In March 2020, the Medical Board of California accused Karima Hirani., M.D. of gross negligence; repeated negligent acts; and excessive prescribing or treatment in her management of a nine-year-old girl with a chief complaint of intermittent stomach pain. The Accusation, shown below, states that Hirani:
- Recommended and/or prescribed a gluten-free, dairy-free, sugar-free diet, several six nutritional supplements.
- Ordered approximately 30 laboratory test panels, many of which were redundant or lacked medical justification.
- Diagnosed the child with active Lyme disease, active varicella (chickenpox), and mycoplasma (walking pneumonia) infections, diagnoses that were not properly supported by the laboratory results.
- Ordered a homeopathic product for the alleged Lyme disease without disclosing that no peer-reviewed studies supported its use.
Hirani operates the Hirani Medical Wellness Center in Culver City, California where she practices what she calls “holistic and preventative medicine.”
Attorney General of California
JUDITH T. ALVARADO
Supervising Deputy Attorney General
PEGGIE BRADFORD TARWATER
Deputy Attorney General
State Bar No. 169127
California Department of Justice
300 South Spring Street, Suite I 702
Los Angeles, California 90013
Telephone: (213) 269-6448
Facsimile: (213) 897-9395
Attorneys for Complainant
MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against:
KARIMA HIRANI, M.D.
Physician’s and Surgeon’s Certificate
|Case No. 800-2017-038476
FIRST AMENDED ACCUSATION
FILED March 7, 2018
- Christine J. Lally (Complainant) brings this First Amended Accusation solely in her official capacity as the Interim Executive Director of the Medical Board of California, Department of Consumer Affairs (Board).
- On August 24, 1994, the Medical Board issued Physician’s and Surgeon’s Certificate Number G 79715 to Karima Hirani, M.D. (Respondent). The Physician’s and Surgeon’s Certificate was in full force and effect at all times relevant to the charges brought herein and will expire on April 30, 2020, unless renewed.
- This First Amended Accusation is brought before the Board under the authority of the following laws. All statutory references are to the Business and Professions Code (Code) unless otherwise indicated.
- Section 2227 of the Code provides that a licensee who is found guilty under the Medical Practice Act may have his or her license revoked, suspended for a period not to exceed one year, placed on probation and required to pay the costs of probation monitoring, or such other action taken in relation to discipline as the Board deems proper.
- Code section 2234 states, in pertinent part:
The board shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following:
(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter.
(b) Gross .negligence.
(c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts.
(1) An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act.
(2) When the standard of care requires a change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph (1), including, but not limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee’s conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care.
- Code section 725 states:
(a) Repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering of drugs or treatment, repeated acts of clearly excessive use of diagnostic procedures, or repeated acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of the community of licensees is unprofessional conduct for a physician and surgeon, dentist, podiatrist, psychologist, physical therapist, chiropractor, optometrist, speech-language pathologist, or audiologist.
(b) Any person who engages in repeated acts of clearly excessive prescribing or administering of drugs or treatment is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($ I 00) nor more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days nor more than 180 days, or by both that fine and imprisonment.
(c) A practitioner who has a medical basis for prescribing, furnishing, dispensing, or administering dangerous drugs or prescription controlled substances shall not be subject to disciplinary action or prosecution under this section.
(d) No physician and surgeon shall .be subject to disciplinary action pursuant to this section for treating intractable pain in compliance with Section 2241.5.
FIRST CAUSE FOR DISCIPLINE
- Respondent is subject to disciplinary action for gross negligence under Code section 2234, subdivision (b). The circumstances are as follows:
- Respondent practices functional medicine and complementary alternative medicine in an integrative practice.
- On September 17, 2017, Patient I, a nine-year-old female, presented to Respondent with a chief complaint of intermittent stomach pain. Her health history also included recurrent ear infections, fear of kidnapping, and a history of an autoimmune illness called Henoch Schonlein Purpura, a disease causing swelling of small blood vessels commonly found in children. Overall, Patient I had seen her pediatrician in May 2015 for an insect bite that had resulted in a fever. Patient 1 ‘smother explained that she wished to be proactive in minimizing stomach sensitivities that may disrupt schooling.
- On the first visit, Respondent recommended a gluten-free, dairy-free, sugar-free diet. She recommended six nutritional supplements. She ordered approximately 30 laboratory panels, which included redundancies, such as two celiac panels from two different laboratories and herpes simplex virus antibody and human herpes virus 6 antibody tests from two different laboratories. Many of the labs were not relevant to Patient l’s chief complaint of intermittent stomachache.
- Respondent proceeded with extensive testing while also acknowledging that blood tests are often not useful in looking for food sensitivities and that positive outcomes for Patient 1 ‘s complaints could occur with a simple anti-inflammatory dietary intervention.
- Patient I returned for a follow-up visit on October 18, 2017. Patient 1’s mother reported that the stomachaches had subsided with the dietary changes, a probiotic, a digestive enzyme, and L-glutamine amino acid.
- The standard of care requires a physician practicing complementary medicine to ordr tests appropriate for the nature and severity of the chief complaint.
- Respondent was grossly negligent in the care and treatment of Patient 1 in that she engaged in excessive and unnecessary testing without medical justification.
SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)
- Respondent is subject to disciplinary action under section 2234, subdivision (c), in that she committed repeated negligent acts in her care and treatment of Patient I. The circumstances are as follows.
- The allegations in the First Cause for Discipline are incorporated by reference.
- Respondent diagnosed Patient 1 with active Lyme disease, active varicella (chicken pox), and mycoplasma (walking pneumonia) infections, diagnoses which are not properly supported by Patient l’s laboratory results. During an interview related to Patient l’s care conducted on behalf of the Board, Respondent admitted that Patient 1 did not have active infections to these agents, but rather an autoimmune process or reaction to the agents that could have been better explained.
- Respondent told the mother of Patient I that Lyme disease could be transmitted through spider bites and mosquito bites without explaining that this view contradicted the opinionof the Centers for Disease Control that the disease is transmitted through tick bites or the rare process of in utero transmission.
- Respondent recommended a homeopathic treatment for the Lyme disease, consisting of low dose immunotherapy (LDI).1 LDI, while safe, is not the conventional treatment for Lyme disease. Respondent did not explain to the mother of Patient 1 that LOI is an alternative and complementary medicine treatment for Lyme disease nor did she explain that there are no peerreviewed studies supporting its use. She did not explain or offer the conventional Lyme disease treatment for Patient 1.
1 LDI involves obtaining liquid antigens from a compounding pharmacy and diluting the liquid hundreds of times such that it contains little of the original substances. Homeopathic doctors believe that if properly diluted, a substance that causes disease symptoms in a healthy person can improve the symptoms in a sick person.
- Respondent told Patient l’s mother that Patient 1 was not very symptomatic despite the three infections, allergies, and “the mold thing going on.” Respondent said nobody else would find “it” and that, “You’re dodging a big bullet if you follow my recommendations.”
- The standard of care is to interpret laboratory tests accurately, explain the results to patients in an understandable way, and to explain the risks and benefits of treatments offered.
- Respondent departed from the standard of care in diagnosing active Lyme, Varicella, and Mycoplasma infections instead of taking adequate time to fully explain the autoimmune phenomena.
- Respondent departed from the standard of care by stating that Lyme disease can be transmitted by spiders and mosquitoes without explaining that this opinion contradicts that of the Centers for Disease control.
- Respondent departed from the standard of care in offering LOI treatment without explaining the homeopathic nature of the treatment and that there are no peer-reviewed studies supporting its use.
THIRD CAUSE FOR DISCIPLINE
(Excessive Prescribing or Treatment)
- By reason of the facts alleged in the First Cause for Discipline, Respondent is subject to disciplinary action under section 725, in that she engaged in excessive testing and treatment in her care and treatment of Patient 1.
WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Medical Board of California issue a decision:
- Revoking or suspending Physician’s and Surgeon’s Certificate Number G 79715, issued to Respondent Karima Hirani, M.D.;
- Revoking, suspending or denying approval of Respondent’s authority to supervise physician assistants and advanced practice nurses;
- If placed on probation, ordering Respondent to pay the Board the costs of probation monitoring; and
- Taking such other and further action as deemed necessary and proper.
DATED: Mar 23, 2020
CHRISTINE J. LALLY
Interim Executive Director
Medical Board of California
Department of Coinsumer Affairs
State of California