An obstetrician formerly employed at Eastern Niagara Hospital has lost his medical license after state health officials upheld charges of gross negligence and gross incompetence in two childbirths in 2012 and 2013.
According to a determination and order from the New York State Department of Health's Board of Professional Medical Conduct, Mohamed A.H. Khalaf was found guilty Jan. 8 of nine misconduct charges related to his care of two diabetic patients, including being absent during delivery and not monitoring one patient's blood sugar levels.
In the latter case, the woman went into diabetic ketoacidosis — a life-threatening condition brought on by extremely high blood sugar — just before giving birth.
In both cases, the newborns died.
An ENH spokesperson said Khalaf had not worked at ENH since 2013. She did not answer a question seeking the beginning and end dates of his employment at ENH.
Khalaf was providing gynecological and obstetrical care at ENH in February 2011 when he began treating a diabetic who later became pregnant.
The morning of Dec. 29, 2012, the patient, then 16, was admitted to ENH in early labor at 23 weeks gestation. Khalaf ordered nursing staff to induce delivery and then left, having instructed nursing staff to handle the delivery. The baby was not expected to survive.
Khalaf also issued postpartum orders at 2 p.m., nearly three hours before the delivery took place. Forty-five minutes after delivery, the child was pronounced dead. Khalaf visited the patient several hours after delivery, but did not conduct an examination and failed to document the visit.
The next morning, Khalaf ordered the patient to be discharged without visiting or examining her. However, he entered a falsified discharge note claiming that he had examined her.
Khalaf's witness in the misconduct hearings held last year in Albany claimed Khalaf did not need to be present for the delivery.
"There is nothing, in standard of care [sic] that I'm aware of, that necessitates a physician to be present for the delivery as long as everybody is in agreement," Dr. Gil Farkash told the Board of Professional Medical Conduct.
Neither Khalaf nor his attorney, James Lantier of Syracuse, could be reached for comment as of press time Thursday.
The board found "no credible evidence that anyone other than (Khalaf), let alone 'everybody,' was in agreement" that Khalaf need not be present for the delivery. The board also found no evidence that Khalaf had discussed it with the patient's family.
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The second misconduct case involved a 27-year-old with obstetrical complications, whom Khalaf treated at ENH and his office, at Lockport Primary Care, from June to November 2013.
Two urine tests, on Oct. 16 and Nov. 13, identified elevated glucose levels, yet Khalaf did not test, evaluate or manage her for high blood sugar during those visits.
On Nov. 8, a glucose tolerance test showed fasting glucose of 241 milligrams per deciliter and a one-hour glucose measurement of 358 mg/dl. (The American Diabetes Association recommends a fasting blood sugar below 130 mg/dl and below 180 mg/dl after eating.) But Khalaf did not manage or treat her for gestational diabetes.
The patient returned to Khalaf's office Nov. 27 complaining of abdominal pain, nausea and vomiting. She had lost 15 pounds in the prior two weeks, yet Khalaf did not test her blood sugar levels. By that point, the patient was about 29 weeks pregnant.
The next morning, the patient was admitted to ENH with fever and chills along with the same symptoms from the night before. Khalaf left testing and evaluation to hospital staff, and never checked to ensure they did, the conduct board found.
Hospital staff measured her blood sugar level at 554 mg/dl and advised Khalaf that she was "very sick." By the time Khalaf arrived at ENH, the patient had been transferred to the intensive care unit. She was then transferred to Women & Children's Hospital of Buffalo, where she was found to be in diabetic ketoacidosis. The next day she was transferred to Millard Fillmore Hospital, where she underwent a Caesarian section. Four hours later, the child died.
While Dr. Farkash dismissed the value of a pair of particular glucose tests not ordered by Khalaf, Khalaf told the board that he had ordered other glucose tests for the patient on two occasions and she did not comply. The conduct board said that was "no excuse at all."
"Patient B needed far more aggressive and immediate management and treatment for her very high blood sugar levels, including daily blood sugar testing, than was given by (Khalaf)," the board wrote.
Meanwhile, Khalaf said he prescribed metformin, a pill-form alternative to injectable insulin, which he said the patient refused. He also claimed he had ordered a glucometer (for self-testing), told the patient to get one, and gave diet and other counseling.
The conduct board found no evidence that Khalaf had ordered a glucometer, nor evidence to support any of Khalaf or Farkash's other claims.
"She needed proper instruction in all aspect of her diabetic management, including proper diet, use of a glucometer, frequent reporting of daily blood sugars and probably insulin," the board wrote. "The blood sugar monitoring from Nov. 8-27 was egregiously inadequate."
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The board sustained two charges of gross negligence, one of two charges of gross incompetence, one charge of "gross negligence on more than one occasion" and one charge of "incompetence on more than one occasion." It also sustained charges of failure to maintain records, improper delegation and fraudulent practice.
The charges appear to follow a pattern of misconduct by Khalaf, who received his license to practice medicine in 1996. In 2006, Khalaf received a five-year suspension over a charge of negligence and failure to maintain records. The board said those charges were "remarkably similar" to the latest complaints. That suspension was stayed with probation and practice monitoring for five years.
What's more, in September 2017 while the charges against Khalaf were pending, another woman, Brandi Brege, told WKBW-TV about a frightening experience she had with the doctor at ENH-Newfane over seven years ago. Brege was in labor and she said Khalaf broke her water about 10 a.m. then left and did not return until about 6 p.m.
“It's terrifying. I could feel the baby coming. I was in pain for hours just waiting to deliver,” Brege said. “Oh, oh my God, it was so terrible; it was the worst pain ever. It felt like my skin was ripping open — and it was.”
When Khalaf did finally return, Brege said, he declared that she was not ready to deliver and planned to go into the break room and make a sandwich. But a nurse confronted Khalaf.
“She said, 'You deliver this baby or I will, right now,'” Brege said.
Brege, who could not be reached for comment on Thursday, told WKBW that her story was another reason why Khalaf should be barred from practicing medicine.
“To be a doctor is to care for someone, to take care of them," she said. "I don't think he should be a doctor at all."