A Long Beach physician had his medical license placed on probation effective March 3 due to his grossly and repeat edly negligent treatment of a 12-year-old girl who later died, according to the state.
Court and Medical Board of California documents state the following:
The girl went to the Emergency Department of St. Mary’s Medical Center in Long Beach after falling down a small grass covered hill in front of a local library on April 22, 2008. She landed hard on her left side, causing severe pain and limping. She was diagnosed with a left thigh contusion and strain, prescribed pain medication and given a note excusing her from school for two days.
The girl went to Dr. Young-Jae Kwon, her pediatrician, four months later and said she had injured her right thigh (which was a mistake; it was the left) and that she was still hurting (which was not a mistake). Kwon examined her and prescribed liquid Motrin for the pain, something he failed to note in her chart.
She returned the following month with a fever and sore throat, leading to another examination. The girl was prescribed an antibiotic and more liquid Motrin but, again, Kwon failed to record that.
The girl returned to Kwon at the end of April 2009 complaining that her left thigh had been hurting for 10 months. The doctor examined her lower extremities, prescribed more liquid Motrin, arranged for an x-ray and wrote a note excusing her from physical education class for two weeks—all of which he failed to note.
She returned the following month, saying the back of her thigh still hurt. Kwon has two progress notes from that visit; one does not document a physical examination, but the second one does say an exam was done and everything appeared normal. He concluded the girl was suffering from a muscle spasm and prescribed more liquid Motrin, something he failed to note again. The girl’s blood panel came back showing significantly abnormal Asparate Transaminase (AST, to test the liver and heart) and Alaine Aminotranserase (ALT, to test for hepatitis, cirrhosis and effects of laser drug therapy)—more than 10 times their normal values—but Kwon failed to document this or plan any follow up to address it.
Around eight days later, the girl returned to say the back of her thigh hurt when she sat down. Kwon failed to document her level of pain but did indicate he gave the same comprehensive examination he had performed eight days before. His impression was “pain on thigh” and he diagnosed her with fibromyalgia, a condition that is very rare in children and adolescents. He approved that she see an orthopedist and considered starting her on the anti-epileptic drug Lyrica to treat the fibromyalgia.
Later that same month, the girl was back in emergency at St. Mary’s due to the pain and soreness in her left inner thigh. She was diagnosed with acute left thigh strain, received a wrap for that leg and was excused from P.E. for seven days.
Four days later, the girl was back in Kwon’s office complaining about the pain in her inner thigh. Again, he failed to note the severity of the pain. Again, he has two different sets of notes from the visit; one does not indicate a physical examination was done, the other one notes a comprehensive exam like the one two weeks before was completed. Both sets of notes bring up the fibromyalgia suspicions of the doctor, but the first does not mention the Lyrica treatment while the second one does, then has Lyricia crossed out and gabapentin, a second anti-epileptic drug, written in its place (without the doc’s initials to indicate a change). The gabapentin is not noted in the prescription chart. The girl’s request for crutches was approved.
Two days later, Kwon requested authorization for a Lyrica prescription to treat the girl’s fibromyalgia, noting her “severe pain” to the left thigh and that she was now walking on crutches. But during Kwon’s later interview with medical board investigators, he said the girl never complained of pain that severe, and that his office manager only wrote that to better ensure approval by the insurance company. The doctor repeated this to the board in regards to completion of the authorization process around Oct. 20, 2009.
The next day, the girl returned to say she was still in pain and was not improving. Kwon failed to note the reason for the visit but did indicate a full exam was done, fibromyalgia was diagnosed and more gabapentin was prescribed, although that is not stated in the prescription chart.
Around Nov. 4, 2009, the girl told the doctor she was doing well and not in as much pain, but Kwon failed to note which thigh was in question on the chart. He did again indicate a full exam was done, fibromyalgia was diagnosed and more medication was prescribed, although that is not stated in the prescription chart. But she was back and in pain again by that Nov. 30, when Kwon noticed large swelling in the tender left thigh. He failed to note any measurement of the thigh on the chart, but he did cut back the gabapentin and added liquid Motrin for the girl’s fever, although this was not noted in the prescription chart.
She returned around Dec. 7, 2009, to complain of continued pain and swelling in her thigh. This time Kwon included measurements of 53.5 centimeters for the right thigh and 57 cm for the left, although he could not explain to the board how that was done. His impression again was fibromyalgia and his plan was to decrease the gabapentin and get an ultrasound of the right thigh. He documented that the Dec. 22 ultrasound showed tissue cysts that were likely due to trauma and hematoma—but he failed to provide a date for his late entry. During Kwon's interview with the board, he said the notes mistakenly indicated the right thigh and that it was the left he was treating—but the ultrasound order was for the right.
The girl returned Dec. 31, 2009, with more swelling to her left thigh and pain in the right thigh during walking. A measurement showed her right thigh was 55 cm and her left was 66 cm. (Again, Kwon could not explain how the measurement was done.) He did not document the pain level, but he did note fibromyalgia was the likely cause. However, he later told the board that he actually thought the cause was a cyst and that he planned to take the girl off gabapentin and refer her to a pediatric rheumatologist for a second opinion.
She came back on Jan. 13, 2010, with severe pain and more swelling in the left thigh. Kwon noted no abnormalities but did document her right thigh now measured 51 cm and the left was 68.5 cm (without being later able to explain how he came up with that, nor how the right thigh measurements kept changing since it was presumably the healthy one). Kwon repeated to the board the bit about how he noted fibromyalgia was the likely cause but really believed it was from a cyst. He prescribed liquid Motrin and told the girl to come back in five weeks.
The next day, the girl was seen by the pediatric rheumatologist, who did not believe the severe pain and swelling was consistent with fibromyalgia and thought the ultrasound indicated an infectious process. He recommended hospitalization. But the following day, the girl returned to Kwon, who noted an exam was done but not that any measurements were taken. His impression now was that the girl had a tumor in her left thigh and recommended she go to Long Beach Memorial Hospital for an evaluation. Later, Kwon added to her record that he first diagnosed hematoma/lymphoma and later thought it to be sarcoma, but he did not date those entries.
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On Jan. 15, 2010, the girl underwent Magnetic Resonance Imaging on her left thigh at Long Beach Memorial, where elongated tissue was measured and multiple cystic areas with fluid were found. Another test showed “abnormal vasculature surrounding and partially coursing through the mass.” Three days later, she underwent a biopsy on her left thigh mass, and synovial cell sarcoma that had metastasized to her lungs was discovered.
She underwent chemotherapy and surgery at Children’s Hospital of Los Angeles, but her pulmonary tumors continued to increase in size and she died of her illness on Jan. 15, 2012.
During the probationary period, Kwon must: submit quarterly updates to the board; have his practice monitored by the state (at his expense); refrain from supervising physician assistants; complete medical education and record keeping courses; and notify all hospitals and facilities where he has privileges of his status.
Violation of any of these conditions could force Kwon to surrender his license, according to the letter of acceptance signed by the doctor and his attorney Raymond J. McMahon on Oct. 21, 2016.