Filed 10/2/19; Certified for publication 10/29/19 (order attached)

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION TWO

DEAN GRAFILO, as Director, etc.,

Plaintiff and Respondent,

v.

EMIL SOORANI,

Defendant and Appellant;

KIMBERLY KIRCHMEYER,

as Executive Director, etc.,

Real Party in Interest.

 B286912

 (Los Angeles County

 Super. Ct. No.

 BS171127)

APPEAL from an order of the Superior Court of 

Los Angeles County. Daniel S. Murphy, Judge. Affirmed.

Fenton Law Group, Benjamin J. Fenton, Dennis E. Lee and 

Alexandra de Rivera, for Defendant and Appellant.

No appearance for Plaintiff and Respondent.
2

Xavier Becerra, Attorney General, Gloria L. Castro, 

Assistant Attorney General, Judith T. Alvarado and 

Christina Sein Goot, Deputy Attorneys General, for Real Party in 

Interest.

______________________________

Dr. Emil Soorani appeals from an order compelling the 

production of his patients’ medical records to the Medical Board 

of California (the Board). We affirm.

FACTUAL AND PROCEDURAL BACKGROUND

I. The Board’s Investigation

Dr. Soorani is a psychiatrist who has been licensed by the 

Board as a physician and surgeon since 1981.

After receiving “information that Dr. Soorani may be 

overprescribing controlled substances[,]” the Board initiated an 

investigation. The Board obtained a Controlled Substance 

Utilization Review and Evaluation System (CURES)

1 report

detailing Dr. Soorani’s prescribing history between June 1, 2012, 

1 CURES “is California’s prescription drug monitoring 

program. By statute, every prescription of a Schedule II, III, or 

IV controlled substance must be logged in CURES, along with the 

patient’s name, address, telephone number, gender, date of birth, 

drug name, quantity, number of refills, and information about 

the prescribing physician and pharmacy. [Citation.]” (Lewis v. 

Superior Court (2017) 3 Cal.5th 561, 565 (Lewis).) The Board is 

authorized to access the CURES database (id. at p. 567), which is 

maintained by the California Department of Justice (id. at 

p. 566).
3

and June 16, 2015. Dr. Jill Klessig, the Board’s medical 

consultant, reviewed the CURES report and identified six of 

Dr. Soorani’s patients—T.M., L.R., A.S., M.J., R.B., and A.D. 

(collectively, the six patients)—who were prescribed controlled 

substances in large quantities or with “erratic patterns.” In 

Dr. Klessig’s opinion, obtaining and reviewing the medical 

records of the six patients were necessary to determine whether 

Dr. Soorani was excessively prescribing controlled substances in 

violation of the Medical Practice Act (Bus. & Prof. Code, § 2000 

et seq.).

In April 2016, a Board investigator sent letters to the six 

patients requesting that they contact him to schedule an 

interview “concerning the care and treatment” they received from 

Dr. Soorani. A medical release form was enclosed that, if signed, 

would authorize Dr. Soorani to disclose all of their medical 

records to the Department of Consumer Affairs, Division of 

Investigation (DOI), Health Quality Investigation Unit.2 Also 

enclosed was a “Notice to Medical Consumers” (capitalization 

omitted) explaining that patient records reviewed in connection 

with DOI investigations “are kept confidential and no 

information about the patient’s care is disclosed to the general 

public . . . .” Although patient records could become part of the 

official record of a legal proceeding, “[e]ven then, efforts are made 

to protect the privacy and identity of the individual patients.” 

The six patients were advised that, if they exercised their “right 

not to consent to the release[,]” DOI would “take the necessary 

2 The Board is a unit of the Department of Consumer Affairs. 

(See Bus. & Prof. Code, § 2001, subd. (a).)
4

steps to subpoena the . . . records.” The Board did not receive a 

signed authorization form from any of the six patients.

In September 2016, an investigator issued investigational 

subpoenas duces tecum (the subpoenas) commanding Dr. Soorani 

to produce the following for each of the six patients: “A certified 

copy of the documentation supporting your rationale for the 

prescriptions you wrote for the patient . . . between the dates 

[June 1, 2012] through [September 12, 2016], including the 

different medications, doses, and refills. Documentation includes 

treatment notes that support the differential diagnosis for the 

medications, the treatment plan and orders, and all follow up 

including reviews of vital signs, patient complaints of side effects 

of medications, laboratory tests to ensure drug efficacy and to 

rule out drug toxicity, and physical examinations.” (Bolding 

omitted.) Each of the six patients was sent a copy of the 

subpoena seeking his or her records, as well as a notice advising 

of the right to object.

Approximately one week later, Dr. Soorani’s attorney sent 

a letter to the Board’s investigator stating that the doctor would 

not produce the medical records sought by the subpoenas without 

patient authorization and invoking the psychotherapist-patient 

privilege (Evid. Code, § 1010 et seq.) and the right to privacy 

under article I, section 1 of the California Constitution. 

Dr. Soorani’s attorney enclosed letters from four of the six 

patients indicating that they did not authorize disclosure of their 

medical records.

II. Petition to Compel Compliance with the Subpoenas

In October 2017, more than a year after the deadline to 

comply with the subpoenas had passed, the director of the 

Department of Consumer Affairs petitioned the trial court for an 
5

order requiring Dr. Soorani to produce the subpoenaed medical 

records. (Gov. Code, §§ 11186, 11187.)

A. Dr. Klessig’s declaration

In support of the petition, the Board submitted a 

declaration from Dr. Klessig, in which she opined that good cause 

existed to believe that Dr. Soorani violated the Medical Practice 

Act and “was practicing medicine outside the standard of care 

when he prescribed narcotics, sedative agents and other 

controlled substances to patients in large amounts.” Obtaining 

the medical records of the six patients was “[t]he only way to 

ascertain whether this is true . . . .” Dr. Klessig detailed the 

following prescribing irregularities regarding the six patients 

that she found in the CURES report.

1. Patient T.M.

According to Dr. Klessig, Dr. Soorani excessively and 

erratically prescribed multiple stimulant and sedative 

medications to T.M.

T.M. was prescribed Vyvanse, “an amphetamine-like 

stimulant” used to treat attention deficit hyperactivity disorder 

(ADHD). Although the maximum daily dose of Vyvanse is 60 to 

70 milligrams, T.M. received 30, 60-milligram tablets, followed 

only 14 days later by another 30, 70-milligram tablets—

effectively “twice the maximum safe dose.” The next month, T.M. 

“switched to amphetamine salts,” but several months later he 

was prescribed the maximum recommended doses of both 

Vyvanse and the amphetamine salts.

T.M. was also prescribed a “very large” two-milligram dose 

of clonazepam, a sedative used to treat panic disorders and 

seizures—problems that “can be worsened by amphetamine use.” 
6

He also received oxycodone and OxyContin—both “strong 

narcotics.”

A few months later, T.M. was prescribed a transdermal 

fentanyl patch, “an extremely potent narcotic with a very high 

risk of unintentional death.” This drug “is only indicated when 

other means of pain management have failed[.]” On the same 

day, he received another prescription for oxycodone, which “in 

combination with the clonazepam was unsafe.”

A month later, T.M. received a fentanyl refill and a new 

prescription for Subsys, another form of fentanyl. Although the 

recommended starting dose of Subsys is 100 micrograms, T.M. 

was given a 600-microgram dose. Several months later, T.M. was 

given 30 doses of 1,200 micrograms. “At the maximum safe 

dose, . . . this should have lasted 7.5 days.” Yet he was prescribed 

another 30 doses only two days later. In the following week, T.M. 

was given an additional 60 doses, followed by 120 doses the next 

week, and another 120 doses two weeks after that.

Dr. Soorani also prescribed T.M. a stimulant used to treat 

sleep disorders at the highest dose while the other stimulants he 

had previously been prescribed at high doses were continued. In 

addition, T.M. received prescriptions for depo-testosterone at an 

interval that suggested “either there was no medical need for it in 

the first place or he was not receiving appropriate 

supplementation.”

In Dr. Klessig’s opinion, “there was a high chance of a 

lethal outcome if” T.M. had taken the medications as prescribed 

to him.
7

2. Patient L.R.

Dr. Soorani allegedly prescribed L.R. “potentially 

dangerous combinations of medications[] . . . with unclear 

medical justification.”

L.R. “received excessive amounts” of methylphenidate, a 

stimulant that could be sold on the street for a few dollars. She 

filled three prescriptions on the same day for a total of 210 pills. 

Although this amount should have lasted 70 days “at the 

maximum safe/recommended dose[,]” she filled the prescriptions 

for another 210 pills only 19 days later.

She was also given amphetamine salts and lorazepam, a 

sedative, with a high starting dose. Another sedative, 

clonazepam, was added while L.R. was “still being prescribed the 

lorazepam.”

She also received 120 tablets of oxycodone at three times 

the usual starting dose even though there was no indication that 

a milder narcotic had been tried first. In addition to the 

oxycodone, Dr. Soorani eventually prescribed L.R. OxyContin. 

While the standard of care requires a slow withdrawal of 

narcotics, L.R.’s narcotic prescriptions stopped abruptly.

3. Patient A.S.

A.S. was prescribed frequent, large amounts of zolpidem, a 

sedative used for sleep. He received 30 tablets of the maximum 

daily recommended dose, but only 11 days later he filled another 

prescription for 30 tablets of a slightly higher dose. He received 

30 more tablets 11 days later, followed by 30 more 11 days after 

that, and another 30, yet again, 11 days later. A.S. continued to 

refill the zolpidem as often as every eight days for an unspecified 

duration. He was also given a prescription for 100 tablets of 
8

clonazepam, which “in combination with the very large doses of 

zolpidem could result in serious oversedation.”

4. Patient M.J.

M.J. was prescribed the sedatives clonazepam and 

zolpidem, which if combined could result in oversedation. At age 

63, he was “at a much higher risk of hidden coronary artery 

disease or vascular disease[,]” and therefore his use of any 

stimulant required caution. Instead, M.J. was given erratic 

amounts of amphetamines, with “dosage changes [that] were not 

done slowly or in a linear fashion.”

5. Patient R.B.

R.B. was given large amounts of the narcotic Endocet, a 

combination of oxycodone and acetaminophen. Six days after 

receiving 50 Endocet tablets, he was given another 170 tablets. 

Twenty days later, R.B. received another 180 tablets. The result 

was “a daily dose of [acetaminophen] well in excess of that 

considered safe.” R.B. was also prescribed oxycodone without 

acetaminophen, OxyContin, and fentanyl. If taken as prescribed, 

this combination of narcotics “would potentially result in a high 

risk of oversedation.”

R.B. was also prescribed “testosterone in a very erratic 

pattern.”

6. Patient A.D.

A.D. received numerous prescriptions for narcotics, 

including 180 oxycodone/acetaminophen tablets followed by 

another 170 tablets only 14 days later. In addition, she was 

given sedatives such as zolpidem, clonazepam, and diazepam. In 

a period of less than three months, A.D. received 240 tablets of 

the normal daily dose of zolpidem. The combined amount of 
9

medication prescribed “put her at high risk for oversedation, 

respiratory sedation, and/or unintentional overdose.”

B. Dr. Soorani’s opposition

Dr. Soorani opposed the petition and offered several 

declarations in support of his position.

1. Dr. Soorani’s declaration

Dr. Soorani provided details about his professional 

qualifications and areas of expertise. He has been “practicing 

pain medicine treating patients with grave psychiatric illness 

since 1982.” With an expertise in psychopharmacology, he has “a 

thorough knowledge of every antidepressant on the market since 

1989.” In 1994, Dr. Soorani became an assistant clinical 

professor of psychiatry at the Geffen School of Medicine at UCLA, 

and has taught medical students interviewing techniques for 

diagnosis and treatment, as well as psychopharmacologic 

management. As a “speaker for numerous pharmaceutical 

companies,” he has instructed other physicians on new 

medications, including Vyvanse, OxyContin, Ambien (zolpidem), 

Xanax (alprazolam), and Actiq (fentanyl citrate).

Dr. Soorani denied overprescribing medication to any 

patient, including the six patients identified by Dr. Klessig. He 

disputed Dr. Klessig’s competency as an expert, stating that 

“[s]he does not appear to have the necessary expertise in 

psychopharmacology or psychiatry . . . .” Four of the six patients 

directed Dr. Soorani “to protect their private medical and 

psychiatric records from disclosure.” The other two patients had 

not provided their consent to the disclosure.

2. Dr. O’Carroll’s declaration

Dr. Soorani submitted the declaration of Dr. C. Philip 

O’Carroll, a physician triple board certified in internal medicine, 
10

psychology and neurology, and pain management, who 

specializes in treating patients with chronic pain and psychiatric 

issues. He opined that Dr. Klessig’s reported findings from the 

CURES report were insufficient to conclude that Dr. Soorani 

overprescribed “or engaged in any inappropriate treatment.”

He explained that pain specialists “see the most complex 

and extreme pain disorders[,]” and that he had “on many 

occasions . . . prescribed doses of medication that are well outside 

the norm.” “Without a thorough understanding of the clinical 

scenario,” according to Dr. O’Carroll, “it is impossible to make a 

[judgment] regarding appropriate dosing.”

He also found Dr. Klessig’s qualifications as an expert 

lacking, stating that she did “not appear to have the minimal 

education, training and experience one would expect a physician 

opining on such matters to have.” Because Dr. Klessig was not a 

pain specialist or psychiatrist, she would have “little insight into 

the complexity of the patients that [such doctors] confront on a 

daily basis.” Dr. O’Carroll also disputed the accuracy of 

Dr. Klessig’s statement regarding the effect of stimulants on 

seizures in ADHD patients.

3. Patient declarations

Dr. Soorani also provided declarations from three of the six 

patients, each strongly objecting to the disclosure of their medical 

records.

Patient M.J. described Dr. Soorani as “a thorough and 

conscientious doctor[,]” who explained the purpose, side effects, 

and alternatives to the medications he prescribed. M.J.’s primary 

care physician knew about the medications prescribed by 

Dr. Soorani and never expressed any concern. M.J. had “shared 

private information about [his] relationships, medical history, 
11

thoughts and feelings” with Dr. Soorani that he wanted protected 

from disclosure. He believed that he knew who had provided the 

information to the Board that Dr. Soorani allegedly 

overprescribed medications. That person “tried to blackmail” the 

doctor and M.J.

Patient R.B. explained that he had been severely injured in 

a car accident when he was a teenager, which resulted in 

numerous surgeries. As a result, he “live[d] in constant and 

severe pain[.]” R.B.’s rheumatologist, dermatologist, 

endocrinologist, and orthopedist knew about the medications 

prescribed to him by Dr. Soorani and believed them to be 

“appropriate and necessary to treat [his] complex medical 

condition.”

Patient A.D. suffered from degenerative disc disease and 

severe arthritis, causing her “excruciating pain[.]” She described 

Dr. Soorani as “the kindest, most gentle soul that [she had] ever 

met.” He was “not just a man who pull[ed] his patients in the 

room and wr[ote] them prescriptions”; rather, he listened and 

tried to help patients better themselves. For example, 

Dr. Soorani had introduced A.D. to yoga. A.D.’s “life would be 

destroyed if [her] records became public”; she had just concluded 

a custody dispute with her ex-husband, and she was “terrified 

that he w[ould] misuse and mischaracterize” her medical 

information before the family court.

C. The trial court’s order

The trial court granted the petition. While recognizing that 

the six patients “undoubtedly have a privacy interest in their 

medical records,” the court found that disclosure was “clearly 

justifie[d]” because of the state’s “compelling interest in ensuring 

that the medical care provided by physicians conforms to the 
12

applicable standard of care.” The court concluded that “[w]hile 

Dr. Klessig’s declaration may not prove that a violation occurred, 

it [was] sufficient to establish a reason to suspect that a violation 

occurred.” The court ordered Dr. Soorani to produce the 

subpoenaed records within 10 days.

This timely appeal followed.

DISCUSSION

I. When the Board Seeks Psychiatric Records, It Must 

Demonstrate a Compelling Interest to Overcome a

Patient’s Right to Privacy.

Privacy is an inalienable right under the California 

Constitution. (Cal. Const., art. I, § 1; Lewis, supra, 3 Cal.5th at 

p. 569.) It is well established that the right to privacy extends to 

medical records (Cross v. Superior Court (2017) 11 Cal.App.5th 

305, 325–326 (Cross)), which may contain “matters of great 

sensitivity going to the core of the concerns for the privacy of 

information about an individual.” (Wood v. Superior Court (1985) 

166 Cal.App.3d 1138, 1147 (Wood).)3 The privacy interest in 

psychiatric records is particularly strong and, in some respects, 

entitled to more robust protection than other types of medical 

3 The California Supreme Court disapproved Wood, supra, 

166 Cal.App.3d 1138 and Board of Medical Quality Assurance v. 

Gherardini (1979) 93 Cal.App.3d 669 (Gherardini) to the extent 

that those cases “require a party seeking discovery of private 

information to always establish a compelling interest or 

compelling need[.]” (Williams v. Superior Court (2017) 3 Cal.5th 

531, 557 & fn. 8, italics added (Williams).) Wood and Gherardini

were not overruled on any other ground, and we rely on them for 

other propositions. (Grafilo v. Cohanshohet (2019) 32 

Cal.App.5th 428, 437, fn. 2 (Cohanshohet).)
13

records. (See In re Lifschutz (1970) 2 Cal.3d 415, 421–422, 434–

435, fn. 20; Susan S. v. Israels (1997) 55 Cal.App.4th 1290, 1298–

1299.)

But the privacy right is not absolute and at times must 

yield to other important interests. (Hill v. National Collegiate 

Athletic Assn. (1994) 7 Cal.4th 1, 37 (Hill); People v. Stritzinger

(1983) 34 Cal.3d 505, 511.) One such countervailing concern is 

“the State of California[’s] . . . most legitimate interest in the 

quality of health and medical care received by its citizens[.]” 

(Gherardini, supra, 93 Cal.App.3d at p. 679.) The Board is a 

primary instrument through which the state addresses that 

interest. (See Arnett v. Dal Cielo (1996) 14 Cal.4th 4, 7–10 

(Arnett).)

The Board “is charged with protecting the public through, 

among other things, issuing medical licenses and certificates, 

reviewing the quality of medical practice carried out by licensed 

physicians, and enforcing the disciplinary and criminal provisions 

of the Medical Practice Act[.]” (Cross, supra, 11 Cal.App.5th at 

p. 311; see also Bus. & Prof. Code, § 2004.) The Board has broad 

investigative powers to accomplish its mandate, including the 

authority to issue investigative subpoenas. (See Bus. & Prof. 

Code, § 2220; Gov. Code, §§ 11180, 11181; Arnett, supra, 

14 Cal.4th at pp. 7–8.) The Board may seek records of 

noncomplaining patients (Wood, supra, 166 Cal.App.3d at 

p. 1144), even when no formal charges have been filed against a 

physician (Arnett, supra, 14 Cal.4th at p. 8).

“The subpoenas must, however, be issued ‘in a manner 

consistent with the California Constitution and the United States 

Constitution.’ (Gov. Code, § 11184, subd. (a).)” (Grafilo v. 

Wolfsohn (2019) 33 Cal.App.5th 1024, 1033 (Wolfsohn).) Thus, 
14

“when information about a patient’s medical record is sought, 

California’s constitutional right to privacy places procedural and 

substantive limits on the [Board’s] subpoena power.” (Ibid.)

“If a party refuses to comply with the administrative 

subpoena, the Board may petition the superior court for an order 

compelling compliance. (Gov. Code, §§ 11186, 11187.)” 

(Cohanshohet, supra, 32 Cal.App.5th at p. 436.) Although not 

“every assertion of a privacy interest under article I, section 1 

must be overcome by a ‘compelling interest[]’” (Hill, supra, 

7 Cal.4th at pp. 34–35; see also Williams, supra, 3 Cal.5th at 

p. 557), because of the highly sensitive nature of psychiatric 

records, when seeking judicial enforcement of an investigational 

subpoena, “a psychiatric patient’s constitutional right to privacy 

requires the [Board] to demonstrate a subpoena for the patient’s 

records is supported by a compelling interest and that the 

information demanded is ‘“relevant and material”’ [citation] to 

the particular investigation being conducted.” (Cross, supra, 

11 Cal.App.5th at p. 317.)

II. The Board Made a Sufficient Factual Showing of Good 

Cause to Compel Compliance with the Subpoenas.

There is no question that the state has compelling interests 

“in ensuring that the medical care provided by Board certified 

doctors conforms to the standard of care” (Fett v. Medical Bd. of 

California (2016) 245 Cal.App.4th 211, 225 (Fett)) and in 

regulating the distribution of controlled substances (Lewis, supra, 

3 Cal.5th at p. 574; Cross, supra, 11 Cal.App.5th at p. 317). 

Dr. Soorani does not contend otherwise.

Rather, he argues that the Board failed to make a sufficient 

factual showing of good cause to justify the invasion of his 

patients’ privacy. Specifically, according to Dr. Soorani, the 
15

Board was required but failed to show the absence of less 

intrusive means to further the state’s compelling interests; that 

Dr. Klessig was not qualified to offer her opinion on Dr. Soorani’s 

prescribing practices; and that Dr. Klessig’s declaration was 

speculative and lacked evidentiary support. We disagree with 

each of these contentions.

A. Standards of review and relevant law

To obtain an order compelling Dr. Soorani’s compliance 

with the subpoenas, the Board bore the burden of demonstrating 

“through competent evidence that the particular records it seeks 

are relevant and material to its inquiry sufficient for a trial court 

to independently make a finding of good cause . . . . [Citations.]” 

(Bearman v. Superior Court (2004) 117 Cal.App.4th 463, 469.)

“The question of whether the Board established good cause 

to intrude on the patients’ privacy rights is reviewed under the 

substantial evidence standard. [Citation.] However, the overall 

question of whether a subpoena meets the constitutional 

standards for enforcement is a question of law. [Citation.]” (Fett, 

supra, 245 Cal.App.4th at p. 216.)

The abuse of discretion standard applies to the trial court’s 

admission of evidence (People v. Waidla (2000) 22 Cal.4th 690, 

717), including the determination of whether an expert is 

qualified to testify (Fett, supra, 245 Cal.App.4th at p. 222).

B. The Board established the absence of less intrusive 

alternatives.

“[A] logical corollary of the compelling interest doctrine is 

the alternatives test. . . . If an alternative means of securing the 

compelling interest can be devised by which to avoid or minimize 

the conflict between the values protected by the constitution and 

the values found to be of compelling interest, that must be done. 
16

[Citation.] This results in a prohibition, among other things, of 

overbroad means of enforcement. It requires that the state 

utilize the ‘least intrusive’ means to satisfy its interest. 

[Citation.]” (Wood, supra, 166 Cal.App.3d at p. 1148.)

In Cross, the court concluded that although the 

requirement that the Board proceed in the least intrusive 

manner meant that it had to first “pursue voluntary means of 

obtaining the information sought before resorting to compulsory 

process,” it did not “impose[] . . . a strict narrow tailoring 

requirement . . . .” (Cross, supra, 11 Cal.App.5th at p. 329.)

Rather, “information demanded by an administrative subpoena 

in a case like this must be ‘“relevant and material”’ to the 

investigation being conducted. [Citations.]” (Ibid.)

Here, the subpoenas were only issued after the Board’s 

medical consultant reviewed the CURES report, identified 

specific patients subject to irregular prescribing patterns, and 

opined that reviewing those patients’ records was necessary to 

determine if the prescriptions were appropriately issued, and

after the Board unsuccessfully sought the six patients’ 

authorizations to access the records. The subpoenas only sought 

information that was “‘relevant and material’” (Cross, supra, 

11 Cal.App.5th at p. 329) to the Board’s investigation. Instead of 

overbroad demands for all patient records, the scope of the 

subpoenas was reasonably limited to only those documents that 

supported Dr. Soorani’s rationale for writing prescriptions to the 

six patients within the specific time period at issue.

Dr. Soorani argues that the Board failed to first employ the 

“wide array of investigative tools at its disposal[.]” He faults the 

Board for not assessing the credibility of the source of the initial 

information it received that he was overprescribing controlled 
17

substances and for not obtaining “complete CURES reports for 

each” of the six patients. Such inquiries—even if informative—

would not have obviated the need to review the patients’ medical 

records to determine whether the prescriptions flagged by 

Dr. Klessig were medically appropriate.

We conclude that the Board’s efforts prior to issuing the 

subpoenas, combined with the limited scope of the requested 

information, satisfy the alternatives test.

C. The trial court did not abuse its discretion by 

admitting and relying upon Dr. Klessig’s declaration.

Dr. Soorani contends that, as an internist, Dr. Klessig was 

not qualified to opine on the standard of care applicable to a 

psychiatrist. 

“The competency of an expert ‘is in every case a relative 

one, i.e. relative to the topic about which the person is asked to 

make his statement.’ [Citation.]” (Huffman v. Lindquist (1951) 

37 Cal.2d 465, 476–477.) If an expert “exhibits knowledge of the 

subject” on which she opines, she need not be a specialist; a 

general practitioner may suffice. (Evans v. Ohanesian (1974) 

39 Cal.App.3d 121, 128; accord Fett, supra, 245 Cal.App.4th at 

p. 222.)

Dr. Klessig is a Diplomate of the American Board of 

Internal Medicine and on the teaching staff of the UCLA medical 

school. As a medical consultant for the state, she reviewed 

“questionable medical and surgical practices of physicians and 

surgeons licensed by the” Board, which required her “to maintain 

familiarity with the standard of practice in the State of 

California.”

Dr. Klessig appropriately testified “to matters within the 

knowledge and observation of every physician, whether or not . . . 
18

a specialist. [Citation.]” (Rash v. San Francisco (1962) 

200 Cal.App.2d 199, 206.) While the fact that she is not a 

psychiatrist specializing in pain management may go to the 

weight of her testimony (ibid.; see also Cross, supra, 

11 Cal.App.5th at p. 327), it does not render that testimony 

incompetent. Possible side effects associated with particular 

drugs, as well as standard recommended doses, are within the 

general knowledge of every physician, particularly one who is on 

the teaching staff of a medical school and employed as a medical 

consultant by the state. (See Cross, at p. 327 [“[T]he nature and 

properties of [Adderall and Vyvanse], their potential 

complications, and the precautions that should be taken by a 

physician who prescribes the medications[] . . . are all topics 

sufficiently within the training and experience of a physician 

with a specialty in internal medicine”].) And, while a 

psychiatrist’s expertise might be necessary to justify or condemn 

Dr. Soorani’s unusual prescribing practices at a later stage of 

administrative proceedings, Dr. Klessig was competent to identify

those unusual prescribing practices at this early juncture.

We find no abuse of the trial court’s discretion in admitting 

and relying upon Dr. Klessig’s expert declaration.

D. Dr. Klessig’s declaration provided the trial court 

with sufficient competent evidence of good cause.

Dr. Klessig’s detailed analysis of the CURES report, with 

its citations to specific prescribing irregularities, provided ample 

evidence to support the trial court’s independent finding of good 

cause to enforce the subpoenas. (See Wood, supra, 

166 Cal.App.3d at p. 1150 [requiring the Board to present 

“sufficient factual justification to permit the trial court to 
19

independently assess the substantiality of the likelihood of 

improper prescription practices”].)

Dr. Klessig recounted specific examples of patients 

receiving high doses and large quantities of drugs, some of which 

could have had dangerous, even fatal, interactions with other 

prescribed medications. This was sufficient to show “the root 

facts upon which [the Board’s] inference of improper prescribing 

[was] based . . . .” (Wood, supra, 166 Cal.App.3d at p. 1150.) As 

this threshold showing was satisfied by Dr. Klessig’s declaration, 

it is immaterial that the Board did not present additional 

evidence of good cause.4

Dr. Soorani’s expert, Dr. O’Carroll, did not testify that the 

prescriptions issued by Dr. Soorani were medically appropriate, 

nor did he contest that they were suspicious. Rather, 

Dr. O’Carroll explained that “a judg[]ment regarding appropriate 

4 Dr. Soorani cites Cohanshohet, supra, 32 Cal.App.5th 428, 

a recent case where the appellate court reversed an order 

compelling a doctor to produce patient medical records. The 

Cohanshohet court found that the declaration of the Board’s 

expert was insufficient to show good cause because it did not 

provide evidence of the total number of patients treated by the 

doctor, “how often similarly situated physicians who specialize in 

pain treatment might prescribe these drugs[,] . . . [and] the 

likelihood that the prescriptions could have been properly issued, 

given what is known of [the doctor’s] practice.” (Id. at p. 440; 

accord Wolfsohn, supra, 33 Cal.App.5th at p. 1036.) But 

“Cohanshohet d[id] not suggest . . . that the evidence absent in 

that case . . . must be present in other cases” to show good cause. 

(Wolfsohn, at p. 1036.) Although Dr. Klessig’s declaration also 

lacked this type of information, we find that it was not necessary 

to a showing of good cause in this case.
20

dosing” is only possible through a “thorough understanding of the 

clinical scenario[.]” This supports the Board’s position that the 

medical records were necessary to its investigation.

To the extent that Dr. Soorani argues that, because the 

actual CURES report upon which Dr. Klessig relied was not 

introduced into evidence, her expert opinion lacked evidentiary 

support, we disagree. No abuse of discretion can be shown in 

allowing Dr. Klessig, as an expert, to “rely on and recite the 

CURES report data in explaining the basis for her opinion. 

[Citations.]” (Cross, supra, 11 Cal.App.5th at p. 328.) 

Dr. Soorani’s reliance on Garibay v. Hemmat (2008) 

161 Cal.App.4th 735, 742–743 and Bushling v. Fremont Medical 

Center (2004) 117 Cal.App.4th 493, 510 is misplaced because 

those cases considered the standard of evidence necessary to 

meet a defendant’s burden in a motion for summary judgment. 

Here, the trial court correctly distinguished a special proceeding 

to enforce an administrative subpoena from a motion for 

summary judgment, observing that the Board was not required to 

prove misconduct.5

Moreover, given that the Board’s burden was not to prove 

wrongdoing but to put forth sufficient evidence to support its 

“inference of improper prescribing” (Wood, supra, 166 Cal.App.3d 

at p. 1150), we find that disagreements with the accuracy of some 

of Dr. Klessig’s statements—such as whether two milligrams of 

clonazepam is a very large dose—are immaterial when the 

evidence is viewed in its totality.

5 Indeed, Dr. Klessig testified that the only way to determine 

whether Dr. Soorani was practicing outside the standard of care 

was to obtain his patients’ medical records.
21

We therefore conclude that the petition to compel 

compliance with the subpoenas was properly granted.

III. Dr. Soorani’s Motion for Judicial Notice Is Denied.

Dr. Soorani asks us to judicially notice printouts of 

webpages from the Prescribers’ Digital Reference and the Mayo 

Clinic website, which provide drug summaries for clonazepam.

“It is a fundamental principle of appellate law that our 

review of the trial court’s decision must be based on the evidence 

before the court at the time it rendered its decision. [Citations.]” 

(California School Bds. Assn. v. State of California (2011) 

192 Cal.App.4th 770, 803.) Therefore, appellate courts “generally 

do not take judicial notice of evidence not presented to the trial 

court.” (Vons Companies, Inc. v. Seabest Foods, Inc. (1996) 

14 Cal.4th 434, 444, fn. 3.) Dr. Soorani has provided no 

persuasive reason for us to deviate from this general rule. Nor 

has he offered any explanation for his failure to present this 

evidence to the trial court. Furthermore, our analysis would not 

change even if we were to take judicial notice of the documents.

Accordingly, we deny the motion for judicial notice.
22

DISPOSITION

The order of the trial court is affirmed. The Board is 

entitled to its costs on appeal.

_____________________, Acting P. J.

ASHMANN-GERST

We concur:

________________________, J.

CHAVEZ

________________________, J.

HOFFSTADT
Filed 10/29/19

CERTIFIED FOR PUBLICATION

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION TWO

DEAN GRAFILO, as Director, etc.,

Plaintiff and Respondent,

v.

EMIL SOORANI,

Defendant and Appellant;

KIMBERLY KIRCHMEYER,

as Executive Director, etc.,

Real Party in Interest.

 B286912

 (Los Angeles County

 Super. Ct. No.

 BS171127)

 ORDER CERTIFYING

 OPINION FOR 

 PUBLICATION

THE COURT:*

The opinion in the above-entitled matter filed on October 2, 

2019, was not certified for publication in the Official Reports.

For good cause it now appears that the opinion should be 

published in the Official Reports and it is so ordered.

*ASHMANN-GERST, Acting P. J., CHAVEZ, J., HOFFSTADT, J.