1 DANIEL E. LUNGREN, Attorney General4patientsafety.org/documents/Chetkowski, Ryszard...

1 DANIEL E. LUNGREN, Attorney General of .the State of California

2 SUSAN K. MEADOWS Deputy Attorney General

3 California Department of Justice 50 Fremont Street, Suite 300

4 San Francisco, California 94105-2239 Telephone: (415) 356-6282

5 Facsimile: (415) 356-6257

6 Attorneys for Complainant

7 BEFORE THE

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DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA

STATE OF CALIFORNIA

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11 In the Matter of the Accusation Against:

12 RYSZARD CHETKOWSKI, M.D.

13 2999 Regent Street, #101-A Berkeley, CA 94705

14 Physician's and Surgeon's

15 Certificate No. G41258

16 Respondent.

17

Case No. 12-95-46238

OAH No. N 9604036

STIPULATION FOR SETILEMENT

18 IT IS HEREBY STIPULATED by and between Ryszard

19 Chetkowski, M.D. (hereinafter "respondent") with the counsel and

20 advice of his attorneys, Robert Sullivan, of the law firm

21 Nossaman, Guthner, Knox & Elliott, and Penelope Cooper, of the

22 law firm of Cooper, Arguedas & Cassman, and complainant Ronald

23 Joseph, in his official capacity as Executive Director of the

24 Medical Board of California ("Board"), by and through its

25 attorney, Daniel E. Lungren, Attorney General, by Susan K.

26 Meadows, Deputy Attorney General, as follows:

27 1. Third Amended Accusation No. 12-95-46238

1.

1 (hereinafter referred as "the Accusation") is presently pending

2 against Ryszard Chetkowski, M.D. (hereinafter referred to as the

3 "respondent"), physician and surgeon's certificate number G-47258

4 before the Division of Medical Quality of the Medical Board of

5 California (hereinafter referred to as the "Division").

6 2. The complainant in said Accusation, Ron Joseph, is

7 the Executive Director of the Board and brought said Accusation

8 in his official capacity only.

9 3. Respondent has fully discussed with his attorneys,

10 Robert Sullivan and Penelope Cooper, the charges and allegations

11 contained in the Accusation and therefore has been fully advised

12 concerning his rights in this matter.

13 4. Respondent's license history and status as set

14 forth in paragraph 2 of the Accusation is true and correct and

15 respondent's address of record is as set forth in the caption of

16 this Stipulation. (A copy of said Accusation is attached as

17 Exhibit A and incorporated by reference in this stipulation.)

18 5. This settlement resolves a contested matter. It

19 does not constitute an admission of liability on any of the

20 allegations contained in the Third Amended Accusation. It shall

21 not be admissible for any purpose in legal proceedings, except

22 those between respondent and the Board.

23 6. For purposes of the settlement of the action

24 pending against respondent in case No. 12-95-46238 and to avoid a

25 lengthy administrative hearing, respondent agrees to comply with

26 the following:

27 A. COMPETENCY EXAMINATION

2.

1 (1) Within six months following the effective date of

2 this stipulation, respondent shall, at his own expense, take and

3 pass an oral clinical examination. This examination is

4 voluntarily taken by respondent.as part of a negotiated

5 settlement of the charges in the Third Amended Accusation. Said

6 oral clinical examination shall be conducted according to the

7 procedures outlined in Business and Professions Code section

8 2293. The examination shall be administered by three physician

9 examiners selected by the Division or its designee. Each of the

10 three physician examiners shall be board certified in

11 obstetrics/gynecology. The examiners shall test for medical

12 knowledge in obstetrics/gynecology with special emphasis on the

13 performance of pelvic examinations and ultrasound procedures. The

14 examination shall be tape recorded.

15 (2) A failing grade from two of the examiners shall

16 constitute a failure of an examination. In the event of a

17 failure, the board shall supply a true and correct copy of a tape

18 of the examination to respondent. If respondent fails the

19 examination, within 45 days following receipt of the tape of the

20 examination, he may request a hearing before an administrative

21 law judge as designated in Government Code section 11371 to

22 determine whether he is entitled to take a second examination.

23 Any such hearing shall be held in accordance with the

24 Administrative Procedures Act, and shall be limited to the

25 determination of the fairness of the examination. Upon a finding

26 that the examination or procedure is unfair or that one or more

27 of the examiners manifested a bias towards respondent, a

3.

1 reexamination shall be ordered.

2 B. EDUCATION

3 (1) Respondent shall successfully complete a Division-

4 approved educational course in the field of gynecologic/pelvic

5 examination in the practice of reproductive endocrinology.

6 Respondent shall propose the course and submit it to the Division

7 for its approval within 30 days after this Stipulation becomes

8 effective. Respondent shall complete the course within 6 months

9 of the effective date of this Stipulation. The course shall

10 include both a didactic and clinical instruction. Respondent

11 shall be examined on his performance in this course.

12 C. COMMUNICATION TRAINING

13 (1) Within six (6) months of the effective date of

14 this Stipulation, respondent shall complete a course in

15 communication and sensitivity training that emphasizes the

16 patient's perception of the physician-patient relationship. This

17 training course shall be no less than 10 hours in length and

18 shall be approved in advance by the Division or its designee.

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D. COSTS OF INVESTIGATION

(1) Respondent shall pay the sum of $5,000.00 (five

21 thousand) to the Division or its designee for the costs of

22 investigation and prosecution of this case. These costs shall be

23 paid in fu1l. within six (6) months of the effective date of

24 Stipulation.

25 7. In the event respondent passes the oral competency

26 examination (or reexamination as applicable) , successfully

27 completes the education requirement, successfully completes the

4 .

1 communication training requirement, and pays cost recovery,

2 respondent agrees to the following:

3 (a) Respondent waives each of his rights, including

4 the right to a hearing on the charges and allegations; his right

5 to confront and cross-examine witnesses who would testify against

6 his; his right to present evidence in his favor or to call

7 witnesses on his behalf, or to so testify himself; his right to

8 contest the charges and allegations and any other rights which

9 may be accorded his pursuant to the California Administrative

10 Procedure Act (Government Code §11500 et seq.); his right to

11 reconsideration, appeal to superior court and to any other or

12 further appeal.

13 (b) Respondent admits that there is jurisdiction for

14 the Board under section 2234 of the Business and Professions Code

15 to enter into this stipulation and to impose a public letter of

16 reprimand upon his certificate of licensure to practice medicine

17 pursuant to section 2233 of the Business and Professions Code.

18 (c) The Division shall withdraw Accusation No. 12-95-

19 46238 heretofore filed, and respondent shall be publicly

20 reprimanded by way of a letter issued by the Executive Director

21 of the Medical Board under section 2233 of the Business and

22 Professions Code. Said public letter of reprimand shall be in

23 the same form as the letter attached as Exhibit B hereto.

24 8. In the event respondent fails the oral competency

25 examination and is not afforded the right to reexamination, or in

26 the event he fails to pass a reexamination, or fails to

27 successfully complete the additional course of education, or

5.

1 fails to successfully complete the communication training or

2 fails to pay cost recovery:

3 (a) Accusation No. 12-95-46238 shall be reinstated and

4 another accusation may be filed charging the respondent with,

5 including, but not limited to, incompetency under section 2234(d)

6 and/or general unprofessional conduct in violation of Business

7 and Professions Code section 2234.

8 (b) The findings and conclusions reported by the

9 physicians conducting the oral competency examination may be

10 received as evidence in the administrative hearing on the

11 Accusation. In the event the Accusation is so reinstated,

12 respondent specifically waives any claim of laches in the

13 prosecution of the action.

14 9. IT IS FURTHER STIPULATED AND AGREED that the terms

15 set forth herein shall be null and void, and in no way binding

16 upon the parties hereto, unless and until accepted by the Medical

17 Board of California. Respondent further agrees that in addition

18 to submitting this stipulation to the Board for acceptance and

19 adoption, counsel for complainant may also submit to the Board a

20 memorandum recommending the stipulation's adoption. Respondent

21 agrees that the memorandum recommending adoption shall not, under

22 any circumstances, be discoverable or disclosed to respondent.

23 ACCEPTANCE

24 I HEREBY CERTIFY that I have read this Stipulation for

25 Settlement in its entirety, that I fully understand the terms of

26 this Stipulation, and I voluntarily agree to them.

27 IN WITNESS THEREOF, I affix my signature this /z~ day

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of

RYSZARD CHETKOWSKI Respondent

I have fully discussed with respondent Ryszard

Chetkowski, M.D. the terms and conditions and other matters

contained in the above Stipulated Settlement and Decision and

approve its form

DATED:

and content.

~(!1/ct1-

··/)~~ ROBERT SULLIVAN Attorney for Respondent

15 I have fully discussed with respondent Ryszard

16 Chetkowski, M.D. the terms and conditions and other matters

17 contained in the above Stipulated Settlement and Decision and

18 approve its form and content.

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23 ENDORSEMENT

24 The foregoing Stipulated Settlement and Decision is

25 hereby respectfully submitted for consideration of the Division

26 of Medical Quality, Medical Board of California, Department of

27

7.

1 Consumer Affairs pursuant to Business and Professions Code

2 section 2233 for consideration and approval.

3 DATEDo ,/kfUtch 11, fftJ 4

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General

Deputy Attorney General

DECISION AND ORDER

The above Stipulation for Settlement is adopted and

shall become the decision of the Medical Board of California,

Division of Medical Quality effective __ M_a..::..y_1'_1o.:._' ______ , 19 9 7.

IT IS SO ORDERED this _]..Sth day of __ nAp~rLlw.lL-___ , 1997.

IRA LUBELL, M.D. Division of Medical Quality Medical Board of California

8.

EXHIBIT A

1 DANIEL E. LUNGREN, Attorney General of the State of California

2 SUSAN KAY MEADOWS (State Bar No. 115092) Deputy Attorney General

3 California Department of Justice 50 Fremont Street, Suite 300

4 San Francisco, California 94105 Telephone: (415) 356-6282

5 Attorneys for Complainant

6

7 BEFORE THE

8

9

DIVISION OF MEDICAL QUALITY MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

10

11 In the Matter of the Accusation Against:

12

Case No. OAH. No.

12-95-46238 N9604036

Ryszard Chetkowski, M.D. 13 2999 Regent Street, #101-A

Berkeley, CA 94705

) ) ) ) ) ) )

TlllRD Al\IENDED ACCUSATION

14 )

15 License No. G47258 ) ) ) 16 Respondent. ______________________________________ )

17

18 The Complainant alleges:

19 PARTIES

20 1. Complainant, Ron Joseph, is the Executive Director

21 of the Medical Board of California (hereinafter the "Board") and

22 brings this accusation solely in his official capacity.

23 2. On or about April 12, 1982, License No. G47258 was

24 issued by the Board to Ryszard Jerzy Chetkowski (hereinafter

25 "respondent''), and at all times relevant to the charges brought

26 herein, this license has been in full force and effect. Unless

27 renewed, it will expire on March 31, 1998.

1.

1 JURISDICTION

2 3. This accusation is brought before the Division of

3 Medical Quality of the Medical Board of California, Department of

4 Consumer Affairs (hereinafter the "Division''), under the

5 authority of the following sections of the California Business

6 and Professions Code (hereinafter "Code"):

7 A. Section 2227 of the Code provides that the Board

8 may revoke, suspend for a period not to exceed one year, or

9 place on probation, the license of any licensee who has been

10 found guilty under the Medical Practice Act.

11 B. Section 2234 of the Code provides that

12 unprofessional conduct includes, but is not limited to, the

13 following:

14 (c) Repeated negligent acts.

15 C. Section 125.3 of the Code provides, in part, that

16 the Board may request the administrative law judge to direct

17 any licentiate found to have committed a violation or

18 violations of the licensing act, to pay the Board a sum not

19 to exceed the reasonable costs of the investigation and

20 enforcement of the case.

21 FIRST CAUSE FOR DISCIPLINE

22 (Patient M.W.!1)

23 (Unprofessional Conduct)

24 4. On or about April 14, 1994, respondent undertook

25

26 1. Initials are used to identify the patients in this Accusation to protect their privacy. The full names of the

27 patients identified will be disclosed to respondent pursuant to any Request for Discovery.

2.

1 to treat patient M.W. who saw respondent for consultation

2 regarding infertility. During the April 14, 1994 appointment,

3 respondent took a medical history from M.W. and performed a

4 pelvic examination. A nurse was present during the pelvic

5 examination the entire time. However, the nurse remained at the

6 head of the examination table.

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5. During the pelvic examination, respondent fondled

and/or massaged M.W.'s.clitoris for a brief period. M.W. was

stunned at this physical contact. After the pelvic examinatio~,

respondent advised M.W. that she would be a good candidate for in

vitro fertilization.

6. Once the examination was finished, M.W. dressed and

returned to respondent's office with her husband. Respondent

told her to make another appointment when she was ready to begin

15 with the procedure. Because of respondent's conduct during the

16 pelvic examination, M.W. never returned to respondent's office

17 for a follow-up appointment.

18 7. Respondent's conduct with respect to patient M.W.

19 as alleged above constitutes cause for disciplinary action

20 pursuant to section 2234 (unprofessional conduct) of the Code.

21 SECOND CAUSE FOR DISCIPLINE

22 (Patient D.S)


24 8. On or about November 28, 1994, respondent undertook

25 to consult with and treat patient D.S. for infertility. D.S. was

26 referred to respondent by her physician because she and her

27 husband wanted to have a second child and were not having

3.

1 success. At her first appointment, D.S. and her husband spoke

2 with respondent in his office for approximately one half an hour.

3 Respondent asked her husband to wait in the waiting room while

4 respondent performed a physical examination on D.S.

5 9. Once in the examination room, D.S. undressed, put

6 on a cover-up, and got into the stirrups for a pelvic

7 examination. D.S. commented to respondent that she was very cold

8 and he rubbed her left'thigh in a circular motion with his palm

9 about four times. After rubbing her thigh, the nurse came into

10 the examining room.

11 10. The nurse positioned herself at D.S.' head while

12 respondent performed the pelvic examination. During the

13 examination, respondent briefly rubbed D.S.'s clitoris

14 approximately four to five times. Respondent's touch was firm.

15 11. D.S. had undergone an unusually high number of

16 pelvic examinations due to her infertility problems, and no other

17 physician had ever touched her in the manner hereinbefore

18 described.

19 12. When respondent conducted the bimanual

20 examination, D.S. felt that everything seemed normal. However,

21 the last part of the examination involved an ultrasound by use of

22 a vaginal probe. During the ultrasound, respondent again rubbed

23 D.S.'s clitoris two or three times as he inserted the probe into

24 her vagina. Again, D.S. had undergone the ultrasound procedure

25 several times in the past and no other physician had ever touched

26 her clitoris in this manner.

27 13. D.S. was very upset regarding respondent's conduct

4.

1 during the pelvic examination and did not make any future

2 appointments with respondent.

3 14. Respondent's conduct with respect to patient

4 D.S. as alleged above constitutes cause for disciplinary action


6

7 THIRD CAUSE FOR DISCIPLINE

8 (Patient A.S.)


10 15. On or about November of 1990, respondent undertook

11 to consult with and treat patient A.S. for infertility. During

12 the pelvic examination that respondent performed on A.S.,

13 respondent briefly rubbed A.S.'s clitoris with his fingers. A

14 nurse was in the room at the time, but she was not obser~ing the

15 examination and was busy writing. A.S. had undergone many pelvic

16 examinations before and had never had her clitoris rubbed in this

17 manner by the examining physician.

18 16. A.S. had to return to respondent's office the next

19 day, or soon after her first visit to continue the fertility

20 procedures. On the next visit, before respondeni inserted the

21 vaginal probe, he again rubbed her clitoris with his fingers.


23 A.S. as alleged above constitutes cause for disciplinary action


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FOURTH CAUSE FOR DISCIPLINE

(Patient W. K.)

(Unprofessional Conduct)

5.

1 18. On or about February or March of 1989, respondent

2 undertook to consult with and treat patient W.K. for infertility.

3 During the course of this treatment, respondent performed only

4 one pelvic examination on patient W.K. During this examination,

5 just before respondent inserted the speculum into her vagina,

6 W.K. felt respondent stroke her clitoris briefly with his finger.


8 W.K. as alleged above constitutes cause for disciplinary action


10 FIFTH CAUSE FOR DISCIPLINE

11 (Patient J.G)


13 20. On or about April of 1987, respondent undertook to

14 consult with and treat patient J.G. for infertility. J.G. had

15 suffered four spontaneous abortions at ten to twelve weeks and

16 had been referred to respondent for consultation. On her first

17 visit, respondent took her into his examination room and

18 performed a pelvic examination. During the pelvic examination,

19 respondent stimulated her clitoris briefly. Although a nurse was

20 present in the room during the pelvic examination, the nurse was

21 standing in the corner and could not observe the pelvic

22 examination.

23 21. After the examination, J.G. paid her bill and left

24 respondent's office. J.G. was upset with respondent. She never

25 returned to respondent for follow-up treatment because of his

26 conduct during the pelvic examination.


6.

1 J.G. as alleged above constitutes cause for disciplinary action


3 SIXTH CAUSE FOR DISCIPLINE

4 (Patient D.C.)

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{Unprofessional Conduct)

23. On or about 1989, respondent began to treat

patient D.C. for infertility. D.C. was unable to become pregnant

at that time and because of insurance coverage concerns was

unable to continue treatment with respondent. In the summer of

1991, D.C.'s insurance coverage changed and she again sought

treatment from respondent for infertility. During the summer of

1991, respondent performed a pelvic examination and a breast

examination on D.C. No nurse was present in the room during

these examinations.

24. When respondent performed the pelvic examination,

he slid his fingers down her clitoris. D.C. found this touching

to be inappropriate and degrading.

25. D.C. was extremely uncomfortable and upset with

19 respondent's conduct. However, D.C. returned to respondent for

20 further treatment because she wanted to have a baby.


22 D.C. as alleged above constitutes cause for disciplinary action


24 SEVENTH CAUSE FOR DISCIPLINE

25 (Patients M.W., D.S., A.S., W.K, J.G., and D.C.)

26 (Repeated Negligent Acts & Unprofessional Conduct)

27 27. Respondent's conduct as set forth above in all

7.

1 Causes for Discipline whether jointly, or in any combination

2 thereof, constitutes cause for discipline pursuant to sections

3 2234 (c) (repeated negligent acts) and 2234 (unprofessional

4 conduct) of the Code.

5 PRAYER

6 ~REFORE, the complainant requests that a hearing be

7 held on the matters herein alleged, and that following the

8 hearing, the Division issue a decision:

9 1. Revoking or suspending License Number G47258

10 heretofore issued to respondent Ryszard J. Chetkowski;

11 2 . Revoking, suspending or denying approval of the

12 respondent's authority to supervise physician's assistants,

13 pursuant to Business and Professions Code section 3527;

14 3. Ordering respondent to pay the Division the actual

15 and reasonable costs of the investigation and enforcement of this

16 case under section 125.3 of the Code;

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4 . Taking such other and further action as the

Division deems necessary and proper.

DATED: frl Mt.JJ J-1 I ~fl 7 I

Executive Director Medical Board of California Department of Consumer Affairs State of California

Complainant

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EXHIBIT B

Ryszard Chetk:owski, M.D. 2999 Regent Street, #101-A Berkeley, CA 94705

EXHIBITB

PROPOSED LETTER OF REPRIMAND

re: Letter of Reprimand in Case No. 12-95-46238, entitled, In the Matter of the Accusation Against Ryszard Chetk:owski, M.D., Certificate No. G47258.

Dear Dr. Chetk:owski:

On or about March 5, 1997, the Medical Board of California filed a Third Amended Accusation No. 12-95-46238 (hereinafter the "Accusation") against your license to practice medicine. This Accusation was based on allegations concerning the performance of pelvic examinations and infertility procedures in your practice.

It has been decided by the Division of Medical Quality of the Medical Board for California pursuant to Business and Professions Code section 2233 that a Public Letter of Reprimand shall be issued in this case. It has been determined that by your successful completion of an oral competency examination in the performance of pelvic examinations and ultrasound procedures, and your successful completion of additional education courses and communication training that you have demonstrated competency in your area of practice.

WHEREFORE, pursuant to the authority of section 2233 of the Business and Professions Code, the Division of Medical Quality of the Medical Board of California hereby withdraws Third Amended Accusation No. 12-95-46238 and issues a public letter of reprimand in this matter, and understands from your conduct and representations that due to the knowledge and insight you have gained, no future violations of the Business and Professions Code will occur.

Very truly yours,

Ron Joseph Executive Direcotr Medical Board of California

1 DANIEL E. LUNGREN, Attorney General4patientsafety.org/documents/Chetkowski, Ryszard...

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