Disciplinary Action against Vicky Hufnagel

Stephen Barrett, M.D.


In June 2004, the Medical Board of California denied the petition of Vicki Hufnagel, M.D., to reinstate her medical license. In 1989 the medical board revoked Hufnagel's license on grounds of "incompetence, gross negligence, dishonesty, false billings and medical records, and repeated acts of clearly excessive use of diagnostic procedures in her care and treatment of six patients." However, the revocation was delayed until she lost her final court appeal in 1996. In 2003, she applied for reinstatement of her license. During the interim, she had stopped practicing medicine in California but continued to advise people and had performed at least ten operations at a Mexican clinic to which she referred patients. In 2004, in the document shown below, an Administrative Law Judge concluded that Hufnagel had "not exercised good judgment by electing to do surgeries on patients in Mexico and cannot be said to be rehabilitated from her earlier unprofessional conduct." Her medical licenses in New York and Hawaii have also been revoked.

Hufnagel's Web site represents her as a "pioneer in advancing women's medicine and crusader for reproductive health rights and female reconstructive surgery." Her 1988 book No More Hysterectomies advocated unsubstantiated reconstructive procedures that she claimed would avoid the need for a hysterectomy.


BEFORE THE
DIVISION OF MEDICAL QUALITY
MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA

In the Matter of the Petition for
Reinstatement of Revoked License of:

VICKI GEORGES HUFNAGEL, M.D.
8635 West Third Street
Los Angles, California 90045,

Physician and Surgeon's
Certificate No. G-35472,

Petitioner.


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Case No. 20-2003-142902

OAH No. L-2004020260

 

PROPOSED DECISION

This matter was heard by Vincent Nafarrete, Administrative Law Judge of the Office of Administrative Hearings, at Los Angeles on March 16 - 18 and March 29, 2004. The Office of Attorney General was represented by John E. De Cure, Deputy Attorney General. Petitioner Vicki Georges Hufnagel, M.D., was present throughout the hearing and represented by William H. Dailey, Attorney at Law.

At the conclusion of the hearing, the record was held open for written argument at the request of petitioner's counsel. Thereafter, on April 12, 2004, said counsel filed a Closing Argument which was marked as Exhibit JI. On April 20, 2004, the Office of Attorney General filed its Reply which was marked as Exhibit 16.

On May 4, 2004, petitioner on her own motion filed an unsolicited letter with the Administrative Law Judge which was marked as Exhibit KK. Said exhibit was marked but not read or considered for purposes of this Proposed Decision.

Oral and documentary having been received, the Administrative Law Judge submits this matter for decision on May 4, 2004, and finds as follows:

FACTUAL FINDINGS

1. On or about March 1, 2002, petitioner Vicki Georges Hufnagel, also known as V. Georges Hufnagel, filed a Petition for Penalty Relief with the Medical Board of California, seeking reinstatement of her revoked medical certificate. On her petition, she indicated that she had not filed any prior petition for penalty relief hearings and had practiced medicine for 20 years from 1976 until 1996.

2. On or about September 6, 1977, the Medical Board of California issued physician and surgeon's certificate no. G-35472 to petitioner V. Georges Hufnagel, M.D. On September 3, 1996, said certificate was revoked.

3. Petitioner attended medical school for two years at the University of California at Davis and then obtained her medical degree from the University of California at San Francisco in 1976. She then completed a rotating internship in obstetrics and gynecology at Cedars-Sinai Medical Center and residency in obstetrics, gynecology, and gynecological oncology at the Albert Einstein College of Medicine in New York. Subsequently, she started the private practice of medicine and was affiliated with Beverly Hills Medical Center from 1981 to 1990, Temple Hospital in Los Angeles from 1990 to 1996, and Thompson Memorial Medical Center in Burbank from 1990 to 1996.

4. (A) On February 25, 1987, Accusation, Case No. D-3613, was made and filed by the Board of Medical Quality Assurance against petitioner. On December 30, 1988, after a 26-day hearing on various dates in November and December 1987 and June and July 1988, Administrative Law Judge Robert A. Neher of the Office of Administrative Hearings issued a Proposed Decision revoking petitioner's certificate, staying revocation for five years, and placing her certificate on probation for unprofessional conduct. The Proposed Decision found that petitioner, in part, knowingly made and signed documents related to the practice of medicine that falsely represented facts, created false medical records, was incompetent in recommending unnecessary procedures and sending a terrorist letter to a patient, negligent in the treatment of a patient, filed dishonest billings, and presented false or fraudulent billing claims.

    (B) On March 6, 1989, the Division of Medical Quality elected not to adopt the Proposed Decision and determined to decide the matter itself upon the record, including the hearing transcript. On August 14, 1989, the Division of Medical Quality issued a Decision in which petitioner' certificate was revoked on several grounds for her care and treatment of six patients, suspended for her care and treatment in cases of four patients, and placed on probation on certain terms and conditions for her care and treatment of two patients.

    (C) On September 8, 1989, the Division of Medical Quality granted petitioner's request and stayed execution of its Decision revoking her certificate pending filing of a petition for reconsideration. On October 4, 1989, she filed a petition for reconsideration with the Medical Board and a petition for writ of mandate and application for a stay order with the Superior Court. On May 18, 1990, the Superior Court denied her application for preliminary injunction but granted, in part, her writ of mandate by directing the Division of Medical Quality to modify its Decision by striking findings and the revocation order or by making new findings as to reasons for its disagreement with the findings of the administrative law judge. Four years later, on June 22, 1994, the Court of Appeal reversed the judgment of the Superior Court and remanded the matter to the Superior Court for further proceedings. Two years later, on September 3, 1996, the Superior Court, after finding on remand that the weight of evidence supported the findings of the Medical Board and that the order of revocation was appropriate under the totality of circumstances as shown by the evidence, denied petitioner's petition for writ of mandate and request for a stay.

5. (A) Thus, effective on September 3, 1996, in the Decision in the Matter of the Accusation against V. Georges Hufnagel, M.D., Case No. D-3613, L-39699, the Division of Medical Quality revoked petitioner's medical certificate on the grounds of incompetence, gross negligence, dishonesty, false billings and medical records, and repeated acts of clearly excessive use of diagnostic procedures in her care and treatment of six patients.

    (B) The Division determined, in part, that, on several dates in 1985, petitioner was incompetent in attempting to suture a laceration and perforation on an asymptomatic post­abortal patient seven days after the previous procedure and performing an uterine suspension on the same patient while her uterus was inflamed and subject to potential infection, performing two non-emergency surgeries on another patient on two consecutive days, excising fatty adhesions from another patient's posterior fundus. for cosmetic purposes when the procedure was inappropriate and increased the patient's risk of having more adhesions, and over-reacting to a patient's bradycardia and performing a laparatomy and continuing with multiple surgical procedures on the same patient when the presumptive diagnosis was bradycardia.

    (C) The Division further found, in part, that, in 1985, petitioner was grossly negligent in the case of one patient in failing and refusing to perform a hysterectomy upon her, refusing and failing to give the patient a clear option as to her treatment choices, and refusing to disclose the need for further surgery. The Division found she ignored the patient's condition in favor of her preconceived notions of the general state of obstetrics and gynecology in the medical community.

    (D) Moreover, the Division found that petitioner's testimony in the hearing lacked credibility and candor and her claim that the false billings and medical records were the fault of her husband not believable. She was found to show no remorse and little understanding of the effects of her conduct; she denied all knowledge of wrongdoing. According to the Decision of the Division, she presented herself as an innovator, developer of new procedures, and a crusader on the cutting edge of OB/GYN and fertility surgery but her assertions were not established by the evidence. Petitioner was found to be one of many medical professionals who believe that too many unnecessary hysterectomies are being performed and whose zeal for a personal bill of fare got in the way of sound medical judgment in some cases and the standard of care in other cases. In other cases, her overblown view of own knowledge and skill was found to have caused her to act incompetently.

6. On or about June 24, 1998, after a hearing and administrative review, the State of New York Department of Health, Board of Professional Conduct, revoked petitioner's New York medical license for unprofessional conduct based on the record of discipline from the Medical Board of California.

7. (A) At all times relevant herein, petitioner has also been licensed as a physician by the State of Hawaii. Her license from that state is in full force and effect and has an expiration date of January 31, 2006.

    (B) On January 30, 2003, the Hawaii Department of Commerce and Consumer Affairs filed a Petition for Disciplinary Action against petitioner's medical license with that state's Board of Medical Examiners. In that petition, the Hawaii department seeks discipline of her medical license based on the disciplinary actions taken by the Medical Board of California and the New York Bureau of Professional Medical Conduct and based on her alleged failure to notify the Hawaii Board of Medical Examiners of the California and New York disciplinary decisions within 30 days.

    (C) On August 18, 2003, petitioner by her counsel in Kailua-Kona, Hawaii, requested a continuance of the Hawaii disciplinary proceeding scheduled for September 2003 on the grounds that she was under medical care for a serious and chronic pulmonary problem that prevented her from traveling. The disciplinary matter on petitioner's Hawaii medical license remains pending.

8. In this proceeding, petitioner seeks reinstatement of her medical certificate, for she strongly desires to practice medicine again. Since her license was revoked in 1996, she indicates that she has not practiced medicine in this state and created protocols to prevent any reoccurrence of any medical or billing problems. If reinstated, she states she would be more selective in choosing her patients and reduce her public activities. She realizes now that she was involved in too many community or public activities which took time away from her practice and business of medicine. She continues to blame her former husband for the medical billing violations. Petitioner also states that she has been in therapy for the past several years now and is also studying Jungian psychotherapy. She contends she is rehabilitated from the conduct led to the revocation of her medical license and sees herself as a more cautious and circumspect person and a mellow, rather than ardent, advocate for women's health issues.

9. Petitioner is clearly active and involved in many community and social issues and organizations that involve women's health. Her social activities predate and have continued after the revocation of her license. She formed and assisted non-profit organizations that advocate and educate the public about women's health care issues and rights. She has presented and lectured at free seminars on women's health issues, provided information and educational materials on informed consent laws and premature births to African American women, and provided free health care in Hawaii. Petitioner has also proposed and advocated for changes in the informed consent laws to help and educate women, in part, about the conservation and repair of organs. In addition, respondent has created the Organization for Post- Tubal Women and presented educational information in the news and media about the disadvantages of tubal ligation. Petitioner has written and lectured extensively on women's health issues and published follow-up books and articles on her book, No More Hysterectomies, which was published in 1988 and has been translated into other languages. Moreover, she has written books on female reconstructive surgery, conducted research and obtained license rights for the use of the argon beam in surgery, and worked on hormonal therapy.

10. (A) With her reinstatement petition, petitioner has submitted letters of recommendation from two physicians. She prepared and placed the letters on diskettes and then gave the diskettes to the two physicians for their review and signatures.

      (B) Robert Mitchell Karns, M.D., testified at the hearing. He admitted that he signed his letter of reference but recanted major portions of his letter. While he agreed that petitioner was a pioneer physician or surgeon who should be able to practice medicine again, Dr. Karns indicated he had no knowledge of her gynecological skills or knowledge and was not well aware of the charges brought against her by the Medical Board. He was not aware that petitioner did work in the African American community. Dr. Karns further stated that, contrary to the statement in his letter, he does not know for a fact that she handled the most complex and difficult cases or had the lowest complication rate among surgeons at the Beverly Hills Medical Center where he was chief of staff in the mid to late 1980's. Dr. Karns did indicate that petitioner was continuously reviewed by the surgical committee and her work was satisfactory. Dr. Karns testified that he had no knowledge that petitioner is incapable of practicing medicine again.

     (C) Hal C. Danzer, M.D., has known petitioner since residency in 1978 and is her current gynecologist. He previously worked with her on many surgical cases on which she demonstrated competence, excellence in reparative gynecology, and creativity in her surgical approach. Dr. Danzer testified that petitioner has very likely retained her technical skills since her license was revoked but would need remedial training and practice monitoring. Dr. Danzer indicated that, if she were to be licensed again, petitioner may be better suited to practice medicine in an office setting specializing in gynecology as opposed to having to a surgical practice.

11. On or about November 20, 2001, the Medical Board by Enforcement Section investigators conducted a search of petitioner's Los Angeles home pursuant to a search warrant issued upon a finding of probable cause by a magistrate. The affidavit for the search warrant alleged, in part, that she was practicing medicine without a license and had performed surgeries on women in Tijuana, Mexico. The search warrant authorized a search of her home for client or patient records, medical records and billings, business records, medical equipment, and electronic storage devices. The Medical Board investigators seized and have retained sundry books, records, and computer equipment. Petitioner complains that the investigators ransacked her home and have not returned records and computer equipment belonging to her. No charges have been filed and no allegations raised in this proceeding as  a result of the search and seizure. Petitioner has, however, been involved in surgical procedures in Mexico.

12. With respect to surgeries in Tijuana, petitioner claims that she acted as a surgical consultant to licensed Mexican physicians who conducted the preoperative physical examinations and diagnostic tests and took the medical histories of the patients. She asserts that she reviewed the medical records and then taught and explained the surgical procedures to the Mexican physicians. She explains that patient advocates from the Hufnagel Institute helped the patients obtain the surgical appointments at the Villa Floresta hospital in Tijuana and directed the patients to complete a patient questionnaire, read informed consent forms, obtain their medical records, consult with their own physicians, and watch two movies including "Erin Brockovich". After the surgeries, petitioner explains that the Mexican physicians made orders for the post-operative hospital care of the patients who consulted with their own doctors when they returned home. Petitioner indicated that she then advised the patients' primary physicians on any issues of post-operative care. She contends that she participated in the surgeries pursuant to protocols and agreements developed with the Mexican physicians and was authorized to do so by her medical license from Hawaii. She was paid $15,000 by the patients for each surgery and set up a billing system in California to collect fees from patients. Petitioner was not completely candid about the level of her participation in those surgeries in Mexico.

13. (A) In the fall of 2001, DS met petitioner at a restaurant in the San Fernando Valley. DS told respondent of her severe uterine fibroid tumors and her desire to save her organs without a blood transfusion due to religious beliefs. Petitioner informed DS that she was not practicing medicine and recommended that DS read her books and access her internet website.

     (B) Two months later, DS contacted petitioner again because she wanted something done for her condition. Petitioner advised DS to call the medical director at the Villa Floresta Medical Center in Tijuana, Mexico, and set up an appointment for surgery. In April 2002, DS went to Tijuana with her medical records and was admitted and received a pre-operative examination at the Villa Floresta hospital. After a one-week stay in said hospital, DS underwent a surgical procedure for removal and treatment of her uterine fibroids. Petitioner performed the surgery and used an argon beam to cauterize and stop any bleeding. Petitioner was assisted by a team of physicians from the hospital. DS received post-operative care for another week at the hospital.

     (C) DS's surgery cost approximately $30,000. DS paid the hospital charges directly to Villa Floresta Medical Center and the balance of her surgery cost through a billing company. DS's health insurance company declined to pay for the procedure. DS would not have undergone the procedure in Mexico if petitioner was not present during the surgery.

She relied upon petitioner's expertise and training in deciding to have the surgery.

14. (A) On an undetermined date in 2002, DB called and asked petitioner if she was still practicing medicine because DB needed help for her severe uterine fibroids. DB lived in Florida and had been told by doctors there that she needed to have a hysterectomy. However, DB had read respondent's book No More Hysterectomies and did not want to have one. Petitioner told DB of the status of her California medical license and said she did not advise or treat any patients in California.

     (B) In the summer of 2002, DB flew to San Diego and met petitioner and the surgical team at the hospital of Villa Floresta Medical Center in Tijuana. There, DB was seen by Mexican physicians, including a gynecologist and hospital medical director. Petitioner performed surgery on DB to remove her uterine fibroids with the assistance of an anesthesiologist and other hospital staff physicians.

     (C) Afterwards, DB was pleased with the results of her surgery and paid the hospital and respondent for the costs of the surgical services. DB would not have undergone the procedure in Mexico if petitioner had not been involved in the surgery.

15. (A) On an undetermined date in 2001, SM called petitioner from New Mexico and talked to petitioner about her condition of a prolapsed uterus. SM had read respondent's book. SM provided petitioner with her medical history. Petitioner advised SM that she was not licensed as a physician in California but could perform surgery on her in Mexico with other physicians present in the operating room.

     (B) On or about June 7, 2001, SM traveled to Tijuana, Mexico, and was admitted to the hospital at the Villa Floresta Medical Center. On June 7, SM signed an "Authorization for Female Reconstructive Surgery" and gave her medical history to the hospital medical director. Thereupon, SM underwent surgery for vaginal, perineal, abdominal wall, and uterine prolapse and uterine fibroids; petitioner performed the surgery and prepared the operative report for the "Hufnagel Procedure". Other physicians from the Villa Floresta hospital assisted petitioner and prepared the operative and post-operative notes and post­operative orders.

     (C) On June 8, 2001, SM paid $7,500 to the Villa Floresta Medical Center and $12,500 to petitioner for the surgery. SM received a discount of$5,000 for agreeing to be an advocate and write letters, speak to others, and appear in a video about petitioner's surgical services. The balance of $14,000 owed to petitioner for the surgery was to be paid to the medical billing company, but SM later refused to pay the balance when she did not receive medical records from petitioner to obtain reimbursement for the procedure from her health insurer. Petitioner had advised SM that Medicare would reimburse her for her procedure performed in Mexico. However, SM did not receive any reimbursement from Medicare.

16. (A) In or about early 2001, PN first called petitioner from her home in Vallejo after reading her book and viewing her website. PN spoke to petitioner about her uterine fibroids. At some undetermined time, petitioner advised PN that she would have to go to Mexico for the procedure and that other physicians would be present because she was not licensed in this state. In April 2001, petitioner invited and allowed PN to observe her perform surgery in Mexico. PN decided to have the surgery based, in part, on petitioner's representations that the procedure would be bloodless due to use of a laser. PN sent her medical records to petitioner.

     (B) On or about June 8,201, PN traveled to Tijuana with her daughter and was admitted to the hospital at the Villa Floresta Medical Center. PN provided her pre-surgical medical history and information to the hospital medical director and signed an "Authorization for Female Reconstructive Surgery". PN indicated that her health problem was fibroids in her uterus, heavy bleeding, and pain and gave blood for laboratory analysis.

     (C) On June 9, 2001, at the Villa Floresta Hospital in Tijuana, petitioner performed the surgical removal of fibroids, adhesions, and ovarian cysts from PN. Physicians affiliated with said Mexican hospital assisted petitioner during the procedure and took medical or surgical notes in Spanish. Petitioner completed the operative report for the procedure and made after-care orders in English. Petitioner also advised PN to see her own physician for follow-up care.

     (D) On June 8, 2001, PN paid Villa Floresta Medical Center $100 for two night's accommodations for her daughter and $7,500 for her hospital costs and medical services. PN also paid $12,000 to petitioner for the surgery. PN received a $5,000 discount from petitioner after agreeing to publicize her surgical expertise and to recommend her to other persons. Pursuant to the agreement, PN spoke about her surgery on two radio talk shows.

     (E) After her surgery, in or about June 2001, PN had difficulty obtaining any reimbursement for her procedure from her health insurance company. Petitioner did not send her an itemized billing statement or return her telephone calls. PN could not download the billing forms from petitioner's internet website. PN thought her surgery was a success but was dissatisfied with petitioner's billing system or billing practices.

17. On an undetermined date, CT underwent a surgical procedure in Tijuana.  Petitioner performed the procedure on CT. She gave CT a copy of the operative report. She also helped CT to file a medical claim and with her billing system. CT did not obtain reimbursement for the procedure from her health insurance company.

18. (A) Based on Findings 12 - 17 above, after her California medical certificate was revoked, petitioner has performed surgery on female patients at a hospital in Tijuana while assisted by physicians and medical staff of the hospital. Petitioner has admitted to having performed between ten to 50 procedures in Mexico.

     (B) While she claims to have performed the surgeries pursuant to protocols developed with the Mexican hospital and/or physicians, it was not established what the terms and conditions petitioner operated under in the Mexican hospital. Nor was it established that petitioner had any medical liability or malpractice insurance when she performed the surgeries or that any of her surgical patients were able to obtain reimbursement for their procedures from health insurance companies. Petitioner performed the surgeries in Mexico not only because she wanted to help the female patients but also because she needed the money.

* * * * * * *

Based on the foregoing findings of fact, the Administrative Law Judge makes the following determination of issues:

LEGAL CONCLUSIONS

1. Grounds do not exist to reinstate petitioner's medical certificate pursuant to Business and Professions Code Section 2307 and Government Code Section 11522 in that it was not established that petitioner is rehabilitated from her prior unprofessional conduct which was the cause for the revocation of her medical certificate, as set forth in Findings 7 ­18 above.

2. Discussion—It has been eight years since the revocation of petitioner's medical certificate and 16 years since the administrative hearing in the matter of the accusation against her. Petitioner has continued her social and community-minded activities to educate the public on women's health issues and advocate for changes in the way that the surgeries on women are viewed and conducted by medical practitioners. She has strongly-held beliefs about the efficacy of hysterectomies and the surgical removal of women's organs. She has written and spoken extensively on the subject and lobbied for changes in the informed consent laws for such procedures. Petitioner's leadership and involvement in women's health issues and organizations coupled with the passage of time constitute evidence of her rehabilitation from her prior unprofessional conduct.

On the other hand, petitioner has seemingly continued to advance her beliefs on gynecology and female surgery and her position as a cutting-edge innovator of surgical techniques at the expense of the public. When her license was revoked, the Medical Board determined that, in one instance, petitioner refused to perform a hysterectomy on a patient and ignored the patient's medical condition in order to follow or impose her personal beliefs. The Medical Board also found she allowed her personal agenda regarding female surgery to interfere with sound medical judgment and the standard of care. Now, it has come to light that petitioner has continued her efforts to change or innovate what she calls female reconstructive surgery by performing surgery out of this country.

In the last few years while her license has been revoked, petitioner has been performing surgeries on women at a hospital in Tijuana, Mexico. It was not established that she is practicing medicine in this state but she is using her publications, internet websites, and staff of her non-profit organization to solicit patients for surgery, obtain medical information or histories, and arrange for the patients to travel to Tijuana for surgery for uterine fibroids or other gynecological conditions. She has not necessarily been treating or caring for patients from her home in Los Angeles but she has certainly been advising them to undergo surgery in Mexico where she has agreements with a hospital and physicians. Her patients have come from California and other states and petitioner has set up a billing system in this state to collect fees from the patients.

Regardless whether or not the patients are happy with the results of the surgeries, however, the problem with the procedure that petitioner has been following to perform surgery in Mexico is that it was not shown that the patients are protected against unfavorable results either by any liability or malpractice insurance or the skills and competencies of the hospital staff or any of the physicians including petitioner. It was not shown that petitioner herself carries any liability insurance to perform surgery in Mexico or has been able to maintain her surgical skills and knowledge since her license was revoked. One of physicians from whom she obtained a letter of reference indicated that petitioner would likely need remedial training and may not be suited to a surgical practice. Moreover, some of the patients are unhappy with the surgeries because they were led to believe that their health insurance companies would reimburse them for the costs. Consequently, petitioner in her desire to perform her female reconstructive surgery in order to help women as well as to earn money for herself and her family has clearly placed these surgical patients at risk to possible surgical complications and actual monetary losses. As such, petitioner has not exercised good judgment by electing to do surgeries on patients in Mexico and cannot be said to be rehabilitated from her earlier unprofessional conduct.

* * * * * * * .

Wherefore, the following Order is hereby made:

ORDER

The Petition for Reinstatement of Revoked License filed by petitioner Vicki Georges Hufnagel, 8635 West Third Street, Los Angeles, California 90048, must be denied, based on Conclusions of Law nos. 1 - 2, jointly and for all.

Dated: June 3, 2004

Vincent Nafarrete
Administrative Law Judge
Office of Administrative Hearings

This page was posted on February 4, 2008.

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