BEFORE THE COLORADO MEDICAL BOARD STATE OF COLORADO CASE NO. STIPULATION AND FINAL AGENCY ORDER IN THE MATTER OF THE DISCIPLINARY PROCEEDING REGARDING THE LICENSE TO PRACTICE MEDICINE IN THE STATE OF COLORADO OF Gary Weiss, M.D. LICENSE NUIVIBER 35800, Respondent. IT IS HEREBY STIPULATED and agreed by and between Inquiry Panel of the Colorado Medical Board (the ?Board?) and Gary Weiss, M.D., (?Respondent?) (collectively "the Parties") as follows: JURISDICTION AND CASE HISTORY 1. Respondent was licensed to practice medicine in the state of Colorado on December 19, 1996 and was issued license number DR 35800, which Respondent has held continuously since that date. 2. The Board has jurisdiction over Respondent and over the subject matter of this proceeding. 3. On June 21, 2012, the Panel reviewed Case Number and determined that ?thher proceedings by formal complaint were warranted pursuant to Section C.R.S. 4. It is the intent of the Parties and the purpose of this Stipulation and Final Agency Order (?Order?) to provide for a settlement of all matters set forth in Case Number without the necessity of conducting a formal disciplinary hearing. This Order constitutes the entire agreement between the parties, and there are no other agreements or promises, written or oral, which modify, interpret, construe or affect this Order. 5. Respondent understands that: a. Respondent has the right to be represented by an attorney of the Respondent?s choice, and Respondent is represented by counsel in this matter; b. Respondent has the right to a formal complaint and disciplinary hearing pursuant to Sections and 0. By entering into this Order, Respondent is knowingly and voluntarily giving up the right to a formal hearing, admits the facts contained in this Order, and relieves the Panel of its burden of proving such facts; (1. Respondent is knowingly and voluntarily giving up the right to present a defense by oral and documentary evidence and to cross-examine witnesses who would testify on behalf of the Panel; and 6. Respondent is knowingly and voluntarily waiving the right to seek judicial review of this Order. FACTUAL BASIS 7. Respondent speci?cally admits and the Panel finds that: a. Respondent is a neurologist who is board certified in neurology and electrodiagnostic medicine. b. Respondent performs and interprets his own MRI studies. Respondent does not have his MRI studies interpreted by a radiologist or neuroradioligist. c. Between May 9, 2009 and July 2011, Respondent was the primary physician treating Patient D.E. for Multiple Sclerosis (1. Respondent diagnosed Patient D.E. with relapsing and remitting MS, with possible secondary progressive MS. Approximately three months later Respondent ruled out secondary progressive MS. e. Relapsing and remitting MS can be treated with Tysabri. Tysabri is a drug that is highly effective at preventing recurrent in?ammation in patients with relapsing and remitting MS. However, Tysabri can cause a life threatening disease called progressive multifocal leukoencephalopathy f. There is no treatment for secondary progressive MS. Patients with secondary progressive MS should not be treated with Tysabri. g. Respondent explained the Option of using Tysabri to DB. and her family and discussed the pros and cons of the medication. h. Doctors treating patients with Tysabri must monitor their patients? neurological status closely based on subjective and objective ?nding. Cognitive impairment is the most common clinical presentation of PML, followed by motor skill abnormalities, language disturbances and visual defects. Objective signs of PML include comparing past magnetic resonance imaging with current MRIs to identify whether there are new brain lesions. i. Patient D.E. started Tysabri treatment in July 2009. Her condition improved for about nine months. j. In September 2010, Patient daughter told Respondent that she was concerned Patient D.E. may be developing PML. She complained her mother was ?acting differently? and becoming forget?il. Respondent discussed this with Patient DE and her spouse and they did not feel like that had been a problem. k. On February 10, 2011, Patient D.E. had an MRI at Respondent?s office that Respondent interpreted. Respondent failed to diagnose a subtle new brain lesion on Patient MRI study that was possibly indicative of PML. I. On May 4, 2011 Respondent performed another MRI on Patient DB and failed to diagnose a new and subtle brain lesion on the May 4, 2011 MRI study that was possibly indicative of PML. m. Respondent performed another MRI on Patient D.E. on June 29, 2011. Respondent noticed a brain lesion on the June 29, 2011 MRI and diagnosed Patient D.E. with PML. n. An MRI study was taken at the Valley View Medical Center in May 2011 and read by a radiologist who made no mention of PML in the radiology report. The radiologist did not have the previous MRI brain studies performed by Respondent when he performed the MRI and wrote his report. 8. The Respondent acknowledges and the Panel ?nds that, if the Panel were to prove the following factual allegations at hearing, it would constitute a prima facie case of unprofessional conduct as de?ned in the Medical Practice Act, and would subject Respondent to discipline. Respondent denies the following allegations: a. It was below the standard of care for Respondent to fail to diagnose Patient brain lesion on the February 10, 2011 MRI. b. It was below the standard of care for Respondent to fail to diagnose Patient brain lesion on the May 4, 2011. c. It is below the standard of care to fail to recognize subjective complaints of memory loss, leg weakness and imbalance as signs of PML. d. It is below the standard of care to continue Tysabri treatments when a patient develops brain lesions indicative of PML and has subjective signs of PML. 9. Respondent admits and the Panel ?nds that the conduct set forth above, if proven, constitutes unprofessional conduct as de?ned in Section C.R.S., which states: (1) "Unprofessional conduct" as used in this article means: Any act or omission which fails to meet generally accepted standard of medical practice; LILI Based upon the above, the Parties agree and stipulate that the terms of this Order are authorized by Section C.R.S. PERMANENT LICENSE INACTIVATION 10. In September 2013, Respondent stopped practicing in Colorado. He permanently relocated to Florida at that time where he is now engaged in the full time practice of medicine. Respondent did not renew his license to practice medicine in Colorado in April 2014 when renewal was due and Respondent?s license has expired. The Board hereby waives the requirement of 12-36-137, C.R.S., of a formal application, including a supporting af?davit for the transfer of a license to inactive status; and the entry of this Order shall be deemed equivalent to a grant of an application for inactive status under 12?36-137, C.R.S. 11. Respondent has not performed any act in the State of Colorado that constituted the practice of medicine nor has he performed any act in any location pursuant to the authority of his license to practice medicine in Colorado since his relocation to Florida in September 2013. Respondent acknowledges that he cannot perform any act in the State of Colorado that constitutes the practice of medicine nor can he perform any act in any other location pursuant to the authority of a license to practice medicine granted by the State of Colorado. 12. Respondent agrees not to apply for reactivation of his license, reinstatement of his license, or to apply for a new license issued by the Board at any time in the ?lture. Respondent understands and acknowledges that he is permanently inactivating a license to practice medicine in the State of Colorado. Respondent agrees not to apply for renewal, reinstatement, reactivation or issuance of a new license to practice medicine in the State of Colorado at any time in the ?iture. Respondent speci?cally waives any right to which he may be entitled pursuant to Section 12-36-1 C.R.S. regarding application for licensure. OTHER TERMS 13. The terms of this Order were mutually negotiated and determined. 14. The Parties acknowledge that they understand the legal consequences of this Order; the Parties enter into this Order voluntarily; and the Parties agree that no term or condition of this Order is unconscionable. 15. All costs and expenses incurred by Respondent to comply with this Order shall be the sole responsibility of Respondent, and shall in no way be the obligation of the Board. 16. So that the Board may notify hospitals of this agreement pursuant to section C.R.S., Respondent presently holds privileges at or is employed by the following hospitals and facilities: 17. This Order and all its terms shall have the same force and effect as an order entered after a formal disciplinary hearing pursuant to section 12-36- C.R.S., except that it may not be appealed. Failure to comply with the terms of this Order may be sanctioned by the Inquiry Panel as set forth in section 12- C.R.S. This Order and all its terms also constitute a valid board order for purposes of section C.R.S. 18. This Order shall be admissible as evidence at any future hearing before the Board. 19. Invalidation of any portion of this Order by judgment or court order shall in no way affect any other provision, which shall remain in full force and effect. 20. During the pendency of any action arising out of this Order, the obligations of the parties shall be deemed to be in full force and effect and shall not be tolled. 21. This Order shall be effective upon approval by the Board and signature by a Board member or other authorized person. Respondent acknowledges that the Panel may choose not to accept the terms of this Order and that if the Order is not approved by the Board and signed by a Board member or other authorized person, it is void. 22. This Order shall be effective upon mailing by ?rst-class mail to Respondent at Respondent?s address of record with the Board, or service by electronic means on Respondent at Respondent?s electronic address of record with the Board. Respondent hereby consents to service by electronic means if Respondent has an electronic address on ?le with the Board. 23. Upon becoming effective, this Order shall be open to public inspection and shall be publicized pursuant to the Board?s standard policies and procedures. This Order constitutes discipline against Respondent?s license. Additionally, this Order shall be reported the Federation of State Medical Boards, the National Practitioner Data Bank and as otherwise required by law. 24. If Respondent is licensed by any other jurisdiction, Respondent shall report this Order to all otherjurisdictions in which Respondent is licensed. 25. Respondent shall submit an update to his pro?le with the Healthcare Professions Pro?ling Program regarding this Order within thirty (30) days of the effective date of this Order. 77%. Gary Weiss, M.D. THE FOREGOING was acknowledged before me this day of Q??m 2014 by Gary Weiss, in the County of 3ma/w? State of 47mm, OTARY PUBLIC 7? La 3? commission expires $231.3 MICHELE L. BOMIHON Notary Public Sum of Florida 3M1 Comm. Enplm Jul 16. 201B Commission I FF 142569 mmw?mm. 1* mod? ?o'uo THE FOREGOING Stipulat' and Final Agency Order is approved and effective this 22-day of i - . ,2014. all i APPROVED AS TO FORM: FOR RESPONDENT FOR THE COLORADO MEDICAL BOARD JOHN W. SUTHERS Attorney General Gary B. Blurthsa. #3992/ Victoria E. Lovato Esq. #31700 Silver DeBoskey Smith Mansion 1801 York St. Denver, CO 80206 Telephone: (303) 399-3000 Email: Attorneys for the Colorado Medical Board, Inquiry Panel Colorado Department of Law Ralph L. Carr Colorado Judicial Center 1300 Broadway, 8th Floor Denver, Colorado 80203 Telephone: (720) 508-6390 Email: jack.wesoky@state.co.us *Counsel of Record