O.C. Obstetrician Practicing as Accusations Accumulate

An obstetrician accused almost a year ago of botching the deliveries of two infants--with disastrous consequences--continues to practice in Santa Ana unfettered by state licensing authorities, even as additional accusations and complaints accumulate against her.

Dr. Farhat Khan, accused by the state medical board last March of negligence contributing to brain damage in one child and the death of another, now faces additional charges of performing unnecessary surgery leading to a 32-year-old woman’s hysterectomy and mishandling two delicate prenatal tests.

Through her attorney, Khan has denied the charges and vowed to fight them. “She’s an excellent board-certified obstetrician, very well-trained, highly regarded by her patients and her colleagues,” said Khan’s attorney, Henry Fenton. “I think she’s going to be completely vindicated in these cases.”

Because most of the cases are several years old, the Medical Board of California does not have the option of immediately shutting down Khan’s practice.

In fact, her case serves as a telling example of how long and arduous the process can be to investigate complaints against a doctor and, if warranted, restrict or remove the physician’s license. Ironically, in Khan’s case, the volume and range of the charges--what would seem to lend urgency to the matter--have actually slowed the process of investigation and prosecution, licensing officials say.

Four years ago, after Khan left a Santa Ana hospital to go to a hair appointment, a laboring patient’s liver ruptured and her baby suffered brain damage from lack of oxygen, according to an investigator with the medical board, which cited the case in its first formal licensing action against the physician last March. In another 1992 case, the board’s accusation contends, Khan failed to notice that a fetus was in distress and was suffocating.

The first child, Albert Sanchez, is blind, deaf and mentally disabled and probably will require institutionalization for the rest of his life, according to medical board documents. The second child died seven days after birth.

Khan has reached an undisclosed out-of-court settlement with the Sanchez family and faces lawsuits in some of the other cases.

The documents contend the doctor allegedly removed the wrong ovary in a third patient and failed to repair a vaginal incision that went too deep in a fourth.

In two of the cases, the medical board charged, Khan tried to cover up her mistakes by falsifying documents.

But as the board dug into these complaints, and Khan continued to see patients, more concerns about her past cropped up.

In November, the board accused Khan of operating inappropriately on a 32-year-old woman’s ovaries in 1991, factors leading to the patient’s subsequent hysterectomy and sterility. And this month, in another action, the board alleged that in two cases dating back as far as 1989, she prematurely performed amniocentesis procedures, in which fluid is extracted from the womb to test for genetic defects. The action endangered mother and child, the board alleged, and Khan lied to one patient about why the process had to be redone.

Officials say they have received--but not yet taken action on--several more complaints.

In state licensing proceedings, the board has accused Khan of gross negligence, repeated negligent acts, incompetence and corruption. In one patient’s case, the state said, she lacked “even a shred of human caring,” telling the woman to “shut up” during the painful extraction of amniotic fluid, refusing to hand over her medical records and ignoring her telephone calls for five days.

Still, licensing officials say, they can’t just briskly step in and shut the doctor’s practice down--not in this case, and not in many others.

First, the accusations remain unproven. Fenton, the doctor’s attorney, has pledged to put up a vigorous fight for her license, calling the state’s charges a “vendetta” carried out by an “extremely overzealous” medical board investigator.

Fenton described the most recent cases filed by the medical board--involving the extraction of amniotic fluid--as “inconsequential” because, he said, they caused no patient harm.

A medical board hearing on the charges is set to begin in April and could last into mid-June. After that, an administrative law judge will make a recommendation to the board on whether it should revoke or restrict the doctor’s license to practice.

Under state law, the only way to immediately suspend a physician’s practice without a hearing is to prove he or she presents an immediate danger to the public. In this case, though officials consider the charges very serious, they say they cannot meet that strict standard with the evidence at hand.

The main problem is that the allegations are dated, licensing officials say. All but one case date back several years. Steve Rhoten, the senior medical board investigator handling the case, says the general rule is that cases must be no more than a year old to qualify for a temporary restraining or suspension order, though judges have some discretion in the matter.

The law is intended to protect patients from harm without unnecessarily snatching away the livelihoods of doctors, medical board and legal officials say.

“No one thinks of taking the right to practice away from [doctors] summarily,” said Paul Hogan, the presiding administrative law judge in Los Angeles, whose office will handle Khan’s disciplinary hearing. “You have to show a cogent reason for doing that.”

Such a measure is granted rarely--only 19 interim suspension or temporary restraining orders were issued last year statewide. By contrast, the board filed 353 accusations against physicians.

In Khan’s case, the first complaint was brought to the attention of the board by a patient’s attorney in January 1994--slightly less than two years after the doctor allegedly botched the delivery that led to the Sanchez baby’s brain damage. The other cases were discovered after the board opened its investigation into that report.

Rhoten described the problem as “classic”: The medical board often hears about cases of alleged malpractice years after the incidents occur. The law requires insurance companies and court clerks to quickly report malpractice judgments and settlements of more than $30,000 to the board, but such reports often are delayed or never made, Rhoten and others said.

“By the time the case is resolved, it is years down the road, far too late for a [temporary] restraining order,” said Melanie Blum, an attorney who voluntarily reported the Sanchez case to the board and has reported several complaints as well. Blum has filed four lawsuits against Khan.

Hospitals too are required to report doctors who have been the subject of disciplinary action--but that process too is often faulty. A deputy state attorney general said last year, for example, that she was dismayed not to have received a report on the Sanchez incident from Santa Ana Hospital Medical Center, where the baby was born. Last March, the hospital declined a reporter’s request to comment on the case.

Rhoten said he worked diligently on the case for 10 months before turning it over to the attorney general’s office for prosecution last year. He is proud of that record, given the case’s complexity.

But by the time the case goes to a hearing in April, it will have taken more than a year for the state’s prosecutor to prepare it.

On the surface, “I know it looks bad,” said M. Gayle Askren, the deputy attorney general handling the case. But he too cited the tremendous spadework needed for a proceeding that could take more than two months and involve 50 to 100 witnesses.

Rhoten said he believes a backlog of cases at the Office of Administrative Hearings might have drawn out the process. Hogan, the presiding administrative law judge, however, said his office has no backlog and can normally schedule a case for hearing within 120 days.

Though Hogan was not familiar with the Khan case, he said it is not unusual for medical board hearings to be delayed because attorneys need more time to prepare.

“What creates that situation is the scope of the individual cases and the necessity for a lot of pretrial discovery to be done,” he said.

The fact that a doctor, such as Khan, remains in practice in the meantime should not be read as a lack of concern on the part of the medical board, a spokeswoman said.

“Obviously the board is concerned or we wouldn’t have filed an accusation and two supplements,” public information officer Candis Cohen said. “She may be a danger to patients.”