DRAFT MINUTES BOARD OF OSTEOPATHIC MEDICINE May 17, Renaissance at Seaworld 6677 Sea Harbor Drive Orlando, FL

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DRAFT MINUTES

BOARD OF OSTEOPATHIC MEDICINE May 17, 2013

Renaissance at Seaworld 6677 Sea Harbor Drive

Orlando, FL 32821 407-351-5555

FRIDAY, May 17, 2013

The meeting was called to order by Dr. Burns, Chair, at 9:00 am. Those present for all or part of the meeting included the following:

MEMBERS PRESENT: Ronald Burns, DO, Chair Joel Rose, DO, Vice Chair Bridget Bellingar, DO Anna Hayden, DO James S. St. Louis, DO

Valerie Jackson, Consumer Member Rina Malan, Consumer Member MEMBERS ABSENT:

COURT REPORTER: American Court Reporting 407-896-1813

STAFF PRESENT:

Anthony Jusevitch, Executive Director

Christy Robinson, Program Operations Administrator Donna McNulty, Esq. – Board Counsel

Michael Lawrence, Esq. – DOH Prosecutor John Truitt, Esq. – DOH Prosecutor

Sondra Nelson, Compliance Officer OTHERS PRESENT:

Judy Rivenbark, MD, PRN Jason Winn, Esq., FOMA

Please note that the meeting minutes reflect the actual order that agenda items were discussed during the meeting and may differ from the agenda outline.

PLEDGE OF ALLEGIANCE AND PLEDGE OF OSTEOPATHIC COMMITMENT

RULES DISCUSSION / PRESENTATION

Tab 1 - 64B15-15.004 - Written Records; Minimum Content; Retention

(Mark Whitten, Board of Pharmacy Executive Director and Michele Weizer, PharmD, Board of Pharmacy member will be present)

Mr. Whitten and Dr. Weizer were present. Dr. Weizer provided the Board with suggested amendments to the Board’s proposed draft changes to the rule. She indicated that the name and concentration of the medication would be useful as often lot numbers and expiration dates are reused. She also recommended adding the date of administration.

Action Taken: Dr. Rose moved to modify the language as recommended:

• Create a new (a) to include the name and concentration of the medication administered • Renumber the remaining items

• Create a new (g) to include the date medication administered Dr. Hayden seconded the motion, which passed unanimously.

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Action on SERC Questions: Dr. Burns moved the proposed changes would not directly or indirectly increase regulatory costs to any entity in excess of $200,000 in the aggregate within one year after implementation, no SERC was needed and legislative ratification was not required. Dr. Hayden seconded the motion, which passed unanimously.

PROBATION AND COMPLIANCE REVIEW

Tab 2 - Lance Ashworth, DO - Request for Payment Extension This item was pulled from the agenda.

Tab 3 - Jerold Ecklind, DO - Appearance for Approval of Monitor Dr. Ecklind was present with his monitor and Dr. Rivenbark from PRN.

Action Taken: After discussion, Ms. Malan moved to approve the appearance and monitor. Dr. St. Louis seconded the motion, which passed unanimously.

Tab 4 - Thomas Hawkey, Do - Request for Reinstatement Dr. Hawkey was present with Dr. Rivenbark from PRN.

Action Taken: After discussion, Dr. Hayden moved to reinstate the license. Ms. Malan seconded the motion, which passed unanimously.

Tab 5 - Mark Pamer, DO - Request for Termination of Probation

Dr. Pamer was present and represented by William Furlow, Esq. Dr. Rivenbark from PRN was also present.

Action Taken: After discussion, Dr. Rose moved to terminate the probation on the license. Dr. Hayden seconded the motion, which passed unanimously.

Additional Action Taken: Dr. Rose moved to deny the request for the removal of practice restriction. Ms. Malan seconded the motion, which passed unanimously.

Tab 6 - Robert Reppy, DO - Request for Payment Extension

Dr. Reppy was present without counsel. Dr. Reppy indicated she was able to regular payments again and no longer needed the seconded extension request.

Action Taken: Dr. Burns moved continue the original payment plan as previously approved by the Board. Dr. Hayden seconded the motion, which passed unanimously.

Tab 8 - Debra Roggow, DO - Appearance for Approval of Monitor

Dr. Roggow was present with her monitor and represented by William Furlow, Esq.

Action Taken: After discussion, Dr. Rose moved to approve the appearance and monitor. Dr. St. Louis seconded the motion, which passed unanimously.

DISCIPLINARY CASES

Tab 9 - Richard R. Wilson, DO – Settlement Agreement - DOH Case #2008-24500 & 2009-22234 Allegations of Complaint: 459.015(1)(x)- malpractice (2 counts); 459.015(1)(t)- inappropriate prescribing (2 counts); 459.015(1)(pp)- violating a law or rule of the board (2 counts); 459.015(1)(o)- medical

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Dr. Wilson was present and represented by William Furlow, Esq. Dr. Rose and Dr. St. Louis were recused due to participation on the probable cause panel. Mr. Lawrence represented the Department and presented the case to the Board.

Action Taken: Dr. Burns moved to accept the settlement agreement as presented: • Reprimand

• $15,000.00 fine to be paid within 2 years of the Final Order • Costs of $12,170.00 to be paid within 2 years of the Final Order

• Completion of the Prescribing Controlled Drugs: Critical Issues and Common Pitfalls of Prescribing course sponsored by the University of Florida in 12 months

• Completion of the Quality Medical Record Keeping for Health Care Professionals course sponsored by the FMA within 12 months

• Completion of 5 hours of Risk Management continuing education within 12 months of the Final Order

• Quality assurance consultation/risk management assessment- initial review to be completed within 60 days and compliance with all recommendations within 6 months of the Final Order • Permanent Practice Restriction: may not own, operate, or work in a Pain Management Clinic • Prohibited from prescribing any controlled substances until compliance with the risk

management review

Dr. Hayden seconded the motion, which passed unanimously.

The settlement agreement was orally amended with respect to the sponsor of the medical records course. Both parties accepted the oral amendments for the record.

Tab 10 - Jacqueline Flud, DO – Settlement Agreement - DOH Case #2011-07247

Allegations of Complaint: 459.0137(2)(a)1- practicing in an unregistered pain management clinic Dr. Flud was not present or represented by counsel. Dr. Hayden was recused due to participation on the probable cause panel. Mr. Lawrence represented the Department and presented the case to the Board.

Action Taken: Dr. Burns moved to accept the settlement agreement as presented: • Letter of Concern

• $5000.00 Fine to be paid within 1 year of the Final Order • Costs of $1660.09 to be paid within 1 year of the Final Order

• Completion of the Legal and Ethical Implications in Medicine: A Physician’s Survival Guide- Laws and Rules course within 1 year of the Final Order

• Completion of the Prescribing Controlled Drugs: Critical Issues and Common Pitfalls of Prescribing course sponsored by the University of Florida in 12 months

Dr. Bellingar seconded the motion, which passed unanimously.

Additional Action Taken: Dr. Burns moved to find that the FMA laws and rules course was deemed equivalent as the course mentioned in the settlement agreement. Ms. Malan seconded the motion, which passed unanimously.

Tab 11 - Rahat Faderani, DO – Settlement Agreement - DOH Case #2010-22214

Allegations of Complaint: 459.015(1)(x)- malpractice; 459.015(1)(t)- inappropriate prescribing; 459.015(1)(o)- medical records violation; 459.015(1)(pp)- violating a aw or rule of the board

Dr. Faderani was present and represented by Sanford Topkin, Esq. Dr. Hayden was recused due to participation on the probable cause panel. Mr. Lawrence represented the Department and presented the case to the Board.

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Action Taken: Ms. Malan moved to accept the settlement agreement as presented: • Reprimand

• $10,000.00 fine to be paid within 30 days of the Final Order • Costs of $12,777.55 to be paid within 30 days of the Final Order

• Permanent Practice Restriction: may not own, operate, or work in a Pain Management Clinic • Permanent Practice Restriction: may not prescribe or dispense any controlled substance Dr. St. Louis seconded the motion, which passed unanimously.

Tab 12 - Amy L. Seinfeld, DO – Settlement Agreement - DOH Case #2009-08561 & 2011-11789 Allegations of Complaint: 459.015(1)(x)- malpractice (2 counts); 459.015(1)(t)- inappropriate prescribing (2 counts); 459.015(1)(pp)- violating a law or rule of the board; 459.015(1)(o)- medical records violation (2 counts)

Dr. Seinfeld was present and represented by Vanessa Reynolds, Esq. Ms. Malan was recused due to participation on the probable cause panel. Mr. Lawrence represented the Department and presented the case to the Board. Mr. Lawrence noted that the last paragraph on page 10 of the settlement agreement should reference schedule V, not schedule II.

Action Taken: After discussion, Dr. Rose moved to reject the settlement agreement as presented. Dr. Burns seconded the motion, which passed unanimously. Dr. Rose then moved to offer the following counter settlement agreement:

• Reprimand

• $10,000.00 fine to be paid within 2 years of the Final Order • Costs of $$20,000.00 to be paid within 2 years of the Final Order

• Completion of the Prescribing Controlled Drugs: Critical Issues and Common Pitfalls of Prescribing course sponsored by the University of Florida in 12 months

• Completion of the Quality Medical Record Keeping for Health Care Professionals course sponsored by the FMA within 12 months

• Completion of 5 hours of risk management continuing education within 1 year of the Final Order

• Practice Restriction- cannot prescribe schedules II-IV controlled substances for a period of 2 years of the Final Order

• Practice Restriction- indefinite restriction from prescribing schedule II controlled substances until such time as she completes a fellowship in pain management or obtains pain

management board certification by the ACGME or AOA

• Practice Restriction- cannot prescribe schedule III or IV controlled substances for at least one year and until completion of the drug course

• Practice Restriction- cannot own, operate or work in a pain management clinic (and the medical school exemption will not apply to the Respondent) until or unless the restriction on schedule II is lifted

• Probation for 2 years to include: indirect supervision, reports, 10% chart review during controlled substance restrictions and 25% chart review (of cases wherein controlled substances were prescribed) once/if the restriction is lifted and other standard probation provisions

Dr. Bellingar seconded the motion, which passed unanimously.

The Department accepted the counter offer and the Respondent asked for 14 days to accept or reject. Break 11:05 – 11:30

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Tab 7 - Dominic Riganotti, DO - Request for Termination of Probation

Dr. Riganotti was present without counsel. Dr. Rivenbark from PRN was also [resent.

Action Taken: After discussion, Dr. Burns moved to approve the appearance and terminate the probation. Ms. Malan seconded the motion, which passed unanimously.

DISCIPLINARY CASES - continued

Tab 13 - Sameh Wanis, DO – Settlement Agreement - DOH Case #2011-17179 This item was pulled from the agenda.

Tab 14 - Ronald Mallonee, DO – Settlement Agreement - DOH Case #2012-04932 Allegations of Complaint: 459.015(1)(w)- unable to practice due to impairment/illness

Dr. Mallonee was present and represented by Briuan Newman, Esq. Ms. Malan was recused due to participation on the probable cause panel. Mr. Truitt represented the Department and presented the case to the Board.

Action Taken: After discussion, Dr. Burns moved to accept the settlement agreement as presented: • Letter of Concern

• Costs of $5116.93 to be paid within one year of the Final Order

• Suspension until respondent can demonstrate the ability to practice with skill and safety which shall include a PRN evaluation; the Board reserves jurisdiction to impose additional terms and conditions including probation

Dr. Hayden seconded the motion, which passed unanimously.

During discussion, it was noted that Dr. Mallonee had already obtained a PRN evaluation which was in the record.

Additional Action Taken: After additional discussion, Dr. Rose moved to reinstate the license. Dr. Hayden seconded the motion, which passed unanimously.

Tab 15 - Sherry Morris, DO – Informal Hearing - DOH Case #2011-06866 Allegations of Complaint: 459.015(1)(b)- licensed disciplined in another state

Dr. Morris was present without counsel. Dr. St. Louis was recused due to participation on the probable cause panel. Mr. Lawrence represented the Department and presented the case to the Board.

Dr. Burns moved to accept the agenda materials and investigative report as presented into the record as evidence. Dr. Rose seconded the motion, which passed unanimously. Dr. Burns moved to find that the respondent was properly served and requested an informal hearing. Dr. Hayden seconded the motion, which passed unanimously. Dr. Burns then moved to adopt the findings of fact as presented in the administrative complaint. Dr. Hayden seconded the motion, which passed unanimously.

The Board heard testimony from the Respondent.

Dr. Burns moved to adopt the conclusions of law as presented in the administrative complaint. Dr. Hayden seconded the motion, which passed unanimously.

Action Taken: After discussion, Dr. Hayden moved to revoke the license. Ms. Malan seconded the motion, which passed unanimously.

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Allegations of Complaint: 456.072(1)(k)- failing to perfume a statutory or legal obligation Additional discussion of this item can be found later in the minutes.

Dr. Yagger was not present or represented by counsel. Dr. Hayden was recused due to participation on the probable cause panel. Mr. Truitt represented the Department and presented the case to the Board. Dr. Burns moved to accept the agenda materials and investigative report as presented into the record as evidence. Dr. Rose seconded the motion, which passed unanimously. Dr. Burns moved to find that the respondent was properly served and requested an informal hearing. Dr. Rose seconded the motion, which passed unanimously. Dr. Burns then moved to adopt the findings of fact as presented in the administrative complaint. Dr. Rose seconded the motion, which passed unanimously. Dr. Burns moved to adopt the conclusions of law as presented in the administrative complaint. Ms. Malan seconded the motion, which passed unanimously.

Action Taken: Dr. Rose moved to impose the following penalty: • $2500.00 fine to be paid within 2 years of the Final Order

• Probation to run concurrent with the loan repayment period; submission of reports every 6 months summarizing the loan repayment status

Dr. Burns seconded the motion, which passed unanimously.

Additional Action Taken: Dr. Burns moved to assess costs in the amount of $560.17 to be paid within 2 years of the Final Order. Dr. Rose seconded the motion, which passed unanimously.

Tab 17 - Lee Gibson, DO – Informal Hearing - DOH Case #2009-25093

Allegations of Complaint: 459.015(1)(o)- medical records violation; 459.015(1)(x)- malpractice Dr. Gibson was present and represented by Susan Bird, Esq. Dr. Hayden was recused due to participation on the probable cause panel. Mr. Truitt represented the Department and presented the case to the Board.

Dr. Burns moved to accept the agenda materials and investigative report as presented into the record as evidence. Ms. Malan seconded the motion, which passed unanimously. Dr. Burns moved to find that the respondent was properly served and requested an informal hearing. Dr. Rose seconded the motion, which passed unanimously. Dr. Burns then moved to adopt the findings of fact as presented in the administrative complaint. Ms. Malan seconded the motion, which passed unanimously.

The Board heard testimony from the Respondent.

Dr. Burns moved to adopt the conclusions of law as presented in the administrative complaint. Dr. Rose seconded the motion, which passed unanimously.

Action Taken: After discussion, Dr. Rose moved to impose the following penalty: • Letter of Concern

• $7500.00 fine to be paid within 1 year of the Final Order

• Completion of the Quality Medical Record Keeping for Health Care Professionals course sponsored by the FMA within 1 year of the Final Order

• Must write an article suitable for publication in the JAOA (article is not required to be

submitted) on the topic of appropriate handoff procedures in the emergency room; the article must be based on the review of at least 10 articles (written within the last 5 years)

Dr. Burns seconded the motion, which passed unanimously.

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Tab 18 - Edward Williams, Jr., DO – Determination of Waiver Hearing - DOH Case #2011-18122 Allegations of Complaint: 459.015(1)(ee)- pre-signing blank prescription forms

Dr. Williams was not present or represented by counsel. Dr. Hayden was recused due to participation on the probable cause panel. Mr. Truitt represented the Department and presented the case to the Board.

Dr. Burns moved to accept the agenda materials and investigative report as presented into the record as evidence. Dr. Rose seconded the motion, which passed unanimously. Dr. Burns moved to find that the respondent was properly served and waived their rights to a hearing. Dr. Bellingar seconded the motion, which passed unanimously. Dr. Burns then moved to adopt the findings of fact as presented in the administrative complaint. Dr. Bellingar seconded the motion, which passed unanimously. Dr. Burns moved to adopt the conclusions of law as presented in the administrative complaint. Dr. Rose

seconded the motion, which passed unanimously.

Action Taken: Dr. Rose moved to impose the following penalty: • Reprimand

• $5000.00 Fine to be paid within 1 year of the Final order • Suspension for 1 year

• Probation for 2 years to include: indirect supervision, reports, log of all controlled substance prescriptions provided to the patient of an ARNP or PA and 25% chart review of those patients listed on the log

• Completion of the NOVA ethics course within 1 year of the Final Order (Respondent must provide NOVA with a copy of his Final Order in this case)

Dr. Bellingar seconded the motion, which passed unanimously.

Additional Action Taken: Dr. Burns moved to assess costs in the amount of $1103.65 to be paid within 1 year of the Final Order. Dr. Rose seconded the motion, which passed unanimously.

LICENSURE APPEARANCES

Tab 19 - Francois Chidiac, DO – Physician in Training Application

Dr. Chidiac was present and represented by ?? He was required to appear before the Board to discuss his application, criminal history, health history and training issues.

Action Taken: After discussion, Dr. Chidiac agreed to waive his 90 day requirement for the record. He was advised to contact PRN and obtain confirmation that the evaluation previously conducted was from a provider within the PRN network and that he was able to practice with skill and safety. Once this information is received the Chair will review and make further recommendations.

Break from 1:30 – 1:50

Ms. Malan had to leave the meeting at approximately 1:45. Tab 34 - Lucas Nourse, DO – Physician in Training Application

Dr. Nourse was present without counsel. Dr. Nourse was required to appear before the Board to discuss his application and pending criminal charges.

Action Taken: After discussion, Dr. Nourse agreed to waive his 90 day requirement for the record. Dr. Hayden moved to require a PRN evaluation and compliance with any recommendations of the

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evaluation and delegate authority to the chair to approve the license or require an appearance. The motion was seconded and passed unanimously.

PROSECUTION SERVICES REPORT

Mr. Truitt provided an overview of the current caseload statistics.

Action Taken: Dr. Burns moved to approve the report and directed the Department to proceed with any cases over a year old. Dr. Rose seconded the motion, which passed unanimously.

REVIEW AND APPROVAL OF MINUTES Tab 20 - February 15, 2013 Meeting Minutes

Action Taken: Dr. Hayden moved to approve the minutes as presented. Dr. Burns seconded the motion, which passed unanimously.

GENERAL BUSINESS / CORRESPONDENCE Tab 21 - 2014 Proposed Meeting Dates

It was the consensus of the Board to hold their meetings on the following dates: March 7, 2014, May 16, 2014, August 22, 2014 and November 14, 2014.

The Board also discussed changing the start times of the August 2013 meeting to 3:00pm on Friday and 8:30am on Saturday.

Tab 35 - Discussion Regarding PDMP Funding The Board discussed this item but took no action.

BOARD CHAIR REPORT – Ronald Burns, DO Tab 36 - Overview of FSMB Annual Meeting

Dr. Hayden and Dr. Burns provided an overview of the annual meeting. Dr. Burns congratulated Dr. Hayden on her appointment to the FSMB Nominating Committee and election as Vice Chair of the AAOE.

BOARD COUNSEL REPORT AND RULES DISCUSSION – Donna McNulty, Esq. Tab 22 - Rules Report

Information item.

Tab 23 - Annual Regulatory Plan for FY 2013/2014 Ms. McNulty provided an overview of the plan,

Action Taken: Dr. Hayden moved to approve the plan as presented and delegate authority for Counsel to work with the Board Chair as needed. Dr. Rose seconded the motion, which passed unanimously.

Tab 24 - 64B15-14.006 - Standards of Practice for Surgery Ms. McNulty provided an overview of the proposed changes.

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• All references to “surgery” or “procedure” should be changed to “surgery/procedure” Dr. Hayden seconded the motion, which passed unanimously.

Action on SERC Questions: Dr. Burns moved the proposed changes would not directly or indirectly increase regulatory costs to any entity in excess of $200,000 in the aggregate within one year after implementation, no SERC was needed and legislative ratification was not required. Dr. Rose seconded the motion, which passed unanimously.

Dr. St Louis left the meeting.

Tab 25 - 64B15-14.007 - Standard of Care for Office Surgery Ms. McNulty provided an overview of the proposed changes.

Action Taken: After discussion, Dr. Burns moved to approve the language as presented. Dr. Bellingar seconded the motion, which passed unanimously.

Action on SERC Questions: Dr. Burns moved the proposed changes would not directly or indirectly increase regulatory costs to any entity in excess of $200,000 in the aggregate within one year after implementation, no SERC was needed and legislative ratification was not required. The motion was seconded and passed unanimously.

Tab 26 - 64B15-14.0076 - Requirement for Osteopathic Physician Office Registration; Inspection or Accreditation

Ms. McNulty provided an overview of the proposed changes.

Action Taken: After discussion, Dr. Burns moved to approve the language as presented. Dr. Bellingar seconded the motion, which passed unanimously.

Action on SERC Questions: Dr. Burns moved the proposed changes would not directly or indirectly increase regulatory costs to any entity in excess of $200,000 in the aggregate within one year after implementation, no SERC was needed and legislative ratification was not required. Dr. Hayden seconded the motion, which passed unanimously.

Tab 27 - 64B15-13.002 - Continuing Education Requirements for Reactivation Ms. McNulty provided an overview of the proposed changes.

Action Taken: After discussion, Dr. Rose moved to approve the language with the following changes: • At least 10 of the 20 hours must be AOA Category I-A

Dr. Hayden seconded the motion, which passed unanimously.

Action on SERC Questions: Dr. Burns moved the proposed changes would not directly or indirectly increase regulatory costs to any entity in excess of $200,000 in the aggregate within one year after implementation, no SERC was needed and legislative ratification was not required. Dr. Hayden seconded the motion, which passed unanimously.

Tab 28 - 64B15-22.004 - Mandatory Registration of Unlicensed Physicians (review of application) Tab 29 - 64B15-12.003 - Applications for Licensure (review of application)

Tab 30 - 64B15-12.009 - Osteopathic Faculty Certificate (review of application) Tab 31 - 64B15-12.005 - Limited Licensure (review of application)

Tab 32 - 64B15-12.010 - Temporary Certificate to Practice in an Area of Critical Need (review of application)

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Action Taken: After discussion, Dr. Hayden moved to approve the language and application changes as presented. Dr. Bellingar seconded the motion, which passed unanimously.

Action on SERC Questions: Dr. Burns moved the proposed changes would not directly or indirectly increase regulatory costs to any entity in excess of $200,000 in the aggregate within one year after implementation, no SERC was needed and legislative ratification was not required. Dr. Hayden seconded the motion, which passed unanimously.

EXECUTIVE DIRECTOR REPORT No report.

COUNCIL ON PHYSICIAN ASSISTANTS REPORT – Ronald Burns, DO Tab 33 - April 4, 2013 PA Council Meeting Minutes

Informational item.

ANESTHESIOLOGY ASSISTANTS COMMITTEE REPORT – Ronald Burns, DO No report.

BUDGET LIAISON REPORT – Rina Malan No report.

PHARMACISTS FORMULARY REPORT - Joel Rose, DO No report.

UNLICENSED ACTIVITY REPORT No report.

RATIFICATION OF LICENSURE

Tab 37 - Ratification of Full Licenses Issued 12/28/2012 – 5/1/2013

Action Taken: Dr. Hayden moved to approve the list as presented. Dr. Burns seconded the motion, which passed unanimously.

Tab 38 - Ratification of Training Licenses Issued 12/28/2013 – 5/1/2013

Action Taken: Dr. Burns moved to approve the list as presented. Dr. Hayden seconded the motion, which passed unanimously.

OLD BUSINESS NEW BUSINESS

DISCIPLINARY CASES - continued

Tab 16 - Scott Yagger, DO – Informal Hearing - DOH Case #2012-14325

Dr. Yagger was present without counsel. He apologized for not being present earlier in the meeting. Mr. Jusevitch explained the Board’s previous actions and outlined the penalty imposed.

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