BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Petition for Reinstatement of:

ZIY AD A. GHABRA

Physician's and Surgeon's Certificate No. C40841

Respondent

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Case No. 8002014008367

OAH No. 2016040652

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DECISION

The attached Proposed Decision is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00p.m. on December 2, 2016.

IT IS SO ORDERED: November 4, 2016.

MEDICAL BOARD OF CALIFORNIA

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Petition for Reinstatement Against:

ZIY AD A. GHABRA, M.D.,

Case No. 800-2014-008367

OAH No. 2016040652

Respondent.

PROPOSED DECISION

Administrative Law Judge Vallera J. Johnson, State of California, Office of Administrative Hearings, heard this matter in San Diego, California, on August 15, 2016.

LeAnna E. Shields, Deputy Attorney General, represented the California Attorney General.

Frederick M. Ray, Esq., represented Ziyad A. Ghabra, M.D.

The matter was submitted on AJ.Igust 15, 2016.

FACTUAL FINDINGS

Education, Training, Experience and License History

1. Ziyad A. Ghabra (petitioner) was born in Damascus Syria, where he lived until he was five years old. At that time, he moved with his family to Lebanon. He attended medical school at the American University of Beirut. He completed his residency in obstetrics and gynecology at the University of Chicago- Lying In Hospital in 1983. Thereafter he moved to Lancaster, California and commenced private practice; at the time, of this incident, he had privileges at three hospitals.

2. On February 14, 1983, the Medical Board of California, Department of Consumer Affairs, State of California (board), issued Physician and Surgeon's Certificate (certificate) No. C 40841 1 to respondent.

3. On July 1, 1992, the board issued Accusation Case No. D-4805. On October 6, 1992, the board issued a First Amended Accusation. On November 3, 1992, an administrative law judge issued an Interim Suspension Order, which suspended respondent from practicing medicine until the final decision was issued. Effective May 28, 1993, after an administrative hearing, the board revoked respondent's certificate.

4. There were multiple causes for revocation of petitioner's license to practice medicine, involving sexual misconduct with multiple women, some employees and some patients; the sexual misconduct occurred over a period of six years. One episode, in 1986 involving a female employee, resulted in a criminal conviction for battery that petitioner sustained in February 1987. Despite a 90-day jail term and three years probation, respondent engaged in further sexual activities with a patient, having intercourse with her both in the examining room and away from his office. As the administrative law judge wrote in the Proposed Decision adopted by the board" ... respondent exploited his status as (the patient's) physician, using the status to induce (her) to consent to sexual intercourse."2 Sexual misconduct with other patients continued to occur until 1992. A final incident in 1992 with a prospective employee of petitioner resulted in other criminal charges being filed. These criminal charges resulted in a felony conviction for sexual assault and false imprisonment in 1993. He was sentenced to a year in jail and probation for three years.

5. On August 17, 1998, petitioner filed a petition for reinstatement. Effective November 11, 1999, after an administrative hearing, the board denied his petition for reinstatement.

In the Proposed Decision adopted by the board, the administrative law judge wrote:

Based on the record before the Administrative Law Judge, there is no credible persuasive showing that would justify the granting of this petition at this time. This is not to say that petitioner has failed to make any showing of changed attitude and circumstances.

[1! ... 1!]

Petitioner feels that he is now a man of strong morals and understands boundaries. This may well be true. However, there

1 The term certificate is used interchangeably with the words license to practice medicine.

2 Page 4, Paragraph 8b of the Proposed Decision adopted by the board.

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is no credible showing of his growth and development other than his testimony and the testimonial letters from 2 physicians that are required as part of the Petition process. The record is lacking in the necessary support from a competent expert in the field of sexual misconduct who can give credible answers about whether petitioner now poses a danger to patients, should be he allowed to practice.

Second Petition for Reinstatement

6. On September 24, 2015, petitioner filed his second petition for reinstatement of his revoked certificate. Among other things, the evidence in this case included:

• The petition for reinstatement, petitioner's statement, letters of support from Abdallah Farrukh, M.D., Jirair Konialian, M.D., George Photias, M.D. and John R. Sealy, M.D., Superior Court Documents;

• Final Decision and Order on the Accusation;

• First Petition for Penalty Relief and attachments (Petitioner's Narrative, MBC Report, Letters of Support from Dr. Konialian and Dr. Farrukh);

• Decision and Order on the First Petition for Reinstatement;

• Petitioner's Psychiatric Records from Dr. Sealy;

• Subject Interview Transcript, dated July 15, 2015;

• Testimony of Dr. Farrukh, Leila Assolin [petitioner's wife], and petitioner;

• Letter from Sex Anonymous Group Coordinator, dated July 18, 2016;

• Certificates of Continuing Medical Education;

• Letter from Reem Shehab, dated August 11, 2016;

• Excerpts from the board's investigation report (interview of Dr. Sealy);

• Dr. Sealy's response via email to the board's investigator;

7. Petitioner and his first wife married in 1981. They have four biological children, and he adopted her son from a prior relationship.

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8. Petitioner has suffered significant traumatic experiences in his personal life. In 1991, his two year-old son drowned. After almost 10 years of marriage, he divorced. After serving five months in jail, he suffered a heart attack. In the late 1990s, he battled cancer.

9. In 1994, he met Ms. Assolin and married her in 1999. Together they have a biological son.

10. Between 2000 and 2009, petitioner practiced medicine in Dubai. While in Dubai, one of his patients learned about his misconduct and discipline by the board. At the time, he was required to hold a medical license issued by his country of origin. Respondent surrendered his license to practice medicine. Thereafter he and his family moved to Damascus. Between 2009 and 2013, he maintained a private practice in Damascus. He and his family returned to the United States when the civil war began in Syria.

11. Dr. Sealy's psychiatric records for petitioner included some records from John Beck, M.D. [petitioner's prior treating psychiatrist], and are dated from July 1987 through July 2015. Though there are notes that are illegible or partly legible, there is relevant information about his background, relationship with his parents, medical education, attitude towards his patients, treatment with Dr. Sealy, hospitalization medical records, and communication with Dr. Sealy regarding his disability benefits.

12. Pursuant to the terms of criminal probation following his first conviction in 1987, petitioner commenced therapy with Dr. Beck. By his own admission, petitioner did not take the therapy seriously; he did not believe that he had a problem and was dishonest with Dr. Beck.

In 1992 petitioner began to realize that he had a problem and began to deal with his issues. In October 1992, petitioner presented to Dr. Beck again and requested psychiatric care for a condition that petitioner identified as "a compulsive disorder of a sexual nature." According to Dr. Beck, petitioner appeared to be "more aware of the nature of his condition and the requirements for its care." In his letter, dated November 10, 1992, Dr. Beck noted that his evaluation of petitioner revealed that he was "much more open and receptive" than he was in 1987; as such, "this state of mind suggests a much more favorable prognosis with treatment than accomplished in 1987."

13. At petitioner's request, he participated in the Professional Assessment Program at Abbott Northwestern Hospital in Minneapolis between December 27 and 31, 1992. Their Diagnostic and Statistical Manual, 41

h Edition, Axis I diagnosis was:

• 309.28- Adjustment disorder with depressed and anxious mood;

• 312.31 -Pathological gambling;

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• 302.90 - Paraphernalia NOS with features of sexual perpetration, exploitation and addiction.

14. Commencing October 6, 1993, Dr. Sealy began outpatient psychotherapy with petitioner, and followed him during his hospitalization at Del Amo Hospital, between December 19, 1993, and January 14, 1994. He concurred with the Axis I diagnosis.

As of April1994, Dr. Sealy anticipated that petitioner would remain in outpatient psychotherapy for one to two years; petitioner was attending 12-step self-help meetings daily, which he anticipated would continue at this intensity for at least one year. In this letter, Dr. Sealy noted: "Therapy focuses on his continuing recovery from sexual and gambling and addictive behavior and the underlying pain with goals to stabilize mood, establish clear personal boundaries, and expand options for being nurtured, handling anxiety and developing a lifestyle congruent with personal problems."

Finally, in this same letter, Dr. Sealy documented petitioner's medical condition; he noted that petitioner had "significant medical problems, including a recent myocardial infarction, herniated nucleus pulposus, L5, hypercholesterolemia, elevated blood pressure and abnormally high blood sugars."

15. While in Dubai between 1999 and 2009, when petitioner returned to the United States, Dr. Sealy provided treatment for petitioner periodically, no more than nine times or so.

In this hearing, petitioner submitted a declaration from Dr. Sealy, dated July 19, 2010. In this declaration, Dr. Sealy noted that his recommendation was based on outpatient sessions on August 24, 2009, and July 9, 2010. Further, Dr. Sealy stated:

Dr. Ghabra represented sincerely and humbly. He now appears as a mature man who is in touch with emotions, very cognizant of the import of professional boundaries, has deep empathy for those he treats, and has strong family support . . . He spoke clearly and softly being fully cooperative about all questions asked. His social/personal life has been stable and healthy ....

Based on his history and evidence Dr. Ghabra has presented regarding his medical practice since 1998, it is my opinion that his Petition for Penalty Relief and Reinstatement of Medical License warrants consideration by the Medical Board of California [Emphasis Added]."

16. Dr. Sealy did not testify as a witness in this proceeding. However, on July 10, 2015, the medical board's investigator interviewed Dr. Sealy and documented their discussion. In his interview, Dr. Sealy expressed support for the petition; Dr. Sealy was aware that the basis for the board's discipline was lack of sexual boundaries with patients; when asked if petitioner admitted any wrong doing, Dr. Sealy reported: "Yes, he was fully

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accountable, that's one ofhis strengths; if he wasn't accountable, I'd have trouble even supporting him now." According to Dr. Sealy, petitioner accepts responsibility and does not blame others; regarding rehabilitation, petitioner is good at getting help. He believes petitioner would get more help if he had the financial resources. However, he encourages petitioner to attend 12-step sexual addiction meetings more regularly and, if the board reinstates petitioner's license, he recommended that there be a condition that he attend such meetings and have a sponsor.

17. Dr. Farrukh provided declarations in support of both petitions and testified as a witness in this hearing.

He has known petitioner since 1983. They practiced in the same hospitals and met in medical staff meetings. Petitioner delivered two of Dr. Farrukh's three children in 1986 and 1988, respectfully. After that, they became friends, socialized and maintained contact, albeit less frequently. Dr. Farrukh was aware of petitioner's personal and professional history.

In Dr. Farrukh's opinion, petitioner is a good, knowledgeable physician who provided good patient care. Dr. Farrukh was aware of the charges in the criminal cases and before the board; he had difficulty believing that the misconduct occurred until petitioner admitted it. When he did so, petitioner candidly admitted that he had a sexual addiction and obtained treatment. Petitioner acknowledged his wrongdoing and accepted responsibility for his actions.

18. Dr. Farrukh and Dr. Ayad, petitioner's employer in Dubai, were high school classmates. Prior to petitioner's employment in Dubai, petitioner disclosed his misconduct to his employer. Dr. Farrukh spoke with Dr. Ayad, including submitting a letter regarding respondent's qualifications as a physician. Dr. Ayad was concerned about petitioner engaging in similar misconduct in Dubai. Presumably, Dr. Farrukh convinced his former high school classmate that petitioner would practice medicine safely. Dr. Ayad reported to Dr. Farrukh that petitioner was respected as a physician in Dubai.

19. Dr. Konialian provided a declaration in support of the petition, dated May 15, 2014. He has known petitioner since 1979; they attended medical school together. They reunited in 1985 in Southern California. He attested to petitioner's skills both in clinical diagnosis and in surgery. Dr. Konialian stayed in touch with petitioner, even after his convictions. Dr. Konialian was aware that petitioner underwent psychiatric therapy including inpatient therapy, 12 step meetings, and individual therapy with his psychiatrist and therapist. In his letter, Dr. Konialian stated:

I believe that these treatments made Ziyad a completely different person. He has matured and has become wiser. The arrogant and manipulative streaks in his character have been eliminated and he has become more transparent. On numerous occasions, after his disciplinary process, I asked him about his future plans in medicine since I believed that his talent should

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not be wasted. Being multilingual and having the utmost skills, I had little concern that Ziyad would have any difficulty getting a medical position somewhere else in the world. Without fail, Ziyad always answered that he wanted to remain near his three surviving children and want to stay as close as possible to them in order to provide them with love and support. This dedication and willingness to put others first demonstrates the transformation that I have seen in Ziyad over the last several decades. His medical skills were never in doubt; however, he is now helpful, considerate, honest and open.

I have seen this transformation in Dr. Ghabra and I believe he has become a better person from the tragedy he lived through. I believe that he deserved what was dealt him by the justice system; I also believe that that punishment was enough to help adequately rehabilitate from his previous actions. I believe that he has the skills and knowledge to help people and that our state would greatly benefit from the experience and talent that he will bring to the community.

20. Attached to the petition is a letter from Dr. Photias, dated April 7, 1998. There is no evidence that he has had contact or knowledge about petitioner since that time. Considering the age of the letter, its reliability is questionable. Therefore, the letter has been disregarded.

21. Petitioner's wife testified in this proceeding. They have been married 15 years, have a monogamous, supportive relationship and communicate. She explained that petitioner told her about the discipline of his medical license and the bases for discipline. Further, when he moved to Dubai and Syria, she moved with him. She explained that he had a good reputation as a physician in Dubai.

22. Attached to the petition was a letter from Reem Shehab, dated August 11, 2016. According to her letter, Ms. Shehab was one of petitioner's patients in Dubai; he had a good reputation as a gynecologist; and, if his license to practice is reinstated in Dubai, she and other women will return to him for care and treatment.

23. Petitioner candidly admitted his wrongdoing, took responsibility for his actions and acknowledged that he had flaws. He admitted that when first referred for treatment by the Court in his criminal case, the treatment was ineffective because he was dishonest and did not believe that he had a problem. In 1993, while in jail, petitioner began to realize how reprehensible his conduct had been towards women and how badly he had abused his position of trust as their physician. At that time, he began taking honest steps towards rehabilitation. With the inpatient and outpatient treatment and 12-step meetings, he addressed numerous issues, including triggers and emotional behaviors that led to the

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improper conduct; learned about boundaries, to look at his prior actions, his mistakes and himself; he learned to be open with his feelings.

In order to maintain his medical skills, petitioner searched for an opportunity to return to patient care. He found such an opportunity in Dubai and later in Damascus. When he practiced, petitioner implemented strategies to guarantee that there would be no further incidents. He always had a female nurse present when he was with patients and maintained a professional attitude at all times. After 15 years of practice, there is no evidence that patient complaints had been filed against petitioner or that he engaged in misconduct that would have resulted in discipline of his license in California.

24. Criminal probation was terminated on February 6, 1997, and on August 5, 2009; his felony convictions were reduced to misdemeanors, set aside and dismissed.

25. Petitioner provided evidence of continuing medical education that he completed between 2005 and 2016. The most recent CME was taken in the United States. There is evidence that he completed 87 hours of CME between April and July 2016. Petitioner testified that he had other evidence of completion of CME that he was not able to locate because it was packed away.

LEGAL CONCLUSIONS

Burden and Standard of Proof

1. In a proceeding for the restoration of a revoked license, the burden rests on a petitioner to prove that he has rehabilitated himself and that he is entitled to have his license restored. (Flanzer v. Board of Dental Examiners (1990) 220 Cal.App.3d 1392, 1398.)

2. A person seeking reinstatement must present strong proof of rehabilitation, and the showing of rehabilitation must be sufficient to overcome the board's former adverse determination. The standard of proof is clear and convincing evidence. Housman v. Board of Medical Examiners (1948) 84 Cal.App.2d, 308, 315-316.

Statutory and Regulatory Authority

3 Business and Professions Code section 2307 provides in part:

(a) A person whose certificate ... has been revoked ... may petition the board for reinstatement or modification of penalty ..

(b) The person may file the petition after a period of not less than the following minimum periods have elapsed from the effective date of the surrender of the certificate or the decision ordering that disciplinary action:

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(1) At least three years for reinstatement of a license surrendered or revoked for unprofessional conduct, except that the board may, for good cause shown, specify in a revocation order that a petition for reinstatement may be filed after two years.

[~] ... [~]

(c) The petition shall state any facts as may be required by the board. The petition shall be accompanied by at least two verified recommendations from physicians and surgeons licensed in any state who have personal knowledge of the activities of the petitioner since the disciplinary penalty was imposed.

(d) ... The board may assign the petition to an administrative law judge designated in Section 11371 of the Government Code. After a hearing on the petition, the administrative law judge shall provide a proposed decision to the board ... which shall be acted upon in accordance with Section 2335.

(e) The ... administrative law judge hearing the petition may consider all activities of the petitioner since the disciplinary action was taken, the offense for which the petitioner was disciplined, the petitioner's activities during the time the certificate was in good standing, and the petitioner's rehabilitative efforts, general reputation for truth, and professional ability .... The hearing may be continued from time to time as the administrative law judge designated in Section 11371 of the Government Code finds necessary.

(f) The administrative law judge designated in Section 11371 of the Government Code reinstating a certificate or modifying a penalty may recommend the imposition of any terms and conditions deemed necessary ...

4. California Code of Regulations, title 16, section 1359 provides:

(a) A petition for modification or termination of probation or a petition for reinstatement of a revoked certificate shall be filed on a form provided by the division.

(b) Consideration shall be given to a petition for reinstatement of license or modification or termination of probation only when a formal request for such has been filed in the division's office

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in Sacramento at least thirty (30) days before a regular meeting of the division or appropriate medical quality review panel.

5. California Code of Regulations, title 16, section 1359 states, in part:

Rehabilitation

When considering a petition for reinstatement ... pursuant to the provisions of Section 11522 of the Government Code, the division ... shall evaluate evidence of rehabilitation submitted by the petitioner considering the following criteria:

(a) The nature and severity of the act(s) or crime(s) under consideration as grounds for denial.

(b) Evidence of any act(s) or crime(s) committed subsequent to the act(s) or crime(s) under consideration as grounds for denial which also could be considered as grounds for denial under Section 480.

(c) The time that has elapsed since commission of the act(s) or crime( s) referred to in subsections (a) or (b).

[~] " . [~]

(e) Evidence, if any, of rehabilitation submitted by the applicant.

6. Rehabilitation is a state of mind, and the law looks with favor upon rewarding with the opportunity to serve, one who has achieved reformation and regeneration. (Pacheco v. State Bar (1987) 43 Cal.3d 1041, 1058.) The amount of evidence of rehabilitation required varies according to the seriousness of the misconduct. The mere expression of remorse does not demonstrate rehabilitation. A truer indication of rehabilitation will be presented if a petitioner can demonstrate by sustained conduct over an extended period of time that he is rehabilitated and fit to practice. (In re Menna (1995) 11 Ca1.4th 975, 987, 991.) The evidentiary significance of a petitioner's misconduct is greatly diminished by the passage of time and by the absence of similar, more recent misconduct. (Kwasnik v. State Bar (1990) 50 Ca1.3d 1061, 1070.)

Evaluation

7. The board licensed petitioner to practice medicine in 1983, more than 33 years ago. Between 1986 and 1992, he engaged in egregious sexual misconduct with multiple females, including patients, employee and a potential employee. As a consequence, he sustained convictions in 1986 and again in 1992. The board denied his first petition for reinstatement in 1999 because petitioner failed to provide support from a competent expert in

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the field of sexual misconduct who could provide credible answers about whether claimant posed a danger to patients should he be allowed to practice.

In this case, petitioner provided evidence of rehabilitation. The record contains administrative hearsay but it supports the direct evidence in this case. There is not only petitioner's statement and testimony but also direct evidence that support his testimony.

Since revocation of his license, petitioner has had significant psychotherapy. He has gained significant insight into himself, appreciates the wrongfulness of his conduct and has taken steps to prevent the problem in the future. Since denial of his first petition for reinstatement, he has practiced for 15 years in Dubai and Damascus without reported incident. He has been married 15 years, is in a monogamous marriage, and has strong family support.

Most significantly, Dr. Sealy, his therapist who provided treatment for sexual addiction, supports reinstatement of his license. The factual bases for Dr. Sealy's opinion is consistent with the facts in this case. However, Dr. Sealy's letter is dated 2010 and appears to be equivocal. Dr. Sealy did not testify as a witness; so, there was no opportunity to cross­examine him. However, the board's investigator contacted Dr. Sealy in 2015, and Dr. Sealy expressed his support for reinstatement of petitioner's license on condition that he is monitored and ordered to attend 12-step programs that deal with sex addiction. Considering the evidence in totality, there is sufficient evidence to establish that petitioner is sufficiently rehabilitated that the public can be adequately protected with appropriate probationary terms and conditions.

Cause Exists to Grant the Petition

8. Petitioner established that he is sufficiently rehabilitated such that he is safe to practice medicine with proper terms and conditions precedent and a period of probation with appropriate terms and conditions.

ORDER

I. The Petition to Reinstate Physician and Surgeon's Certificate No. C 40841 of Ziyad A. Ghabra, M.D. is granted.

II. Physician and Surgeon's Certificate No. C 40841 issued to Ziyad A. Ghabra, M.D. is reinstated, revoked and placed on probation for seven years on the following terms and conditions.

A. Clinical Training Program (Condition Precedent)

Within 60 calendar days of the effective date of this Decision, petitioner shall enroll in a clinical training or educational program equivalent to the Physician Assessment and

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Clinical Education Program (PACE) offered at the University of California- San Diego School of Medicine Program (Program). Petitioner shall successfully complete the Program not later than six months after his initial enrollment unless the board or its designee agrees in writing to an extension of that time.

The Program shall consist of a comprehensive assessment program comprised of a two-day assessment of petitioner's physical and mental health; basic clinical and communication skills common to all clinicians; and medical knowledge, skill and judgment pertaining to internal medicine and anesthesiology, and at minimum, a 40-hour program of clinical education in the area of practice in petitioner's residency and intended area of practice and which takes into account data obtained from the assessment, Decision(s), Accusation(s), and any other information that the board or its designee deems relevant. Petitioner shall pay all expenses associated with the Clinical Training Program.

Based on petitioner's performance and test results in the assessment and clinical education, the Program will advise the board or its designee of its recommendation(s) for the scope and length of any additional educational or clinical training, treatment for any medical condition, treatment for any psychological condition, or anything else affecting petitioner's practice of medicine. Petitioner shall comply with Program recommendations.

At the completion of any additional educational or clinical training, petitioner shall submit to and pass an examination. Determination as to whether petitioner successfully completed the examination or successfully completed the Program is solely within the Program's jurisdiction.

Petitioner shall not practice medicine until he has successfully completed the Program and has been so notified by the board or its designee in writing, except that petitioner may practice in a clinical training program approved by the board or its designee. Petitioner's practice of medicine shall be restricted only to that which is required by the approved training program.

B. Psychiatric Evaluation (Condition Precedent)

Within 30 calendar days of the effective date of this Decision, and on whatever periodic basis thereafter may be required by the board or its designee, petitioner shall undergo and complete a psychiatric evaluation (and psychological testing, if deemed necessary) by a board-appointed board certified psychiatrist, who shall consider any information provided by the board or designee and any other information the psychiatrist deems relevant, and shall furnish a written evaluation report to the board or its designee. Psychiatric evaluations conducted prior to the effective date of the Decision shall not be accepted towards the fulfillment of this requirement. Petitioner shall pay the cost of all psychiatric evaluations and psychological testing.

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Petitioner shall comply with all restrictions or conditions recommended by the evaluating psychiatrist within 15 calendar days after being notified by the board or its designee.

Unless he appeals this Decision, on the effective date, petitioner shall attend 12-step sex addiction group and have a sponsor. No later than 15 calendar days after being notified by the board or its designee, petitioner shall attend 12-step sex addiction group for the period , of time recommended by the evaluating psychiatrist, and for the number of times per week recommended by the evaluating psychiatrist. Petitioner shall provide documentary evidence of the foregoing as required by the board or its designee.

Petitioner shall not practice medicine until this psychiatrist determines that it is safe for him to do so.

C. Psychotherapy

Within 60 calendar days of the effective date of this Decision, petitioner shall submit to the board or its designee for prior approval the name and qualifications of a California­licensed board certified psychiatrist or licensed psychologist who has a doctoral degree in psychology and at least five years of postgraduate experience in the diagnosis and treatment of emotional and mental disorders.

Petitioner shall comply with all restrictions or conditions recommended by the evaluating psychiatrist or psychologist within 15 calendar days after being notified by the board or its designee. No later than 15 calendar days after being notified by the board or its designee, petitioner shall commence psychotherapy for the period of time and the number of times per week recommended by the evaluating psychiatrist or psychologist, until the board or its designee deems no further psychotherapy is necessary.

The psychotherapist shall consider any information provided by the board or its designee and any other information the psychotherapist deems relevant and shall furnish a written evaluation report to the board or its designee. Petitioner shall cooperate in providing the psychotherapist any information and documents that the psychotherapist may deem pertinent.

Petitioner shall have the treating psychotherapist submit quarterly status reports to the board or its designee. The board or its designee may require petitioner to undergo psychiatric evaluations by a board-appointed board certified psychiatrist. Prior to the completion of probation, if petitioner is found to be mentally unfit to resume the practice of medicine without restrictions, the board shall retain continuing jurisdiction over petitioner's certificate, and the period of probation shall be extended until the board determines that petitioner is mentally fit to resume the practice of medicine without restrictions.

Petitioner shall pay the cost of psychotherapy and psychiatric evaluations.

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D. Professional Boundaries Program

Within 60 calendar days from the effective date of this Decision, Petitioner shall enroll in a Professional Boundaries Program equivalent to the Professional Boundaries Program offered by the PACE. At the Professional Boundaries Program's discretion, petitioner shall undergo and complete the Professional Boundaries Program's assessment of petitioner's competency, mental health and/or neuropsychological performance, and at minimum, a 24-hour program of interactive education and training in the area of boundaries, which takes into account data obtained from the assessment and from the Decision(s), the Accusation(s) and any other information that the board or its designee deems relevant. The Professional Boundaries Program shall evaluate petitioner at the end of the training, and the Professional Boundaries Program shall provide any data from the assessment and training as well as the results of the evaluation to the board or its designee.

Failure to complete the entire Professional Boundaries Program not later than six ( 6) months after petitioner's initial enrollment shall constitute a violation of probation unless the board or its designee agrees in writing to a later time for completion. Based on petitioner's performance in and evaluations from the assessment, education, and training, the Professional Boundaries Program shall advise the board or its designee of its recommendation(s) for additional education, training, psychotherapy and other measures necessary to ensure that petitioner can practice medicine safely. Petitioner shall comply with Professional Boundaries Program recommendations. Upon completion of the Professional Boundaries Program, petitioner shall submit to a final evaluation. The Professional Boundaries Program shall provide the results of the evaluation to the board or its designee. The Professional Boundaries Program shall be at petitioner's expense and shall be in addition to the continuing medical education (CME) requirements for renewal of licensure.

The Professional Boundaries Program has the authority to determine whether or not petitioner successfully completed the Program.

A professional boundaries course taken after the acts that gave rise to the charges in the Amended Accusation, but prior to the effective date of this Decision may, in the sole discretion of the board or its designee, be accepted towards the fulfillment of this condition.

E. Professionalism Program (Ethics Course)

Within 60 calendar days of the effective date of this Decision, petitioner shall enroll in a Professionalism Program, which meets the requirements of Title 16, California Code of Regulations, section 1358. Petitioner shall participate in and successfully complete the Professionalism Program. Petitioner shall provide any information and documents that the Professionalism Program may deem pertinent. Petitioner shall successfully complete the classroom component of the Professionalism Program not later than six months after petitioner's initial enrollment, and the longitudinal component of the Professionalism Program not later than the time specified by the Professionalism Program, but no later than one year after attending the classroom component. The Professionalism Program shall be at

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petitioner's expense and shall be in addition to the CME requirements for renewal of his certificate.

A Professionalism Program taken after the acts that gave rise to the charges in the Amended Accusation, but prior to the effective date of the Decision may, in the sole discretion of the board or its designee, be accepted towards the fulfillment of this condition.

Petitioner shall submit a certification of successful completion to the board or its designee not later than 15 calendar days after successfully completing the Professionalism Program or not later than 15 calendar days after the effective date of the Decision, whichever is later.

F. Third-Party Chaperone

During probation, petitioner shall have a third-party chaperone present while consulting, examining or treating female patients. Within 30 calendar days of the effective date of the Decision, petitioner shall submit to the board or its designee, for prior approval, the name(s) of persons who will act as the-third party chaperone.

If petitioner fails to obtain approval of a third party chaperone within 60 calendar days of the effective date of this Decision, petitioner shall receive a notification from the medical board or its designee to cease the practice of medicine within three calendar days after being so notified. Petitioner shall cease the practice of medicine until a chaperone is approved to provide monitoring responsibility. Each third-party chaperone shall sign (in ink or electronically) and date each patient medical record at the time the chaperone's services are provided. Each third-party chaperone shall read the Decision(s), the Amended Accusation(s), and fully understand the role of the third-party chaperone.

Petitioner shall maintain a log of all patients seen for whom a third-party chaperone is required. The log shall contain the: (1) patient initials, address and telephone number; (2) medical record number; and (3) date of service. Petitioner shall keep this log in a separate file or ledger, in chronological order, shall make the log available for immediate inspection and copying on the premises at all times during business hours by the board or its designee, and shall retain the log for the entire term of probation.

Petitioner is prohibited from terminating employment of a board-approved third party chaperone solely because that person provided information as required to the board or its designee.

If the third party chaperone resigns or is no longer available, within five calendar days of such resignation or unavailability, petitioner shall submit to the board or its designee, for prior approval, the name of the person(s) who will act as the third party chaperone. If petitioner fails to obtain approval of a replacement chaperone within 60 calendar days of the resignation or unavailability of the chaperone, petitioner shall receive a notification, from the board or its designee, to cease the practice of medicine within three calendar days after being

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so notified. Petitioner shall cease the practice of medicine until a replacement chaperone is approved and assumes monitoring responsibility.

G. Notification

Within seven days of the effective date of this Decision, petitioner shall provide a true copy of the Decision on the First Amended Accusation, as well as this Decision to the Chief of Staff or the Chief Executive Officer at every hospital where privileges or membership are extended to petitioner, at any other facility where petitioner engages in the practice of medicine, including all physician and locum tenens registries or other similar agencies, and to the Chief Executive Officer at every insurance carrier which extends malpractice insurance coverage to petitioner. Petitioner shall submit proof of compliance to the board or its designee within 15 calendar days.

This condition shall apply to any change(s) in hospitals, other facilities or insurance earner.

H. Supervision of Physician Assistants

During probation, petitioner is prohibited from supervising physician assistants.

I. Obey All Laws

Petitioner shall obey all federal, state and local laws, all rules governing the practice of medicine in California and remain in full compliance with any court ordered criminal probation, payments, and other orders.

J. Quarterly Declarations

Petitioner shall submit quarterly declarations under penalty of perjury on forms provided by the board, stating whether there has been compliance with all the conditions of probation.

Petitioner shall submit quarterly declarations not later than 10 calendar days after the end of the preceding quarter.

K. General Probation Requirements

Compliance with Probation Unit Petitioner shall comply with the board's probation unit and all terms and conditions of

this Decision.

Address Changes At all times, petitioner shall keep the board informed of petitioner's business and

residence addresses, email address (if available), and telephone number. Changes of such

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addresses shall be immediately communicated in writing to the board or its designee. Under no circumstances shall a post office box serve as an address of record, except as allowed by Business and Professions Code section 2021(b).

Place of Practice Petitioner shall not engage in the practice of medicine in his or patient's place of

residence, unless the patient resides in a skilled nursing facility or other similar licensed facility.

License Renewal Petitioner shall maintain a current and renewed California certificate.

Travel or Residence Outside California Petitioner shall immediately inform the board or its designee, in writing, of travel to

any areas outside the jurisdiction of California, which lasts, or is contemplated to last, more than 30 calendar days.

In the event petitioner should leave the State of California to reside or to practice, petitioner shall notify the board or its designee in writing 30 calendar days prior to the dates of departure and return.

L. Interview with the Board or its Designee

Upon request for interviews, with or without prior notice, petitioner shall be available in person either at petitioner's place of business or at the probation unit office, throughout the term of probation.

M. Non-practice While on Probation

Petitioner shall notify the board or its designee in writing within 15 calendar days of any periods of non-practice lasting more than 30 calendar days and within 15 calendar days of petitioner's return to practice. Non-practice is defined as any period of time petitioner is not practicing medicine in California as defined in Business and Professions Code sections 2051 and 2052 for at least 40 hours in a calendar month in direct patient care, clinical activity or teaching, or other activity as approved by the board. All time spent in an intensive training program, which has been approved by the board or its designee, shall not be considered non-practice. Practicing medicine in another state of the United States or federal jurisdiction while on probation with the medical licensing authority of that state or jurisdiction shall not be considered non-practice. A hoard-ordered suspension of practice shall not be considered as a period of non-practice.

In the event petitioner's period of non-practice while on probation exceeds 18 calendar months, petitioner shall successfully complete a clinical training program that meets the criteria of Condition 18 of the current version of the board's "Manual of Model

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Disciplinary Orders and Disciplinary Guidelines" (Condition A herein) prior to resuming the practice of medicine.

Petitioner's period of non-practice while on probation shall not exceed two years.

Periods of non-practice will not apply to the reduction of the probationary term.

Periods of non-practice will relieve petitioner of the responsibility to comply with the probationary terms and conditions with the exception of this condition and the following terms and conditions of probation: Obey All Laws; and General Probation Requirements.

N. Completion of Probation

Petitioner shall comply with all financial obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the completion of probation. Upon successful completion of probation, petitioner's certificate shall be fully restored.

0. Violation of Probation

Failure to fully comply with any term or condition of probation is a violation of probation. If petitioner violates probation in any respect, after giving notice and the opportunity to be heard, the board may revoke probation and carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke Probation, or an Interim Suspension Order is filed against petitioner during probation, the board shall have continuing jurisdiction until the matter is final, and the period of probation shall be extended until the matter is final.

P. License Surrender

Following the effective date of this Decision, if petitioner ceases practice due to retirement or health reasons or is otherwise unable to satisfy the terms and conditions of probation, petitioner may request to surrender his license. The board reserves the right to evaluate petitioner's request and to exercise its discretion in determining whether or not to grant the request, or to take any other action deemed appropriate and reasonable under the circumstances. Upon formal acceptance of the surrender, within 15 calendar days, petitioner shall deliver petitioner's wallet and wall certificate to the board or its designee, and petitioner shall no longer practice medicine. Petitioner will no longer be subject to the terms and conditions of probation. If petitioner re-applies for a medical license, the application shall be treated as a petition for reinstatement of a revoked certificate.

Q. Probation Monitoring Costs

Petitioner shall pay the costs associated with probation monitoring each and every year of probation, as designated by the board, which may be adjusted on an annual basis. Such costs shall be payable to the board and delivered to the board or its designee no later than January 31 of each calendar year.

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R. Completion of Probation

Petitioner shall comply with all financial obligations (e.g., restitution, probation costs) not later than 120 calendar days prior to the completion of probation.

Upon successful completion of probation, petitioner's certificate shall be fully restored.

DATED: September 27, 2016

~DocuSigned by:

~J.J~ 241611FC5D26411

VALLERA J. JOHNSON Administrative Law Judge Office of Administrative Hearings

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