Further Restrictions Placed on Eye Doctor : Medicine: Investigators say La Jolla physician continues to practice despite orders to stop. He is barred from his office.

Investigators have discovered additional cases of unnecessary surgeries performed on mostly elderly patients and altered medical records in the practice of a La Jolla eye doctor accused of misconduct and bilking Medicare, the attorney general’s office said Friday.

Dr. Jeffrey Rutgard, temporarily barred from practicing medicine, now has been ordered to stay out of his office and to remove his name from office doors after a judge found that the eye doctor was flouting his license suspension by accompanying another doctor as he saw patients.

After his suspension, Rutgard brought other doctors to his offices to maintain his practice. His staff informed patients that Rutgard would be present during their appointments.

“Rutgard was practicing medicine in violation of the suspension order,” said Deputy Atty. Gen. Sanford Feldman. “He was diagnosing, recommending treatment and examining patients, albeit with somebody else there. If he’s allowed to practice, he represents a danger to the public.”

Rutgard was served Thursday with orders from the judge that instructed him to “avoid the appearance of the practice of medicine.”

In the orders, Administrative Law Judge M. Gayle Askren wrote: “By keeping his practices open . . . by having his staff call patients to induce them to resume treatment, and by announcing he would be present . . . (Rutgard) has involved himself in the practice of medicine.

“Suspension from practice requires cessation from practice. Cessation from practice requires no contact, either himself or through a staff person,” with patients.

Rutgard, who earned $4 million annually in his lucrative practice in La Jolla and San Diego, was unavailable for comment.

His Miami-based attorney, Rene A. Sotorrio said his client had violated neither the spirit nor the letter of the law.

“My client is an innocent man who is being victimized because he is high-profile, very successful, and made a great number of enemies among his competitors,” Sotorrio said. “It’s a tragic situation of a man who has received no due process and has been stripped of his livelihood.”

At Sotorrio’s request, the hearing for Rutgard, originally scheduled for Monday, has been postponed until Oct. 1 so the lawyers can address the state’s accusations, detailed in 400 pages of documents.

Rutgard, 41, has been accused by the attorney general’s office of a slew of improprieties, including bilking Medicare, paying $10,000 in hush money to an employee, doctoring medical records to justify surgeries, and operating on patients without their consent or without their knowledge that they were undergoing surgery.

“Rutgard ran a completely corrupt practice and could not be trusted in any way,” Feldman wrote in an application filed earlier this month asking the judge to strengthen the suspension order. “Now Rutgard drives the point home one more time by failing to comply with the court’s order of suspension and by continuing to cause medical charts to be falsified.”

On May 15, an administrative law judge prohibited Rutgard from practicing medicine, saying he posed a serious risk of injury to the community.

Rutgard then brought in another doctor, Dr. Henry Hirschman of Long Beach, to handle his practice. Rutgard, however, accompanied Hirschman in the examining room with patients, discussed the patients’ history and, in some cases, their future treatment, the attorney general alleged.

On several occasions, Rutgard, at Hirschman’s request, looked at patients’ eyes, the attorney general alleged. And dubious office practices continued, such as instructing office staff members to write on a patient’s records that they had discussed various treatments and understood the possible dangers--even when no such discussion had occurred, the attorney general alleged.

“By being there, by discussing the patient with Dr. Hirschman. . .by making chart entries and by examining the patient in conjunction with Dr. Hirschman, Rutgard continues to give patients the opportunity to believe he is playing a role in their care,” Feldman wrote. “Following suspension, Rutgard continues to instruct staff in medical matters. Worse, he instructs them to make false entries in medical charts, just as he did before suspension. This is outrageous.”

Hirschman was unavailable to comment Friday, and he is no longer working in Rutgard’s office.

Rutgard’s lawyers argued that the eye doctor had to accompany Hirschman because the state had confiscated all the patient records, and this way Rutgard could clue in his colleague.

But, on Friday, Feldman countered that Rutgard was welcome to photocopy the patient records--an offer that the doctor has not accepted.

“How would Rutgard ever remember patients’ histories--he was seeing 180 patients a day?” Feldman said.

When the state accused Rutgard of improprieties last month, it cited abuses in about 30 cases. Investigators have now discovered more patients--as well as office staff--who allege improprieties in the doctor’s practice, according to court records filed earlier this month. The additional findings paint a grim picture of unethical practices--from altering patient records to staging phony vision tests.

One patient, 74-year-old Pete Morales, told investigators that Rutgard performed cataract surgery on his right eye in 1991 and on his left eye in January of this year. This past March, Rutgard operated on Morales’ eyelids.

Morales’ patient records, obtained by the state, say that he complained about having trouble driving, seeing street signs, and about problems with glare.

But Morales, in a declaration, said that he had not told those complaints to Rutgard or anyone at the office.

“I did not say that glare was getting worse or that it was hard to drive,” Morales said in the declaration. “In fact, I do not drive a car and have not driven a car since 1977.”

Bonnie Novak, a former supervisor of ophthalmic technicians who worked in Rutgard’s office for three years beginning in January, 1989, told investigators that she and others created phony eye tests so Rutgard’s patients would seem to have worse vision than they really did.

“Rutgard told me that, if a patient had no visual complaints or had anything positive to say about his vision, I was not to enter that on the chart except for post-op patients,” she told investigators.

“A couple of times, I spoke to Rutgard about the fact that he was not discussing risks (of operations) with patients,” Novak said in a declaration. “He said we do not want to scare the patients away.”