BEFORE THE .1 OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 162013-3885 GLEN EDWARD MARIN, D.O. 214-22 73?l Avenue Baysidc, NY 11364 Osteopathic Physician?s and Surgeon?s License No. 20A5127 Respondent DECISION AND ORDER The attached Stipulated Surrender of License is hereby adapted by the Osteopathic Medical Board of California, Department of Consumer Affairs, as its Decision in this matter. This Decision shall become effective ORDERED l/ 3? 1/ 2 (19/71 OR THE OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA CONDETT, 13.0., PRESIDENT DEPARTMENT or CONSUMER AFFAIRS KAMALA D. HARRIS Attomey General of California Jose R. 6613mm Supewising Deputy Attorney General JANE ZACK. SIMON Deputy Attorney General State Bar No. 1 16564 455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102?7004 Telephone: (415) 703-5544 Facsimile: (415) 7036480 Email: anezack.simon@doi.ca. gov A?cmeysfor Complainant Osteopathic Medical Board ofC?aEiform?a REFQRE THE OSTEOPATHIC BOARD @Ei DEPARTMENT OF CONSUNEER AFFM STATE OF in the Matter of the Accusatien Against: Case No. 16001.3?3885 GLEN EDWARD MAREN, an STEFEIIATED SURRENBER 01? 214422 73?? Avenue LISEWE Bsyside, NY 11364 Osteopathic Physicien's and Surgeons License No. 20A5127 Respondent. I IT IS HEREBY AND AGREED by and between the parties in this proceeding, diet the following metters are true: 1. Angelina M. Button (Complement) is the Executive Director of the Osteopathic Medical Board. of California (Board) This action has at all times been maintained solely in the official capacity of the Executive Dieector of the Osteopathic Medical Board of California; who is represented by Kernels D. Harris Attorney General of the State of California, by Jane Zack Simon, Deputy Attorney General. 2. Glen Edward Merin,D.0. (Respondent) enters ietc this Stipulated Surrender cf Licesse after censultation with his New York attorneys, mjuglas Nadjari of Ruskin MoscouFaltischelc 13C, Whose address is East Tower 1521? Floor, 1425 RXR Flees, Uniondale, NY 1 Stipulated Surrender of License (16?20138885) co \1 Ch Us \5the charges and allegations in the Accusatioa. Respondent also has carefully readand tmderstands 11556. 3. Respondent has received, read, discussed with his legal consultant, and understands the Accusation which is presently on file and pending in case number 16-201 36885 (Accusation) a copy of which is attached as Exhibit A 4. Respondent has carefully read, discussed with his legal consultantand understands the effects of this Stipulated Surrender ot?Lioense (Stipulation) 5. Respondent is fully aware of his legal rights in this matter, including the right to a hearing on the charges and allegations in the Accusation; the right to be represented by counsel, at his own expense; the right to confront and crosswexamine the witnesses against him; the right to present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel the attendance of witnesses and the production of documents; the right to reconsideration and. court review of an adverse decision; and all other rights accorded by the California Administrative Procedure Act and other applicable laws. 6. Respondent voluntarily, knowingly,_arid intelligently waives and gives up each and every right set forth above. 7. Respondent agrees that hosed exclusively on the action of the New York; State Board ?for Professional Medical Conduct as alleged in the Accusation, and not on any acts or conduct which. occurred in Califorriia, cause exists to discipline his California osteopathic physician?s and surgeon?s certi?cate Iporseaot toBusiness and Professions Code sections 141 and 2305. Respondent lives and practices in New York, has no intention of practicing in California, and wishes to surrender his California license at: this time. Pursuant to section 2224(1)) of the Business and Professions Code, this Stipulation for Surrender of License shall he suhj cot to the approval of the Board. Resporident understands and agrees "that the Board?s staff and counsel for Complainant may oomunieate directly with the Board. regarding this Stipulation without notice to or participation by Respondent or his legal consultant. By signing this Stipulation, Respondent understands and agrees that he may not Withdraw his agreement or seek to rescind the Stipulation prior to the time the Board considers 2 Stipulated Surrender of License (1.o~201 3-3885) and acts upon it. In the event that this Stipulation is rejected for any reason by the Board, it will be of no force or effect for either party. The Board will not be disqualified from further action in this matter by Virtue of its consideration of this Stipulation. 9. Upon acceptance ofthis Stipulation by the Board, Respondent understands that he will no longer be permitted to practice as an osteopathic physician and surgeon in California, and also agrees to surrender and cause to be delivered. to the Board any license and wallet certificate in his possession before the effective date of the decision. 10. The admissions made by Respondent herein are only for the purposes of this proceeding, or any other proceedings in which the OsteOpathie Medical Board or other professional licensing agency is involved, and shall not he admissible in any other criminal or civil proceeding. 1.1. Respondent fully understands and agrees that if he ever tiles an application for relicensure or reinstatement in the State of California, the Board shall treat it as a petition for reinstatement, and Respondent must comply with all laws, regulations and procedures for reinstatement of a revoked license in effect at the time the petition is filed. 12. Respondent understands that he may not petition for reinstatement as an osteopathic physician and surgeon for a period of three (3) years from the effective date of his surrender. Information gathered in connection with Accosation number 16m2013~3885may he considered by the Board in determining whether or not the grant the petition for reinstatement. For the purposes of the reinstatement hearing, the allegations contained in Accusation number 16? 20136885 shell be deemed to he admitted by Respondent, and Respondent waives any and all defenses based on a claim of laches or the statute of limitations. ?13. Respondent shall pay the Board costs of investigation and enforcement in the amount of $700.00 prior to issuance of a new or reinstatedlicense. 14. it? he parties understand and agree that facsimile or electronic copies of this Stipnieted Surrender of License, including facsimile or electronic signatures thereto, shall have the same force and effect as the originals. Stipulated Surrender of License ('16~2013~3885) MTANCE have care?illy read the above Stipulated Surrender of License. I enter into it freely and voluntarily and with full knowledge of its force and effect do hereby surrender my Osteopathic Physician's and Surgeon?s Certi?cate Number 20A5127to the Osteopathic Medical Board of California, for its formal acceptance. By signing this stipulation to surrender my license, I recognize that upon its formal acceptance by the Board, I will lose all rights and privileges to practice as an osteOpathic physician and surgeon in the State of California and I also will cause to be delivered to the Board any license and wallet certi?cate in my possession before the effective date of the decision. DATED: fki._% (AL I have read and fully charge" wi I'll Respondent Glen Edward Marin, D.O. the terms and conditions and other matters contained in the above Stipulated Surrender of License. I approve its form and content. DATED: Ruskin PC ENDORSEMENT The foregoing Stipulated Surrender of License is hereby respectfully submitted for consideration by the Osteopathic Medical Board of California. DATED: \Uy?o KAMALA D. HARRIS Attorn ieral Attorneys for Complainant - I Stipulated surrender of License (162013-3885) KAMALA D. HARRIS Attorney General of California 2. . 2. 0313 R. Gusanano Supervising Deputy Attorney General x, in . JANE ZACK SIMON {1611 -1 0i 3 Deputy Attorney General State Bar No. 1 16564 QSTEQPAWHEQ MEBEEISAL 455 Golden Gate Avenue, Suite 11000 QF CALEFQRNEA San Francisco. CA 94102 Telephone: (415) 703-5544 Facsimile: (415)703-5480 A?omeysfor Complainant Osteopathic Medicai Board of California BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 16-2013-3 885 GLEN MARIN, D.O. 214?2273 Avenue ACCUSATION Bayside, NY 11364 Osteopathic Physician?s and Surgeon's License No. 20A5127 ReSpondent. The Complainant alleges: PARTIES 1. Angelina M. Burton (Complainant) brings this Accusation solely in her of?cial capacity as the Executive Director of the Osteopathic Medical Board of California. Department of Consumer Affairs. 2. On March 1, 1985, the Osteopathic Medical Board of California issued Osteopathic Physician's and Surgeon's License Number 20A5127 to Glen Edward Marin, D.O. (Respondent). The Osteopathic Physician?s and Surgeon's license is in delinquent status, having expired On I March 31, 2013. .Accusation (16~2013~3 8 85) eoqoxuunJURISDICTION 3. This Accusation is brought before the Osteopathic Medical Board of California (Board), Department of Consumer Affairs, under the authority of the following laws. All section references are to the Business and Professions Code unless otherwise indicated. A. Section 3600 of the Code states that the law governing licentiates of the Osteopathic Medical Board of California is found in the Osteopathic Act and in Chapter 5 of Division 2, relating to medicine. B. Section 36002 of the Code states: "The Osteopathic Medical Board of California shall enforce those portions of the Medical Practice Act identi?ed as Article 12 (commencing with Section 2220), of Chapter 5 of Division 2 of the Business and Professions Code, as now existing or hereafter amended, as to persons who hold certi?cates subject to the jurisdiction of the Osteopathic Medical Board of California, however, persons who elect to practice using the term or suf?x as provided in Section 2275 of the Business and Professions Code, as now existing or hereafter amended, shall not be subject to this section, and the Medical Board of California shall enforce the provisions of the article as to persons who make the election. After making the election, each person so electing shall apply for renewal of his or her certi?cate to the Medical Board of California, and the Medical Board of California shall issue renewal certificates in the same manner as other renewal certi?cates are issued by it. C. Section 2305 of the Code provides, in part, that the revocation, suspension, or other discipline, restriction or limitation imposed by another state upon a license to practice medicine issued by that state, that would have been grounds for discipline in California under the Medical Practice Act, constitutes grounds for discipline for unprofessional conduct. D. Section 141 of the Code provides: For any licensee holding a license issued by a board under the jurisdiction of a department, a disciplinary action taken by another state, by any agency of the federal government, or by another country for any act substantially related to the practice regulated by the California license, may be ground for disciplinary action by the respective state licensing board. A certified copy of the record of the disciplinary action taken against the licensee by another state, an agency of the federal government, or by another country shall be conclusive evidence of the events related therein. Nothing in this section shall preclude a board from applying a specific statutory provision in the licensing act administered by the board that provides for discipline based upon a disciplinary action taken against the licensee by another state, an agency of the federal government, or another country.? Accusation (162013?3885) Section 125.3 of the Code states, in pertinent part, that the Board may request the administrative law judge to direct a licentiate found to have committed a Violation or Violations of the licensing act to pay a sum not to exceed the reasonable costs of the investigation and enforcement of the case. CAUSE FOR DISCIPLINE (Discipline, Restriction, or Limitation Imposed by Another State) 5. On May 15, 2013, the New York State Board for Professional Medical Conduct (New York Board) issued a Consent Order regarding Respondent?s license to practice in New York. The Consent Order resolved a pending Statement of Charges alleging that Respondent engaged in unprofessional conduct in that he engaged in inappropriate verbal and/or physical conduct during examination and treatment of a patient. Respondent?s New York license was placed on probation for three years. Terms of probation include a chaperone requirement for any examination or treatment of female patients and completion of continuing medical education. A copy of the Consent Order issued by the New York Board is attached as Exhibit A. 6. Respondent?s conduct and the action of the New York State Board for Professional Medical Conduct as set forth in paragraph 5, above, constitute unprofessional conduct within the meaning of section 2305 and conduct subject to discipline within the meaning of section 141(a). PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Osteopathic Medical Board of California issue a decision: 1. Revoking or suspending Osteopathic Physician's and Surgeon's License Number 20A5127, issued to Glen Edward Marin, DO. 2. Revoking, suspending or denying approval of Glen Edward Marin, authority to supervise physicianrassistants; 3. Ordering Glen Edward Marin, D.O. to pay the Osteopathic Medical Board of California the reasonable costs of the investigation and enforcement of this case, pursuant to Business and Professions Code section 125.3; Ordering Respondent to pay the Osteopathic Medical Board of California the reasonable costs of probation monitoring, if he is placed on probation; and 5. Taking such other and further action as deemed necessary and proper. . . a DATED: [flaw/3m. ,Zm? 1% "7 642% ANGELINA M. BURTON Executive Director Osteopathic Medical Board of California Department of Consumer Affairs State of California Complainant Accusation [16~2013?3885) EXHIBIT A NEWYORK i Him cfepmmum 11f EALTH 15141511111411: May l6, 201.1 ($13.11 11111311 11.111111131131111 RECEIPT 11.119 1111 1131:? {31511 Edward Marin, .O. DACT Re: 11111111131: No. '1 6.26.1 7 1312111? Dr. Marin: 13111110331115 3 copy {11" 1.111: ?1?01 11: 811116 Board for 13101653101131 (111111111111 (311111111111 I 011,161 N11 13 144 1.1115 1111161 and any 1112111111} 11113111111111 1111116111 1111131311110 1111113133, 201. P11111311 111111131 11111 11111151111111; 1021301111 1111 mecssional Madical Cohqnduct 911 11111311 3111111 41111100131111 York 11 212?417 4445 5311113111131, REDACTED Katharine A. Hawking. .M..D.. .13. Executive Secretary 13011111 1'01 meessimnal Met-110:1] {30111111131 1-inc105ure cc: 1311111311115 11111111111. Esq. Ruskin 11110150111 1: 13? Falli?chelm PC. 1423 KER Ptam 151151 11.111513; 15111 Hour NY 1 155611425 HEALTH SDOH -:1--Heaiti1NYGa? NEW "1?0th SENATE: DEPARTMENT OF STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT Ich No. 13geemeemt GLEN EDWARD MARIN, i ORDER Upon the application of (Respondent) Glen Edward Mann. in the attached tilerisruertt Agreen'uent and Order. which IS made a part of [hie Consent Order, It 18 ORDERED, that the Consent Agreement, and its: terms. are adopted and It IS further ORDERED. that this Consent Order shall be effective Upon issuance by the Board. eItheI by IneiItI-?Ig of a copy. of this Consent Order, either by first stage. meil te Reependeet at the address; in the attach-ed Consent Agreement or Dy certi?ed mail te ReEthde-nt?e attorney. OR I upcn tecsirrtile transmission to Respondent Dr Respondent's attorney whichever is first. SO ORDERED. 5/15/2013 REDACTED . . ARTHUR s. MD. Chair - State Board for Medical Conduct - #313119 :31" Maw Yam, and 1.3313821 then-?18 No. 15215111? 13311119 Maw Yuri: State. Educa?cm I a?nc 1 win advige the Director G1 ma {3an :31 Conduct any change NEW YORK DEPAR OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER my: camsem AGREEMENT GLEN E-Ezwmn Em. AND womm Gian Edward 13.0., that 31! mime fofimvmg .atakem?nts ara true: 71% an or 3131:1141me 1 1985 I was: licengad 1m pmc?ca empathic madame In the: ?-eparimarii. My mum REDACTED 1 madam-11am that 1113 Maw York State; 80am far P-m?as-sima! Medicai Conduct (Emmi) has margad me with ma apaci?ca?m-n a1 prai?awianai as 3.31: 1mm in a Swmmant of Slam-?gas. maritad as Exhibit attached be: and part o-fih?s .Df addraa-Ls 1 Elm mam Agmemaant .1 ag-raa nut to mmest the a1lagaflans, in fun satisfaction of'tha chaxges againsi me, and agitate it) the following penalty: 1 a Pumuanl la FLY. Pub. Health Law 13 230na(9), shall he placard on for a p?rldd'o?lartae yaam. ?ubje?t t6 terms set forth En attached II n- I further awe-.52 that the Congem Order shall Impasse ?ne fallcwing - cmditmng: l'hm l?espc-r1dant shall, ln the {:0qu of medicine ln New York Slam. axamlna and treat any female patiemt only in the pr'a-aanca er? a mapamna, as is: more Fully sat in attached sandman shall lake a??m 120 days afber the Com-3am Ordei?s a??acthra data and continue: so long as Regpandent ramlns a "?anges: in New York Stain}; and "?lial Fl?apond-eant shlall remaln In continuum all rem'u-immanta of Mfr?. Educ. Law including but not llmited in: {ha requirements that a 1153:1338 shall regiatar and mntinue f0. he! naglalleraci with ma. Maw Yc-rk aim Dapamnent (except during periods: of actual suspensian) and that a licensee aha-ll pay all ragistra?gr: ?at-m. Remand?nl shall no?? axerc?aa the. option providers: in Ni?. Educ. Law'gk 8502(4) tm avoid raglalmtlan and payment of F9655. This. sandman shall take: affect-120 claw Then Gena-ant- 0mm affec?ve claim and will can?tlnue: an Early; as Reamn-dant ramaim a in New Vnrk. Sta-ta; and That Respanclent shall remain In centimmus mmpiianca all rtaquinamenfa of Pub. Health Law 25395-519?) and 10 Hum-n. lnoiuding but not i-imfted to the. requirements mm a licensee: shaft: report to depamant de?a?ftr?enf ?ub?c physician pro?fe far the licensee; continue in nattfy the departmam 01? any change in pm?ia infunnatlon within 30 days {IF-any change (or in the case: of op?onal infarma?wn. wiihin 365 days mr such Change); and, In ad?ition it: sash 133119313 reporta and noti?catimn of any changea, update his or he: pm?ka in-fmna?on w?fhl-n six manhs prior to the expiration date the iim?saa?a registration Ina-rind, 1711;192:1335: submit changes tc; his or ?new phyainim pm?ielinfmma?on aithar using tha depa?menfa seams-m web ?ite air an forms: {3de by ma dapartmam, and limnsae shali in the Winms, and-mwsama?a OF any changes, ??anges: 83.1mm is} this This Gandhi-cm Shall take gaffes? 36 days mama Cam-jars affamva date and shall continua 50 2mg as Rasmmant r?maim a isaema in Maw York gram, Rmpond?nt?a faifum to with ma mn?itiun, if prawn and ms at a hearing pumuanrm my. Pub. Law 239, ahaii perqfeaslmnail misconduct as de?ned in Educ. Law ?-6530{21) and .Y Educ Law? 6530(23), Patantfal panal?ea for failure To comply with ?rhia mndi?cn may inducing all panal?es profeasmnai mfamnduat sat-21* farm in NY. Pub. Heaith Law 230-3, inciuding but next ?mitad 10: r-evorza?cn .ur auap-?nsion of ?name, cansure and reprimand, pmbati?n, public; sewba andlar ?ne; of up to $101000 per speci?cation of miamnd um: faunci; and Mammy?Wm. That Respondent shall cooperate fully with the Of?ce a-f Medina! Gondmt (QPMC) in its ad??ii?'l?fr?d?o? and 'ar?iforc?i??i??fd?hisa Consent. Ordeal" and in Eta tnves?gaiiona of mattam mwmin? Respondent. Raspondent shall respond In a timeEy mannar to all OPMC requaafs for wriftmn pearfo'dic vari?catlon of Reapondem?s compliance with this} Garment Order. Rempondeant shalt mass?: with a pamon desEgnated by the: Direcmr of OPMC, as. cilrescheadu 'R'espondant Sham respond? pmmp?y and pmvida an dacument'; and Enfon?na?on within Respondent?s; central, am directad?. This; madman shadi- take: a?ect upcn the Board's immance of the Cdnaant Order and wii'i con?nua 30 Eon-g at; Respondent remafna [icenaad in New York State. stipulate: {hat my failure to comply any: candltiuha Qf this; Claimant O'I?dar mna?tu?a misconduct as de?nad by NY. Educ. Law 6636(29). i agree that if! am charged with miscanduct En Mum, mm (Swami . Agraemar? and Guitar aha? be: admitt'ad [nm widenaa In that pmmadmg. ask me 805%! in adapt this Agreement. undamtand that Wt?a 80am dues nut adopt Canaan: Agraamant, none? 0f Eta terms shalt bind ma or an admf?asiqh {If any of the ads m? 2111an this: Gonmm Mreamemt shat! net. tug used agafmf me fn any my and mu b2:- kept in mm 3 Gamma-m: and the Blizzard's demla'l sh?a? be without pmjudim hp the parading dimlpfinary :pmcaedfng and the Boa-rats ?nai d-atannina?cn pursuant to MY. Pub. Haaith Law. mum." agree that, the Board adopts this Coneem wreemem, the Chair of the Board shelf-ideas a W'it? tame; were met the Godsem Order I shed! take effect upon its ieeu-ance by the Board. efiher by mailing of a copy of the Cement Order by ?rst aided wait to me at the address in this Consent Agreement, To my .aiiomey my ewe free ed?! and mi: under entered, mpulsion or redeem. In mmsidere?dn art the merrier wimddt ihe mdeue?eks and m? a hearing on the media, I kndwingiy waiw . my sigh: ?3 denied: the Cease-n1: Greer fer which i awry, whe?rer edmilrn i-etratively or by cer??ed mad, DR upon Ifeceim'ile transmission ta me or my attemey, is ?nd. The Gender]? Order, this agreemm, and all attach-ed Ethbi-?a she-i1 be public document-a, 1 mm only de?ant identities, deny, redacted. As pub?e documente, they may be pasted on I- the .Depertrnerrt?e Websfte? QPMC dhal] report ibis action to the National Pradmoder Deter I Bank and the Federe?dn of State Medical Boards, and any other rammed that the Director at? (3PM eheil deem apprepzriate remade that the eeno?on and Consent Greer ere amhodzed by Pub Hee?h Lew eg 239 and and mat?die Board and QPMC have the red'uierte pewere 2:3 1:63:73;sz idem-den! terms. iask the Beard to adept this; {Saree-rd Agreement of waiver: in? me er the 'Beerd'e am? this Garment Ag reemeet, me it?! reserve this; I redeem iegree in: be 1391.:er by the Comm Order and .l ash: the? ?re Beard adopt the. we err! Agreement. "f undersized and agree that the attorney for the Dap?r?nf??t. the Director of 0?er and UTE Chair of 1m: Board each retain complete di?ecretidn'ai?rer to enter {me the I proposed agmement rand Cmnsent Order, bawd upon my applica?on, or 10 decline [to cm can limit that discretion. DA TE "so. I ?rm-?21" s?parate writiean or oral communication ?w I . We undersigned agrae to Raspondant?s aitachad Comm Agreaman?r and tca rtza "propcsed penalty Erma and mndhinna ._mwnm .. .d . . EDACTE 1:10:3ng M. NADJAR: Atkamay far Reaponderg; Hana: In.? q- REDACTED GERARD A. CABRERA, ESQ. Ammata Emma of Pramssinnal Mediaai Gahduct WE: ?is? 3 REDACTED MLEERVES 31mm . Of?ce: 01? Profewianal Madicai Ennduci mm. ., Exhibit NEW YCRK DEPARTMENT OF HEALTH FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER STATEMENT or - 'rw 7 CHARGES GLEN Do. . GLEN EQWARD DO, the Respondent. was authorized to practice rnedicrne in New York State on or about Juty 1985 by the of License Number 'tt?ZBt? by the New York State Education Department. FACTUAL ALLEGATFONS A On or about July 18? 2007. Respondent, during hi3 examination and treatment of Patient engaged in Inappropriate verbal and/or physical SPECIFICATEON OF CHARGES Respondent is; charged with committing professional misconduct as defined in MY. Educ. Law by willfully bareseing, abusing. or intimidating a patient either [:Jt-ryeicalty or verbally. as alleged in the facts: of Paragraph A - MW y, . DATE M'er?oh 2013 . New York? New York REDACTED eormemeesom Deputy Counsel . Bureau bf'Professional Medicat Conduct on Respondent shall cooperate fully with, and. resoond in a timely manner to. OPMC Terms of Probation Respondent?s conduct shall conform to moral and professional standards of conducii and governing law. Any act of professional misconduct by Respondent as defined by NY Educ. Law .6530 or 6531 shall constitute a violation of probation and may 5 subiect Resoondent to an action pursuant to NY. Pub. Health Law 230(19}. Respondent shall maintain active registration of Respondent's license (except during periods of actual suspension) with the New York State Education Department Division of Professional Licensing Services. and shall pay all registration fees. Reapondent shall provide the Director. Office of Professional Medical Conduct . (DEMO). Rivervievv Center. 150 Broadvvay, Suite 355. Albany. New York 12204? 2TB. with the following information. in writing, and ensure that this information is kept current: a full description of Respondent's employment and practice; all I professional and residential addresses and telephone numbers within and outside New York. State: and all investigations, arrests. charges, convictions or disciplinary actions by any local, state or federal agency. institution or facility. Respondent shall notify OPMC, in writing. within 30 days of any additions to or changes in the required information. requests to provide written periodic verification of Respondent's compliance with the terms of this Consent Order. Upon the Director of request. Respondent shall rneet in person with the Director's design-ea Respondent?s failure to pay any monetary penalty by the prescribed date shall sutject Respondent to all provisions of iaw'relating to debt collection by New York State. including but not limited to: the imposition of interest. late payment charges and collection tees; referral to the New York State Department oi Taxation and Finance for collection; and non-renewal of permits or licenses {Tax Law Stat-e Finance Law '18; CPLR 5001; Executive Law 32] The probation period shall toll when Respondent is not engaged in active medical practice in New York State for a period of 30 consecutive days or more. Respondent shall notify the Director of OPMC. in writing. if Respondent is not currently engaged in. or intends to leave. active medical practice in New York. State for a cor-isecutive 30 day period. Respondent shall then notitv the Director again at least ?to days before returning to active practice. Upon Respondent's return to active practice in New York State, the probation period shall resume and Respondent shall fulfill any unfulfilled probation terms and such additional reoriirenients as the Director may irnpoee as reasonably relate to the matters set Forth in Exhibit or as are necessary to protect the public health Ff; the Director of OPMC may review Respondent's professronai performance This rewew may include but shall not be limited to: a review of office records. patient records. hospital charts. and/or electronic records; and interviews with or periodic Visits With Respondent and staff at practice locations or OPMC offices Respondent shall adhere to federal and state guidelines and professional i of care With respect to. infection control practices. Respondent shall ensure education, training and oversight ofali office personnel involved in medical care. With respect to these practices. tit) Respondent shall maintain complete and legible medical records that accorateiv reflect the evaluation and treatment of patients and contain all information required by State rules and regulations concerning controlled substances. tome-spondent shall enroll in and successfully complete a continuing education program in areets) to be determined by the Director of OPMC. This. continuing education program is subject to the Director of prior written approval and ahali be successfully completed within the first 90 days of the probation period. '5 it'lFtespondent shall comply with this Consent Order and all its terms, and ahail bear . all associated compliance costs. Upon receiving evidence of noncompliance With. or a: violation of. these terms. the Director of OPM-C and/or the Board may initiate a violation of probation proceeding. and/or any other such proceeding authorized by- law? against Respondent. EXHIBIT Chaperorie Condition ano treat any female patient only in the presence of a chaperone. The chaperon-e Respondent shall. in the course of practicing medicine in New York State examine i ehall be a licensed or regiatered health care proteealonal or other health care worker, shall not he eternity member, personal friend. or be in a relationehip With Respondent which could pose a conflict with the chaperone'e resaonaloilities. The chaperone shall he proposed by Respondent and subject to the written the approval at the Director of OPMC. Prior to the approval of any individual as; chaperone. Respondent shall cause the proposed cheperone to execute and submit to the Director oi OPMC an acknowledgment of the ohaperone?s agreement to undertake all of the reeponeibilltiee of the role of chaperone. Said acknowledgment shall be made upon 1 a term provided by and acceptable to the Director. Respondent shall provide the ohape-rone with a copy of the Order and all of its attachments and shall. without fail. pause the approved chaperon-e to: 3 a) to; E3) Report quarterly to DPMC regarding the chaperoning of Respondent?s practice . Report within 2-4 hours any failure of Respondent to comply with the Order, including, but. not limited to, any failure by Respondent to have the ehaperone present when required, or any conduct, whether verbal or physical, by Reepondent in the presence of any patient. Confirm the chaperone?s presence at each and every examination and treatment of a female patient by Respondent, by placing the chaperone?s name title and i date in the patient record for each and every visit, and by maintaining a separate log, kept in the chaperone?s own possession, listing the patient name and date of visit for each and every patient visit chaperoned. Provide copies of the log described in paragraph c, above, to OPMC at least quarterly and eaten immediately upon the Director's request. .