GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH BOARD OF MEDICINE IN RE: RAMON L. GONZALEZ, IMJ). 6207 CAPELLA AVENUE BURKE, VA. 22015 ORDER OF THE BOARD OF MEDICINE Jurisdiction This matter comes before the Districtof Columbia Board of Medicine pursuant to 7 DC. Of?cial Code (2001) otherwise known as the Health Oc?upations Revision Act The provides for the regulation of the practice of medicine by the DC. Board of Medicine. - On June 3, 2003 Ramon L. Gonzalez, MD. was served with a ?Notice of Intent to Take'Disciplinary Action. The ?Notice?'contained six (6) chargesl summarizing the allegations that prompted the Maryland Board of Physician Quality Assurance, on October 9, 2002, to revoke his license to practice and prohibit him from applying for reinstatement for at least 15 years. Pursuant to the ?Notice Dr. GOnzalez was advised that he had twenty days from receipt of the ?Notice to request a hearing. Dr. Gonzalez did not request a hearing the time prescribed. ?7 Charge 1 contained one (I) Speci?cation; Charge 11 contained two (2) Speci?cations; and Charge contained one (1) Speci?cation; Charge IV contained one (1) Speci?cation; Charge contained two (2) Speci?cations; and Charge VI contained two (2) Speci?cations- 17 new? {4103.1 provides: If a person who was sent a notice of a propoSed action pmsuant to 4102 does not mail or deliver a request for a hearing within the time and in the manner required under that section, a board may, without a hearing, take the action contemplated in the notice. no. Of?cial Code (2001) provides in pertinent part: Upon determination by the board that a[n] .. . licensee .. . has committed any of the acts described in subsection of this section the board may: (2) Revoke or suspend the license of. any licensee; On July 25, 2003 at its regularly scheduled meeting the Board of Medicine was advised that Dr. Gonzalez had not requested a hearing. The Board reviewed again the allegations against him. Based on the seriousness of the allegations, the Board of Medicine voted the following sanction: OBQER Based on the aforementioned, it is hereby ORDERED that the license of Ramon L. Gonzalez, MD. shall be and is hereby REVOKED. William A. Matory, MD. Chairperson D.C. Board of Medicine 2 District of CoinmbiaiMunicipal Regulations =1 . of VIRGINIA globe? A- Nablke? Department office/{It Professions D'remor 8603 West Broad Street, 5th Floor FAX (804) 6629943 February 7, 2005 Ramon Leopoldo Gonzalez, M.D. CERTIFIED MAIL 6207 Capella Avenue 7160 3901 9848 3154 5828 Burke Virginia 22015 RE: License No.: 0101-036843 Dear Dr. Gonzalez: In accordance with Sections 54.1?105, 54.1-11.0, 541?2400, 22?4020, and 22-4021 of the Code of Virginia (1950), as amended you are hereby given notice that the Virginia Board of Medicine ("Board") will convene a formal administrative hearing to consider the reinstatement of your license to practice medicine in the Commonwealth of Virginia. Your license was mandatorily suspended by Order of the Department of Health Professions entered September 14, 1998, pursuant to Section 54.1~2409 of the Code, due to your entering into a Consent Order with the Maryland State Board of Physician Quality Assurance, which suspended your license to practice medicine in that state. Pursuant to Section 54.14409 of the Code, the reinstatement of your license shall require the affirmative vote of three?fourths of the members of the Board present at the hearing. Please be advised that upon the introduction of evidence relating to your competency and fitness to practice medicine, the Board will also consider evidence that you may be in violation of certain laws governing the practice of medicine in Virginia, as set forth in the attached Statement of Particulars. The formal administrative hearing will be held in accordance with the provisions of Sections and 2.2-4024.F of the Code, before a panel of the Board, with a member of the Board presiding. You have been scheduled to appear before the Board on March 11? 12, 2005, in the offices of the Department of Health Professions, 6603 West Broad Street, Richmond, Virginia. You will receive written confirmation at a later date regarding the specific date and time of your hearing. A map is enclosed for your convenience. Your presence is required thirty (30) minutes in advance of the appointed time. Please report to the 5th floor receptionist, who will direct you to a waiting room. Please be seated in the waiting room and you will be called when the Board is ready to meet with you. Board of Audiology 8. Speech - Language Pathology - Board of Dentistry - Board of Funeral Directors 8- Embalmers - Board of - Board of Nursing Board of Nursing Home Administrators Board of Optometry - Board of Pharmacy - Board of Counseling Board of Physical Therapy Board of - Board of Social Work - Board of Veterinary Medicine Board of Health Professions Notice of Formal Hearing Ramon Leopoldo Gonzalez, MD. - Page 2 of3 You have the following rights, among others: to appear in person or by legal counsel; to present factual data, argument or proof in connection with your proceeding; and to have notice of any contrary fact basis or information in the possession of the Board. Should you wish to subpoena witnesses, requests for subpoenas must be made, in writing, in accordance with the enclosed instructions for RequestingSubpoenas. Please care?rlly read tliefollowing paragraphs, which contain date?sensitive and important information regarding this proceeding. EVIDENCE You have the right to the information that will be used by the Board in reaching a decision regarding this matter; therefore, I enclose the Commonwealth's evidence. Please note that these documents are enclosed o_nly with the original notice sent by certified mail and must be claimed at the post office. Further, if you are represented, it is your responsibility to provide the enclosed materials to your attorney. If you have any questions or objections regarding the content of this package, you must contact Assistant Attorney General William C. Garrett at (804) 786-2071. Should you wish to file any objections to the Commonwealth?s evidence, you must file your objections in writing, addressed to me at the Board office, no later than 12 noon on February 17, 2005. If you have not filed any objections by February 17, 2005, the exhibits will be distributed to the Board members for their consideration when discussing the allegations with you and when deliberating upon vour case. If you do file objections, the Commonwealth has until 12 noon on February 23, 2005, to file a response to the objections, in writing and addressed to me at the Board office. The chairperson of the proceeding will rule on the motion. EVIDENCE Should you wish for the Board to consider additional information relative to this proceeding, you must submit fifteen (15) copies of any such documents to Renee S. Dixson, Discipline Case Manager, Virginia Board of Medicine, 6603 West Broad Street, 5th Floor, Richmond, Virginia 23230, by February 22, 2005. You may not submit your documents by facsimile or e-mail. The Commonwealth must file any objections to your Submissions in writing, addressed to me at the Board office, no later than 12 noon on February 24, 2005. If no objections have been received by February 24, 2005, the evidence will be distributed to the Board members for their review, and will be considered by the Board as evidence when it deliberates upon your case. If the Commonwealth raises objections, you have until 12 noon on February 28, 2005, to file your response to the objections, in writing and addressed to me at the Board office. The chairperson of the proceeding will rule on the motion. Notice of Formal Hearing Ramon Leopoldo Gonzalez, MD. Page3 of3 OTHER PRE-HEARING MOTIONS If you or Assistant Attorney General William C. Garrett wish to make any pie-hearing motions regarding matters other than the exhibits, including offers of settlement, each of you is directed to file motions, in writing, addressed to me at the Board office by February 25, 2005. Responses to motions filed must be submitted by 12 noon on March 1, 2005. The chairperson of the proceeding will rule on the motion. REQUEST FOR A CONTINUANCE Absent exigent circumstances, such as personal or family illness,. a request for a continuance after February 18, 2005, will not be considered. If you obtain counsel, you should do so as soon as possible, as a motion for a continuance due to the unavailability of counsel will not be considered unless received by February 18, 2005. Relevant sections of the Administrative Process Act, which govern proceedings of this nature, as well as laws relating to the practice of medicine and other healing arts in Virginia cited in this notice can be found at To access this information, please click on Code of Virginia for laws and Virginia Administrative Code for regulations. Please indicate, by letter to this office, your intention to be present. Sincerely, William L. Harp, MD. Executive Director Virginia Board of Medicine IMfGonzaluzZiZNFii.Lloc Enclosures: Statement of Particulars Commonwealth's Exhibits 1-5 Instructions for Requesting Subpoenas Map cc: Thomas B. Leecost, D.P.M., President, Virginia Board of Medicine Robert A. Nebiker, Director, Department of Health Professions Renee S. Dixson, Discipline Case Manager, Board of Medicine William C. Garrett, Assistant Attorney General [Iv/enclosures] John A. Stanwix, Ir., Adjudication Specialist T.C. Butera, D.P.M, Senior Investigator [100832] VIRGINIA: BEFORE THE BOARD OF MEDICINE IN RE: RAMON LEOPOLDO GONZALEZ, M.D. License No.: 0101-036843 STATEMENT OF PARTICULARS The Virginia Board of Medicine ("Virginia Board") alleges that grounds exist for the denial of Dr. Gonzalez' Petition for Reinstatement. Specifically, Dixi'Gonzalex may have violated Section [formerly of the Code of Virginia (1950), as amended in that, his license to practice medicine has been restricted in other jurisdictions. Specifically: I. On or about March 25, 1998, Dr. Gonzalex? license to practice medicine was suspended for a period of one (1) year by the Maryland State Board of Physician Quality Assurance ("Maryland Board?). 2. On or about October 9, 2002, Dr. Gonzalez' license to practice medicine was revoked by the Maryland Board for a period of not less than fifteen (15) years. 3. On or about July 9, 2003, Dr. Gonzalez? license to practice medicine was revoked by the District of Columbia Board of Medicine. FOR THE BOARD William L. Harp, MD. Executive Director Virginia Board of Medicine DATE: "7 VIRGINIA: BEFORE THE BOARD OF MEDICINE IN RE: RAMON LEOPOLDO GONZALEZ, M.D. License No.: 0101-036843 ORDER In accordance with the provisions of Sections 541?105, 541-110, 22?4020, and 22?4021 of the Code of Virginia (1950), as amended a formal administrati't/e hearing was convened before the Virginia Board of Medicine (?Virginia Board?), on March 11, 2005, in Richmond, Virginia, to consider Dr. Gonzalez? Petition for Reinstatement of his license to practice medicine, which was mandatorily suspended by the Virginia Department of Health Professions on September 14, 1998, and to receive and act upon evidence that Dr. Gonzalez may have violated certain laws governing the practice of medicine in Virginia. These matters are set forth in the Board's Notice of Hearing and Statement of Particulars dated February 7, 2005. Pursuant to Sections and of. the Code, the hearing was held before a panel of the Virginia Board with a member of the Board presiding. Howard M. Casway, Senior Assistant Attorney General, was present as legal counsel for the Board. The proceedings were recorded by a certified court reporter. The case was prosecuted by William C. Garrett, Assistant Attorney General, and John A. Stanwix, Ir., Adjudication Specialist for the Department of Health Professions. Dr. Gonzalez appeared at the formal administrative hearing and was not represented by legal counsel. FINDINGS OF FACT Now, having properly considered the evidence and testimony presented, the Virginia Board makes the following findings of fact by clear and convincing evidence: Order Ramon Leopoldo Gonzalez, M.D. Page 2 of 4 1. Dr. Gonzalez was issued license number 0101-0368435 by the Virginia Board to practice medicine in the Commonwealth of Virginia on June 28, 1984. Said license was suspended by the Virginia Department of Health Professions by Order entered September 14, 1998, in accordance with Section 541?2409 of the Code. 2. On or about March 25, 1998, Dr. Gonzalez? license to practice medicine was suspended for a period of one (1) year by the Maryland State Board of Physician Quality Assurance Maryland Board?). 3. On or about October 9, 2002, Dr. Gonzalez? license to practice medicine was revoked by the Maryland Board for a period of not less than fifteen (15) years. The Maryland Board?s decision was based in part upon the conclusion that "Dr. Gonzalez? ingrained pattern of self?gratification at the expense of'his patients, incompetent practice, and deceit and corruption makes it appear unlikely that he was ever fit to practice medicine.? 4. On or about July 9, 2003, Dr. Gonzalez? license to practice medicine was revoked by the District of Columbia Board of Medicine. 5. Dr. Gonzalez provided no substantive evidence to show that he has appropriately recognized and addressed the serious issues related to sexual predation and ethical behavior, nor has he demonstrated the competency required to practice medicine in the Commonwealth of Virginia. CONCLUSIONS OF LAW Findings of Fact #2-4 constitute a violation Section [formerly of the Code. Order - Ramon Leopoldo Gonzalez, M.D. Page 3 of 4 ORDER WHEREFORE, based on the foregoing Findings of Fact and Conclusions of Law, it is hereby ORDERED that the PETITION TO REINSTATE the license of Ramon Leopoldo Gonzalez, M.D., is DENIED. It is further ORDERED that Dr. Gonzalez' license to practice medicine in the Commonwealth of Virginia be, and hereby is, REVOKED. Upon entry of this Order, Dr. Gonzalez shall comply with Section 541?2920 of the Code, if applicable. Upon entry of this Order, the license of Ramon Leopoldo Gonzalez, M.D., will be recorded as revoked. Pursuant to Section 541?24082 of the Code and consistent with the terms of this Order, should Dr. Gonzalez seek reinstatement of his license after a period of three (3) years, he shall be responsible for any fees that may be required for the reinstatement and renewal of his license prior to issuance of his license to resume practice. As provided by Rule of the Supreme Court of Virginia, Dr. Gonzalez has thirty (30) days from the date of service (the date he actually received this decision or the date it was mailed to him, whichever occurred first) within which to appeal this decision by filing a Notice of Appeal with William L. Harp, M.D., Executive Director, Board of Medicine, at 6603 West Broad St., Fifth Floor, Richmond, Virginia 23230. In the event that this decision is served by mail, three (3) days are added to that period. Pursuant to Section of the Code, the signed original of this Order shall remain in the custody of the Department of Health Professions as a public record, and shall be made available for public inspection and copying upon request. Order Ramon Leopoldo Gonzalez, M.D. Page 4 of 4 FOR THE BOARD William L. Harp, Executive Director Virginia Board of Medicine ENTERED: 4 VIRGINIA: BEFORE THE DEPARTMENT OF HEALTH PROFESSIONS IN RE: RAMON L. GONZALEZ, M.D. License N0.: 0101-036843 ORDER In accordance with Section 54.1-2409 of the Code of Virginia (1950), as amended, I, John W. Hasty, the Director of the Virginia Department of Health Professions, received and acted upon evidence that the license of Ramon L. Gonzalez, M.D., was suspended by the State Board of Physician Quality Assurance for the State of Maryland. A certi?ed copy of the Consent Order is attached to this Order and is marked as Commonwealth's Exhibit No. l. WHEREFORE, by the authority vested in the Director of the Department of Health Professions pursuant to Section 54.1-2409 of the Code, it is hereby ORDERED that the license of Ramon L. Gonzalez, M.D., to practice medicine in the Commonwealth of Virginia be, and hereby is, SUSPENDED. Pursuant to Section 9-6.14: 14 of the Code, the signed original of this Order shall remain in the custody of the Department of Health Professions as a public record and shall be made available for public inspection and copying upon request. W, 4? JohnbV. Hasty, Director Department of Health Professions ENTERED: - I Lt MD.ORD COMMONWEALTH of VIRGINIA Departrnent of Heal th Professions John W. Hasty 6606 West Broad Street, Fourth Floor Director Richmond, Virginia 23230-1717 TEL (804) 662?9900 FAX {304) 662-9943 TDD (304) 662-7197 CERTIFICATION OF DUPLICATE RECORDS I, John W. Hasty, Director of the Department of Health Professions, hereby certify that the attached Consent Order, entered March 25, 1998, regarding Ramon L. Gonzalez, M.D., is a true copy of the records received from the State Board of Physician Quality Assurance for the State of Maryland. War (QR/ref Date: 7 John W. (Zlasty Board of Audiology a Speech-Language Pathology Board of Dentistry - Board of Funeral Directors 5. Embalrners - Board of Medicine - Board 0! Nursing Board of Nursing Home Administrators - Board of Optometry - Board 0! Pharmacy - Board 0! Professional Counselors Board at - Board of Social Work - Board of Veterinaryr Medicine IN THE MATTER OF BEFORE THE RAMON L. GONZALEZ. M.D. STATE BOARD OF PHYSICIAN RESPONDENT QUALITY ASSURANCE LICENSE NUMBER 029566 CASE NUMBER 96?!063 On September 24, [997, the State ol?Maryland Board of Physician Quality Assurance (the ?Board") voted to charge Ramon L. Gonzalez, MD. (the ?Respondent") (DOB. 02/l4/48), .- License Number D29566, under the Maryland Medical Practice Act (the Md. Code Ann, Health Occ. ?l4~404 ([997 Cum. Supp). The pertinent provisions of HO. ?l4-404 provides: Subject to the hearing provision of?l4~405 ofthis subtitle, the Board, on the af?rmative vote ofa majority ofits full authorized membership, may reprimand any licensee, place any licensee on probation, or suspend or revoke a license ifthe licensee: (3) Is guilty ofimmoral or unprofessional conduct in the practice of medicine; (I l) Will?Jlly makes or ?les a false report or record in the practice ofmedicine; (18) Practices medicine with an unauthorized persoa or aids an unauthorized person in the practice of medicine. BA ND Alter discussions with Respondent's attorney, and prior to the tiling ol?t?ormal charges, a Case Resolution Conference was held on January 2 l, 1908 As a result ot?the CRC, the proposed Consent Order was presented to the Board at its meeting on February 25, 1998. :3 EWHIBIT 3. 2 On the affirmative vote ofa majority ofits Full authorized membership. the Board agreed to enter into the following Consent Order. FINDINGS OF FACT I. At all times relevant to these charges, Respondent was and is a physician licensed to practice medicine in the State of Maryland. He was initially licensed in Maryland on July (3, I983. 2. The Respondent currently has an o?ice based practice at 105 Spring Street, Silver Spring, Maryland. The Respondent has hospital privileges at Holy Cross Hospital. 3. On or about February 14, I996, the Board received information that the O?ice ofthe Attorney General, Medicaid Fraud Control Unit entered into civil settlement agreement with Respondent. The agreement resolved any and all matters related to an investigation initiated by MFCU of Respondent?s Medicaid billings during the years 1989 through [993 inclusive. 4. The Board?s investigation revealed that at least two former employees of Respondent were neither licensed nor certified as a physician or physician?s assistant in Maryland during the years 1989 through 1993 inclusive. They routinely examined patients and documented treatment notes in the patients? medical records. They routinely took histories and physicals, administered allergy and immunization shots, drew blood and performed pregnancy testing. The Respondent billed the Medicaid program as ifthese patients received comprehensive examinations by Respondent. ix) 5. The Board's investigation also revealed that Patient was Respondent?s patient from September 1990 through June 1996. RespOndent employed Patient A to work in his o?ice in mid- I 991 and shortly afterwards they began a sexual relationship. Respondent impregnated Patient A and she gave birth to Respondent's child in January 1993. 6. In the matter ofPatient A vs. Ramon L. Gonzalez, MD. in the Circuit Court for Montgomery County, Respondent on the record admitted paternity, and a State of Maryland birth certificate veri?ed Respondent as the father of Patient A?s child. 7. The Respondent voluntarily ceased the practice of medicine on November 4, I997. CONCLUSIONS OF LAW Based on the foregoing Findings of Fact, the Board concludes, as a matter oflaw, the following: The Respondent is guilty of unprofessional conduct in the practice of medicine, willfully making a false record in the practice of medicine, and practicing medicine with unauthorized persons or aiding unauthorized persons in the practice of medicine in violation ofMd. Code Ann, Health Occ. ?l4-404(a) (3), (1 1 and (13) (I996). QRDER Based upon the foregoing Findings of Facts and Conclusions of Law, it is this 28th day of February, I998, by the State of Maryland Board of Physician Quality Assurance: ORDERED that the Respondent?s license to practice medicine in the State ofMaryland is To insure confidentiality, the patient?s name is not used in this Consent Order. The Respondent is aware ofthe identity of Patient A. '1 .3 hereby SUSPENDED for one 1) year, eti?ective on the date the Consent Order is executed by the Board, and be it Further ORDERED that the Respondent shall cease and desist from the use ot'any unauthorized person in the Respondent's practice of medicine; and be it Further ORDERED that within thirty (30) days ot?the Board's execution ot?this Consent Order, the Respondent shall submit to a evaluation to be conducted by a Board approved (the ?evaluating The evaluating shall make speci?c findings in his/her report regarding the Respondent?s understanding ofappropriate physician- patient boundaries, his ?tness to practice medicine and the likelihood ofhis engaging in boundary violations ot'the physician-patient relationship in the ?Jture. The evaluating shall submit his/her written report to the Board within fifteen (l5) business days after the evaluation. Respondent shall follow all recommendations made by the evaluating The Respondent shall be responsible for all costs ofthe evaluation. ORDERED that iftherapy is recommended by the evaluating the Respondent shall participate in with a Board approved (the ?treating at intervals to be determined to be clinically necessary by the treating The Respondent shall participate in for a period of at least one (1) year. I. The treating shall submit written reports to the Board?s Compliance Division on a basis. These reports shall be limited to documentation ofthe Respondent?s attendance and payment for The Respondent shall be responsible for ensuring that these reports are submitted in a timely fashion. 2. At the conclusion ofone (1) year, the ReSpondent may apply to the Board or its designated sub-committee to terminate upon his tiling ot'a written statement from his treating that continuing is no longer necessary. In the event the Respondent terminates therapy prior to the receipt ot?the Board?s approval, the treating shall immediately notify the Board that Respondent has terminated therapy. 3. The Respondent shall sign a release permitting Board stall'to release information contained in the Board ?le to the evaluating and treating 4, The Respondent shall be responsible for all costs associated with with the treating during probation. ORDERED that the Respondent, during the period of active suspension imposed above. shall enroll in, and success?illy complete shall complete a Board approved course on medical ethics and a Board approved medical records billing and coding course. The Respondent shall be responsible for all costs associated with enrollment in the two (2) courses. The Respondent shall submit documentation to the Board as to the completion of each course within ?fteen (15) days. ORDERED that the ReSpondent shall comply will all the terms and conditions of his Medical and Chirurgical Physician Rehabilitation Committee Advocacy Contract? Respondent shall sign a release authorizing the Physician Rehabilitation Committee to release any and all information to the Board. a AND BE IT FURTHER ORDERED that ifall the aforementioned conditions are complied with, the Respondent may petition the Board for reinstatement of his medical license on November 4. l998, that date being one year from the date Respondent voluntarily ceased the practice of medicine. 3 The Advocacy Contract is not a public document and is not attached. 5 ORDERED that in the event the Board reinstates the Respondent?s medical license, the Respondent shall be placed on PROBATION for a period ot?TH REE (3) YEARS. subject to the following terms and conditions: I. The Respondent's treating shall recommend whether any further is necessary during the period ofprobation. The Respondent shall comply with the recommendations ofhis treating with regard to participating in further Respondent shall not terminate therapy without prior Board approval. 2. The Board shall conduct a peer review ofRespondent's practice to be conducted one year after the effective date ofthis order. The Board at its discretion, may require additional peer reviews during the three (3) year period of probation 3. Ifthe peer review report indicates to the Board that the Respondent?s medical practice fails to meet appropriate standards, pursuant to HO. or otherwise violates the Medical Practice Act H.O. ?l4-401 et seq, the Board may, in its discretion, modify the terms and conditions set forth in this Consent Order. In the event that the Respondent is found to be practicing below the standard of care as determined by the Board through appropriate peer review, and ifthe peer review determination is approved by the Board, the Respondent?s failure to meet appropriate standards shall constitute a violation of probation. 4. Upon request by the Board at the time ofthe practice review, and at any other time during the probationary period at the discretion ofthe Board, Respondent shall provide af?davits from each employee of Respondent, stating name, training, any other certification, and job description; and it is further ORDERED that the Respondent shall, if requested by the Board, obtain the services of an independent outside auditing service to review patient billings. Respondent would pay the cost ot?such auditing and would authorize the auditor to report their findings to the Board; and it is further ORDERED that ii'the Respondent Fails to comply with any terms or conditions set forth above. or Fails to comply with the laws and regulations governing the duties which can be delegated by a physician, then this failure shall be deemed a violation ofthis Consent Order; and beit further ORDERED that after conclusion ot?the probationary period imposed under this Consent Order, the Respondent may petition the Board For termination of his probationary status without any further conditions or restrictions; and be it ?irther ORDERED that pursuant to Md. Code Ann, State Gov?t ?lO-226? and COMAR [0.3205, the Respondent is subject to summary suspension if an investigation or peer review indicates to the Board that there is substantial likelihood ofa risk ofserious harm to public health, safety or welfare by the ReSpondent; and be it further ORDERED that ifthe Respondent violates any ofthe terms or conditions ofthis Consent Order, as set Forth herein, then the Board, after notice and an Opportunity for a hearing and a determination ofviolation by a preponderance ofthe evidence-may impose any other disciplinary sanctions it deems appropriate, said violation being proved by a preponderance ofevidence; and be it further ORDERED that the Respondent shall be responsible for all costs incurred under this Consent Order; and be it further ORDERED that this Consent Order is considered a public document pursuant to Md. Code Ann. State Gov?t ?l0~6l l. :1 5931. (I996). 3 9x)? - Cl 4 Date Suresh c. Gabi-mo, Chair Board of Physician Quality Assurance By signing this Consent, I hereby accept and agree to be bound by the foregoing Consent Order and its conditions and restrictions, consisting of nine (9) pages. I, Ramon L. Gonzalez, MD. acknowledge that I am represented by legal counsel, and have had the opportunity to consult with counsel before entering into and signing this document. By this Consent, I hereby admit the Findings of Fact and Conclusions of Law contained herein. I acknowledge the validity of this Order as if it were made after the conclusion of a formal evidentiary hearing in which I would have the right to counsel, to confront witnesses, to give testimony, to call witnesses on my own behalf and to all other substantial procedural protection provided by law. I acknowledge the legal authority and thejurisdiction ofthe Board to initiate I HEREBY ATTEST AND PENALTY 0F PERJURY 0N FULL ui?f??ING DOCUHENT IS a ORIGINAL CORRECT COPY OF THE FILE is at OFF YLAND STATE these proceedings and to issue and enforce this Consent Order. I recognize that I am waiving my right to appeal any adverse ruling ofthe Board that might have followed :iiy such hearing. I Fully comprehend the language, meaning and terms r-w I 7/ ?23 Date Ramon L. Gorzalez, VD. ?1 STATE OF MARYLAND OF MARYLAND I HEREBY CERTIFY that on the Mday ofl?aCW?l [998 before me, a Notary Public of the State and city/county aforesaid, personally appeared Ramon L. Gonzalez, MD. and made oath in due form of law that the execution of the foregoing Consent Order is his voluntary act and deed. As witness my hand and notarial seal. (A at 537 Notary Public l? My Commission expires: ob IN THE MATTER OF BEFORE THE MARYLAND RAMON L. GONZALEZ, M.D. STATE BOARD OF PHYSICIAN Respondent. QUALITY ASSURANCE License Number: 29566 BPQA Case No.: 96-1063 FINAL DECISION AND ORDER Procedural Background Dr. Gonzalez having been previously suspended pursuant to a Consent Order. the Board tarn'ialiy notified Dr. Gonzalez of its intent not to reinstate him on October 24, 2001. On that same date, the Board charged him with violating that Consent Order and, in addition, with the following violations of the Medical Practice Act: (1) practicing medicine without being licensed, in violation of Md. Code Ann., Health Occ lit-601; (2) trauoulentlv obtaining a license to practice medicine in violation of Md. Code Ann. Health Occ. 14-404 (3) frau:iulentlv using a license to practice medicine in violation of Md. Code Ann, Health Occ. 14?404 (4) con mitting immoral or unprofessional conduct in the practice of medicine in violation Md. Code Ann. Health Occ. 14-404 (5) being or mentally incompetent in violation of Md. Code Ann, Health Occ. 14404 (6) being habitually intoxicated in violation of Md. Code Ann, Health Occ. 14-404 (all7i?. (7) being addicted to narcotics in violation of Md. Code Ann, Health 000. 14?404 (aliQB); providing professional services while under the influence of alcohol or narcotics, in violation of Mid. Code Ann, Health Occ. t4-404 (9) willfully making a false report in the practice of medicine in violation of Md. Code Ann? Health Occ. 14404 (10) practicing medicine with an unauthorized person in violation of Md. Code Ann, Health Occ. 14-404 (11) selling or giving away drugs for an illegal purpose in violation of Md. Code Ann, Health Occ. 14-404 (12) failing to give the notice required under Md. Code Ann, Health Occ. 14-404 (13l willfully making a false representation when applying for a license in violation of Md Code Ann. Health Occ. 14?404 and (14} failing to keep adequate medical records in violation of Md. Code Ann, Health Soc. ?14404 A hearth :m al. of Muse issues was held before an Administrative Law Judge on April 16 and id, 2002. The Administrative Law Judge issued a Proposed Decision on July 12, 2002. The Administrative Law Judge proposed that Dr. Gonzalez be found to have violated the Consent Order and that he had in addition violated each of the sections of the Medical Practice Act as charged. The Administrative Law Judge proposed as a disposition that Dr. Gonzalez not be reinstated to practice and that his license be revoked Written Exceptions were filed with the Board and an oral Exceptions Hearing was held before the full Board on September 25, 2002. After consideration of the entire record in this case, including the record made before the Administrative Law Judge, the Proposed Decision and the written and oral Exceptions. the Board issues this Final Decision and Order. Findings of Fact. The Board adopts the Findings of Fact in the Administrative Law Judge?s Proposed DeciSion. The Board finds that these facts have been proven by clear and convmcing evidence, The Board also adopts with only the minor modifications noted below the comments in the Discussion section of the PrOposed Decision.? The Proposed Decrsion of the Administrative Law Judge is incorporated by reference and is attached to this Final Decision and Order as Attachment A. The Board enlarges upon the Discussion section of the Proposed Decision as follows. The Board agrees that Dr. Gonzalez sexual misconduct with his patients clearly VlelatEBS the sexual misconduct regulations at 1032.17.02. The Board, however. is not relying exclusively on this regulation. The prohibition against sexual sconduc: vvitn patients has existed since time immemorial and is in fact prohibited by the Hippocratic Oath. The Board has always considered this conduct as immoral or unprofessional conduct in the practice of medicine and has always adjudicated these Cn pages 13. 15 and 16 of the Proposed Decision. the Administrative Law Judge referred to the effect of the Consent Order of March 28. 1998 as a ?revocation.? That word should be replaced with ?Suspensio On page 15, in the first full paragraph. the term ?1998 Consent Order? should read ?1988 Disposition Agreement." On the third line of page 16, "revocation" should be replaced with ?application for reinstatement," cases this way since long before the existence of this regulation. The violation of Md. Code Ann. Health Occ. 14-404 does not rest on violation of this regulation alone Conclusion of Law The Board adopts the Conclusions of Law proposed by the Administrative Law Judge. Dr. Gonzalez violated the terms of the Consent Order of March 28. 1998 and violated the Medical Practice Act as charged. Sanc?on The Board will modify somewhat the sanction proposed by the Administrative Law Judge. Dr. Gonzalez deceived the Board from the time of his initial application in 1983 by feeling to reveal that he had been dismissed from two medical residencies for fondling teenaged female patients and that he was an abuser of drugs and alcohol. He had abused his patients sexually since medical school, and he continued to do so through his residencies and in his subsequent private practice, including one case of nonconsensual sex forced on a patient. At the time of his application and during a later period When he was under a private ?Disposition Agreement? with the Board due to his drug and alcohol problems from 1988 to 1990. he failed to reveal his sexual transgressions or his sexual addiction. At his private medical office he consistently overbilled patients for services not performed and il'l addition allowed unlicensed medical personnel to treat patients. later ordering these personnel to alter the medical records to male appear that he had provided the treatment. He failed to keep adequate medical records on his patients, and those records which he did keep showed that his diagnosis was often inconsistent with his physical findings. His examinations were extremely brief. though he almost always billed for an extended or comprehensive exam. He sexually pursued female patients while in the medical office. As part of a rehabilitation contract with the Physician Rehabilitation Committee, he agreed to cease all practice for one year beginning on November 4. 1997. He did not cease practice. On March 28, 1998 he signed a Consent Order with the Board which required that he be suspended from practice for one year. Nevertheless, he continued to practice while suspended. When he signed the Consent Order. he did not reveal to the Board. nor to the evaluating him for the Physician?s Rehabilitation Committee, that he had recently had simultaneous multiple sexual affairs with female patients. ln that Consent Order, he agreed to conditions regarding his therapy, and reporting requirements, yet he violated many of these. He falsely stated on his applicat-on for reinstatement in June of 2000 that he had complied with these conditions. The Board Will also deny reinstatement of Dr. Gonzalez to the active practice of medicine. At the time of the Consent Order of March 28, 1998, Dr. Gonzalez failed to advise the Board or the Physician?s Rehabilitation Committee ofthe fact that he was continuing his sexual predation on his female patients. And in any case he subsequently violated rtual?, every significant condition of the Consent Order. Dr. Gonzalez poses not mly a clear tnreat of abuse to every female patient but also a threat to the-health of all 0? his patients and a significant danger to the public fisc as well as the funds of private in-surarca comaanies. His; pattern of abuse and deception is variegated and career?long and appears to result from character defects which have been resistant to years of treatment. He is extremely fortunate to be in a system which has to a large extent dealt with his transgressions as if they were merely the result of emotional problems. But he has abused this system also by years of hiding the true facts from the and by failing to perform the treatment recommended. in light of the now available history of Dr. Gonzalez? years of transgressions and deceit, the recommendations of some of the evaluating cautious as they may have appeared at the time, now seem inappropriate in light of the public danger prese?gnted3 Dr. Gonzaiez? ingrained pattern of self-gratification at the expense of his patients, .ncornpetent practice, and deceit and corruption makes it appear unlikely that he was ever fit to practice medicine. The Board agrees with the Administrative Law Judge that his license to practice medicine should now be revoked. In addition, the Board Will order that it will not entertain any petition for reinstatement for at least fifteen years in addition, if any petition for reinstatement is filed, Dr. Gonzalez will bear the burden of proving by clear and convincing evidence: (1) that he is currently competent to practice medicine and (2) that he has been rehabilitated and has undergone a change in character as demonstrated by his conduct over a long period of time.3 in the event that Dr Gonzalez files an application for reinstatement. he will not be entitled to any presumption that he was ever competent or that his character was ever fit for the practice of :tteolcine. ?3 5: )r em note are advocated to" Dr to FBUFD to practice because ?[hle does not present a risk to a relatively Wide potential patient pool, including males, children under 12 or the elderly 20,? i Another evaluator opined that he be allowed to practice in a ?closely supervised institution. ?lCt treating women and not prescribing controlled drugs." (Tr. 95. See Ex. 26.3) 3 See In Re Murray, 316 Md. 303, 305 (1989), in which 3 Similar standard was used for an attorney disbarred for egregious conduct. See also Board cases of In Re Wilkinson, No. 93-0806, in re Levitt 990053 and in re Finucan, 99-0263. ORDER Based upon the foregoing Findings of Fact and Conclusions of Law. it is by a majority of the fuli authorized membership of the Board: ORDERED that Dr. Gonzalez? application for reinstatement be DENIED, and be it further ORDERED that Dr. Gonzalez license to practice medicine in the State of Matyland be and is hereby and be it further ORDERED that Dr. Gonzalez shall not apply for reinstatement of his license to practice medicine in the State of Maryland any earlier than fifteen (15) years from the effective date of this Final Order and until, after filing a formal application for reinStatement, Dr Gonzalez makes a clear and convincing showing to the Board not only of medical competence, but also of rehabilitation and a change in character, demonstrated by his conduct over a long period of time. At the time of any such applicatiorl, Dr. Gonzalez shall not be entitled to any presumption that he was ever competent or that his character was ever fit for the practice of medicine. ORDERED that Dr. Gonzalez shall be responsible for any costs necessary to compzy with this Final Order; and be it further ORDERED that this Final Order is a public document to Md. Code Ann. State Gov; 10-611 et seq. r: /7 I a: -?wv/K?e yewx Date C. lrving Find/er, Jr. Executive Director Marytand State Board of Physician Quality Assurance Notice Of Right To Appeal lf Dr. Gonzalez is dissatisfied with this Final Opinion and Order of the Board, he has the right to file within 30 days a direct judicial appeal of. this decision with the circuit court, under Md. Code Ann, Health Occ. 14-408 Md. Code Ann., State Gov?t? 10-222 and the Maryland Rules of Procedure at Ch.7?200 et seq. ATTACHMENT A STATE BOARD OF PHYSICIAN BEFORE JAMES W. POWER, QUALITY ASSURANCE AN ADMINISTRATIVE LAW JUDGE v. OF THE MARYLAND OFFICE OF ADMINISTRATIVE HEARINGS RAMON L. GONZALEZ M.D. Lic. N0. D29566 CASE NO. DHMH-BPQA-71-200100026 PROPOSED DECISION STATEMENT OF THE CASE ISSUE SUMMARY OF THE EVIDENCE FINDINGS OF FACT DISCUSSION CONCLUSIONS OF LAW PROPOSED DISPOSITION STATEMENT OF THE CASE On October 24. 2001. the Maniand State Board of Physician Quality Assurance ("Board") gitirges against Ramon L. GonzaIez. ?"Respoudent") for immoraI or unprotbssiumi cumin.? tIic ofmedicine in Violation MedicaI Practice Act. Md. Code Heaitii CIch IJSIITIJI. Ib). I3). IT). 181and ?Suit? Uri Dec-ember 20. 2000? the Board a'iitcd to dcny the Respondent's Jpplicutiin flirt .ii?Iiis I Ijnictss otherwise provided. aIl statutory citations are to the Health Occupations article. A pre-hearing conference was conducted on February 8, 2002, attended by Valerie I. Shealer. Assistant Attorney General, Counsel for the Board. The Respondent did not appear for the pie-hearing conference and indicated in writing prior to the prehearing conference that he would not attend the prehearing conference or the hearing. The hearing was held on April l6 and 18. 2003. at the Of?ce of Administrative Hearings tiilroy Road. Hunt Valley. Maryland, before James W. Power Administrative Law Judge pursuant to Md. Code Ann. Health Occ. l-lwlOS(a) (Supp. 2001). The Respondent arrived late on .-\pril lo. and remained for approximately one hour before leaving the hearing. He did not cross-examine any witnesses. testify or produce any evidence.1 Procedure in this case is governed by the contested case provisions of the Administrative Procedure Act. the Rules of Procedure of the Board of Physician Quality Assurance, and the Rules of Procedure of the Of?ce of Administrative Hearings. Md. Code Ann. State Gov't 10- Ilill through 103426, 1909 Supp. 2000); Code of Maryland Regulations (ItilNlAR 28.02.01. ISSUES .- :he Respondent violated a Consent Order dated March . U1 nether the Respondent?s application for reinstatement should be denied Willing. tld. Health (lee. Code Ann. i Hull)?. 3 'l?l?e lien: in; was :crieduled for three days. April. lo. i7 l8. The Board?s witnesses were not able to appear on i? .?titliougn the Respondent arrived late {or the hearing, he was adviser that he would have all day April. 1" and par: ofthe day on .Xprl 3002 to testify and present any evidence. The Respondent left the hearing on April Him and did not return. (3) l4?! (6) Whether the Respondent is subject to sanction for practicing medicine without being licensed, in violation ofMd. Health Occ. Code Ann. 14-601. Whether the Respondent fraudulently obtained a license to practice medicine in violation of. Md. Health Occ. Code Ann. Whether the Respondent fraudulently used a license to practice medicine in violation of Nld. Health Occ. Code Ann. Whether the Respondent committed immoral or unprofessional conduct in the practice of medicine in violation ot?Nld. Health Occ. Code Ann. Halo-Mala Whether the Respondent is physically or mentally incompetent in violation of Md. Code Ann. Health Occ. 9? Whether the Respondent is subject to revocation for being habitually intoxicated in violation of Md. Code Ann. Health Occ. Whether the Respondent is subject to revocation for being addicted to narcotics in violation of Md. Code Ann. Health Occ. 9' ".Vhethcr t'te Respondent is subject to revocation for providing professional while under the in?uence of alcohol or narcotics. in violation of Md. Health We; Whether the Respondent is subject to :?ex'ocation l?or \xilltitlly making a raise report in the of medicine in violation of Md. Code Ann. Health Occ. lelHlall ?1 J. (12) Whether the Respondent is subject to revocation for practicing medicine with an unauthorized person in violation of Md. Code Ann, Health Occ. (13) Whether the Respondent is subject to revocation for selling or giving away drugs for an illegal purpose in violation of Md. Code Ann, Health Occ. 14- 1 it Whether the Respondent is subject to revocation for failing to give the notice required under Md. Code Ann. Health Occ. lSi Whether the Respondent is subject to revocation for willfully making a false epresentation when applying for a license in violation ot?Md. Code Ann. Health Occ. ti 6) Whether the Respondent is subject to revocation for failing to keep adequate medical records in Violation of Md. Code Health Occ. SUMMARY OF EVIDENCE l'lie Hoard submitted the following exhibits into evidence Ru. rt, :l for license Bti. 4t :2 St. Hospital tile 3d. Wit Letter t'orm St. Mary?s Hospital Bd. =12? Letter from Executive Director Btl? if: - $31. Mary?s Hospital Memorandum lief letter to 'St. Xlurffs Hospital Bu? $133 Hospital Letter lit; Meniorttnuuin Head Nursing lie :17- ii?ixestigatik?e letter Bu Complaint lie; '14 - Cinipbell County Hospital rile Bo zi-ll Subpoena to Campbell County Hospital 13x. - Letter to Commission 14.} Letter to Campbell County HOSpital Bd Ex. 24.4 - Letter to Commission Bil. Ex. #45 Letter to Commission -4- Bd. Bd. Bd. Bd. Bd. Bd. Btl. Bd. Bd. Bd. Bd. Bd. Bu}. Bti. .l X. Mei rj?i rm rf? Vii/fixer~414.. Reports of Dr. A Evaluation report Follow up report Follow up report Follow up report Letter to Dr. Harkness Letter to Department Letter to Board Letter from Respondent Letter to Holy Cross Hospital - Letter to Medical and Chirurigal Faculty .l - Letter to Washington Adventist Hospital Letter to Commission Letter to Washington Adventist Letter to Commission 15 - Letter to Commission #5 lo - Letter to Dr. Goodwin 7 Letter to Medical and Cliirurgical Faculty 3-5Medical and Chiurgical Faculty l9 A Letter to Medical and Chiurgical Faculty ter to Medical and Chiurgical Faculty Lt - Letter to Medical and Chiurgical Faculty - Letter to Medical and Chiurgical Faculty Letter from Hazeldon Fellowship Club Report ofDr. Letter from Dr. r-x Letter to Uri} :tter to Commission of Dr Liv-if! Cross Hospital Letter to Medical and Cliirtirgical acuity Letter io Medical and Cliit?urgical Faculty Letter to Medical and Citirurgical Faculty . -md Chit?tirgical Faculty Later to .ci'ct' it) .etter u) Medical and Faculty -etzer Lo Medical and Cliirurgical Faculty -ctter to and Cliirurgical Faculty Disposition Agreement Peer Review report Compliance Monitoring Report Complaint Form Peer Revient? Report r- .Ex. #l4? .Ex. #15 . F1416 - .Ert. Termination of Disposition Agreement Letter to Board Settlement Agreement Advocacy Contract Bd. lit. 3113 Report of Dr. 801. Ex. #19 - Report ofDr. Bd. Et. #20 - Report ofDr. Bd. lit. - Letter to Medical and Chirurgical Faculty Btl. Ex. 320.2 - Evaluation and Treatment Summary Btl. Ex. 320.3 - Letter to Medical and Chirurgical Faculty Bil. llx. :r-Zl - Consent Order Bd. Ex. 2:33 - Report of Dr. Bd EX. ?11 A Letter to Board Bdi Ex. 312.: - Letter to Medical and Chirurgical Faculty . Bd. Ex. 3:3 - Letter to Board Bd. 3f. - Report from Respondent Bti. 1'15 Report ot?Dr. Bd. iix 7? lo - Report ofDr Bti. Eix 2110.1 - Evaluation Bu. lix 316.2 Letter to Medical and Chirurgical Faculty Bu. $126.3 Re?evaluation Bot fixi 4117? - Letter to Board Bu. lit $.18 etter form respondent Bd Ex :39 - Letter to Board Brit Ex. =30 - Letter to Board Bti. - ,-\pplication for reinstatement Bil Ex. 52 Letter from Respondent Bil It. ?3 - Records otXls. SW nu. <3 7] - Letter to Medical and Chirurgical Faculty Bu; i3: Letter to Medical and Cliirurgical Faculty nu. '34 -- insurance records I 'l?rigon insurance PM - Kaiser Foundation Health Plan l3: letter to Baord Bi; Lin - Report frorn Board Be. Letter from Attorney it; ?Vs: - fetter from criminal Justice information System Bu. 7 a Letter to Medical and Chirurgical Faculty {do --4U Voluntary cessation agreement M. ??11 - Letter from Blue Cross (Sci. i7 Letter from DC. Board ot?Nledicine en. 43 - Letter to Medical and Cliirurgical Faculty The Respondent did not submit any exhibits. Testimony "the Board presented the testimony ot?Lisa Watts. Compliance Analyst with the Board, and Steven apabianco. Medicaid Fraud Investigator. The Respondent did not present any tesrimonv. FINDINGS OF FACT having considered all of the evidence presented. I ?nd the following facts by clear and convincing evidence: 1. The Respondent graduated from the University .of Chile Medical School in 1974. At that time he was almost terminated from the medical school because of sexual interaction with an obstetrics-CW patient during his medical school experience. At the same time. he became addicted to amphetamines and alcohol. either in medical school or shortly thereafter. in l078, the Respondent relocated to the Washington DC. area and was admitted to residencies in pediatrics at Georgetown University Hospital (OCR) and Howard Knit ersity Hospital The Respondent received certificates from these programs even though he was Terminated from them for the sexual fondling of adolescent patients L. ?n he applied for a license to practice :nedicine in the State at Maryland. In its. application tor iicensure. the Respondent that he was not addicted drugs or alcohol; had never been hospitalized for a nervous or medical condition; and had never been discharged from or had a contract voided by any hoSpital service or training program. -7r in his l983 application. the Respondent failed to disclose to the Maryland Board of Medical Examiners that he was addicted to drugs and alcohol and he was treated for depression in the years immediately preceding his license application. In his 1983 application, the Respondent failed to disclose that he began abusing amphetamines. alcohol. and non-consensually fondling patients during medical school; was nearly expelled from medical school shortly before graduation because he had engaged in a sexual relationship with an obstetrics patient to whom he had been assigned: non~consensually sexually fondled teenage female patients during residencies at Georgetown University Hospital and Howard University Hospital; and was discharged from both university programs for these actions. The Respondent began working at St. Mary?s Hospital in Leonardtown, Maryland ("St Mary?s") in 1984. On January 16. H985. St. Mary?s submitted the ?rst complaint against the Respondent. The Respondent had exhibited bizarre behavior in the emergency department on December 34. l984. This included irrational verbally abusive and odd behavior. such as trequentl}' leaving the ED to consult medical books {located in his cart in order to treat patients in the ED and returning to the ED with his clothes coxered in mud. . Ste .?xlarf. ?s complaint was tiled and the Mar} and State Board of Physician Quality Assurance {the "Board"} opened Case No. 85?0277. . St \lary?s suspended and eventually terminated the Respondent?s medical staff privileges because ofthe December 1984 incident. . 117,121 . St. Mary?s noti?ed the Commission on Medical Discipline (the ?Commission?) that the Respondent?s privileges had been terminated because the December 1984 incident indicated serious emotional problems and/or possible substance abuse. . St. Mary?s also informed the Commission that the Respondent did not disclose his behavioral health history on this original application for medical staff privileges. . in April 1985, the Commission referred this matter to the Medical and Chirurgical Faculty t? Maryland Peer Review Committee (?Peer Review Committee?) for investigation. The Peer Review Committee determined that the Respondent required and substance abuse evaluation under the guidance of the Physician Rehabilitation Committee ("Physician Rehabilitation Committee?l . The Respondent had several hospitalizations for substance abuse and sexual addiction from 1985 to 1988. . On January 16. 1988. the Respondent entered into a non-public disposition agreement 1"Disposition Agreement?) with the Commission. -. The Disposition Agreement required that the Respondent remains abstinent from alcohol and drugs. comply with the Physician Rehabilitation Committee contract and undergo a peer review ol? his medical practice. ?a February representatives orthe Peer Review Commi co noucted rag ck.? .yu sucticc review :nandatcd o} the Disposition Agreement. The Peer Review Committee i?ound that The Respondent 5 patient medical records were substandard and that patient care was substandard. This included inadequate patient histories and descriptions ot?patient?s complaints and inadequate or missing 20. 1. tin .lni physical observations and vital signs. The Peer Review Committee recommended that the Respondent receive medical re-education and he limit his practice to patients 18 years of age and under. On May 18. 1989, the Board probation unit noted that the Respondent violated the Disposition Agreement because he failed to tile the three most recent quarterly status reports of his substance abuse rehabilitation. In June 1989. the Maryland State Department of Health and Mental Hygiene Hle") informed the Respondent that there vvere irregularities with his billing practices. The Respondent had billed ninety-nine percent ofhis of?ce visits as comprehensive and extended of?ce visits. In contrast, his peers? billings for comprehensive and extended of?ce visits were only twenty-two percent The Respondent also frequently submitted billings for comprehensive and extended offices visits when patient treatment consisted only of allergy shots and/or immnnizations. This billing practice. know as "upcodingi'. was prohibited for reimbursement by state law. . On September l4. 1989. a new complaint against the Respondent was tiled with the Board, A parent whose child as treated by the Respondent tiled the complaint and alleged false billing. ?nla; ll). 19%. the Respondent filed a Petition for Dismissal of Disposition Agreement. 1 NJ. the Board referred the fraudulent billing complaint to the State Medicaid Fraud Control L'nit for investigation. -10.. 25. in September 1995, the Board terminated the 1988 Disposition Agreement. At no time prior to this did the Respondent tell the Board of his long-term chemical and sexual addictions. . On February 22. 1996. the MFCU concluded its investigation and entered into a binding agreement (?Settlement Agreement?) in lieu of the MF tiling criminal charges of Medicaid fraud against the Respondent. The Settlement Agreement required restitution and additional money damages. . While practicing in Silver Spring, the Respondent allowed unlicensed personnel to provide medical services. and instructed them to alter the medical records to disguise the fact that unauthorized personnel were providing services. . The Respondent failed to diagnose dehydration in a child who vomited for a number of days. did nothing to assist a child who passed out in his presence. The Respondent also spent less than ?ve minutes with patients and was quick to prescribe medicine. . During examinations with female patients. the Respondent would rub the patients buttocks. perform rough vaginal examinations. wiggle his ?ngers intravaginall}; kiss female patients and chase them around the of?ce. . The Respondents medical records had inadequate patient histories. inadequate description of complaints. inadequate or missing physical observations and vital :i ms 1 and inadequate or missing follow up care. :ie Respondent?s diagnosis was often inconsistent with the physical tindings. . The Respondent?s practice did not have the required notice involving the Center for Disease Control. as required by law. -11- 3.3.. kg.) DJ The Respondent initiated and engaged in sexual activity with several patients. The Respondent initiated sexual activity with Patient A. who gave birth to the Respondent?s child in January 1993. The Respondent also initiated sexual activity twice with Patient B. Two years later. the Respondent forced sexual intercourse with Patient during treatment. On May 23. 1996, the Board opened Case No. 96-1063 after receipt of the May 22. 1996 letter concerning the Respondent. . Pursuant to the meeting with the Respondent and the Physician Rehabilitation Program Director (?Director?), the Physician Rehabilitation Committee referred the Respondent for treatment to the Menninger Clinic. in Topeka. Kansas. The Menninger Clinic specializes in addictions therapy and rehabilitation, including sexual addiction. i. The Nlenninger Clinic evaluated the Respondent in August. 1997 and diagnosed him a sexual offender with other serious behavioral health problems. . 0n Notember 4. 1997. the Respondent signed a voluntary cessation ot?practice agreement for at least one year. (,Zin starch ZS. 1998i the Respondent entered into the Consent Order with the Board to resolve the matters under investigation {Case No. 96-1063) l. he Consent Order suspended liis iieense for one year and contained proi?isions includingr therapy. medication. self-help groups and sexual t)t?fender treatment. . Between 1.998 and 1999 the Respondent vioiated the Consent Order to practice medicine by practicing medicine and billing insurance companies for his services. 40. The Respondent applied for Reinstatement of his Medical License in June, 2000. In the application. the Respondent certi?ed that all the information supplied to the Board was true and acourate. 41. The ReSpondent?s answers on part of the application for reinstatement misrepresented that the reason his Maryland medical license was inactive was the Medicaid fraud investigation; the case concerning his long?term chemical dependence case was ?closed? in 1997: and the District ofColumbia Board ofMedicine ?suspended? his medical license. 4: On December 20. 2000. the Board voted to deny the Respondent's Application for Reinstatement of Medical License. DISCUSSION The evidence presented by the Board in this case outlines the career ofa physician who displayed an extensive history of sexual abuse of female patients. deceit and dishonesty with respect Le his dealings with the Board. and a lack ot?competence in the practice of medicine. This career is tloeumented through reports from the Respondent?s mental health providers. records and interviews with numerous employees and patients of the Respondent over the years. to exact issues in the present case involve the Respondent?s reapplicatton from his current lC?w eaten. u?ioltutoti ol? :1 Consent Order. as Well as revocation based ori numerous other grounds. ?ahieh not discovered until recent years. These issues however. can be broadly grouped into the three categories above. i.e. those involving the Respondent?s dealings with the Board. those Lil?vt)l\ int; personai misconduct and those involving competence in the praCtice ot? medicine. The most critical issues are those involving the Respondent?s relationship with the Board. If the Board had known the true extent of the Respondent?s alcohol, drug and sexual disorders. it may well have been able to take steps many years ago to prevent the Respondent from committing the other violations involving personal misconduct and incompetence in the practice of medicine. The obvious question is how the Respondent was able to practice medicine for so many }eurs and escape any substantial consequences for his actions. There are two reasons for this. the Respondent misrepresented his background to the Board?and also worked with a socio-econornic group of people. i.e. Hispanics. who held doctors in high respect and did not consider reporting sexual abuse or misconduct as an option. As stated by the Medicaid Investigator. Mr. Copabianco. many of the Respondent?s patients either did not wish to disclose any information about the Respondent or felt it was inappropriate for them to make a complaint about a medical professional. lie .tlso pointed out that the Respondent was often the only medical protbssional sum: in certain neighborhoods and individuals were reluctant to complain. for fear: at these 'nedieai seryiees might stop. One woman. who had been raped by the Respondent. :?eit 3:11:15. "7 :e?itise she had previously had consensual sex with the Respondent and did not report this because :?I?iier own guilt. lov-e?, er. the Respondents opportunity to work among this population tt'asdue to his excitit?uil misrepresentation ot? his background with the Board. From his time in medical school. the Res :t'ndent had problems with sexually abusing females. He was dismissed from two residencies due to this behavior. Yet these facts were not disclosed to the Board when he applied -14- for his medical license. When the ReSpondent?s behavior was brought to the attention of the Board. it was limited to problems with alcohol and drug abuse, not a sexual disorder. In 1988 the Respondent signed a non-public disposition agreement. however this related to his problems with alcohol and drugs. In 1995 the Board terminated the 1998 consent order but the Respondent did not apprise the Board at that time that he had a sexual disorder and had been diagnosed with such since 1986. As time went one the Respondent?s problems with his sexual disorder, as well as the ongoing problems with alcohol and drugs began to emerge?dl?lowever. this information was not voluntarily communicated by the Respondent, but was discovered through reports of and treating doctors. The Respondent was given abundant opportunities to seek professional treatment for his these disorders. While the Respondent did in fact accept such treatment. he showed no regard for his dealings with the Board, as evidence by the fact that he continued practicing medicine after November, 1997. after signing a voluntary agreement not to practice medicine for a year. This was con?rmed by patient and insurance records showing the aantinued practicing medicine until at least October. 1000 Stised on the Respondent's failure to disclose his sexual disorder and his termination I mm residencies due to this disorder~ ne is clearly subject to revocation for t'raudulently ortaaning anc using a medical license in violation of dec Health C?cc. Code Ann. 14-404mm 7" l: is also subject to revocation {or practicing medicine without a license in \?iolat L-?c at We? iisalta Ucc. Code 14,601. T'ie Respondent?s situation since the Board?s prior revocation has not changed. He has not aenetited from treatment or shown any indication that he is willing to work with the Board and abide by its regulations. The Respondent presented no testimony and evidence during the hearing, let alone any mitigation with respect to his current revocation. Therefore, the Board?s denial of the Respondent's revocation should be upheld under Md. Health Occ. Code Ann. 14- 400. The Respondent has also shown incompetence in the practice of medicine, as shown by his records and patient reports. The dominant feature of the Respondent's practice was a concern with pro?t. rather than proper medical care. The Respondent kept substandard medical records including inadequate patient histories. inadequate descriptions of patient?s complaints and inadequate or missing physical observations and vital signs. Reports were very brief with no little or no elaboration. It appears the average time seen by the ReSpondent was less than ?ve minutes. The Respondent would often rush through of?ce visits before giving an inaccurate or incomplete diagnosis or quicldy prescribing medication. The litespondent's diagnosis was often inconsistent with the physical findings. The Resaondm once failed :o diagnose dehydration in a child who vomited for a number ofdays and did nothing to assist a child who passed out in his presence. ?additioi'iailjr. the Respondent would allow unauthorized individuals to examine patients. This ta: mimic-d ihrough records and interviews with his employees. Not only did the Retit?tl?ltle??l allow patients to be seen by unlicensed individuals. but he tried to hide this bfi ordering employees to alter patient records. ?be Respondent's pro tit motive is also seen in his billing practices. The Respondent billed ninety?nine percent of his patient?s of?ce visits as comprehensive and extended. -16- even when the visits only consisted of allergy shots or immunizations. This billing practice. known as "upcoding". is prohibited for reimbursement by state law. The Respondent also failed to maintain the requisite forms to purchase Schedule [1 drugs and kept iniectable Demerol (a narcotic) out in the open rather than stored in a locked cabinet. The Respondent regularly provided injectable Demerol to Employee A and on at least one occasion to Employee 8. The employees then took the injectable Demerol home for self? administration. The Respondent also provided medical services while being treated for alcohol and drug abiised. and is subject to revocation for providing professional services while under the in?uence of aicohc?l or narcotics. He began abusing amphetamines and alcohol during medical school. His medical privileges were suspended and he was ultimately terminated from St. Mary?s hospital because of his substance abuse problem. lhe record replete of these instances where the Respondent provided substandard care and kept inadequate and fraudulent records. What is more striking is how this pattern extended Fienherthe :herctore conclude that the Respondent is subje to revocation for being habitually addhned.u)narcohesin violation it'N-ld. Lode Health Qcc. Code Ann. Health Occ. li-ill?Haiti?sl. prowiuing pr: res-9i ma. serxices while under the in?uence of alcohol or narcotics. in violation of Mid. Joe Ann. Health Md. Code Ann. Health Dec. 9? selling or giving away drugs for an illegal purpose in violation ot?Nld. Code Ann. Health Occ. practicing -17- medicine with an unauthorized person in violation of Md. Code Ann, Health Occ. 14- 8) making a false report in the practice of medicine in violation of Md. Code Health Occ. The most serious charges however. with respect to the public safety, are those dealing with the Respondent?s personal conduct while practicing medicine. This issue focuses on the Respondent's sexual abuse of female patients, extending from his time in medical school to the present. ?Sexual misconduct? is defined as: "Sexual misconduct" means a health care praCtitioner?s behavior toward a patient. former patient, or key thirdparty, which includes: ta) Sexual impropriety; Sexual violation; or to) Engaging in a dating, romantic, or sexual relationship which violates the code of'ethics ofthe American Medical Association. American Osteopathic r-lssociation. American Association, or other standard recognized professional code of'ethics of the health care practitioner's discipline or specialty. lhe Respondent?s suggestive and overt conduct and his efforts to cultivate an intsnat: relationship with Patients constitute sexuality impropriety. which is defined as: 'at gestures. or expressions that are seductive. sexttaily magnate or sexually demeaning to a patient or a he}: tlzirdpartj' regardless of the sexual occurs inside or outside ota professional setting. Nit "Sexual improprieti? includes, but is not limited to: Hi Failure to provide prit'acytor disrohing,? til] Performing a pelvic or rectal examination without the use ot?gloves; tilt) losing the health care practitioner-patient relationship to initiate or tot'icit a dating, romantic, or sexual relationship: and -13- (iv) Initiation by the health care practitioner of conversation regarding the health care practitioner's sexual problems, sexual likes or dislikes, 0r fantasies. 10. 32. 1 7. 0212(2). Under any interpretation of the above law, the Respondent engaged in conduct which was clearly improper. His actions went beyond suggestive talk. but involved deliberate sexual violation of numerous female patients over a period of years. The nature and extent of the Respondent?s problems with sexually abusing female patients are well documented in the record. At every location where the Respondent either trained. was an intern or practiced medicine. he took. advantage of female patients by engaging in either consensual or unconsensual sexual activity. His employees told investigators that it was common knowledge that the Respondent chased women around the of?ce and had sexual relations with them in the of?ce. This sexual actit ity as ot?more interest to the Respondent than actually providing any meaningful medical services. tn light or the extensive nature of this abuse. it is clear that the Respondent?s problems in cealing ith females involves more than an occasional lapse injudgement or poor choice. It rises to {lie let ei t? an addiction. and the Respondent was actually diagnosed with a sexual disorder. While practicing. the Respondent would grope female patients proposition them and engage in doth oluntarjx and involuntary sexual relations. Despite treatment for this disorder. there Is that the Respondent is any more qualified in his personal life now. than .2 he pas; practice medicine. He clearly presents a risk to any group of female patients whit: cannot 77: monitored or controlled by the Board. Options which had been tried in the past. seen as restrit ting the Respondent?s practice to avoid adult females are simply not realistic. The only alternative is to ensure that the Respondent no longer has any medical license or privileges in -19- Maryland. therefore conclude that the Respondent is subject to revocation for immoral or unprofessional conduct in the practice of medicine in violation of Md. Health Occ. Code Ann. l4w401tait?3), being is physically or mentally incompetent in violation of Md. Code Health Occ. CONCLUSIONS OF LAW 1 :onclude as a matter of law The Respondent violated a Consent Order dated March 28. 1998. 2, The Respondent?s application for reinstatement should be denied under Md. Health Occ. Code Ann. 14?409. 3. The Respondent practiced medicine without being licensed. in violation ofMd. Health Occ. Code Ann. 14-601. 4. The Respondent fraudulently obtained a license to practice medicine in violation of Md. Health Occ. Code Ann. i. The Respondent fraudulently used a license to practice medicine in violation of Mid. Health Occ. Code Ann. The Respondent committed immoral or unprofessional conduct in the practice of medicine in violation Md. Health "Dec. Code Ann. 3. Respondent is physically or mentally incompetent in violation of .?vld. Code Health Dec. 9' The Respondent is habitually intoxicated in violation of Md. Code Ann. Health Occ. -20- 9. The Respondent is addicted to narcotics in violation of Md. Code Ann, Health Occ. 10. The Respondent provided professional services while under the in?uence of alcohol or narcotics, in violation of Md. Code Ann. Health Occ. l. The Respondent willfully making a false report in the practice of medicine in violation of Md. Code Ann. Health Occ. ll The Respondent practiced medicine with an unauthorized person in violation of Mid. Code Ann. Health Occ. . 13. The Respondent gave away drugs for an illegal purpose in violation of Md. Code Health Occ. H. The Respondent failed to give the notice required under 14?404 Md. Code Ann. Health Occ. The Respondent willfully made a false representation when applying for a license in violation of Md. Code Ann. Health Occ. id. The Respondent failed to keep adequate medical records in violation of Md. Code Health Dec. 9' l4-404lah40). PROPOSED DISPOSITION PROPOSE. that the charges tiled by the Board on Detober A. 3001 awiins: the Res-conceit: lie ljl?HELl). and that the Board impose the following disciplinary action: The Respondent?s application for reinstatement of his license be denied. 3, The Respondent be revoked for practicing medicine without being licensed. in violation or?Md. Health Occ. Code Ann. 14-601. .3. The Respondent be revoked for fraudulently obtaining a license to practice medicine in violation of Md. Health Occ. Code Ann. 4. (J: 9. The Respondent be revoked for fraudulently using a license to practice medicine in violation of Md. Health Occ. Code Ann. The Respondent be revoked for committing immoral or unprofessional conduct in the practice of medicine in violation Md. Health Occ. Code Ann. The Respondent be revoked for being physically or mentally incompetent in violation of Md. Code Ann. Health Occ. The Respondent be revoked for being habitually intoxicated in violation ofMd. Code Ann. Health Dec. 9' The Respondent be revoked for being addicted to narcotics in violation of Md. Code Health Occ. The Respondent be revoked for providing professional services while under the in?uence of alcohol or narcotics. in violation ot?Nld..Code Ann- Health Dec. 9? l-l? 404mm) The Respondent be revoked for willfully making a false report in the practice of medicine in violation of Md. Code Ann. Health Occ. i l. The Respondent be revoked for practicing medicine with an unauthorized person if. violation ot?Md. Code Ann. Health Dec. 3' l-l?40?llail 18). The Respondent be revoked for giving away drugs for an illegal purpose in violation of Md. Code Ann. Health Occ. The Respondent be revoked for failing to give the notice required under 14-404 Md. Code Health Occ. H. The Respondent be revoked for willfully made a false representation when applying for a license in violation of Md. Code Arm, Health OCC. 9? 15. The ReSpondent be revoked failing to keep adequate medical records in violation of Md. Code Ann. Health Occ. vr/llDate //James W. Power Administrative Law Judge cc: Valerie l. Shealer. Asst. Attorney General Ramon L. Gonzalez MD, by regular and certi?ed mail NOTICE TO FILE EXCEPTIONS {tn} party may tile exceptions. in writing. to this Proposed Decision with the Board of a Quality Assurance within fifteen (15) days of receipt of the decision. The Of?ce of Hearings is not a party to any review process. Md. Code State Gov?t 9? 10816 (NW) anti (HUMAR