New York State Board for Professional Medical Conduct 433 River Street, Suite 303 - Troy, New York 12180-2299 - (513) 402-0863 Richard F. Dames. MD. Kendrick A. Sears. MD. Commissioner i/L/ i Chair NYS Department of Heat?: Michael A Gonzalez. RPA. Wendy E. Saunders Woe Chair Chief of Sta? Ansel R. Marke.M.D.. J.D. Keith W. Sam's. Director Executive Smtary Cities of Professions. Medical Conduct October 2, 2007 CERTIFIED MAIL-RE TURN RECEIPT REQUESTED Jack M. German, MD. Re: License No. 134700 Dear Dr. German: Enclosed is a copy of Order 07-210 of the New York State Board for Professional Medical Conduct. This order and any penalty provided therein goes into effect October 9, 2007. If the penalty imposed by this Order is a surrender, revocation or suspension, you are required to deliver your license and registration within ?ve (5) days of receipt of this Order. If the (locument(s) are lost, misplaced or destroyed, you are required to submit to this of?ce an af?davit to that effect. Enclosed for your convenience is an af?davit. Please complete and sign the a?idavit before a notary public and return it to: Of?ce of Professional Medical Conduct, New York State Department of Health, 433 River Street, Suite 303, Troy, NY 12180~2299 Sincerely, Ansel R. Marks, M.D., J.D. Executive Secretary Board for Professional Medical Conduct Enclosure cc: Anthony A. Scher, Esq. Wood and Acher 222 Bloomingdale Road, Suite 311 White Plains, New York 10605 NEW YORK STATE DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT CONSENT ORDER IN THE MATTER OF JACK M. GORMAN, M.D. BPMC No . 0 7-210 Upon the application of (Respondent) JACK M. GORMAN, MD. in the attached Consent Agreement and Order, which is made a part of this Consent Order. it is: ORDERED, that the Consent Agreement, and its terms. are adopted and it is further ORDERED. that this Consent Order shall be effective upon issuance by the Board, either I by mailing of a copy of this Consent Order, either by ?rst class mail to Respondent at the address in the attached Consent Agreement or by certi?ed mail to Respondent's attomey, OR 0 upon facsimile transmission to Respondent or Respondent's attorney. whichever is ?rst. SO ORDERED. DATE: 3 0*2007 KENDRICK A. SEARS, MD. Chair State Board for Professional Medical Conduct NEW YORK STATE DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER CONSENT E. OF AGREEMENT i JACK M. GORMAN. M.D. AND ORDER JACK M. GORMAN M.D., representing that all of the following statements are true, deposes and says: That on or about July 1, 1978, was licensed to practice as a physician in the State of New York. and issued License No. 134700 by the New York State Education Department. My current address is and I will advise the Director of the Of?ce of Professional Medical Conduct of any change of address. I understand that the New York State Board for Professional Medical Conduct ("Board") has charged me with one speci?cation of professional misconduct. A copy of the Statement of Charges, marked as Exhibit is attached to and part of this Consent Agreement. 1 do not contest the First Speci?cation, Practicing with Negligence on More Than One Occasion. in full satisfaction of the charges against me, and agree to the following penalty: My license shall be suspended for an inde?nite period but no less than six months. I shall be subject to a condition that comply with attached Exhibit (?Guidelines for Closing a Medical Practice Following Medical License Revocation, Surrender or Suspension of Six Months or More") Upon compliance with all the conditions of this Consent Order, but no sooner than six months from the effective date of this Consent Order. i may petition the Board for a Modi?cation Order staying the inde?nite suspension of my license. understand and agree: That any Modi?cation Order the Board may issue, in the exercise of its reasonable discretion, may include terms of probation. and/or further conditions on my practice. That the Board will exercise its reasonable discretion upon my petition for a Modi?cation Order through a Committee on Professional Conduct after a proceeding in which I have met a burden of proof and persuasion, as further set forth in attached Exhibit That the Committee's exercise of discretion shall not be reviewable by the Administrative Review Board. further agree that the Consent Order shall impose the following conditions: That Respondent shall return all of?cial New York State prescriptions to the Bureau of Narcotic Enforcement. and shall surrender Respondent's Controlled Substance Registration Certi?cate to the United States Department of Justice, Drug Enforcement Ad ministration, within 30 days of the Consent Order's effective date. Further, within 30 days of returning these prescriptions and surrendering this Registration. Respondent shall provide the Director of OPMC (?Director?) with written evidence, satisfactory to the Director, that Respondent has complied with this condition. That Respondent shall remain in continuous compliance with all requirements of NY. Educ Law 6502 including. but not limited to, the requirements that a licensee shall register and continue to be registered with the New York State Education Department (except during periods of actual suspension) and that a licensee shall pay all registration fees. Respondent shall not exercise the option provided in NY. Educ Law 6502(4) to avoid registration and payment of fees. This condition shall take effect 30 days after the Consent Order?s effective date and will continue so long as Respondent remains a licensee in New York State; and 7 That Respondent shall cooperate fully with OPMC in its administration and enforcement of this Consent Order and in its investigation of all matters concerning Respondent. Respondent shall respond to all OPMC requests for written periodic veri?cation of ReSpondent's compliance with the terms of this Consent Order. Respondent shall meet with a person designated by the Director of OPMC, and shall provide OPMC with all documents and information within Respondent's control, as directed. This condition shall 3 take effect upon the Board's issuance of the Consent Order and will continue so long as Respondent remains licensed in New York State. I stipulate that my failure to comply with any conditions of this Consent Order shall constitute misconduct as de?ned by New York State Education Law 6530(29). If I am charged with professional misconduct in future, I hereby stipulate and agree that this Application and Consent Order, and/or related Modi?cation Orders. shall be admitted into evidence in that proceeding as part of the Department's casein-chief, at the sole discretion of the Department. i ask the Board to adopt this Consent Agreement. I understand that if the Board does not adopt this Consent Agreement. none of its terms shall bind me or constitute an admission of any of the acts of alleged misconduct; this Consent Agreement shall not be used against me in any way and shall be kept in strict con?dence; and the Board's denial shall be without prejudice to the pending disciplinary proceeding and the Board's ?nal determination pursuant to the Public Health Law. I agree that. if the Board adopts this Consent Agreement, the Chair of the Board shall issue a Consent Order in accordance with its terms. i agree that this Consent Order shall take effect upon issuance by the Board, either by mailing of a copy of the Consent Order by ?rst class mail to me at the address in this Consent Agreement, or to my attorney by certi?ed mail, OR upon facsimile transmission to me or my attorney, whichever is ?rst. This Consent Order, this Consent Agreement, and all attached Exhibits shall be public documents, with only patient identities. if any, redacted. As public documents. they may be posted on the Department's website. I stipulate that the proposed sanction and 4 Consent Order are authorized by NY. Pub. Health Law 230 and 230?a. and that the Board for Professional Medical Conduct and the Of?ce of Professional Medical Conduct have the requisite powers to carry out all included terms. I ask the Board to adopt this Consent Agreement of my own free will and not under duress. compulsion or restraint. In consideration of the value to me of the Board's adoption of this Consent Agreement, allowing me to resolve this matter without the various risks and burdens of a hearing on the merits, knowineg waive my right to contest the Consent Order for which apply. whether administratively or judicially, I agree to be bound by the Consent Order. and ask that the Board adopt this Consent Agreement. I understand and agree that the attorney for the Department, the Director of the Of?ce of Professional Medical Conduct and the Chair of the State Board for Professional Medical Conduct each retain complete discretion either to enter into the proposed agreement and Consent Order, based upon my application, or to decline to do so. I further understand and agree that no prior or separate written or oral communication can limit that discretion. A DATE: 6 . RMAN, MD. ESPONDENT DATE: [07 303,7? 9 DATE: 0'7 The undersigned agree to Respondent's attached Consent Agreement and to its proposed penalty. terms and conditions. KN Attorney for ndent E. KAPLAN Assocnate Counsel Bureau of Professional Medical Conduct ector Of?ce of Professional Medical Conduct EXHIBIT NEW YORK STATE DEPARTMENT OF HEALTH PROFESSIONAL MEDICAL CONDUQT IN THE MATTER i STATEMENT 01? i OF TI JACK M. GORMAN M.D. I: CHARGES .ACK M. GORMAN MD, the Respondent, was authorized to practice medicine in New York State on or about July 1, 1978, by the issuance of license number 134700 by the New York State Education Department. FACTUAL ALLEGATIONS A. Respondent, a mismanaged transference and/or counter-transference in the care of Patient A, resulting in inappropriate sexual contact with the patient. SPECIFICATION OF CHARGES FIRST SPECIFICATION NEGLIGENCE ON ONE OCCASION Respondent is charged with committing professional misconduct as de?ned in NY. Educ. Law 6530(3) by practicing the profession of medicine with I negligence on more than one occasion as alleged in the facts of two or more of the following: 1. Paragraph A. i 5e DATE: st .2007 ew York. New York ROY NEMERSON Deputy Counse! . . Bureau of Professuonal Medical Conduct EXHIBIT The suspension of Respondent's license shall be terminated only after Respondent makes a showing to the satisfaction of a Committee on Professional Conduct (Committee) of the State Board for Professional Medical Conduct (Board) that Respondent has successfully complied with or completed a course of therapy and ongoing evaluation and is no longer incapacitated for the practice as a physician, and a Committee makes a determination that Respondent is both fit and clinically competent tp practice as a physician. Respondent shall provide the Office of Professional Medical Conduct (OPMC) with a proposed treatment plan for advice as to whether it is generally appropriate; however, the determination of successful compliance with or completion of a course of therapy, and the determination that Respondent is no longer incapacitated for the active practice as a physician, shall be made solely by the Committee. After Respondent completes at least 6 months of suspension pursuant to the terms of this Consent Order, and upon Respondent?s request, a Committee shall be convened to hear and evaluate Respondent?s showing, as set forth in paragraph 1 above. The Board will make reasonable attempts to convene a Committee within 90 days of Respondent's request; however, Respondent's request shall not be perfected until the Director of OPMC receives all the required documentation, and complies with all the Conditions, set forth in paragraph 3 below. The Board shall determine the procedural nature of the proceeding through the exercise of the Director of OPMC's reasonable discretion upon consultation with Counsel, Bureau of Professional Medical Conduct (Counsel). Proceedings before a Committee shall {191 be in the nature of a hearing pursuant to N. Y. Pub. Health Law 230, but shall instead be informal and intended only to address any facts, evidence, information, circumstances, or issues relating to the advisability of terminating Respondent?s license suspension. The Committee shall be given access to evidence including. but not limited to: a. Any evidence pertaining to Respondent's compliance with the conditions imposed. b. Any evidence that the Director or Counsel deems appropriate. Upon requesting that a Committee be convened, pursuant to paragraph 2, Respondent shall provide the Director of OPMC with the following: a. The signed acknowledgment and curriculum vitae from the proposed supervising physician referred to in paragraph 5b. The signed acknowledgment and curriculum vitae from the proposed therapist referred to in paragraph 5c. Certi?ed true and complete copies of all evaluation and treatment records relating to Respondent?s andlor mental health treatment, whether in an in-patient, out-patient. after- care or consultation setting; the certi?ed records shall be forwarded directly to OPMC by the treatment providers, facilities and evaluators. The records shall re?ect all treatment and evaluation provided, and shall include the results of all tests conducted to evaluate Respondent's ?tness and clinical competence to practice medicine, whether the treatment, evaluation and testing occurred before, or while, the suspension was in effect. Documentation of Respondent's participation in the program(s) of the Committee for Physicians' Health of the Medical Society of the State of New York or other equivalent program(s). Documentation shall include but not be limited to veri?cation of compliance with treatment and testing, and forensically valid alcohol/drug screening, if any. Fully executed waivers of patient con?dentiality concerning any previous and prospective treatment records. A current, independent, in-depth evaluation by a board- certi?ed who shall be pre-approved by the Director, showing that he is ?t and clinically competent to practice as a physician. Respondent shall follow any further or continuing recommendations of the evaluating Documentation of successful completion of a continuing education program in the area of physician-patient boundaries that has been pre-approved in writing by the Director of OPMC. Upon request of the Director of OPMC. Respondent shall attend, participate in and cooperate with an interview with designated personnel from the OPMC. Provision of the documents listed in this paragraph shall not, alone, constitute a showing that Respondent is no longer incapacitated for active practice as a physician. At least 14 days before the scheduled date of the proceeding referred to in paragraph 2, Respondent shall provide OPMC with the following: a. Certi?ed true and complete copies of records updating and/or mental health care treatment (and alcohol/drug screening, if any) since the date of the original submissions referred to in paragraph 30. b. Evidence that Respondent has maintained adequate knowledge and competence to practice as a physician; this evidence shall include documentation of continuing medical education and, at the Director of OPMC's request, a report of an independent evaluation of Respondent's medical knowledge and competence. Submission of the evidence listed in this paragraph shall not, alone, constitute a showing that Respondent is no longer incapacitated for active practice as a physician. if the Chair of the Committee issues an Order ?nding that Respondent has successfully completed the prescribed course of treatment and has regained ?tness and competence to practice medicine, and therefore terminates the suspension of Respondent's license, the Order shall further impose a period of probation, pursuant to NY. Pub. Health Law 230-a, during which Respondent's practice as a physician shall be subject to conditions imposed for a period of no less than five years. Upon Respondent's successful completion of two years of the period of probation, Respondent may petition the Director for an early release from probation, and the Director shall exercise reasonable discretion in deciding whether to grant this petition. The minimum conditions of probation shall include the following: a. At the direction of the Director of OPMC. Respondent shall submit to periodic interviews with, and evaluations by, a board?certi?ed or other licensed mental health practitioner designated by the Director. This practitioner shall report to the Director regarding Respondent's condition and Respondent's ?tness or incapacity to practice as a physician. Respondent's medical practice shall be supervised by a licensed physician ("practice supervisor") proposed by Respondent and approved, in writing, by the Director of OPMC. The supervising physician shall be familiar with Respondent's history and history of inappropriate behavior, and with the Order and its conditions. The supervising physician shall supervise Respondent's compliance with the conditions of practice imposed by the Order. The supervising physician shall be in a position to regularly observe and assess Respondent's medical practice. The supervising physician shall acknowledge willingness to comply with the supervision terms by executing the acknowledgment provided by OPMC. Respondent shall ensure that the supervising physician submits quarterly reports to OPMC regarding the quality of Respondent's medical practice, any unexplained absences from work and certifying Respondent's compliance with each condition imposed, or detailing Respondent's failure to comply. The supervising physician shall report any suspected inappropriate behavior, questionable medical practices or possible misconduct to OPMC. Respondent shall engage and continue in treatment with a board- certi?ed or other licensed mental health care practitioner ("therapist") proposed by Respondent and approved, in writing, by the Director of OPMC. Respondent shall cause the therapist to submit a proposed treatment plan addressing Respondent's major issues and Respondent shall cause the therapist to provide quarterly reports to OPMC certifying whether Respondent is in compliance with the treatment plan, or detailing Respondent's failure to comply. Respondent shall follow any further or continuing recommendations of the therapist. OPMC, at its discretion, may provide information or documentation from its investigative tiles concerning Respondent to Respondent?s therapist. The therapist shall report to OPMC immediately if Respondent leaves treatment against medical advice or displays any of a suspected or actual relapse of inappropriate behavior. The therapist shall acknowledge willingness to comply with the reporting requirements with respect to treatment by executing the acknowledgment provided by OPMC. The terms set forth in paragraph 5 are the minimum probation terms related to ?tness to practice to be imposed on Respondent upon the termination of Respondent?s license suspension, and other terms may be added by the Committee. All compliance costs shall be Respondent?s responsibility. Respondent's failure to comply with any condition imposed at the time of suspension termination may result in disciplinary action against Respondent with charges of professional misconduct as de?ned by the New York State Education Law, including but not limited to NY. Educ. Law 6530(29). If a Committee denies a petition by Respondent for license suspension termination, Respondent shall be barred from requesting that a Committee be convened to hear a petition for license suspension termination for 9 months from the date of the denial. In addition to the terms set out in paragraph 5, and any other terms added by the Committee, upon the termination of Respondent's license suspension, Respondent shall also be subject to the following standard terms of probation: a. Respondent's conduct shall conform to moral and professional standards of conduct and governing law. b. Respondent shall provide the Director, Of?ce of Professional Medical Conduct (OPMC), Hedley Park Place, 433 River Street Suite 303, Troy, New York 12180-2299 with the following information, in writing, and ensure that this information is kept current: a full description of Respondent's employment and practice; all professional and residential addresses and telephone numbers within and outside New York State; and all investigations. arrests, charges, convictions or disciplinary actions by any local, state or federal agency, institution or facility. Respondent shall notify OPMC, in writing, within 30 days of any additions to or changes in the required information. Any civil penalty not paid by Respondent by the prescribed date shall subject Respondent to all legal provisions pertaining to debt collection, including the imposition of interest, late payment charges and collection fees, referral of the debt to the New York State Department of Taxation and Finance for collection. and the non? renewal of permits or licenses. [Tax Law 171(27); State Finance Law 18; CPLR 5001; Executive Law 32]. The probation period shall toll when Respondent is not engaged in active medical practice in New York State for a period of 30 consecutive days or more. Respondent shall notify the Director of OPMC, in writing, if Respondent is not currently engaged in, or intends to leave, active medical practice in New York State for a consecutive 30 day period. Respondent shall then notify the Director again at least 14 days before returning to active practice. Upon Respondent's return to active practice in New York State, the probation period shall resume and Respondent shall ful?ll any unful?lled probation terms and such additional requirements as the Director may impose as reasonably relate to the matters set forth in Exhibit or as are necessary to protect the public health. Respondent's professional performance may be reviewed by the Director of OPMC. This review may include, but shall not be limited to a review of of?ce records, patient records, hospital charts, andior electronic records, as well as interviews and/or periodic visits with Respondent and staff at practice locations or OPMC of?ces. Respondent shall maintain legible and complete medical records which accurately re?ect the evaluation and treatment of patients. The medical records shall contain all information required by state rules and regulations regarding controlled substances. Respondent shall comply with this Consent Order and all its terms, conditions, restrictions, limitations and penalties and shall be responsible for all associated compliance costs. Upon receiving evidence of non-compliance with the Consent Order, or any violation of its terms, the Director of OPMC and/or the Board may initiate a violation of probation proceeding and/or any other proceeding against Respondent authorized by law. EXHIBIT GUIDELINES FOR CLOSING A MEDICAL PRACTICE FOLLOWING MEDICAL LICENSE REVOCATION, SURRENDER OR SUSPENSION OF SIX MONTHS OR MORE Respondent shall immediately cease the practice of medicine in compliance with the terms of the Consent Order. Respondent shall not represent that Respondent is eligible to practice medicine and shall refrain from providing an opinion as to professional practice or its application. Within 15 days of the Consent Order?s effective date. Respondent shall notify all patients that Respondent has ceased the practice of medicine. and shall refer all patients to another licensed practicing physician for continued care. as appropriate. Within 30 days of the Consent Order's effective date, Respondent shall have Respondent's original license to practice medicine in New York State and current biennial registration delivered to the Of?ce of Professional Medical Conduct (OPMC) at 433 River Street Suite 303, Troy, NY 12180- 2299. Respondent shall arrange for the transfer and maintenance of all patient medical records. Within 30 days of the Consent Order's effective date. Respondent shall notify OPMC of these arrangements, including the name, address. and telephone number of an appropriate contact person. acceptable to the Director of OPMC, who shall have access to these records. Original records shall be retained for patients for at least 6 years after the last date of service, and for minors, for at least 6 years after the last date of service or 3 years after the patient reaches the age of majority. whichever time period is longer. Records shall be maintained in a safe and secure place that is reasonably accessible to former patients. The arrangements shall ensure that all patient information is kept confidential and is available only to authorized persons. When a patient or authorized representative requests a copy of the patient?s medical record. or requests that the original medical record be sent to another health care provider, a copy of the record shall be provided or sent at reasonable cost to the patient (not to exceed 75 cents per page). Radiographic. sonographic and like materials shall be provided at cost. A quali?ed person shall not be denied access to patient information solely because of inability to pay. Within 15 days of the Consent Order's effective date, if Respondent holds a Drug Enforcement Agency (DEA) certi?cate, Respondent shall advise the DEA in writing of the licensure action and shall surrender Respondent's DEA controlled substance certi?cate, privileges, and any unused DEA #222 US. Of?cial Order Forms Schedules 1 and 2, to the DEA. Within 15 days of the Order's effective date, Respondent shall return any unused New York State of?cial prescription forms to the Bureau of Narcotic Enforcement of the New York State Department of Health. Respondent shall have all prescription pads bearing Respondent's name destroyed. lf no other licensee is providing services at Respondent's practice location, Respondent shall dispose of all medications. Within 15 days of the Order's effective date, Respondent shall remove from the public domain any representation that Respondent is eligible to practice medicine, including all related signs, advertisements, professional listings, whether in telephone directories or otherwise, professional stationery or billings. Respondent shall not share, occupy or use of?ce space in which another licensee provides health care services. Respondent shall not charge. receive or share any fee or distribution of dividends for professional services rendered (by Respondent or others) while barred from practicing medicine. Respondent may receive compensation for the reasonable value of services lawfully rendered, and disbursements incurred, on a patient's behalf prior to the Consent Order's effective date. If Respondent is a shareholder in any professional service corporation organized to engage in the practice of medicine and Respondent's license is revoked. surrendered or suspended for 6 months or more pursuant to this Order, Respondent shall, within 90 days of the Consent Order's effective date, divest all ?nancial interest in the professional services corporation in accordance with New York Business Corporation Law. if 10. Respondent is the sole shareholder in a professional services corporation, the corporation must be dissolved or sold within 90 days of the ConSent Order's effective date. Failure to comply with the above directives may result in civil or criminal penalties. Practicing medicine when a medical license has been suspended. revoked or annulled is a Class Felony, punishable by imprisonment for up to 4 years, under N.Y. Educ. Law 6512. Professional misconduct may result in penalties including revocation of the suspended license, and/or fines of up to $10,000 for each specification of misconduct, under N.Y. Pub. Health Law 230-a. 5530?? De rtment PPORTUNITY. - 0 of ealth n, x- ANDREW M. CUOMO HOWARD A. ZUCKER, M.D., JD. SALLY DRESLIN, M.S., R.N. Governor Acting Commissioner Executwe Deputy CommisSJone-r January 21,2015 CERTIFIED MAIL-RETURN RECEIPT REQUESTED Jack M. German, MD. Re: License No. 134700 Dear Dr. German: Enclosed is a copy of the New York State Board for Professional Medical Conduct (BPMC) Modi?cation Order No. 15-0! 1. This order and any penalty provided therein goes into effect January 28, 2015. Please direct any questions to: Board for Professional Medical Conduct, 90 Church Street, 4th Floor, New York, NY 10007-2919, telephone 212?417-4445. Sincerely, Katherine A. Hawkins, MD, .D. Executive Secretary Board for Professional Medical Conduct Enclosure cc: Bruce Brady, Esq. Une Whitehall Street New York. NY 10004 - Snare Pass List-mm; 'i?e.ver. Aloeny. NY 12273? heaith my gov NEW YORK STATE DEPARTMENT OF HEALTH BPMC No- 15-011 STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER MODIFICATION OF OF JACK M. GORMAN, MD. CONSENT ORDER This matter was brought to the New York State Board for Professional Medical Conduct (BPMC) for decision at the request of Jack M. German, M.D., (Licensee), License No. 134700. Licensee was subject to BPMC Order No. 07-210 (Order), effective October 9, 200?. The Order suspended Licensee?s license to practice medicine for an inde?nite period of no less than six (6) months. The purpose of this proceeding was to determine whether the suspension was to he stayed upon the satisfaction of a Committee on Professional Conduct of the State Board for Professional Medical Conduct that Licensee, among other things, has successfully complied with or completed a course of therapy and ongoing evaluation, which includes a determination that Licensee is no longer incapacitated for the active practice of medicine and that he is both fit and competent to practice as a physician. Licensee requested that the Order be modi?ed to allow him to engage in the practice of medicine to the extent of conducting research within a medical school department of and/or neuroscience. A meeting of the Committee was held in the above-entitled proceeding on July 25, 2014. Licensee appeared with his attorney, Bruce Brady, Esquire, before a Committee of the State Board for Professional Medical Conduct consisting of Steven l. Sherman, D.O., M.S., Chair, Krishna R.S. Gujavarty, M.D., and Constance Garrow Diamond, DA. The Committee determined, by unanimous 2 decision, after review of the documents submitted for the petition and careful consideration of all evidence and testimony provided that the suspension of Licensee?s license shall be stayed and he shall be allowed to practice medicine subject to the following conditions. THEREFORE, IT IS HEREBY ORDERED THAT: The suSpension on the Licensee's license to practice medicine in the State of New York is stayed and that he shall be subject to the following conditions: Commencing on the effective date of the Order, and for as long as he holds a New York State medical license, Licensee?s practice shall be restricted to conducting research in an accredited institutional setting where Licensee may only see individuals who are participating in a research study being conducted within that institutional setting. Any request for modi?cation of the above condition must be submitted in writing to the Director of the Of?ce of Professional Medical Conduct (OPMC). If a modification is granted. Licensee shall be subject to any further conditions the Director, in his sole discretion, deems appropriate based on matters underlying BPMC Order No. 07-210 andfor any circumstances or in formation known to the Director at the time of Licensee?s request. Licensee?s failure to comply with such conditions shall constitute misconduct as de?ned by NY. Educ. Law 653009). Licensee shall cooperate fully with OPMC in its administration and enforcement of this Order and in its investigation of all matters concerning Licensee. Licensee shall respond in a timely manner to all OPMC requests for written periodic veri?cation of Licensee?s compliance with this Order. Licensee shall meet with a person designated by the Director of OPMC, as directed. Licensee shall 3 respond and provide all documents and information within Licensee?s control, as directed. These conditions shall take effect upon the Board?s issuance of this Order and will continue so long as Licensee remains licensed in New York State. Licensee shall maintain active registration of his license with the New York State Education Department Division of Professional Licensing Services, and pay all registration fees. This condition shall be in effect 120 days after the effective date of the Order and will continue for as long as Licensee remains licensed in New York State. Licensee shall remain in continuous compliance with all requirements of N.Y. Pub. Health Law 2995-a(4) and 10 1000.5, including but not limited to the requirements that a licensee shall: report to the Department all information required by the Department to develop a public physician profile for the Licensee; continue to notify the department of any change in pro?le information within 30 days of any change (or in the case of optional information, within 365 days of such change); and, in addition to such periodic reports and noti?cation of any changes, update his profile information within six months prior to the expiration date of the Licensee's registration period. Licensee shall submit changes to his physician pro?le information ei?dier electronically using the department's secure web site or on forms prescribed by the Department, and Licensee shall attest to the truthfulness, completeness and correctness of any changes Licensee submits to the department. This condition shall take effect 30 days after the Order's effective date and shall continue so long as Licensee remains a licensee in New York State. Licensee?s failure to comply with this condition, if proven and found at a hearing pursuant to N.Y. Pub. Health Law 230, shall constitute professional misconduct as de?ned in N.Y. Educ. Law 653001) and N.Y. Educ. Law 6530(29). Potential penalties for failure to comply with this condition may include all penalties for professional misconduct set forth in NY. Pub. Health Law {5 230-3, including but not limited to: revocation or 4 suspension of license, Censure and Reprimand, probation, public service andfor ?nes of up to $10,000 per Speci?cation of misconduct found. Licensee shall provide the Director of 0PMC with the following information and shall ensure that such information is kept current: a full description of Licensee?s employment and practice; all professional and residential addresses and telephone numbers within and outside New York State; all current and past hospital, facility, medical practice af?liations andfor applications for such af?liations; all professional licenses held and applied for; and all investigations, arrests, charges, convictions or disciplinary actions by any local, state or federal agency, institution or facility. Licensee shall notify OPMC, in writing, within thirty (30) days of any additions to or changes in the required information. This requirement will continue until Licensee completes the probation imposed by this Order. Licensee's return to practice is subject to the following terms of probation. Unless otherwise indicated, these terms shall remain in effect for a period lasting ?ve (5) years from the effective date of this Order. Licensee may not commence the practice of medicine in New York State until all preposed monitors have been approved in writing by the Director of 0PMC. l. The period of probation, including some or all of the terms and conditions described herein, may be tolled, at the discretion of the Director of OPMC, during periods in which the Licensee is not engaged in the active practice of medicine in New York State. Licensee shall notify the Director, in writing, if he is not currently engaged in or intends to leave the active practice of 5 medicine in New York State for a period of thirty (30) consecutive days or more. Licensee shall then notify the Director again at least fourteen (14) days before returning to active practice. Upon the Licensee?s return to active practice in New York State, the period of probation shall resume and the Licensee shall ful?ll any un?ul?lled probation terms and such additional requirements as the Director may reasonably impose or as are necessary to protect the public health. 2. Licensee shall remain free from alcohol and all other mood altering substances other than those prescribed for Licensee's treatment by a physician or other licensed health care practitioner aware of Licensee's history of alcohol dependency and mental illness. Licensee shall not self- prescribe any medications. 3. Licensee shall be monitored by a quali?ed health care professional (Sobriety Mon itor) proposed by Licensee and approved in writing by the Director of the OPMC. The Sobriety Monitor is to be familiar with Licensee's history of alcohol dependency, mental illness and with the terms of this Order. Licensee shall submit the name of a preposed successor within seven (7) days of learning that the approved Sobriety Monitor is no longer willing or able to serve. a. The Sobriety Monitor shall oversee Licensee's compliance with the terms and conditions imposed herein and shall cause to be performed forensically valid, random, directly observed, unannounced urine, breath, oral ?uid, blood andfor hair tests for the presence of alcohol and other drugs in Licensee. Licensee shall provide drug screens at a frequency of no less than six (6) times per month for the ?rst twelve (12) months. The Licensee shall be called on a seven day a week basis and drug screens must include weekend and evening collections. After twaive (12) months, if Licensee has been ?Jlly compliant with this Order, a request for a reduction in the number of drug screens may be submitted for approval in writing by the Director of 0PMC. b. The Sobriety Monitor shall notify OPMC immediately if Licensee refuses such a test. c. The Sobriety Monitor shall notify OPMC immediately if any drug screen reveals, or if the monitor otherwise learns, the Licensee is not alcoholi?drug ?ee. d. Every three (3) months, the Sobriety Monitor shall submit to OPMC a report certifying compliance with each of the terms of this Order or describing in detail any failure to comply. The quarterly reports shall include forensically valid results of all tests for the presence of alcohol and other drugs performed during that quarter. e. Licensee shall report to the Sobriety Monitor within four (4) hours of being contacted by the Sobriety Monitor to submit a urine, breath, oral ?uid, blood andfor hair specimen. Licensee shall avoid all substances that may cause positive results such as poppy seeds/mouthwash/cough medication/hand sanitizer/herbal teas. Any positive result will be considered a violation of this Order. g. If Licensee is to be unavailable for sobriety monitoring for a. period of 15 days or more, Licensee shall notify his Sobriety Monitor and seek and receive prior written permission from the Director of OPMC subject to any additional terms and conditions required by the 7 4. Licensee may not apply for a Drug Enforcement administration controlled substance registration. Licensee shall not obtain any of?cial New York State prescriptions and he shall not prescribe any medications. 5. Licensee shall be supervised in his practice by a licensed physician (Practice Supervisor) proposed by Licensee and approved in writing by the Director of 0PMC. The Practice Supervisor shall be on-site at all locations, unless determined otherwise by the Director of OPMC, and shall be in a position to regularly observe and assess Licensee?s medical practice. The Licensee shall make available to the Practice Supervisor any and all records or access to the practice requested by the Practice Supervisor. The Practice Supervisor is to be familiar with Licensee's history of alcohol dependency, mental illness and with the terms of this Order. Licensee shall submit the name of a proposed successor within seven (7) days of becoming aware that Licensee?s approved Practice Supervisor is no longer willing or able to serve in that capacity. a. The Practice Supervisor shall submit a report to OPMC every three (3) months regarding the quality of Licensee?s practice, any unexplained absences from work, and Licensee?s compliance or failure to comply with each condition described within this Order. b. The Practice Supervisor shall establish the capability of immediately obtaining a drug screen on Licensee in response to any complaint or observation that indicates Licensee may not be drug or alcohol ?-ee c. The Practice Supervisor shall immediately report any suspected or actual impahrnent, inappropriate behavior, perceived deviation from accepted standards of medical care or possible misconduct to OPMC. d. The Practice Supervisor shall notify OPMC immediately if Licensee violates any term(s) of this Order 6. Licensee shall not treat any friends or family members. 7. Licensee shall enroll in and successfully complete a minimum of 50 hours of Category I continuing medical education (CME) each year with at least 30 hours in the ?eld of Licensee shall provide written continuation to 0PMC of his completion of the CME courses. 8. Licensee shall continue in individual therapy with a quali?ed health care professional (Therapist). proposed by Licensee and approved, in writing, by the Director of OPMC. The Therapist is to be familiar with the Licensee's history of alcohol dependency and mental illness, and with the terms of this Order. Licensee will continue in treatment at a ?'equency determined by the Therapist, under a treatment plan approved by the Director of OPMC, for the duration of the probation. OPMC. at its discretion, may provide information or documentation from its investigative ?les concerning Licensee to Licensee?s Therapist. Licensee shall submit the name of a preposed successor within seven (7) days of becoming aware that the Licensee's approved Therapist is no longer willing or able to serve in that capacity. a. The Therapist shall submit reports to OPMC every three (3) months certifying compliance with treatment by Licensee and describing in detail any failure to comply. 9 b. The Therapist shall report immediately to 0PMC any signi?cant pattern of absences, suspected or actual impairment, failure to comply or discontinuation of recommended treatment, including any prescribed medications, by Licensee. 9. The Director of OPMC shall reserve the authority to direct the Licensee to undergo an independent evaluation by a practitioner or facility (Evaluator) approved by the Director of OPMC that specializes in alcohol/chemical dependency issues andfor mental illness andfor professional boundary issues. The Licensee shall execute authorizations to provide the Evaluator with copies of all previous treatment records and provide the Evaluator with a copy of this Order. The Licensee shall execute authorizations. and keep said authorizations active, allowing the Evaluator to obtain collateral information and communicate with the Director of OPMC or his designee. 0PMC, at its discretion, may provide information or documentation from its investigation ?les conceming the Licensee to the Evaluator. Reports of such evaluations shall be submitted directly to the Director of OPMC. Licensee shall follow treatment recommendations made by the Evaluator. if the Evaluator determines that the Licensee is not fit to practice, the Licensee shall immediately cease practice until it is determined he is ?t to resume practice. Failure to comply with the treatment recommendations will be considered a violation of this Order. 10. Licensee shall continue participation in self-help fellowship AA, NA, Caduceus, other). Licensee shall maintain an ongoing relationship with a sponsor. 1. Licensee shall continue enrollment in the Committee for Physicians Health and shall engage in a contract with CPH that fully describes the terms, conditions and duration of a recovery program. Respondent shall fully comply with the contract. 10 a. Licensee shall provide a written authorization for CPI-I to provide to the Director of 0PMC with any/all information or documentation requested by OPMC to determine whether Licensee is in compliance with the CPH contract and with this Order, including full access to all records maintained by with respect to Licensee. b. Licensee shall cause to report to 0PMC if Licensee re?zses to comply with the contract, refuses to submit to treatment or if his impairment is not substantially alleviated by treatment. CPH shall report immediately to OPMC if Licensee is regarded at any time to be an imminent danger to the public. 12. Licensee shall inform all treating physicians or other health care practitioners of Licensee's history of alcohol dependency and mental illness. Licensee shall advise OPMC, within seven (7) days, of any controlled or mood-altering substances dispensed, administered or prescribed to him by any treating physician or other health care practitioner. 13. The Director of OPMC shall reserve the right to review Licensee?s professional performance. This review may include, but shall not be limited to, a review of of?ce records, patient records andfor hospital charts (inclusive of electronic records), and interviews with or perLodic visits with Licensee and staff at his practice locations or OPMC of?ces. 14. Licensee shall maintain legible and complete medical records that accurately re?ect the evaluation and treatment of all patients. The medical records shall contain all information required by State rules and regulations regarding controlled substances. 15. Licensee shall adhere to Federal and State guidelines and professional standards of 1 1 care with respect to infection control practices. Licensee shall ensure education, training, and oversight of all office personnel involved in medical care, with respect to those practices. 16. Licensee shall conduct himself in all ways in a manner be?tting his professional status and shall conform fully to the moral and professional standards of conduct and obligations imposed by law and by his profession. 17. Licensee shall personally meet with a person designated by the Director of OPMC as requested by the Director, at a time and location determined by 0PMC. 18. Should Licensee practice medicine in another state, he shall provide written authorizations for the State Medical Board and/or the Physician Health Program to provide the Director of OPMC with anyfall information or documentation as requested by OPMC. l9. Licensee shall comply with all terms, conditions, restrictions and limitations to which he is subject pursuant to the Order and shall assume and bear all costs related to compliance of the Order. Upon receipt of evidence of noncompliance with, or any violation of these terms, the Director of OPMC andfor the Board may initiate a violation of probation proceeding andfor any such other proceeding against Licensee as may be authorized pursuant to the law. As Licensee agreed in the Consent Order, failure to comply with any of the conditions described above may result in disciplinary action. 12 This Order shall be emotive upon issuance. Dual: Stow I. Sherman, 13.0., MS. Co . a . NYE Board for Pm?ssional Medic-ll Conduct