Jesus Caquias, M.D. Escapes
Third Disciplinary Action
Stephen Barrett, M.D.
In 2010, the Texas Medical Board charged Jesus Caquias, M.D. with providing substandard care that involved negligence, inadequate recordkeeping, poor medical judgment, poor decision-making, failure to use proper diligence, and/or non-therapeutic prescribing and/or treatment. Caquias operates a medical office in Brownsville, Texas and worked part-time for CARE Clincs, an Austin-based facility that offered dubious and expensive services for children with autistic spectrum disorders. The charges, noted below, involved dealings with four patients. Two diagnosed with autism and another one with headaches were given IV vitamin infusions and other inappropriate treatments at his office. The fourth patient was a child whose mother brought him to a CARE satellite clinic in Florida whose staff Caquias had trained. The complaint states that staff members, who were not licensed to practice medicine used his signature stamp to order an "extremely large battery of diagnostic tests and several prescriptions." The board charged that his failure to prevent his stamp from being misused "demonstrated a lack of proper diligence in his professional practice." In February 2011, the board amended its complaint to add a fifth patient who the complaint states received chelation therapy at CARE's Austin facility after being improperly diagnosed with heavy metal toxicity
Caquias had been previously disciplined twice. In 2006, the Texas Board concluded that he had failed to maintain adequate medical records and ordered him to (a) resign from his role as a gatekeeper in the county indigent program, (b) undergo remedial training in recordkeeping, and (c) have his practice monitored for two years. In 2007, he signed an agreed order under which he was fined $5,000 and agreed to stop (a) advertising in a manner that would cause confusion to the public, (b) using overly broad claims that would "tend to mislead the public as to cures for diseases" and (c) advertising with references to organizations not recognized by the American Board of Medical Specialties.
This time, however, the charges were dismissed. In 2012, a hearing was held during which the central issue was whether or not his records were adequate. Caquias testified that records that would exonerate him were destroyed while in FBI custody. (The records seized by the FBI were destroyed by fire or water after a pilot intentionally crashed his airplane into Austin's IRS building.) The presiding administrative law judges concluded that without complete records, the board could not prove its case against Caquias. The board argued that Caquias's patient management was substandard, but the judges said that because this was not charged in the complaint, it could no longer be considered.
HEARING CONDUCTED BY THE
TEXAS STATE OFFICE OF ADMINISTRATIVE HEARINGS
SOAH DOCKET NO. 503-
LICENSE NO. F-8432
IN THE MATTER OF THE
JESUS ANTONIO CAQUIAS, M.D.
TEXAS MEDICAL BOARD
Filed March 31, 2010.
TO THE HONORABLE TEXAS MEDICAL BOARD AND THE HONORABLE ADMINISTRATIVE LAW JUDGE TO BE ASSIGNED:
COMES NOW, the Staff of the Texas Medical Board (the "Board"), and files this Complaint against Jesus Antonio Caquias, M.D., ("Respondent"), based on Respondent's alleged violations of the Medical Practice Act ("the Act"), Title 3, Subtitle B, Texas Occupations Code, and would show the following:
The filing of this Complaint and the relief requested are necessary to protect the health and public interest of the citizens of the State of Texas, as provided in Section 151.003 of the Act.
II. LEGAL AUTHORITY AND JURISDICTION
1. Respondent is a Texas Physician and holds Texas Medical License No. F-8432, that was originally issued on December 3, 1980. Respondent's license was in full force and effect at all times material and relevant to this Complaint.
2. Respondent received notice of the Informal Settlement Conference ("ISC") and appeared at the ISC, which was conducted in accordance with §2001.054(c), GOV'T CODE and § 164.004 of the Act. All procedural rules were complied with, including but not limited to, Board Rules 182 and 187, as applicable.
3. No agreement to settle this matter has been reached by the parties.
4. All jurisdictional requirements have been satisfied.
III. FACTUAL ALLEGATIONS
Board Staff has received information and based on that information believes that Respondent has violated the Act. Based on such information and belief, Board Staff alleges:
1. Respondent is a physician in the Brownsville, TX area. He worked as a physician for the Center for Autistic Spectrum Disorders and Nutrigenomics ("CASD") in Austin, Texas, on a part-time contract basis to provide and supervise medical diagnosis and treatment for autistic children. Patients would travel from all over the country to see Respondent at the CASD in Austin, because he represented that he had treated autism successfully.
a. Respondent saw adult Patient A1 on January 8, 2007, for severe migraine headaches. The patient reported a history of hyperthyroidism, painful migraine headaches and body aches since a "betrayal by a friend." She also reported chronic fatigue and difficulty sleeping. Respondent did not document any physical examination. Respondent signed an "amino acid supplement schedule" for Patient A.
1The identity of the Patients will be provided to the Administrative Law Judge under seal in order to protect the Patients' confidentiality rights.
b. The next visits recorded metal levels and interpretations based on possible effects of those levels on the patient's possible symptoms, but no patient history or physical examination was documented. Respondent ordered laboratory tests to diagnose various mineral and vitamin abnormalities in the patient. There is no documentation of assessment, monitoring of headaches, or discussion with the patient. At these visits, the only documentation is a short recommendation such as "no deficiency detected, repeat test" or "vitamin B's IV recommended, Detoxification IV recommended." Respondent failed to document any therapeutic rationale, monitoring or results for his medical treatment of Patient A.
c. Patient A received an intravenous infusion on December 1, 2006, of "Vitamin B complex, McGuff vitamin C, methylcobalamin, heparin, procaine, folic acid, Vitamin B6 and magnesium sulfate 50%." The volume of liquid and the amount of each substance infused was not recorded. On December 2, 16 and 17, 2006, the patient received similar infusions that included lithium, and the volumes of liquid and the amount of each substance infused again were not recorded.
d. Respondent failed to appropriately document his supervision of the care, including intravenous infusions. rendered to Patient A.
a. Patient B was a 19-year-old woman diagnosed with autism who was brought in by her parents to see the Respondent initially on February 26, 2007. The patient's parents provided Respondent with a developmental history and medical history including: psychotropic medications; difficulty with auditory processing; being distracted easily; and being easily disoriented. Patient B's past medications included: Risperdal, Seroquel, Zyprexa, Cogentin, Paxil, Adderall, Buspar, and Ritalin. Respondent's physical exam of Patient B is documented only by a check-off type of physiCal examination record, and several items were not marked. The failure to mark items on this check-off form indicates that the particular conditions listed and unmarked were not determined by Respondent or his staff.
b. Respondent recommended that Patient B take a long list of vitamins, probiotics, anti-oxidants, valtrex 500 mg BID, and IV treatments.
c. Over the next two years, Respondent saw the patient one to two times each month, and only provided non-specific documentation such as "symptoms improved" or "tremendous progress in cognitive and social skill." Respondent did not document any physical examinations during this time. The vast majority of the notes deal with assessment of vitamin or mineral deficiency or excess and recommendation for a large number of vitamin or mineral supplements. Respondent failed to document any therapeutic rationale, monitoring or results for his medical treatment of Patient B.
d. The patient received approximately 12 intravenous infusions, initially with the McGuff B complex, lithium, methyl cobalamin, and vitamin C combination. In September 2008, Respondent added anti-oxidative IV therapy and phoshatidylcholine phenybutrate IV therapy. Respondent continued to order anti-oxidative IV therapy and phoshatidylcholine phenybutrate IV therapy for this patient. The volumes of the infusions and the amount of each substance infused were not documented. There is no documentation of any assessments, monitoring, observations, or discussion with the patient or family.
e. Respondent failed to appropriately document his supervision of the care, including intravenous infusions, rendered to Patient B.
a. Patient C was a four-year-old girl diagnosed with autism that was brought in by her parents to see the Respondent initially on July 28, 2006. The patient's parents provided to Respondent a developmental history and medical history including: aloofness; developmental delay, and decreased eye contact. There is no physical examination documented until 2008. That 2008 physical exam of Patient C is documented only by a check-off type of physical examination record, and several items were not marked. The failure to mark items on this checkoff form indicates that the particular conditions listed and unmarked were not determined by Respondent or his staff.
b. Patient C received McGuff vitamin C and B-complex infusion which included methyl cobalamin, procaine, Vitamin B6, and magnesium sulfate 50%, and five courses of phoshatidylcholine phenyl butyrate IV therapy during this time. The volumes of the infusions were not documented. There is no documentation of any assessments, monitoring, observations, or discussion with the patient or family. Respondent failed to document any therapeutic rationale, monitoring or results for his medical treatment of Patient C.
c. Respondent failed to appropriately document his supervision of the care, including intravenous infusions, rendered to Patient C.
a. In early 2008, the owner of CASD decided to open up a satellite office in Tampa, Florida. Respondent participated in the opening of the Florida CASD clinic by training the doctor and staff who would be providing care in Florida in the protocols for treatment of autism that he had developed at CASD in Texas. CASD planned to implement the protocols and procedures used in the Austin clinic for the same use in the Florida clinic. No one modified the forms and procedures regarding billing to remove all the signatures and authorizations used by the Austin clinic and substitute the appropriate authorizations for use in the Florida clinic.
b. A mother of an autistic child in Florida took her child to the Florida CASD clinic on June 1, 2008, and met with Jeff Baker, a naturopathic provider who is neither a licensed doctor or nurse. Mr. Baker recommended an extremely large battery of diagnostic tests and several prescriptions according to the protocols that Respondent had established for the CASD clinic. These tests and prescriptions were not supported by a physical examination by a licensed care provider or any documented medical condition of the patient. All documentation from the Florida clinic for this patient was made on documents that had the CASD Austin clinic address.
c. At the beginning of June 2008, the personnel in the CASD Florida clinic sent instructions to the Texas clinic to (a) fax a prescription request to a pharmacy in New Jersey that was owned by another doctor who was employed by CASD to provide and supervise medical care for the clinic patients in Florida and (b) fax orders for several laboratories to perform the large battery of tests on specimens provided by the patient in Florida on June 2, 2008. The instructions were for the prescriptions and orders to be authorized by Respondent.
d. The CASD staff used a stamp to provide Respondent's signature for the prescriptions and the laboratory test orders in Respondent's name. The CASD staff did not check with Respondent on June 2, 2008, to receive his permission or instructions to use his signature for this specific purpose.
e. Respondent's failure to take appropriate and adequate measures at the time that the Florida clinic was opened to prevent his signature stamp from being involved in activities of the Florida clinic demonstrated a lack of proper diligence in his professional practice.
Prior Board Orders:
a. The Board entered an Agreed Order on June 22, 2006, ("2006 Order") due to Respondent's failure to maintain adequate medical records in his position as "gatekeeper" for the Cameron County indigent patient program. The 2006 Order required Respondent to: submit charts to a chart monitor quarterly for two years; attend the University of California San Diego Physician Assessment and Clinical Education ("PACE") medical recordkeeping program within one year; and resign from his position as "gatekeeper" for the Cameron County indigent patient program.
b. The Board entered an Agreed Order on April 13, 2007, ("2007 Order") due to Respondent's misleading advertising. The 2007 Order required Respondent to cease the misleading advertising and to pay an administrative penalty of $5,000.
7. Respondent's actions in this case are below the standard of care due to one or more of the following: inadequate medical recordkeeping; negligence in providing medical services; failure to use proper diligence; poor medical judgment; poor decision making; and non-therapeutic prescribing and/or treatment.
8. The actions of the Respondent as specified above violate one or more of the following provisions of the Medical Practice Act:
a. Respondent is subject to disciplinary action pursuant to Section 164.051 (a)(1) of the Act based on Respondent's commission of an act prohibited under Section 164.052 of the Act.
b. Section 164.051 (a)(6) of the Act, failing to practice medicine in an acceptable professional manner consistent with public health and welfare, is further defined by Board Rule 190.8(1)(A), the failure to treat a patient according to the generally accepted standard of care; Board Rule 190.8(1 )(B), negligence in performing medical services; Board Rule 190.8(l)(C), failure to use proper diligence in one's practice; Board Rule 190.8(1 )(D), failure to safeguard against potential complications; Board Rule 190.8(1 )(H) failure to disclose reasonable alternative treatment to the proposed treatment or treatment; and Board Rule 190.8(1 )(K) prescription or administration of a drug in a manner that is' not in compliance with Board Rule §200 relating to the standards for physicians practicing complementary and alternative medicine.
c. §164.052(a)(5) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent's unprofessional or dishonorable conduct that is likely to deceive or defraud the public as provided by Section 164.053 of the Act, or injure the public.
d. Section 164.051 (a)(3) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent's committing or attempting to commit a direct violation of a rule adopted under this subtitle. Specifically, Respondent violated of Board Rule 165.1, by failing to maintain adequate medical records and Board Rule 200.3 by failure to follow guidelines for the practice of complementary and alternative medicine.
e. Respondent has committed a prohibited act or practice within the meaning of Sections 164.052(a)(5) and 164.053(a)(5) of the Act by prescribing or administering a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed.
This case involves patient harm, and multiple violations of the Act and Board rules.
IV. APPLICABLE STATUTES AND RULES FO
THE CONTESTED CASE PROCEEDING
The following statutes, rules, and agency policy are applicable to the conduct of the contested case:
- Section 164.007(a) of the Act requires that the Board adopt procedures governing formal disposition of a contested case before the State Office of Administrative Hearings.
- 22 TEX. ADMIN. CODE, Chapter 187 sets forth the procedures adopted by the Board under the requirement of Section 164.007(a) of the Act.
- 1 TEX. ADMIN. CODE, CHAPTER 155 sets forth the rules of procedure adopted by SOAH for contested case proceedings.
- 1 TEX. ADMIN. CODE, CHAPTER 155.507, requires the issuance of a Proposal for Decision (PFD) containing Findings of Fact and Conclusions of Law.
- Section 164.007(a) of the Act, Board Rule 187.37(d)(2) and Board Rule 190 et. seq., provides the Board with the sole and exclusive authority to determine the charges on the merits, to impose sanctions for violation of the Act or a Board rule, and to issue a Final Order.
V. NOTICE TO RESPONDENT
IF YOU DO NOT FILE A WRITTEN ANSWER TO THIS NOTICE WITH THE STATE OFFICE OF ADMINISTRATIVE HEARINGS WITHING 20 DAYS OF THE DATE NOTICE OF ADJUDICATIVE HEARING WAS MAILED, A DEFAULT ORDER MAY BE ENTERED AGAINST YOU, WHICH MAY INCLUDE THE DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE REVOCATION OF YOUR LICENSE. IF YOU FILE A WRITTEN ANSWER, BUT THEN FAIL TO ATTEND THE HEARING, A DEFAULT JUDGMENT MAY BE ENTERED AGAINST YOU, WHICH MAY ALSO INCLUDE THE DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING
THE REVOCATION OF YOUR LICENSE. A COPY OF ANY RESPONSE YOU FILE WITH THE STATE OFFICE OF ADMINISTRATIVE HEARINGS SHALL ALSO BE PROVIDED TO THE HEARINGS COORDINATOR OF THE TEXAS MEDICAL BOARD.
IF YOU FAIL TO ATTEND THE HEARING, THE ADMINSTRATIVE LAW JUDGE MAY PROCEED WITH THE HEARING AND ALL THE FACTUAL ALLEGATIONS LISTED IN THIS NOTICE CAN BE DEEMED ADMITTED, AND THE RELIEF SOUGHT IN THIS NOTICE MIGHT BE GRANTED.
WHEREFORE, PREMISES CONSIDERED, Board Staff requests that an administrative law judge employed by the State Office of Administrative Hearings conduct a contested case hearing on the merits of the Complaint, and issue a Proposal for Decision ("PFD") containing Findings of Fact and Conclusions of Law necessary to support a determination that Respondent violated the Act as set forth in this Complaint.
TEXAS MEDICAL BOARD
Lee Bukstein, Staff Attorney
Texas State Bar No. 03320300
Telephone: (512) 305-7079
FAX # (512) 305-7007
333 Guadalupe, Tower 3, Suite 610
Austin, Texas 78701
This page was amended on January 4, 2013.