The Medical Board of California is looking at a new accusation against an Orange family medicine doctor whose license, in a separate case of alleged gross negligence, was placed on probation last March.
The accusation against Dr. Christopher Holden became effective on Dec. 28, according to the medical board.
It concerns Holden's treatment of a 91-year-old woman he saw about once a month for "house calls" at Oceanside Senior Home in Huntington Beach from February through December 2013. He treated her for dementia with psychosis, congestive heart failure, chronic obstructive pulmonary disease, hypertension, hypothyroidism, degenerative joint disease, insomnia, anxiety, poor vision and, later, a coccyx decubitus ulcer, which is more commonly called a "bed sore."
The patient had been taking the anxiety medication Ativan when Holden was called to the home on April 29, 2013, about her worsening anxiety. He prescribed the anti-psychotic drug Seroquel to be taken along with the Ativan but, according to state regulators, the doctor did not inform the patient's daughter of the change in medication.
The bed sore developed on the patient's left side around October 2013, and during a Nov. 22 visit that same year, Holden noted on her medical chart a stage three decubitus ulcer and ordered an evaluation by Accent Care, a home health care service. But soon thereafter, the patient's Oceanside Senior Home caregiver contacted Holden and his assistant several times to report Accent Care had failed to evaluate and treat the bed sore, according to board investigators, who say Nov. 22, 2013, marked the doctor's last visit with the patient.
The patient's daughter learned of the ulcer during a hospice evaluation, and she opted for medical management over hospice care. The patient was transferred from the senior home to the Hoag Wound Care Center on Dec. 19, 2013, when the ulcer was diagnosed as a stage four.
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Anyone who has dealt with a bedridden senior knows the state takes very seriously bed sores, which are generally categorized as either stage one, two, three or four and, the higher the number, is more prone to infection and serious complications. The standard for medical care in California is that anyone with a stage two or higher wound must be transferred out of a residential care operation for the elderly to a facility offering a higher level of care.
The newly arrived Hoag patient required surgical debridement of the infectious and/or necrotic tissues to go along with the wound management, which mostly involves frequent (and, for the patient, painful) cleaning of the immediate area around the wound.
Failing to ensure the elderly patient's wound was receiving the proper care and prescribing psychoactive drugs to a patient who lacked decision-making capacities constituted gross negligence on the part of Holden, according to state regulators, who also accuse him of repeated negligent acts. In seeking a possible license revocation hearing before the board, state officials are also pointing to Holden's past case that we reported on March 31, 2017.
At that time, Holden's license to practice medicine had been placed on probation for three years due to his "grossly negligent" treatment of a 46-year-old woman with uterine cancer. 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. Instead, he did pretty much the complete opposite and never did diagnose the disease. She eventually developed cervix cancer.