LICENSE NO. 

IN THE MATTER OF

BEFORE THE
THE LICENSE OF
FERNANDO T. AVILA, MD. TEXAS MEDICAL BOARD

AGREED ORDER

On the r? day of  2011, came on to be heard before the

Texas Medical Board (the ?Board?), duly in session, the matter of the license of Fernando T.
Avila, M.D. (?Respondent?).

 

On October 7, 2010, the Respondent appeared in person, with counsel, Jennifer 
Rogers, at an Informal Show Compliance Proceeding and Settlement C(mference in response to a
letter of invitation from the staff of the Board. The Board?s representatiVes were Scott Holliday,
DO, and Julie Attebury, members of the Board. Joseph M. Tabaracci represented Board staff.

Upon the recommendation of the Board?s representatives and with the consent of
Respondent, the Board makes the following Findings of Fact and Conclusions of Law and enters
this Agreed Order.

BOARD CHARGES

The Board alleges as follows: Respondent failed to meet the standard of care related to
cervical epidural steroid injections. Shortly after an injection procedure was completed on
August 17, 2007, Patient A suffered an anoxic brain injury. Speci?cally, it was charged that
that Respondent: failed to monitor Patient A?s vital signs during the procedures; failed to have
the required personnel present during administration" of Level anesthesia (Propofol); and
failed to document sedation records for any of Patient A?s steroid injection procedures.

Additionally, Board alleges that Respondent failed to be registered with, or pay fees to,
the Board for the administration of Of?ce Based Anesthesia, and also failed to previde a

complete set of Patient A?s medical records to  authorized representative for Patient A.

Page 1 of 9

BOARD HISTORY

Respondent has had a prior history with the Board as follows:

1. On March 28, 2003, Respondent entered into an Agreed Order related to the
failure to release medical records, and was assessed a $1000 administrative
penalty.

2. On August 26, 2005, Respondent entered into an Agreed Order related to
employing a physician whose licensed had been revoked, and was assessed a
$1000 administrative penalty.

3. On August 21, 2009, Respondent entered into an Agreed Order related to non-
therapeutic prescribing for two patients and failure to properly document his
prescribing, and was required to obtain 20 hours CME in two years and attend the
PACE medical-recordkeeping course in one year.

4. On August 27, 2010, Respondent entered an Agreed Order related to the
documentation of justi?cations for continued prescribing of controlled substances

to one patient, and the Order requires a practice/chart monitor for two years.

FINDINGS

Upon the recommendation of the Board?s representatives and with the consent of
Respondent, the Board makes the following Findings and Conclusions of Law and enters this
Agreed Order. The Board ?nds the following:

1. General Findings:

a. Respondent received all notice required by law. All jurisdictional requirements
have been satisfied. Respondent waives any defect in notice and any further right
to notice or hearing under the Medical Practice Act, Title 3, Subtitle B, Texas
Occupations Code (the ?Act?) or the Rules of the Board.

b. Respondent currently holds Texas Medical License No. G-2899. Respondent was
originally issued this license to practice medicine in Texas on February 27, 1983.
Respondent is not licensed to practice in any other state.

c. Respondent is primarily engaged in the practice of anesthesiology. Respondent is
board-certi?ed in anesthesiology by the American Board of Anesthesiology, a

member board of the American Board of Medical Specialties.

Page 2 of 9

 

(1.

Respondent is 54 years of age.

Speci?c Panel Findings:

a.

Respondent saw Patient A more than 20 times of which approximately one-half of
the patient?s visits involved the administration of cervical epidural steroid
injections. 4

During Patient A?s injection procedures, Respondent failed to keep any sedation
records, including any records that he had monitored the patient?s vital signs.
During Patient A?s final procedure of four injections on August 17, 2007, the
patient received approximately 100 mg of Propofol, which in the Board?s opinion,
was an excessive amount of Level intravenous anesthesia for this patient?s size
and weight. I

Respondent, with the exception of himself, failed to have any ACLS-certi?ed
staff attending to Patient A when she was administered Propofol on August 17,
2007.

Patient A, awake and attended by two medical assistants after Respondent left the
room for 5?1 0 minutes, suffered a respiratory arrest and lost consciousness.
Respondent returned immediately and initiated emergency resuscitation until
Patient A?s vital signs resumed and stabilized, after which he transferred Patient
A to the Nix Hospital ICU, where she was diagnosed with an anoxic brain injury.
Subsequently, during Patient A?s rehabilitation for the brain injury, the patient
was diagnosed with lung cancer and died on January 18, 2008.

Respondent failed to have his practice registered for of?ce-based anesthesia
services as required for a practice that administers Level services.

After a proper request from the executor of Patient A?s estate, Respondent failed

to provide a complete set of the requested patient records.

Mitigating Factors:

a.

In determining the appropriate sanctions in this matter, the Panel considered the

following mitigating factors:

i. Respondent admitted his failure to timely register his of?ce?based

anesthesia services with the Board.

Page 3 of 9

ii. Respondent admits he failed to provide a complete set of records
requested by Patient A?s estate, but did so later, as soon as he learned that
only a partial set of records had been provided.

Respondent has taken the PACE course in medical-recordkeeping.

iv. Respondent has developed new internal-use forms to ensure complete
medical record documentation vital sign data).

v. Since 2008, Respondent has employed two CRNAs,
at least one of whom is available to assist him during any procedure.

4. Respondent does not admit or deny the Findings of Fact and Conclusions of Law set
forth in this Agreed Order. However, Respondent has cooperated with Board staff in
the investigation of the allegations related to this Agreed Order. Respondent's
cooperation, through consent to this Agreed Order, pursuant to the provisions of
Section 164.002 of the Act, will save money and resources for the State of Texas. To
avoid further investigation, hearings, and the expense and inconvenience of litigation,
Respondent agrees to the entry of this Agreed Order and to comply with its terms and

conditions.

CONCLUSIONS OF LAW

Based on the above Findings, the Board concludes that:

1. The Board has jurisdiction over the subject matter and Respondent pursuant to the
Act.

2. Section of the Act authorizes the Board to take disciplinary action
against Respondent based on Respondent?s commission of an act prohibited under Section
164.052 of the Act.

3. Section authorizes the Board to take disciplinary action against
Respondent based on Respondent?s Violation of Board Rules, speci?cally, Board Rule 165.1
failure to maintain adequate medical records; Board Rule 165.2 failure to release medical records
upon proper request; Board Rule 170.3 failure to comply with the Board?s guidelines for the
treatment of pain; Board Rule failure to follow Board guidelines for the provision of
anesthesia services in an outpatient setting; and Board Rule 192.4(a) failure to register with the

Board as a provider of of?ce-based anesthesia services.

Page 4 of9

4. Section of the Act authorizes the Board to take disciplinary action
against Respondent based on Respondent?s failure to practice medicine in an acceptable
professional manner consistent with public health and welfare, as de?ned by: Board Rule
failure to meet the generally accepted standard of care; Board Rule 
failure to exercise diligence in one?s professional practice; and Board Rule failure to
safeguard against complications.

5. Section of the Act authorizes the Board to take disciplinary action
against Respondent based upon Respondent?s unprofessional or dishonorable conduct that is
likely to deceive? or defraud the public or injure the public.

6. Section 164.001 'of the Act authorizes the Board to impose a range of disciplinary
actions against a person for violation of the Act or a Board rule.

7. Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition
of this matter through an Agreed Order.

QIQLLR

Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that
Respondent shall be subject to the following terms and conditions:

l. The entry of this Order shall constitute a PUBLIC REPRIMAND by the Board.

2. Within one year from the date of the entry of this Order, Respondent shall enroll in
and successfully complete the Knowledge, Skills, Training, Assessment, and Research
program?s Clinical Competency Assessment offered by the Texas Health
Science Center Rural and Community Health Institute.

Upon Respondent?s acceptance into the KSTAR program, Respondent shall execute a
written request and authorization to KSTAR representatives to provide a complete copy of the
?nal assessment report to the Compliance Division within 15 days of its completion.
Respondent shall successfully complete any and all retraining, remedial measures, and/or other
recommendations made by KSTAR based Upon the assessment.

3. Within one year from date of the entry of this Order, Respondent shall enroll in and
successfully complete the preparation course for anesthesia board certi?cation offered by Neil
Jensen, or an equivalent course approved in advance by the Executive Director. To obtain

approval for a course other than the Neil Jensen course, Respondent shall submit in writing to the

Page 5 of 9

 

Compliance Division of the Board information on the course, to include at least a reasonably
detailed description of the course content, faculty, course location, and dates of instruction.
Respondent shall submit documentation of attendance and successful completion of this
requirement to the Compliance Division of the Board on or before the expiration of the time limit
set forth for completion of the course.

4. This Order shall clarify that, after the date of the entry of this Order, all chart monitor
reports remaining to be done under the requirement set forth in Ordering Paragraph No. 1 of
Respondent?s Agreed Order, dated August 27, 2010, (Attachment A) shall emphasize the
monitoring of anesthesia records with speci?c focus on the following: EKG, SPOZ, ETC02,
respiration rate, blood pressure, heart rate, and the mechanism used for oxygen delivery.

5. Respondent shall pay an administrative penalty in the amount of $2,000 within 60
days of the date of the entry of, this Order. The administrative penalty shall be paid in a single
payment by cashier's check or money order payable to the Texas Medical Board and shall be
submitted to the Board for routing so as to be remitted to the Comptroller of Texas for deposit in
the general revenue fund. ReSpondent's failure to pay the administrative penalty as ordered shall
constitute grounds for further disciplinary action by the Board, and may result in a referral by the
Executive Director of the Board for collection by the Of?ce of the Attorney General.

6. The time period of this Order shall be extended for any period Of time that:
Respondent subsequently practices exclusively outside the State of Texas; Respondent's
license is subsequently cancelled for nonpayment of licensure fees; (0) this Order is stayed or
enjoined by Court Order; or for any period of time longer than 60 consecutive days that
Respondent does not actively practice medicine. If Respondent leaves Texas to practice
elsewhere or ceases active practice for more than 60 consecutive days, Respondent shall
immediately notify the Compliance Division of . the Board in writing. Upon Respondent?s return
to active practice or return to practice in Texas, Respondent shall notify the Compliance Division
of the Board in writing. When the period of extension ends, Respondent shall be required to
comply with the terms of this Order for the period of time remaining on the Order. Respondent
shall pay all fees for reinstatement or renewal of a license covering the period of extension or
tolling. 

7. Respondent shall comply with all the provisions of the Act and other statutes

regulating the Respondent?s practice.

Page 6 of 9

 

8. Respondent shall fully cooperate with the Board and the Board staff, including Board
attorneys, investigators, compliance of?cers, consultants, and other employees or agents of the
Board in any way involved in investigation, review, or monitoring associated with Respondent's
compliance with this Order. Failure to fully cooperate shall constitute a violation of this order
and a basis for disciplinary action against Respondent pursuant to the Act. 

9. Respondent shall inform the Board in writing of any Change of Respondent's of?ce or
mailing address within. 10 days of the address change. This information shall be submitted to the
Registration Department and the Compliance Department of the Board. Failure to provide such
information in a timely manner shall constitute a basis for disciplinary action by the Board
against Respondent pursuant to the Act. Respondent agrees that 10 days notice of a Probationer
Show Compliance Proceeding to address any allegation of non-compliance of this Agreed Order
is adequate and reasonable notice prior to the initiation of formal disciplinary action.
Respondent waives the 30-day notice requirement provided by of the Medical
Practice Act and agrees to 10 days notice, as provided in 22 Texas Administrative Code


10. Any violation of the terms, conditions, or requirements of this Order by Respondent
shall constitute unprofessional conduct likely to deceive or defraud the public, or to injure the
public, and shall constitute a basis for disciplinary. action by the Board against Respondent
pursuant to the Act.

11. Respondent shall be permitted to supervise and delegate prescriptive authority to
physician assistants and advanced practice nurses and to supervise surgical assistants.

12. This Order does not supercede the August 27, 2010 Agreed Order (Attachment A).

RESPONDENT WAIVES ANY FURTHER HEARINGS OR APPEALS TO THE BOARD OR
TO ANY COURT IN REGARD TO ALL TERMS AND CONDITIONS THIS AGREED .
ORDER. RESPONDENT AGREES THAT THIS IS A FINAL ORDER.

THIS ORDER IS A PUBLIC RECORD.

(Signature Pages Follow)
Page 7 of 9

I, FERNANDO AVILA, M.D., HAVE READ AND UNDERSTAND THE FOREGOING
AGREED ORDER. I UNDERSTAND SIGNING, I WAIVE CERTAIN RIGHTS. I
SIGN IT VOLUNTARJLY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE
ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEMENT OF ANY KIND,

VERBAL, WRITTEN OR OTHERWISE. 
DATED: ?at/MY 5 ,20 

I
M144
FERNANDO T. AVILA, M.D.
Rcspondent

STATE OF 7571;?
COUNTY OF 3am

?7330260) -

SWORN TO AND ACKNOWLEDGBD BEFORE ME, the undersigned Notary Public, on this

,20/1 .

Ignature otary Public
cad/vita: Aka 3?7, :w I 5

 

(Nanny Seal)
EMILY qua:

?rm?
AUGUST 27. zbia 

N1


     
  
 

   
  

Page 8 of 9

SIGNED AND ENTERED by the presiding of?cer of the Texas Medical Board on this 2 77/
day of  2011.

MW MCIMLLW MID Err

Irvin E. Zeitler, J12, D.O., President
Texas Medical Board

 

Page 9 of 9

 

LICENSE NO. G-2899

IN THE MATTER OF
BEFORE THE
7 THE LICENSE OF
FERNANDO T. AVILA, MD. TEXAS MEDICAL BOARD

AGREED ORDER
On the ?2 1 day of  2009, came on to be heard before the

Texas Medical Board (the ?Board"), duly in session, the matter of the license of Fernando T.
Avila, MD. (?Respondent?). .

On November 7, 2008, Respondent appeared in person, with counsel Jennifer Rogers, at
an Informal Show Compliance Proceeding and Settlement Conference, in response to a
letter of invitation from the staff of the Board. The Board?s representatives were Timothy Webb,
.D., a member of the Board, and Janet Tomelli-Mitchell, MD, a member of a District Review
Committee. Katie Johnsonius represented Board staff at the ISC. Elaine Snow prepared the
Agreed Order.

Upon the recommendation of the Board?s representatives and with the consent of
Respondent, the Board makes the following Findings of Fact and Conclusions of Law and enters
this Agreed Order.

FINDINGS OF FACT

The Board ?nds that:

a. Respondent received?all notice required bylaw. All jurisdictional requirements
have been satis?ed. Respondent waives any defect in notice and any ?rrther right to notice or
hearing under the Medical Practice Act, Title 3, Subtitle B, Texas Occupations Code (the ?Act?)
or the Rules of the Board. 

b. ReSpondent currently holds Texas Medical License No. 6-2899. Respondent was
originally issued this license to practice medicine in Texas on February 27, 1983. Respondent is

not licensed to practice in any other state. 

Page 1 of 11 Pages

ATTACHMENT i

 

C.

Respondent is primarily engaged in the practice of anesthesiology. Respondent is

board certi?ed by the American Board of Anesthesiology and Pain Medicine, a member of the
American Board of Medical Specialties.

d.

e.

Respondent is 53 years of age.

Respondent has not received a prior disciplinary order from the Board.

6. Patient 

a.

Patient A initially presented to Respondent as a new patient on July 24, 2002,
complaining of mid thoracic, scapular and axial pain. A Magnetic Resonance
Imaging report from July- 12, 2002, was cited in the initial evaluation
(performed prior to the initial visit), which was compatible with cervical
spondylosis. The evaluation also. noted a history of Codetron use. Note was
made of ?regular? alcohol use. The patient was diagnosed with thoracic pain and

possible cervical radiculopathy. Respondent did not suf?ciently document an

. initial detailed history or examination of this patient, and his records lacked

essential documentation of physical examination. 
Respondent placed Patient A on Schedule II opioid medications and an anti-
in?amrnatory drug. Electrodiagnostics were ordered and prior treatment with
muscle stimulation was continued. In the ensuing months, Respondent added
carisoprodol to this patient?s prescribed medications.

Respondent recommended and/or attempted several therapeutic methods to
address the patient?s pain, but Respondent did not indicate the success or failure
of these methods in the patient?s records. 

On December 4, 2002, Patient A reported somnolence on the medication regimen,
but the patient reported it was not severe enough to affect ?inction nor was it
constant. Respondent continued with physical therapy, and no changes Were
made to Patient A?s medications. I

Patient A was involved in a motor vehicle accident in February 2003, which

caused further injury to Patient A?s back and required halo traction. Respondent . 

worked with the hospital physicians to prescribe pain medications appropriate for

Patient A?s acute condition from the accident, and Respondent visited Patient A at

Page 2 of 11 Pages

 

home when released from the hospital, where Patient A convalesced for three
months.

. ,On May 28, 2003, ReSpondent ordered an MRI and neurological consultation and
discontinued the use of Soma, Ambien and Vioxx. On June 25, 2003, Patient A?s
record re?ects pain on a scale of 5 out of 10, muscle spasm and trouble falling
asleep. Soma and Ambien were re-started. On August 25, 2003, Patient A denied
side effects from the medications and exhibited no physical signs of distress.

. In September 2003, Patient A was found incapacitated at work. Respondent
addressed this condition by discontinuing Soma and switching the patient to
Robaxin. Respondent continued the patient?s other medications.

. Throughout'the early part of 2004, Patient A?s medication regimen remained
fairly stable during this period, and Patient A reported 90% improvement with
medications during February and March 2004 visits. During the May 10, 2004
visit, Patient A reported missing a great deal of work. Records indicate that
Respondent continued tracking Patient A?s progress every one to two months. A
brief period of opioid decrement ensured, but the medications were subsequently
increased with reported decrease in pain control, supplemented by muscle
relaxants.

During the year 2005, Respondent followed Patient A?s progress every One to two
months. During visits in January, February, March, and May, Patient A reported
good pain control and denied any side effects. In August 2005, weight gain and
increased headaches were documented, but Patient A reported adequate pain
control and activities of daily living. No changes were made in Patient A?s pain
medication during the August, October, and November 2005 visits. I

In January 2006, Respondent initiated a trial of Zana?ex; this was switched to
Flexeril in February 2006, and Lyrica was initiated. During subsequent visits in
April, May, June, July, and September of 2006, Patient A reported good function
and pain control.

. Patient A continued to work as a pharmacist throughout Respondent?s treatment. I

Respondent should have used other (non-narcotic) pain control therapies, rather I

Page 3 of 11 Pages

than initially prescribing potentially addictive substances. Additionally,
Respondent?s record keeping was inadequate for Patient A?s treatment. I

1. Respondent did not attempt to control Patient A?s pain with non-narcotics.

m. Respondent did not refer Patient A to an outside consultant for 
testing, behavioral therapy diagnostic injections, re~imaging or surgical
consultation.

11. Respondent failed to assess Patient A?s high risk of addiction; Respondent was
inattentive to ?red ?ag? behaviors indicating possible aberrant medication use,
and Respondent failed to suf?ciently respond to the adverse effects Patient A
received from opioid medications.

7. Patient B:

a. Patient presented to the Respondent on April 26, 2002, with initial complaints
of multiple arthralgias and myalgias subsequent to an Epstein-Barr viral infection,
Past medical and surgical history included: hypothyroidis; multiple
cosmetic procedures; hysterectomy; acid re?ux disease; depression; presumably
reactive airway disease; and hypertension. Social history revealed that the patient
occasionally used alcohol. I

b. Respondent did not sufficiently document an initial detailed history or
examination of this patient, and his records lacked essential documentation of
physical examinations. Laboratory studies revealed hyperlipidemia and a positive
titer for chronic EBV antibodies. Respondent diagnosed Patient with chronic
nociceptive pain due to EBV and myofascial pain 

c. Respondent immediately prescribed the patient with potent opioid analgesics, oral
steroids, muscle relaxants, (tizanidine), and aquatic therapy. No behavioral
evaluation was ordered.

d. Patient next visited 'ReSpondent two weeks later (May 13, 2002), reporting the
medical regimen prescribed offered improvement with the shooting pain, but only
temporary relief from the aching pain. Respondent changed the narcotic and
muscle relaxant, and rapidly escalated them. Patient did not; attend the aquatic
therapy that was recommended, and Respondent did not conduct a'subsequent

follow-up regarding the recommendation.

Page 4 of 11 Pages

On. June 28, 2002, Respondent recorded that Patient experienced side effects of 
edema, which required the use of diuretics. As a result of the edema, Morphine
Sulfate Immediate Release was discontinued, and Actiq was initiated. Despite
documentation of a negative rheumatologieal evaluation, Respondent increased
steroids in July for Patient B's complaints of stiffness in the hips and extremities
as well as treatment for complaints of numbness.

In August 2002, Respondent noted Patient overused short-acting opioids
outside prescription boundaries. Respondent addressed the increased pain by
adding a class of extended-release opioids to the patient?s regiment, supplemented
by more tizanidine.

. In September 2002, Patient reported occasional somnolence- and continued
edema but reported pain control and good results with Codetron treatment.
Respondent discontinued the Duragesic patches, Azmacort Metered Dose Inhaler
and Tegaderrn, decreased Patient B?s Morphine Sulfate Contin and increaSed
Actiq. On December 4, 2002, Patient reported good results with prescribed
medication but the patient also reported nausea. On December 20, 2002, Patient
reported increased pain and that the current medication was no longer effective.
Respondent discontinued MS Contin and started Oxycontin.

. In January and early February of 2003, Patient reported minimal improvements
but the nausea, and insomnia continued. During a subsequent visit on February
27, 02003, Patient reported the pain was 90% under control with improved
edema, but Patient reported hallucinations upon taking more than the prescribed
Zana?ex at bedtime, which was decreased. Patient was provided the additional
treatments of N-methyl-D-aspartate antagonists and guaifenesin. At
subanesthetic doses, these medications have mild stimulant effects, but at higher
doses, they may induce dissociation and hallucinations. Respondent made no
documentation of the effectiveness of either medication.

Respondent added hypnotics in March 2003 to treat Patient B?s insomnia and-
recommended aquatic therapy. In May 2003, he added two anticonvulsants and
an antidepressant without documenting treatment rationale. In June of 2003,

Patient reported increased depression and anxiety. Prozac was increased, but

Page 5 of 11 Pages

Gabitril was discontinued for drovirsiness. During visits in July and August 2003,

- Patient reported better condition and functioning, and no changes were made
other than to add Lactulose for mild constipation and to order physical therapy.
In October of 2003, Respondent treated Patient B?s pain ?are-up with Medrol
Dose Pak. Respondent?s notes from December 2003 re?eCt Patient had been
treated by both a rheumatologist and endocrinologist. Patient reported
increased pain; Oxycontin was increased.

j. From February through April 2004, Patient reported doing much better and
medications were not changed. In May of 2004, Patient reported an 80'to 90%
improvement in pain control but also reported occasional sweating, nausea,
insomnia, drowsiness, and fatigue. Peripheral edema was treated by changing the
opioid medication with a diuretic. Patient B?s Morphine Equivalent Daily Dosage
was approximately 1300 milligrams throughout the summer,
despite continued documentation'of adverse side effects.

k; In January and March of 2005, Patient reported good pain control, and
Oxycontin was decreased (in January) and later discontinued in May of 2005.
During the May 2005 visit, Patient reported increased pain. Oxycontin was
discontinued and Palladone was initiated. Patient B?s regimen was again
escalated to a MEDD of over 1500 mg daily.

1. Respondent should have used other (non?narcotic) pain control therapies, and
Respondent?s record keeping was inadequate for Patient B?s treatment.

m. Respondent did not refer Patient to an outside consultant for? 
testing, behavioral therapy, diagnostic injections, re-imaging or surgical
consultation. .

n. Respondent failed to assess this patient?s high risk of addiction, and he was
inattentive to ?red ?ag? behaviors indicating possible aberrant medication use.
Respondent failed to sufficiently respond to the adverse effects Patient received
from opioid medications.

8. Respondent has cooperated in the investigation of the allegations related to this
Agreed Order. Respondent's cooperation, through consent to this Agreed Order, pursuant to the

provisions of Section 164.002 the Act, will save money and resources for the State of Texas. To

Page 6 of 11 Pages

avoid ?rrther investigation, hearings, and the expense and inconvenience of litigation,

Respondent agrees to the entry of this Agreed Order and to comply with its terms and conditions.

CON '81 NS OF LAW

Based on the above Findings of Fact, the Board concludes that:

1. The Board has jurisdiction over the subject matter and Respondent pursuant to the
Act. 

2. Section of the Act authorizes the Board to take disciplinary action
against a person based on the person?s failure to practice medicine in an acceptable professional
manner consistent with public health and welfare as ?rrther de?ned in Board Rule 
(D): (A), failure to treat a patient according to the generally accepted standard of care; (B),
negligence in performing medical services; (C), failure to use proper diligence in one?s
professional practice; and (D), failure to safeguard against potential complications.

3. Section of the Act authorizes the Board to take disciplinary action
against Respondent based on Respondent?s violation of a Board rule, speci?cally Board Rule
165.1, regarding maintaining adequate medical records and Board Rule 170, regarding pain
management.

4. Section of the Act authorizes the Board to take disciplinary action
against a physician based upon the physician?s unprofessional or dishonorable conduct that is
likely to deceive or defraud the public or- injure the public, as further de?ned by Board Rule
providing medically unnecessary services to a patient or submitting a billing
statement to a patient'or a third party payer that the licensee knew or should have known was
improper. "Improper" means the billing statement is false,- fraudulent, misrepresents services
provided, or otherwise does not meet professional standards. 

5. Sections and of the Act authorize the Board to take
disciplinary action against Respondent based on Respondent writing prescriptions for or
dispensing to a person who is known to be an abuser of narcotic drugs, controlled substances, or
dangerous drugs or to a person who the physician should have known was an abuser of the

narcotic drugs, controlled substances, or dangerous drugs.

Page 7 of 11 Pages.

6. Sections and of the Act authorize the Board to take 
disciplinary action against Respondent based onRespondent prescribing or administering a drug
or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or .
treatment is administered or prescribed.

7. Sections and of the Act authorize the Board to take
disciplinary action against Respondent based on Respondent prescribing, administering, or
dispensing in a manner inconsistent with public health and welfare, dangerous drugs as de?ned
by Chapter 483, Health and Safety Code; or controlled substances scheduled in Chapter 481
Health and Safety Code; or controlled substances scheduled in the Comprehensive Drug Abuse
Prevention and Control Act of 1970, (21 U.S.C. ?801 et seq). 

8. Section 164.001 of the Act authorizes the Board to impose a range of disciplinary
actions against a person for violation of the Act or a Board rule. Such sanctions include:
revocation, suspension, probation, public reprimand, limitation or restriction on practice,
counseling or treatment, required educational or counseling programs, monitored practice, public
service, and an administrative penalty. 

9. Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition
of this matter through an Agreed Order.

10. Section l64.002(d) of the Act provides that this Agreed Order is a settlement

agreement under the Texas Rules of Evidence for purposes of civil litigation.
ORDER

Based on' the above Findings of Fact and Conclusions of Law, the Board ORDERS that
Respondent shall be subject to the following terms and conditions for a period of two years from
the date of the entry of this Order

1. Within two years from the date of the entry of this Order, Respondent shall enroll in
and successfully complete at least 20 hours of continuing medical education approved
for Category I credits by the American Medical Association in the subject of pain management,
approved in writing in advance by the Board. To obtain approval for the course, Respondent
shall submit in writing to the Board information on the course, to include at least a reasonably
detailed description of the. course content and faculty, as well as the course location and dates of

instruction. Respondent shall submit documentation of attendance and successful completion of

Page 8 of 11 Pages

this requirement to the Board on or before the expiration of the time limit set forth for
completion of the course. The CME requirements set forth in this paragraph shall be in addition I
to all other CME reciuired for licensure maintenance or any other CME required by this Order.

2. Within one year from date of the entry of this Order, Respondent shall enroll in and
successfully complete the medical recordkeeping course offered by the University of California
San Diego Physician Assessment and Clinical Education (PACE) program, or an. equivalent
course approved in advance by the Executive Director. To obtain approval for a course other
than the PACE course, Respondent shall submitin writing to the Board information on the
course, to include at least a reasonably detailed description of the course content, faculty, course
location, and dates of instruction. Respondent shall submit documentation of attendance and
successful completion of this requirement to the Director of Enforcement for the Board on or
before the expiration of the time limit set forth for completion of the course.

3. The time period of this Order shall be extended for any period of time that: 
Respondent subsequently practices exclusively outside the State of Texas; Respondent's
license is subsequently cancelled for nonpayment of licensure fees; this Order is stayed or
enjoined by Court Order; or for any period of time longer than 60 consecutive days that
Respondent does not actively practice medicine. If Respondent leaves Texas to practice
elsewhere or ceases active practice for more than 60 consecutive days, Respondent shall
immediately notify the Board in writing. Upon Respondent?s return to active practice or return
to practice in Texas, Respondent shall notify the Board in writing. When the period of extension
ends, Respondent shall be required to comply with the terms of this Order for the period of time
remaining on the Order. Respondent shall pay all fees for reinstatement or renewal of a license
covering the period of extension or tolling.

4. Respondent shall comply with all the provisions of the Act and other statutes
regulating the Respondent?s practice. 7

5. Respondent shall fully cooperate with the Board and the Board staff, including Board
attorneys, investigators, compliance officers, consultants, and other employees or agents of the
Board in any way involved in investigation, review, or monitoring associated with Respondent?s 
compliance with this Order. Failure to fully cooperate shall constitute a violation of this order

and a basis for disciplinary action against Respondent pursuant to the Act.

Page 9 of 11 Pages

I 6. Respondent shall inform the Board in writing of any change of Respondent's of?ce or
mailing address within 10 days of the address change?. This information shall be submitted to the
Permits and Registration Department and the Compliance Department of the Board. Failure to
provide such information in a timely manner shall constitute a basis for disciplinary action by the
Board against Respondent pursuant to the Act. Respondent agrees that 10 days notice of a
Probationer Show Compliance Proceeding to address any allegation of non-compliance of this
Agreed Order is adequate and reasonable notice prior to the initiation of formal disciplinary
action. Respondent waives the 30-day notice requirement provided by of the
Medical Practice Act and agrees to 10 days notice, as provided in 22 Texas Administrative Code


7. Any violation of the terms, conditions, or requirements of this Order by Respondent
shall constitute unprofessional conduct likely to deceive or defraud the public, or to injure the
public, and shall constitute a basis for disciplinary action by the Board against Respondent
pursuant to the Act. 

8. Respondent shall be permitted to supervise and delegate prescriptive authority to
physician assistants and advanced practice nurses and to supervise surgical assistants.

9. The above-referenced conditions shall continue in full force and effect, without
opportunity for amendment except for error in drafting, for one year following the date of entry
of this Order. If, after the passage of one-year period, Respondent wishes to seek amendment or
termination of these conditions, Respondent may petition the Board in writing. The Board may
inquire into the request and may, in its sole discretion, grant or deny the petition without ?irther

appeal or review. Petitions for modifying or terminating may be ?led only once a year thereafter.

RESPONDENT WAIVES ANY FURTHER HEARINGS OR APPEALS TO THE BOARD OR
TO ANY COURT IN REGARD TO ALL TERMS AND CONDITIONS OF THIS. AGREED
ORDER. RESPONDENT AGREES THAT THIS IS A FINAL ORDER.

THIS ORDER IS A PUBLIC RECORD.

I, FERNANDO AVILA M.D., HAVE READ AND UNDERSTAND THE FOREGOING
AGREED ORDER. I UNDERSTAND THAT BY SIGNING, I WAIVE CERTAIN RIGHTS. I

Page 10 of 11 Pages

SIGN IT VOLUNTARILY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE I

ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEMENT OF ANY KIND,
VERBAL, WRITTEN OR OTHERWISE.

DATED: 70 ,2009.

Kim

FERNANDO AVILA, MD.
Respondent

 

STATE OF  
COUNTY OF  4

SWORN TO AND CKNOWLEDGED BEFORE ME, the undersigned Notary Public, on this
day of 2009. 



      

Signature of Notary Public
(Notary Seal)

 ADELIAGRODHIGUEZ
   f; Nmary Public. State of Texas
1 My Commission Expires



 SEPT, 30, 2010

 

 

 

 

SIGNED AND NTERED by the presiding of?cer of the Texas Medical Board on this

 

 

day of ,2009.
Agra: Q)
Irvin E.Zeitler,Jr.,D.O., re dent 
Texas Medical Board

Page 11 of 11 Pages

LICENSE NO: 

IN THE MATTE-R OP
BEFGRE THE.

i
I 
THE LICENSE or 
assistance avna, MI). 

AGREED ORDER

heard before the
Texas Medical Board (the ?Board?), duly in session, the matter of the license of Fernando T.
Ari! {?Resnondent?).

0n April 23, 2030, Respondent appeared in personiwith coiinsel Jennifer H. Rogers, at 
an Informal Show Compliance Proceeding. and Settlement Conference in response to a letter of

invitation from the sta?? of the Board. The Board?s representatives were Allan Shoikin, Mil,

- A. 

 

and Patricia Blackwell, both members of the Board. Kyle Smith represented Board Staff

season cannon

Respondent failed to adeqnately document the rationale to support . his decision to continue

prescribing narcotics to a patient after she tested positive for cannabinoids on one occasion.

BOARD HISTORY

Respondent has previously been the subject of disciplinaiy action by the Board as
follows:

I. On August 21, 2009', the Board and Respondent entered into an Agreed Order
"reqmring that Within two years he obtain '20 hours of Continuing Medical Education (CME) in
pain management and that within one year he complete the Medical Recordkeeping course
offered by the University of Califomia San Diego Physician Assessment and Clinical Education
(PACE) Program. The action was based on Respondent?s non-therapeutic prescribing of pain
medications-and other drugs to two patients and his failure to properly document his prescribing.

2. On August 26, 2005, the Board and Respondent entered into an Agreed Order

assessing an administrative penalty of $1,000. The action was based on the fact that Respondent

Page I of 8

violated state law by employing a physician whose medical license. had been revoked as a non.-
practicing Physician Administrative Assistant. I

3. On March 23, 2003, the Board and Respondent entered into an Agreed Order
assessing an administrative penalty in the amount of $1,000. The action was based on aviolation

of Board rules relating to release ot'medicai records.

Upon the recommendation ?of the Board?s representatives and with the consent of
Respondent, the Board makes the following Findings and Conclusions of Law and enters this

Agreed Order.

'i'he Board ?nds the following:

1. General indings:

3. Respondent received all notice required by law. All jurisdictional requirements
have been satis?ed. Respondent waives any. defect in notice and any further right
to notice or hearing under the Medical Practice Act, Title 3, Subtitle B, Texas
Occupations Code (the ?Act?) or the Rules of the- Board; -



Respondent Currently holds Texas Medical License No. (?i-2899; Respondent was
originally issued this license to practice medicine in Texas on February 27, 1983.
Respondent is not licensed topracticc-in any other state.

c. Respondent is primarily engaged in the practice of anesthesiology and pain
management. Respondent is board certi?ed by the American Board {of
Anesthesiology, a member of the American Board of Medical Specialties.

d. Respondent is 54 years of age.

2. Speci?c Panel Findings:
Medical Records: The Board found that Respondent?s treatmentwas appropriate, but
Respondent failed to document justi?cations, other reasoning, and patient eminseling
details in the patient?s medical record that supported his treatment decision to
continue prescribing narcotics to a patient a?er she tested positive for cannabinoids

on one occasion in 2002.

Page 2 of8



1.

.3. Mitigating Factors:

In determining the appropriate sanctions in this matter, the Panel considered the

following mitigating factot:
Respondent has cooperated in the investigation of the aliegations reiated to
this Agreed Order. Respondent's cooperation, (Enough consent to this ?greeti -
Order, pursuant to the provisions of Section 164.002 the Act, will save money
and resources for the State ofTexas. To avoid further investigation, hearings,
anti the expense and inconvenience of" iitigati?on', ResPUnti?ent agrees to" the

entry of this Agreed Order and to comply with its terms and conditions.

a

The Board has jurisdiction over the subject matter and Respondent pursuant to the

pane

2. Section of the Act authorizes the Board totake diseipiinary action

against Respondent based on Respondent?s vioiation of a Board mie, speei?eaiiy Board Ruie

 E, which requires themaintenaneerof  method} records
3. . Section 164.06} of the Act authorizes the Board to impose a range of disei-plinary

actions against a person for vioiation of the Act or a Board ruie.

?04.0udi?laj 01' ACE ad?l?i'iaeo tilt; Hoard I



4. 5603510

disposition of this matter aneung an Agreed Order;

Q3253

Rees-J!- rm the above Findinoe? . or! Conclusin?c AFTMV Hm Rom-r1 that 999119116931! '7
- . - .. .3521! 

shall be subject to the following tones and conditions for aperiod of two years:

Fir!
0?3

Lb. I

E,
a?

1. While under the terms of this Order, Respondent?s practice shall be monitored by a.

physician (?inoriitm?), in accordance with $64130 of the Act. The Compliance Division

i?l?-?fl I I'l" Z. '-Ill?l' Il?li?vi II. ?l 1.
u; ?Av ennui; Manuela-?um: new Aanuuwui chad an?; valid-118v usv naavnaayvn m1) us mi) 



The monitor shall have-expertise in a similar specialty area as Respondent. The Compliance
Division shall provide a copy of this Orderto the monitor, together with other information
necessary to  the :?i?ionitot'.

a. As requested by the Compliance Division, Respondent shall prepare and provide
complete ieg?h?le copies of selected patient medical records (?selected records?). The Compliance

.-

snail records it

UT at 3U 'iy Cii?ii 

period Following the last day of the month of entiv of this Order (?reporting period?). The

Compliance Division may select records for more than 30 patients, up to 10 percent of the



patient seen during a reporting period. it 

see at least 30' patients during any
three-month period, the term of this Order shall be extended until Respondent can Submit a
suf?cient number of records tor a monitor to review.

the monitor snail the toiiowmg duties:

l) Personally review the selected records;

Prepare written reports documenting any perceived de?ciencies and any
recommendations to improve Respondent?s medical record keeping or assist
in the ongoing monitoring process Reports shall he submitted as requested by
the Compliance Division; and

5) Perform any other duty that. the ('fompiiance Division determines assist.
the e??ective monitoring of Respondent?s practice.
c. The Compliance Division shall provide to Respondent a copy of any de?ciencies
or recommendations submitted by the monitor- Respondent shall implement the
recommendations  directed by the Compliance Division.

d. The monitor shall be the agent of the Board, but shall be

Lough the Board. Such. compensation and any costs incurred

ompensated by the

0

ale. monitorsth

I

he   to the Retard  remitted" he  Board  the m. nit-or  



not charge the compensation and costs paid to the monitor to any patients.

'3 tin-u:-   than Hyde?s: shall  ev.pnd3?g ?at  tun, A. .11, 

1.1. txl?uv 12-91": '41. .1511: \l sun-1enher?nn. ?He: anterior: Parr-incurrin- ant-21.4.? thri- .41. {kl Qr?e?..nn. 
. . -. -.- - mum, ..
i I A, 



on.?

(it
4
C)



license is subsequently cancelled for nonpayment of licensure fees; this Order is stayed or

enjoined by Court Order, or  for any period of time longer than 66- cunsecutwc days that

ha.? .A v. s. --M .a 
Ill 1H1. IHIH- Inc 'Jf?ll? - nuts :1 It?l w- an nh-u I I I 
may: (Q?an il?ub?livv nJKEUAusiiv. LA Acatuu 9b 

elsewhere or ceases active practice for more than 60 consecutive days, Respondent. shall

immediately notify the Board in writing. Upon Respondent?s return to active practice or return-

. - . 

to practice in T?exas, snail {will} the Beast. Hi writing. When  period oi extension
ends, Respondent shall be required to comply-with the terms of this Order for the period of time
remaining on the Order. Respondent shall pay all fees for reinstatement or renewal of a license
covering the period oi?cxtnision or Filing.

3. Respondent shall comply with all the? provisions of the Act and other Statutes
regulating the Respondenti?s practiceRespondent Trait ruliy

cooper-at with me Board and tile Doard st 1, morning Board
allomeys. investigators, compliance oliicers, consaltants. and other enr loyees or agents of the
Board in any way involved in investigation, review, or monitoring associated with Respondent's
compliance With this Order. failure to fully cooperate shall constitute a VIolation oftlus order
and a basis for disciplinary actionagainst Respondent pursuant to the Act.

5. Respondent shall inform the Board in writing of any change of Respondent's o?ice or
mailing address within 10 days ofthe address change. This information shall he submitted to the
Registration ?(apartment and the Compilations Department of??ie Hoard. Failm?e to provide such
information in a timely manner shall constitute a basis for disciplinary action by the Board
against Respondent pursuant. to the Act.

Any violation ot'the terms, conditions, or requirements of this (Jrcier by Respondent
shall constitute unprofessional conduct likely to deceive or defraud the public, or to injure the
paling. and shall constinite   for, disciplinary action. by the Board; against Respondent
pursuant to the Act.

7. Respondent shall be permitted to supervise and delegate prescriptive authority to
to supervise singles! assistan-

8.  aha-v9. referenced conditions shall continue in tbs-c2 and e?iger}! wither}!

opportunity for amendment, except for clear error in drafting, for one year following the date of
than annt 11's Quin If crane- can reagent?:- #119 nun-.vnaf mrirul Dnenmvi-ant uric 1e: . opal??
Unl- Ll?u L-L, UL ?1 BULLUULJS. 

wild-J. anus. Lu zLUu

nr rm :?nhnn a? flame.? .
u. -

The Board may inquire into the request and may, in its sole discretion, grant or deny the petition -
without further appuu} ur rcviuw. Puiiliuns fur Illudifyillg ur may in: mud uniy once

.1 5? iik?t'??ii?f.

RESPONDENT AFFEAZS TO Fit" (R

5.17"" Fit-?7?. (?it 
Ax} 1 wdu1\i uxu 411.4?. L141\1Viu Ann-J u: 

ORDER. RESPONDENT AGREES THAT mis IS A FINAL ORDER.

E. FERNANDO T. MD. READ AND FDREGDIN

AGREED ORDER. I UNDERSTAND THAT BYSIGNING, WAIVE- CERTAIN RIGHTS. I

3.151! IT munger 1 1mm? 91? AM) mm GREEK mm111,?? A A. 1 All?1

f" Ethan


 

I ENTIRE :xumrr?aum'r mm nmm: m?ur?R OF ANY 521510..

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m"er who a 


RespondenL

i; 01-"  


i

  
   

Signature otary Public

"J'U-wi- 
\l 

mm 


 EMILY c. mmaz
1* MY coumssnou EXPIRES
AUGUST 27.'2oi3

 at} -
.


 

SIGNED AND ENTERED by the presiding of?cer of the Texas Medical Board on this
day of 2010. 

 

 

Irvin E. Zeitler, Jr., DQJresid?ent
Texas Medical Board

Page 8 of8

 

LICENSE NO. 

IN THE MATTER OF
BEFORE THE
THE LICENSE OF
 T. AVILA, MD. TEXAS MEDICAL BOARD

AGREED ORDER

On the :2 1 day of  2009, came on to be heard before the
Texas Medical Board (the ?Board?), duly  session, the matter of the license of Fernando T.
Avila, MD. (?Respondent?). 

On November 7, 2008, Respondent appeared in person, with counsel Jennifer Rogers, at
an Informal Show Compliance Proceeding and Settlement Conference, in response to a
letter of invitation from the staff of the Board. The Board?s representatives were Timothy Webb,
a member of the Board, and Janet Tornelli-Mitchell, M.D., a member of a District Review
Committee. Katie Johnsonius represented Board staff at the ISC. Elaine Snow prepared the
Agreed Order.

Upon the recommendation of the Board?s representatives and with the consent of
Respondent, the Board makes the following Findings of Fact and Conclusions of Law and enters

this Agreed Order.

 

FINDINGS OF FACT
The Board ?nds that:

a. Respondent received all notice required by law. All jurisdictional requirements
have been satisfied. Respondent waives any defect in notice and any further right to notice or
hearing under the Medical Practice Act, Title 3, Subtitle B, Texas Occupations Code (the ?Act?)
or the Rules of the Board.

b. Respondent currently holds Texas Medical License No. Respondent was
originally issued this license to practice medicine in Texas on February 27, 1983. Respondent is

not licensed to practice in any other state. 

Page 1 of 11 Pages

C.

Respondent is primarily engaged in the practice of anesthesiology. Respondent is

board certi?ed by the American Board of Anesthesiology and Pain Medicine, a member of the .

American Board of Medical Specialties.

(1.

e.

Respondent is 53 years of age.

Respondent has not received a prior disciplinary order from the Board.

6. Patient A:

a.

Patient A initially presented to Respondent as a new patient on July 24, 2002,
complaining of mid thoracic, scapular and axial pain. A Magnetic Resonance
Imaging report from July 12, 2002, was cited in the initial evaluation
(performed prior to the initial visit), which was compatible. with cervical
spondylosis. The evaluation also noted a history of Codetron use. Note was
made of ?regular? alcohol use. The patient was diagnosed with thoracic pain and

possible cervical radiculopathy. Respondent did not suf?ciently document an"

initial detailed history or examination of this patient, and his records lacked

essential documentation of physical examination. I
RespOndent placed Patient A on Schedule II opioid medications and an anti-
in?ammatory drug. Electrodiagnostics were ordered and prior treatment with
muscle stimulation was continued. In the ensuing months, Respondent added
carisoprodol to this patient?s prescribed medications.

Respondent recommended and/or attempted several therapeutic methods to
address the patient?s pain, but Respondent did not indicate the success or failure
of these methods in the patient?s records.

On December 4, 2002, Patient A reported somnolence on the medication regimen,
but the patient reported it was not severe enough. to affect ?anction nor was it

constant. .Respondent continued with physical therapy, and no changes were

made to Patient A?s medications.

Patient A was involved in a motor vehicle accident in February 2003, which
caused further injury to Patient A?s back and required halo traction. Respondent
worked with the hospital physicians to prescribe pain medications appropriate for

Patient A?s acute condition from the accident, and Respondent visited Patient A at

Page 2 of 11 Pages

 

home when released from the hospital, where Patient A convalesced for three
months.

On May 28, 2003, Respondent ordered an MRI-and neurological consultation and
discontinued the use of Soma, Ambien and Vioxx. On June 25, 2003, Patient A?s
record re?ects pain on a scale of 5 out of 10, muscle spasm and trouble falling
asleep. Soma and Ambien were re?started. On August 25, 2003, Patient A denied
side effects from the medications and exhibited no physical signs of distress.

In September 2003, Patient A was found incapacitated at work. Respondent
addressed this condition by discontinuing Soma and switchingthe patient to
Robaxin. Respondent continued the patient?s other medications.

Throughout?the early part of 2004, Patient A?s medication regimen remained
fairly stable during this period, and Patient A reported 90% improvement with
medications during February and March 2004 visits. During the May 10, 2004
visit, Patient A reported missing a great deal of work. Records indicate that
Respondent continued tracking Patient A?s progress every one to two months. A
brief period of opioid decrement ensured, but the medications were subsequently,
increased with reported decrease in pain control, supplemented by muscle
relaxants.

During the year 2005, Respondent followed Patient A?s progress every one to two
months. During visits in January, February, March, and May, Patient A reported
good pain control and denied any side effects. In August 2005, weight gain and
increased headaches were documented, but Patient A reported adequate pain
control'and activities of daily living. No changes were made in Patient A?s pain
medication during the August, October, and November 2005 visits.

In January 2006, Respondent initiated a trial of Zana?ex; this was switched to
Flexeril in February 2006, and Lyrica was initiated. During subsequent visits in
April, May, June, July, and September of 2006, Patient A reported good ?inction
and pain control.

. Patient A continued to work as a pharmacist throughout Respondent?s treatment.

Respondent should have used other (non-narcotic)rpain control therapies, rather

Page 3 of 11 Pages

 than initially prescribing potentially addictive substances. Additionally,
Respondent?s record keeping was inadequate for Patient A?s treatment.

1. Respondent did not attempt to control Patient A?s pain With non-narcotics.

m. ReSpondent did not refer Patient A to an outside consultant for 
testing, behavioral therapy diagnostic injections, re-imaging or surgical
consultation.

11. Respondent failed to assess Patient A?s high risk of addiction; Respondent was
inattentive to ?red flag? behaviors indicating possible aberrant medication use,
and Respondent failed to sufficiently respond to the adverse effects Patient A
received from opioid medications.

7. Patient B:

a. Patient presented to the Respondent on April 26, 2002, with initial complaints
of multiple arthralgias and myalgias subsequent to an Epstein-Barr viral infection,
Past medical and surgical history included: hypothyroidis; multiple
cosmetic procedures; hysterectomy; acid re?ux disease; depression; presumably
reactive airway disease; and hypertension. Social history revealed that the patient
occasionally used alcohol. 

b. Respondent did not suf?ciently document an initial detailed history or
examination of this patient, and his records lacked essential documentation of
physical examinations. Laboratory studies revealed hyperlipidemia and a positive
titer for chronic EBV antibodies. Respondent diagnosed Patient with chrOnic
nociceptive pain due to EBV and myofascial pain 

0. Respondent immediately prescribed the patient with potent opioid analgesics, oral
steroids, muscle relaxants, (tizanidine), and aquatic therapy. No behavioral
evaluation was ordered.

(1. Patient next visited Respondent two weeks later (May 13, 2002), reporting the
medical regimen prescribed offered improvement with the shooting pain, but only
temporary relief from the aching pain. Respondent changed the narcotic and
muscle relaxant, and rapidly escalated them. Patient did not attend the aquatic
therapy that was recommended, and Respondent did not conduct a subsequent

follow-up regarding the recommendation.

Page 4 of 11 Pages

On June 28, 2002, Respondent recorded that Patient experienced side effects of
edema, which required the use of diuretics. As a result of the edema, Morphine
Sulfate Immediate Release was discontinued, and Actiq was initiated. Despite
documentation of a negative rheumatological evaluation, Respondent increased
steroids in July for Patient B?s complaints of stiffness in the hips and extremities
as well as treatment for complaints of numbness.

In August 2002, ReSpondent noted Patient overused short-acting opioids 
outside prescription boundaries. Respondent addressed the increased pain by
adding a class of extended-release opioids to the patient?s regiment, supplemented
by more tizanidine.

In September 2002, Patient reported occasional somnolence and continued
edema but reported pain control and good results with Codetron treatment.
Respondent discontinued the Duragesic patches, Azmacort Metered Dose Inhaler
and Tegaderm, decreased Patient B?s Morphine Sulfate Contin and increased
Actiq. On December 4, 2002, Patient reported good reSults with prescribed
medication but the patient also reported nausea. On December 20, 2002, Patient
reported increased pain and that the current medication was no longer effective.
Respondent discontinued MS Contin and started Oxycontin.

In January and early February of 2003, Patient reported minimal improvements
but the nausea, and insomnia continued. During a subsequent Visit on February
27, 72003, Patient reported the pain was 90% under'control with improved
edema, but Patient reported hallucinations upon taking more than the prescribed
Zana?ex at bedtime, which was decreased. Patient was provided the additional
treatments of N?methyl-D-aspartate antagonists and guaifenesin. At
Isubanesthetic doses, these medications have mild stimulant effects, but at higher
doses, they may induce dissociation and hallucinations. Respondent made no
documentation of the effectiveness of either medication.

Respondent added hypnotics in March 2003 to treat Patient B?s insomnia and
recommended aquatic therapy. In May 2003, he added two anticonvulsants and
an antidepressant without documenting treatment-rationale. In June of 2003,

Patient reported increased depression and anxiety. Prozac was increased, but

Page 5 of 11 Pages

Gabitril was discontinued for drowsiness. During visits in July and August 2003,
Patient reported better_ condition and functioning, and no Changes were made
other than to add Lactulose for mild constipation and to order physical therapy.
In October of 2003, Respondent treated Patient B?s pain ?are-up with Medrol
Dose Pak. Respondent?s notes from December 2003 re?ect Patient had been
treated by both a rheumatologist and endocrinologist. Patient reported
increased pain; Oxycontin was increased. 

j. From February through April 2004, Patient reported doing much better and
medications Were not changed. In May of 2004, Patient reported an 80 to 90%
improvement in pain control but also reported occasional sweating, nausea,
insomnia, drowsiness, and fatigue. Peripheral edema was treated by changing the
opioid medication with a diuretic. Patient B?s Morphine Equivalent Daily Dosage
was approximately 1300 milligrams throughout the-summer,
despite continued documentation of adverse side effects.

k; In January and March of 2005, Patient reported good pain control, and
Oxycontin was decreased (in January) and later discontinued in May of 2005.
During the May 2005 visit, Patient reported increased pain. Oxycontin was
discontinued and Palladone was initiated. Patient B?s regimen was again
escalated to a MEDD of over 1500 mg daily.

1. Respondent should have used other (non-narcotic) pain control therapies, and
Respondent?s record keeping was inadequate for Patient B?s treatment.

m. Respondent did not refer Patient to an outside consultant 
testing, behavioral therapy, diagnostic injections, re-imaging or surgical
consultation. I I

n. Respondent failed to assess this patient?s high risk of addiction, and he was
inattentive to ?red ?ag? behaviors indicating possible aberrant medication use.
Respondent failed to suf?ciently respond to the adverse effects Patient received
from opioid medications.

8. Respondent has cooperated in the investigation of the allegations related to this
Agreed Order. Respondent's cooperation, through consent to this Agreed Order, pursuant tothe

provisions of Section 164.002 the Act, will save money and resources for the State of Texas. To

Page 6 of 11 Pages

avoid further investigation, hearings, and the expense and inconvenience of litigation,

Respondent agrees to the entry of this Agreed Order and to comply with its terms and conditions.

CONCLUSIONS OF LAW

Based on the above Findings of Fact, the Board concludes that:

l. The Board has jurisdiction over the subject matter and Respondent pursuant to the
Act.

2. Section of the Act authorizes the Board to take disciplinary action
against a person based on the person?s failure to practice medicine in an acceptable professional
manner consistent with public health and welfare as ?irther de?ned in Board Rule 
(D): (A), failure to treat a patient according to the generally accepted standard of care; (B),
negligence in performing medical services; (C), failure to use proper diligence in one?s
professional practice; and (D), failure to safeguard against potential complications.

3. Section of the Act authorizes the Board to take disciplinary action
against Respondent based on ReSpondent?s violation of a Board rule, speci?cally Board Rule
165.1, regarding maintaining adequate medical records and Board Rule 170, regarding pain
management. I

4. Section of the Act authorizes the Board to take disciplinary action
against a physician based upon the physician?s unprofessional or dishonorable conduct that is
likely to deceive or defraud the public or injure the public, as further de?ned by Board Rule
providing medically unnecessary services to a patient or submitting a billing
statement to a patient or a third party payer that the licensee knew or should have known was
improper. "Improper" means the billing statement is false, fraudulent, misrepresents services
provided, or otherwise does not meet professional standards.

5. Sections and of the Act authorize the Board to take
disciplinary action against Respondent based on Respondent writing prescriptions for or
dispensing to a person who is known to be an abuser of narcotic drugs, controlled substances, or
dangerous drugs or to a person who the physician should have knownwas an abuser of the

narcotic drugs, controlled substances, or dangerous drugs.

Page 7 of 11 Pages

6. Sections and of the Act authorize the Board to take
disciplinary action against Respondent based on Respondent prescribing or administering a drug
or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or
treatment is administered or prescribed.

7. Sections and of the Act authorize the Board to take
disciplinary action against Respondent based on Respondent prescribing, administering, or
dispensing in a manner inconsistent with public health and welfare, dangerous drugs as de?ned
by Chapter 483, Health and Safety Code; or controlled substances scheduled in Chapter 481
Health and Safety Code; or controlled substances scheduled in the Comprehensive Drug Abuse
Prevention and Control Act of 1970, (21 U.S.C. ?801 et seq.). 

8. Section 164.001 of the Act authorizes the Board to impose a range of disciplinary
actions against a person for violation of the Act or a Board rule. Such sanctions include:
revocation, suspension, probation, public reprimand, limitation or restriction on practice,
counseling or treatment, required educational or counseling programs, monitored practice, public
service, and an administrative penalty. 

9. Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition
of this matter through an Agreed Order.

10. Section 164.002(d) of the Act provides that this Agreed Order is a settlement

agreement under the Texas Rules of Evidence for purposes of civil litigation.
QM

Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that
Respondent shall be subject to the following terms and conditions for a period of two years from
the date of the entry of this Order

1. Within two years from the date of the entry of this Order, Respondent shall enroll in
and successfully complete at least 20 hours of continuing medical education approved
for Category I credits by the American Medical Association in the subject of pain management,
approved in writing in advance by the Board. To obtain approval for the course, Respondent
shall submit in writing to the Board information on the course, to include at least a reasonably
detailed description of the course content and faculty, as well as the course location and dates of

instruction. Respondent shall submit documentation of attendance and successful completion of

Page 8 of 11 Pages

 

this requirement to the Board on or before the expiration of the time limit set forth for
completion of the course. The CME requirements set forth in this paragraph shall be in addition
to all other CME required for licensure maintenance or any other CME required by this Order.

2. Within one year from date of the entry of this Order, Respondent shall enroll in and.
successfully complete the medical recordkeeping course offered by the University of California
San Diego Physician Assessment and Clinical Education (PACE) program, or an.equivalent
course approved in advance by the Executive Director. To obtain approval for a course other
than the PACE course, Respondent shall submit in writing to_ the Board information on the
course, to include at least a reasonably detailed description of the course content, faculty, course
location, and dates of instruction. Respondent shall submit documentation of attendance and
successful completion of this requirement to the Director of Enforcement for the Board on or
before the expiration of the time limit set forth for completion of the course.

3. The time period of this Order shall be extended for any period of time that:
Respondent subsequently practices exclusively outside the State of Texas; Respondent's
license is subsequently cancelled for nonpayment of licensure fees; this Order is stayed or
enjoined by Court Order; or for any period of time longer than 60 consecutive days that
Respondent does not actively practice medicine. If Respondent leaves Texas to practice
elsewhere or ceases active practice for more than 60 consecutive days, Respondent shall
immediately notify the Board in writing. Upon Respondent?s return to active practice or return
to practice in Texas, Respondent shall notify the Board in writing. When the period of extension
ends, Respondent shall be required to comply with the terms of this Order for the period of time
remaining on the Order. Respondent shall pay all fees for reinstatement or renewal of a license
covering the period of extension or tolling.

4. Respondent shall comply with all the provisions of the Act and other statutes
regulating the Respondent?s practice.

5. Respondent shall fully cooperate with the Board and the Board staff, including Board
attorneys, investigators, compliance of?cers, consultants, and other employees or agents of the
Board in any way involved in investigation, review, or monitoring associated with Respondent's 
compliance'with this Order. Failure to fully cooperate shall constitute a violation of this order

and a basis for disciplinary action against Respondent pursuant. to the Act.

Page 9 of 11 Pages

6. Respondent shall inform the Board in writing of any change of Respondent's of?ce or
mailing address within 10 days of the address change. This information shall be submitted to the
Permits and Registration Department and the Compliance Department of the Board. Failure to
provide such information in a timely manner shall constitute a basis for disciplinary action by the
Board against Respondent pursuant to the Act. Respondent agrees that 10 days notice of a
Probationer Show Compliance Proceeding to address any allegation of non-compliance of this
Agreed Order is adequate and reasonable notice prior to the initiation of formal disciplinary
action. Respondent waives the 30?day notice requirement provided by of the
Medical Practice Act and agrees to 10 days notice, as provided in 22 Texas Administrative Code
.

7. Any violation of the terms, conditions, or requirements of this Order by Respondent
shall constitute unprofessional conduct likely to deceive or defraud the public, or to injure the-
public, and shall constitute a basis for disciplinary action by the Board against Respondent
pursuant to the Act.

8. Respondent shall be permitted to supervise and delegate prescriptive authority to
physician assistants and advanced practice nurses and to supervise surgical assistants.

9. The above-referenced conditions shall continue in full force and effect, without
opportunity for amendment except for error in drafting, for one year following the date of entry
of this Order. If, after the passage of one-year period, Respondent wishes to seek-amendment or
termination of these conditions, Respondent may petition the Board in writing. The Board may
inquire into the request and may, in its sole discretion, grant or deny the petition without ?thher

appeal or review. Petitions for modifying or terminating may be ?led only once a year thereafter.

RESPONDENT WAIVES ANY FURTHER HEARINGS OR APPEALS TO THE BOARD OR
TO ANY COURT IN REGARD TO ALL TERMS AND CONDITIONS OF THIS. AGREED
ORDER. RESPONDENT AGREES THAT THIS IS A FINAL ORDER.

THIS ORDER IS A PUBLIC RECORD.

I, FERNANDO AVILA, M.D., HAVE READ AND UNDERSTAND THE FOREGOING
AGREED ORDER. I UNDERSTAND THAT BY SIGNING, I WAIVE CERTAIN RIGHTS. I

Page 10 of 11 Pages

SIGN IT VOLUNTARILY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE

ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEIWENT OF ANY KIND,
VERBAL, WRITTEN OR OTHERWISE.

390 ,2009.



FERNANDO AVILA MD.
Respondent

 

 

STATE or WW

SWORN TO AND CKNOWLEDGED BEFORE ME, the undersigned Notary Public, on this
day of 2009.

600mm

      

Signature of Notary Public
(Notary Seal)

 

 

 ADELIAG.RODRIGUEZ
 Notary Public. State of Texas
=2 .  My Commission Expires
2435;}; 533-? SEPT. 30, 2010



 

 

 

SIGNED AND NTERED by the presiding of?cer of the Texas Medical Board on this
[2 day of 2009. 

(x 
Irvin E. Zeitler, Jr, D.O., wdent 
Texas Medical Board

Page 11 of 11 Pages

 
 
 
 
  
 
 
  
 
 
  
 
   
   
  
 
  
  
  
 

IN. THE MATTER OF-

  '-he'arfing TEX.  CODE  .2004): 

- nos-momma  -

 

(3-2899 I 
THE LICENSE OF    

MD.   - 

 

.  

011- of -     

      

c?ine 011-1301385113.

T'?xas State    in .segsion,.  

On- August       
WW Show C?m?lim?e as:  

invitatiqn- -f_rom the taff- of the     

 

. represmfatiVes of tli??-EBoard-, and  - - 

a member I I.
. . Upon the re-Qommendatio? wrese?ta?y'es  consent-golf: .
Respondent. the. Board makes the'following-Fihdings- of Fact andfConclusi'onsagofLaw   -

this - -   . . .. --

 

The Board ?nds that:
I -1-. Respondent received   law. All

have -  

 
 

ofthe-Bo'ard. I I . . .    
Reappndem  

 

 

 
 

 

.      .

 

4. ReSpondent is 49 years of age. . .
5. Respondent has not previOusly been the subject of disciplinary -actiOn- bythe
Board. I.I .-
6. At issue. was Respondent?s alleged employment of John Campa, M.D., 'whose
licensewas revoked by the state of Tennessee. I I I 
7 7. John A. Catnpa, M.D.. a Tennessee licensee, Was under. a-Tennessee- Board 
Order and-had his license revoked on February-.1. 2002. i I  I 
8. I Victor. .Casillas, United States Probation and-?iParole Of?cer in San-Antonio, Texas-t-
reported that Dr. Camps was charged" in the EasternDisn-iet of Tennessee With 76': counts of
fraud related to health care fraud. He was sentenced .On-rAngust 24, 200i "told-Ernonths in prison.
and he was released - on or. about June 27.32003 to three years. of supervised- pr-obation. His
probation is due for termination on June I I
9. Respondent hired John a inf-the
Respondent?s asked Respondent to consider hiring C'ampa until he could- Lon-his
feet. I   I 
10. Dr. Campa?s duties included __pIreparing= medical narratives, letters of medical I
- necessity, Texas Workers Compensation of reconsideration and rebuttalsfj-to:-_ 
revieWS, Independent Medical Examinations. Designated Doctor. Examinations-and-{Rennired'
Medical Examinations. I I . I
11. Respondent wrote a letter to- the TennesseeJBoard of Medical Examiners-dated
. June 24,- 2004, explaining that Mr. Canipa hadbeen employed with-his clinic since July 1, 2003
as a nonapracticing physician administratiye?aSsociate. 
I a 12. Dr. Carnpais conviction was unrelated to patient careissues.
1-3. Before-rheallowed Dr. Campa?-to Work Respondent spoke to -
probation of?cer; and they discussed Dr. Catnpa?s employment. I I I

14. Respondent made it cloar'thatDr. 'Canipa would in no way treat patients or handle 
billing15. The. Board?s Representatives found  Respondent vialated the .

 

annoying "a physicia?wvvhose  

 

However, the Panelists. found it miti' ating that. Respondent "parole? -.

Fernando T. 05-0409Mgreed?0rderdoc - page 2.4.5.943?

 

 

  

 

   

of?cer,- did not represent to his patients that a practicing:- physieianr-and did . not
allow Dr. Ca'r'npa'todo so and limited Dr. Campa?s duties to? paper work and dictation. 

16. Respondent,fhas cooperated  investigation. of the allegations {rel ?ted to this .
. Agreed Order. Respondent's cooperation,-  consent to-this Agreed Orders-Pursuant to the ..
provisions of Section. 164.002 the Act, will save money  resources for. the- of Texas. To

avoid further investigation, hearings, and; the expense and ?inconvenience of -. litigation,

Respondent agrees of this Agreed Order its terms and conditions.

 

Based on the. above Findings of-F'act',  Board concludes that:
1. - The Board has jurisdiction-oven the subject thatter and Respondent- pursuant- to the 
2. Section or action 
against Rospondent based on Respondent-employing-a  whose license'itopractice-medicine - 
has been suspended,- c?anceled, Or revoked.    I 

Section 164.001 of the Act-a?thorizesth?esBoard to impbse a-rango of disciplinary
actions against a. person for violation of. the Act Board: rule. Stich 
rev??a??n= suspensions 01013311011, .PUbliG?-= glimitation or _-'rest1iction on' magi-Ge,
counseling or treatment, required. educational'or; counseling.  monitored,prac?ce,. public
service, and an administrative penalty. - .
4. Section of the Act authorizes the Board to. resolve and make a

. disposition of this matter through an . 
I 5. the. Act-'proirides gthat  Jagged-Ordentis alisettl I .-
agreement-under the'Tean Rules of Evidence-for purposesiof civil litigation. i "1 

 

Based on the above Findings Beard-ORDERS-that: .
1. Respondent shall togsupervisecanddelegate prescriptive-authority- to I 
i      

 

2. Respondent shall pay   inthcamount .ooawissm- I .-
days of the entry of this Order. The .adminiStrative  Shall be paidria a payment-Shy.  

r. 05-0409Mgreed ardendoc - . . Paggj ofjpage;

 

 

 

cashier?s check or money order payable to the. of-Medicali-Examiners .

be submitted to the, Director of COtnpliancE-?fot-?ie?Board: sO as:  .

- Comptroller of Texas for- deposit in the.ge??t?l?fevenu?i?f?ndy .Rgspondentiseafaimeito pay the 

administrative penalty-asyordered shall- constitutb: disciplinary action-by the 

Board, and may result in a referral by the Ex??utive' Directpr Idf-?the Board-  

Of?ce of the Attomgy General.  . . 
3. This Ordershall automatiganwminate upmu payment of the .- adminismtiye'
penalty. - - 

ANY 
TO ANY COURT TO ALL CONDITIONS-OF I 
ORDER: RESPONDENT AGREES THAT-5114113118 A FINA-L 

THIS ORDER Is A PUBLIC RECORD.

1, FERNANDO T. Min, HAVE-READ.ANDUNDERSTAND THEFOREGOING
AGREED ORDER. I BY SIGNING, I CERTAIN 1
.SIGN I  ARE-ED ORDER CONTAINSTHE 
1 ENTIRE AGREEMENT AND THERE NO OTHER AGREEMENT 10F  ?Nu . 
VERBAL, OR OTHERWISE.  

 
 

 

       


T. 05.0409ugreed ardendac i Pag?4 ?5.9m

 

 

 

 

 

 
 

STATE 0 

COUNTY OF

SW0 TO AND . .KNOWLED-GED BEFORE-ME, the undersigned-fi-Notafy Public,
I  . day Of w/Zd?ofm {12005. - - I 

  

 

gimme Public.

 

 

(Notary Seal)

 

 

SIGN-ED ENTER-ED of?ceit?fa?wTexasT-State ofMedical -
Examiners 'on-thisiday of 4.T?iias - State} Bpard-of Medical 

   

 

IG-lP?hy?cianslAvHa, Femanda T. 05.0mm Orderdoa   1 - Pagest Page-v

 

 

 

1"



  
   
   
    
   
  
 
    
  
  

'rli :r'air

 



 

 

??mtmr'kml?lh?'. i?

rn?lal merry-m 'iieirr'tm'nm 

 

 

 

 

 

 

G-ZISE

On this the  - day of
exas State Board of Medical Examiners ("the 
Fernando Avila, M.D. ("Respondent"). 

IN THE MATTER OF .  
HE LICENSE OF   
ERNANDO AVILA, M.D.   



BEFORE THE

TEXAS STATE BOARD

OF MEDICAL EXAMINERS
2312133

 2003, came-on to be heard before the
yard") duly in session the matter of the license

 signature of Respondent on this Order,

 

espondent waived the right to appear at an In?? 

final Settlement Conference/Show Compliance

 

. 

 

roceeding pursuant to TEX. OCC. CODE ANN., 
64.061 (Vernon 2002) and all rights pursuant

 6 entry of this Order to resolve the matters-lat
Upon recommendation of the Board's  and with the consent of Respondent, the .

card makes the following ?ndings of fact  
orth herein: 9

1. Respondent, Fernando Avila, 

eceived- all: notice that may be required by law  
equirement-s have been satis?ed under TEX. 

n'the notice and anyfurther right to notice or-llt
la
t$2001.03 through .054; and the Rules of 
ADMIN. CODE Chapter 187).  

 

 

2, The Board has jurisdiction over  
I by the rules of the Board. All jurisdictional

002)? (hemian the BY entering into 

 

 3 Subtitle - 054, 164.007, and -
.. TEX. CODE ANN. 2001.051 0.54

Wernon 2002), including, but not limited to the notice and hearing, and instead agrees to

latessed herein. David wofford represented

(inclusions of law and enters this Order as set

 

 

 Texas medical license (3?2899-

"?l?subject matter and Respondent. Respondent

 CODE ANN., TITLE 3, Subtitle Wernon
.iAgreed' Order, Respondent waives any defect

 under the Act; TEX. CODE ANN.
State. Board of Medical Examiners (22 TEX.

 

    
   
    
  
 
     

 

 

 
 

 

 

 

 
 
 
 

 
 
 
 

 

 

 

 

 

3. Respondent has been in the practic

ears.

  
 
   
   
  
  
 
  
 
  

4. Respondent?s of?ce received, ?'oini

 

-5.

Respondent has corrected his of?ce-
eleased to a patient or authorized representative 

Law:

1. ReSpondent is subject to discipliri'

dmin. Code Section 

 

4.
monetary administrative penalty not to exceeid-

 

 

opies of medical records of patient M.L. in' Septicn
because of Respondent?s employees? inac
the Medical Practice Act and Board Rules regarc

clease of those records by the patient or the patient
 159.006 of the Medical Practice Act and 22 Texas

Based on the above Findings of Fact, the

2. Section 164.002(a) of the Act Eat
drsposrtron of matter through an Agreed Order
3. Section 164.002(d) of the Act 

agreement under the Texas Rules of Evidence for};
Sections 165.001 and 165.003 

of medicine in Texas for approximately 20

 attorney representing M.L., a request for
nber 2002. The request was not complied with
ie'quate knowledge regarding the requirements
ling the release of medical records.

policy to insure that patient records are

 15 business days of a request for the

tats representative, in accordance with Section
Admin. Code Section 



 makes the following Conclusions of

 

action pursuant to Section of .

 Act by committing a direct or indirect violatijo Eof a rule adopted under this Act? Speci?cally
 failing to release medical records within 15 day icf the initial requestts its-required by 22 Tean

tthorizes the Board to resolve and make a

that this Agreed Order is a settlement
Err-poses of civil litigation.

the Act authorize the Board to impose a
 thousand dollars for- each

separate violation of the Act or Board rule by a ?ction licensed or regulated under the Act.

 

 

 
   

 

 

 

 
 
 

03;: 

 

Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that:

  
  
  
 
  
   
    
  
 
  

 1. Respondent shall pay an administrative penalty in the amount of one thousand
:;f?ollars by cashier?s check or money {Order payable to the Texas State Board of
 Examiners and submitted to the Directoraof Compliance for the Board for routing so as

 

 

 i  be remitted to the Comptroller of Texas for deposit in the general revenue ?md before the
  Expiration of ninety (90) days from the date the A 'eed Order is approved by the Board.

 

.  i 2. Respondent?s failure to pay the ad .inistrative penalty as ordered shall constitute
fgrounds for further disciplinary action by the Board-?as provided for .in the Act, and may result in

   referral by the Executive Director of the Board-Tor collection by the Of?ce of the Attorney
  
  3. Respondent shall comply with all p?rpyisions of the Act, and other statutes and

 

 

 regulating the Respondent?s practice, as is required by law.

 4. Respondent shall inform the Boardip writing of any change of Respondent's

 f?ce or mailing address within ten (10) days of ;_address change. This information shall be
 to the Permits Department and the Dirac or of Compliance for the Board; Failure to
 such information in a timely manner shalil' enstitute a basis for disciplinary action by the

card against Respondent pursuant to the Act. i 

 

ESPONDENT WAIVES ANY FURTHER  INGS 0R APPEALS TO THE BOARD 0R
0 ANY COURT IN REGARD TO ALL TE 5 [s AND CONDITIONS OF THIS AGREED
RDER. RESPONDENT AGREES THAT THIS A FINAL ORDER.

 

ELF-THIS ORDER IS A PUBLIC RECORD.

 

 

 

 

 

 

 

 

 

 . 

 



- 



  
  
 
  
   
   
  
  
  
  
  
 

I, FERNANDO AVILA,

DATED: 5/ 9/03

 

ESTATE OF ?agra?

 

g?zoos.

 

 

 

 

 

 

the same for all purposes expressed therei

n.
1d of?ce this 42 day of

Given under my hand and of?cial sealiax

SIGNED AND ENTERED by the presidir

 Examiners on this  day of 

M.D., 

.2003.

READ AND UNDERSTAND THE

EOREGOING ORDER. I UNDERSQAND THAT BY SIGNING, I WAIVE

GERTAIN RIGHTS. I SIGN IT 
OONTAINS THE ENTIRE AGREEMENT AND
NY KIND, VEREAL, WRITTEN OR OTHERWISE

 

 UNDERSTAND THIS AGREED ORDER
THERE IS No OTHER AGREEMENT 0F

ix

FERNANDO AVILA, MD.
RESPONDENT



BEFORE ME, the undersigned Notmjy
ERNANDO AVILA, M.D. known to me to be
Einstrument, an Agreed Order, and who after being by me duly sworn, on oath, stated that he

use

Texa-

 

.E

qublic, on this day personally appeared
the person whose name is subscribed to this

 

I odd?il (gan

 
 
 

i name of Notary Public

'9 an expirewo a:

13 of?cer of the Texas State Board of Medical
2003.

   


3i President
3 State Board of Medical Examiners