-monthly. Over his months and years of treatment, A.K. would be prescribed escalating and de-escalating doses of Celexa, Klonopin, Zoloft, Seroquel, Lexapro, Ambien, Provigil, Wellburtin, Prozac, Adderall, Silenor, Effexor, Remeron, Lunestra, Trazadone and a steroid hormone. But medical charts for some weeks during the various treatment periods showed the patient's levels were normal for someone with his supposed afflictions.

In an accusation filed Nov. 1, Kirchmeyer concludes that Schack "excessively prescribed drugs and committed repeated acts of clearly excessive use of diagnostic procedures in the care and treatment of" A.K. The medical board official accused Schack of unprofessional conduct, repeated negligent acts, failure to maintain adequate and accurate records and "prescribing, dispensing or furnishing dangerous drugs without appropriate medical indication."

Kirchmeyer requested the medical board conduct hearings to consider revoking, suspending or placing on probation Schack and Imarah's state licenses to practice medicine. Probation could include the medical professionals being prohibited from supervising nurses and physician assistants, according to court documents.

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