before the medical board of california department of …4patientsafety.org/documents/morgan,...
TRANSCRIPT
BEFORE THE MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
In the Matter of the Accusation Against: ) ) ) ) ) ) ) )
COURTNEY RICARDO MORGAN, M.D.
J>hysician's & Surgeon's Certificate No. C129554
·) )
MBC File# 800-2017-032367
OAHNO. 2017090492
Respondent. ) ~~~~~~~~~~~~~-~~~~~.
ORDER CORRECTING NUNC PRO TUNC CLERICAL ERRORS IN FACTUAL FINDINGS PARAGRAPHS 5 AND 7 OF THE
DECISION
Based upon a Request for corrections from Respondent, the Medical Board of California (hereafter "board") finds that there are clerical errors in paragraphs 5 and.7 of the Factual Findings section of the Decision in the above-entitled matter and that such clerical errors should be corrected so that the paragraphs will conform to the Texas Medical Board's issued Order.
IT IS HEREBY ORDERED that Factual Findings paragraphs 5 and 1 contained on page 2 of the Decision in the above-entitled matter be and hereby is amended and corrected nunc pro tune as of the date of entry of the decision to read as follows. ·
1. Paragraph 5, line 3 of the Decision, "Hope Medical Services" is replaced by "Hop Medical Services";
2. Paragraph 7, is replaced with "The ALJ found that Respondent's medical recordkeeping was inadequate for eight patients. He had treated one patient with a body mass index of 17 .94 with Marinol for weight gain without properly recording lab results or risk factors · for the patient's medications. F:or another patient, who complained of a cough, respondent prescribed promethazine with codeine cough syrup without documenting the nsk factors for taking codeine in the patient's record."
April 5, 2018
/ Kristina Lawson, JD, Chair Panel B
BEFORE THE MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
In the Matter of the Accusation Against:
) ) ) )
COURTNEY RICARDO MORGAN, M.D.) Case No. 800-2017-032367
Physician's and Surgeon's Certificate No. C129554
Respondent
) ) ) ) ) )
OAH NO. 2017090492
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 5:00 p.m. on April 19, 2018.
IT IS SO ORDERED: March 20, 2018.
MEDICAL BOARD OF CALIFORNIA
Kristina Lawson, JD, Chair Panel B
BEFORE THE MEDICAL BOARD OF CALIFORNIA:
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
In the Matter of the Accusation Against:
COURTNEY RICARDO MORGAN, M.D.,
Physician's and Surgeon's Certificate No. C129554
Respondent.
Case No. 800-2017-032367
OAH No. 2oi 7090492
PROPOSED DECISION
Administrative Law Judge Jill Schlichtmann, State of California, Office of Administrative Hearings, heard this matter on February 1, 2018, in Oakland, California.
Deputy Attorney General Keith Shaw represented complainant Kimberly Kirchmeyer, Executive Director, Medical Board of California, Department of Consumer Affairs.
Respondent Courtney Ricardo Morgan, M~D., represented himself and was present throughout the administrative hearing.
The record closed and the matter was submitted for decision on February 1, 2018.
FACTUAL FINDINGS
1. On March 29, 2014, the Medical Board of California (Board) issued Physician's and Surg~on's Certificate No. C129554 to Courtney Ricardo Morgan, M.D; (respondent). The license has been active at all times relevant here and will expire on March 31, 2018, unless renewed. ·
2. On July 27, 2017, complainant Kimberly Kirchmeyer, acting in her official capacity as Executive Director of the Board, issued an accusation against respondent. The accusation alleges that respondent's California license is subject to discipline because of disciplinary action taken ~y the Texas Medical Board.
Re;,pondent 's Background
3. Respondent earned degrees in mechanical and biomedical engineering from the University of Miami. He attended medical school at the Howard University College of Medicine. In 2007, respondent completed a residency_ in family medicine at Jackson Memorial Hospital in Miami.
4. After he completed his residency, respondent moved tQ Victoria, Texas, to provide medical care to an underserved community. He.owned two outpatient family medicine clinics: Hop Medical Services and DriveThru Doc. _Respondent opened DriveThru Doc to provide low cost care to.indigent patients. Respondent practiced in Victoria, Texas, for 10 years, until thy Texas Medical Board issu·ed its Filial Order on March 3, 2:017, placing . his license on probation. At that point, respondent closed his practice and moved to California.
Action by the Texas Medical Board
5. -On Febl°uary 2tJ" 2016, th~ ·e~ecµtiye st~ff of the Texas Medical Board filed a coinplaint allegfog that: a) for the month of. ¥:arcp 2013, resp.ondent wrote prescriptions for opioids, beilZodiaz:epines, pr carisoprodolJpa ni~jority ()~.his pat~~ritsat Hope Me.gical Servic:e~ withput r~gistering ~sa· pain difl.lc~.as requi~eqby.Te;Xas law; b) for nine;patients, respdnd¢nt failed t9 meet the stalldard of qire apd engaged-in dahger_ous and nontherapeutic prescriWng; c) respondent violated a state Iaw.by.allowirig anuiilicensed eniploye,e to have acce.ss tq his prescription pad a11q' signature stamp; and d) he self-prescribed a controlled substanc;es, Phentermine, a weight-loss drug, to himself for a period of over 72 hours, which viofates TexaS:law. · .· · .·. · · · ·-. - ·
. ·-·:1 ' - '·.
'· ., ,, . ' ' :~-. -·_
6. A hearing wash~lcl before an adti,iinistrati\reJa\vju'dge (ALJ):on Jl1ly 11, 2016: The ALJ sustained some,. but not all, of the allege,d-.violations. The ALJ found that althoug.h respondent was dearly. fl family medi~~W~ ph~~i.C,ian, dilling_ the month of March 2013,_63 percent of his patients.at Hop Medical Services received a prescription for opioids, benzodiazepine,s, 'or carisoprodol, requiring him to register as a pain medicine clinic, which he had not done. The ALJ recommended a low penaltyfor the violation.
7. The ALJ found.that respondent's medical recordkeeping was inadequate for two patients. He had treated one patient wi,th a body mass index of 17 .94 with Marino I for weight gain without properly documenting a patient history; physical examination; diagnostic, therapeutic, and lab results; appropriate evaluations and consultations; treatment objectives; and informed consent. For another patient who complained of a cough, respondent prescribed promethazine with codeine cough syrup without documenting the need for the ·medication.
2
8. Respondent treated six patients for obesity at his DriveThru Doc clinic by ptescrioing Plierttennine. -The ALJ fol.ind that resporfdenrviolateff the standard of care·· because he did not record any lab results or the patients' family, medical or social histories, or obtain informed consent or a treatment agreement. ·
9. The ALJ did not find evidence that respondent prescribed medications for purposes other than to assist with their medical conditions; no patient harm or evidence of abuse or addiction was established. With regard to the Phentermine prescription, the ALJ did not find that the prescribing was non-therapeutic.
10. The ALJ found that respondent violated Texas law by leaving his prescription pad and signature stamp in the custody of a rion-licensed employee. There was no evidence of theft or misuse; however the potential for misuse was there.
11. Respondent admitted, and the ALJ found, that respondent prescribed a 30-day supply of Phentermine for himself on November 28, 2012, which violated Texas law.
12. Based on the ALJ's findings and legal conclusions, on March 3, 2017, the Texas Medical Board issued its Final Order. Respondent's Texas license was revoked; the revocation was stayed; and respondent was placed on probation for a period of 10 years on the following conditions:
a) Respondent was required to surrender his Drug Enforcement Administration (DEA) controlled substances registration;
b) Respondent was prohibited from obtaining a DEA controlled substances registration until he received authorization from the Texas Medical Board and only after making a written petition and personal appearance before the Texas
· Medical Board or its authorized representative;
c) Respondent's practice was restricted to a pre-approved group practice or institutional setting;
d) Respondent was restricted from treating chronic pain.
e) Respondent was restricted from treating himself, family members or close personal acquaintances;
f) Respondent was ordered to contact the Texas A & M Health Science Center Knowledge, Skills, Training Assessment and Research (KSTAR) program to schedule an assessment and to follow any recommendations of KSTAR;
g) Following the KSTAR assessment and any recommended retraining, respondent was subject to oversight by a practice monitor;
3
order.
h) Respondent was ordered to complete educational courses in the areas of prescribing controlled substances, medical record keeping, risk management, obesity treatment, treatment for low testosterone and erectile dysfunction;
i) Respondent was ordered to take and pass with a score of 75 or above, the Medical Jurisprudence Examination; and,
j) Respondent was ordered to provide a copy of the order to all hospitals, nursing homes, treatment facilities and other health care entities where respondent had privileges.
13. Respondent has filed a petition for judicial review of the Texas Medical Board
Respondent's Evidence
14. Respondent has_ C()IIlplie<;l with the Texas _Medical Board order, by completing the foll.owing continuing medical education courses: RiSk Management(5 hours); Medical Error Pre~enticm and Root CatisyA~alysis (2 hour~); I>i~gnosirig anQ Treating.Overweight and Obese Patients (5 hours); Male Sexual Dysfoncti_on (10 hours); Optimizing Opioid Safety and Efficacy (15 hours); Irritable Bowel Syndrome (10 hours); Anemia in the Elderly (5 hours); and Osteoporosis: :piagnosis and Managelil~;rit (5 hours). J.le,spondent has not completed the evaluation by Texas A & M Health Science Center, Knowledge, Skills, Training, Assessment, and Research program because it is expensive· and respondent does not have the res01.1;rces to pay for it.
15. ·Respondent providydsworn _state~~nts frppi several p~fientstbthe Texas Medical Board. One patient reported having be:eii'rt!sporiderit's patiep_t for si)( ye~rs and having received caring, attentive treatment. A sec_ond p~tie:rit had se~n respondent for seven years and described respondent as wonderful, caring, kn(Jo/ledgeable,weU.:.educated and intelligent. A third patient reported that she received treatment from respcindeIJt for 10 years.
·The patient reported that respondent had an impeccable bedside ~anner, listened.to her and sat with her when her mother was dying in the hospital. The last patient, a nurse, reported that respondent had treated the patient for five years; she praised respondent's understanding and respectful nature.
16. From mid-2017 until January 2018, respondent practiced in California. On weekdays, he worked at Placita Medical Clinic in Watsonville. On weekends, respondent worked at the Family Health Care Centers of Greater Los Angeles (FHCCGLA), in Downey.
17. Respondent provided character references from Sophia N. Chun, M:D., Chief Medical Officer, and Santos Martinez, Director of Human Resources, of FHCCGLA. Both letters are dated in January 2018. Dr. Chun reports that respondent served as a family medicine physician at the facility from August 2017 to January 2018. FHCCGLA is comprised of four non-profit community health centers that provide comprehensive primary
4.
care for men, women, adolescents, and children living in the South-East region of Los Angeles. Dr. Chun supervised respondent's work.· She·repotts that respondent practiced with utmost skill, care and professionalism, and described him as an experienced physician whose prior medical work allowed for a seamless transition into the practice. Dr. Chun. concludes by stating that respondent had pro~en himselfas asset to the organization and that she had every confidence in his clinical skills and judgment. Dr. Chun is aware of respondent's.discipline in Texas, but supports his continued licensure in California.
Martinez reports that respondent quickly established an excellent rapport with patients and staff, and displayed competence, compassion and kindness. Martinez notes that respondent had impressive academic credentials and reports that the organization hopes to re-employ him. Martinez supports respondent's continued unrestricted practice in California.
LEGAL CONCLUSIONS
1. The burden of proof in this matter is on the Board and the standard of proof is ·clear and convincing evidence. (Ettinger v. Bd. of Medical Quality Assurance (1982) 135 Cal.App.3d 853.) .
2. Pursuant to Business and Professions Code sections 141 and 2305, the Board is authorized to impose discipiine on a licensee who has been disciplined in another state, without a broad inquiry into the unqerlying facts. (Marek v. Board of Podiatric Medicine (1993) 16 Cal.App.4th 1089.) This is true even where the respondent has not admitted to the truth of the allegations recited in a stipulation to a disciplinary order or consent decree. (Ibid.)
3. Business and Professions Code section 2305 provides:
The revocation, suspension, or other discipline, restriction, or limitation imposed by another state upon a license or certificate to practice medicine issued by that state, or the revocation, suspension, or restriction of the authority to practice medicine by any agency of the federal government, that would have been grounds for discipline in California of a licensee under this chapter, shall constitute grounds for disCiplinary action for unprofessional conduct against the licensee in this state.
Cause for discipline in California exists pursuant to Business and Professions Code section 2305. (Factual Finding 12.)
4. Whether discipline should be imposed in California must also be evaluated pursuant to Business and Professions Code section.141, subdivision (a), which provides:
For any licensee holding a license issued by a board under the jurisdiction of a department, a disciplinary action by another
5
state, by any agency of the federal government, o.r by another country for any act substantially related to.the practice regulated by the California license, may be a ground for disciplinary action by the respective state licensing board. A certified copy of th~ record of the disciplinary action taken against the licensee
. l:>y another state, an agency of the federal government, or another country shall be conclusive evidence of the events related therein.
Cause for discipline also exists pursuant to Business and Professions Code section 141. (Factual Finding 12.)
Disciplinary Considerations
5. The purpose of tl~e Medical Practice Act1 is to assure the high quality of medical praetiCe; iii other words,' to keep unqualified persons and. those guilty of unprofessional conduct out of the medical profession.·. (Shea v. Board of Medical Examiners (1978) 81 Cal.App.3d 564, 574.) The purpose of physician discipline is to protect the public and to aid in the rehabilitation of licensees. (Bus. & Prof. Code, § 2229.)
6. . The. Board has adopted guidei.ines to assist in the evaluation· of physician discipline. (Manual of Model Disciplinary Orders and Disciplinary Guidelines, 12th Edition.) The gui~elines recommend thatin out-of~statediscipline cases, the minimum level of discipline sholild be the same ·a~ that for a similar violation in California; the maximum is . revocation. The minimum reGoinmended level of discipline for inappropriate prescribing and inaccura,te recordkeeping is stayed revocation and five years of probation, with conditions including a suspension of 60days; a restric.tion on prescribing contrnlled substances, maintaining records and access to records and inventories; an education course, a prescribing practices course, a medical record keeping course, an ethics course, a solo practice prohibition, a clinical training program and practice monitoring. Complainartt recommends
· revocation, but if probation is granted, complainant ask~ _that it be under the same terms and conditions that the Texas Medical Board ordered.
The Texas Medical Board took this matter very seriously and the ALJ findings raise concerns about respondent's practice. On the other hand, no patients were harmed and respondenf has worked successfully in California. Completion of courses on ethics,
. prescribing practices and medical record keeping, as well as a clinical training program would aid respondent in his rehabilitation arid assure the Board that respondent is safe to
· practice under supervision. The evidence does not support a restriction on respondent's DEA permit as long as respondent maintains records and access to records and inventories of all controlled substances ordered, does not engage in solo practice and his practice is monitored. Respondent is not currently practicing; therefore a 60-day suspension would serve no
I Business and Professions Code sections 2000 ,through 2521.
6
practical purpose. A five-year probationary period with appropriate conditions will protect the public while aiding respondent in his rehabilitation.
ORDER
Physician's and Surgeon's Certificate No. C129554 issued to respondent Courtney Ricardo Morgan, M.D., is revoked. However, revocation is stayed and respondent is placed on probation for five years upon the following terms and conditions:
1. Controlled Substances - Maintain Records and Access to Records and Inventories
Respondent shall maintain a record of all controlled substances ordered, prescribed, dispensed, administered, or possessed by respondent, and any recommendation or approval which enabks a patient or patient's primary caregiver to-possess or cultivate marijuana for the personal medical purposes of the patient within the meaning of Health and Safety Code section 11362.5, during probation, showing all the following: 1) the name and address of the patient; 2) the date; 3) the character and a quantity of controlled substances involved; and 4) the indications and diagnosis for which the controlled substances were furnished.
Respondent shall keep these records in a separate file or ledger, in chronological order. All records and any inventories of controlled substances shall be available for immediate inspection and copying on the premises by the Board or its designee at all times during business hours and shall be retained for the entire term of probation.
2. Education Course .
With_in 60 calendar days of the effective date of this Decision, and on an annual basis thereafter, respondent shall submit to the Board or its designee for its prior approval educational program(s) or course(s) which shall not be less than 40 hours per year, for each year of probation. The educational program(s) or course(s) shall be aimed at correcting any areas of deficient practice or knowledge and shall be Category I certified. The educational program(s) or course(s) shall be at respondent's expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure. Following the completion of each course, the Board or its designee niay administer an examination to test respondent's knowledge of the course. Respondent shall provide proof of attendance for 65 hours of CME .of which 40 hours were in satisfaction of this condition.
7
3. Prescribing Practices Course
4.
Within 60 calendar days of the effective date of this Decision, respondent shall enroll in a course in prescribing practic~s approved ill advance by the Board or its designee. Respondent shall provide the approved course provider with any inform.ation and documents that the approved course provider may deem pertinent. Respondent shall participate in and successfully complete the classroom component of_ the course not later than six months after respondent's initial enrollment. Respondent shall successfully complete any other component of the course within one year of enrollment. The prescribing practices course shall be at respondent's expense and shall be in addition to the CME requirements for renewal of licensure. ·
•',: ' . '
A prescribing practices course taken afte,r the acts that gave rise to the charges in. t~e Accusat\0.11, ~lit prio; to the effectiv~ date of the. Dedsion may, in the
-s9l~ .qissreiion of the Board O{itS design~e, be ~cc:epted towards the fulfiih11ent bf this c.ondition if the., co~rse "Yould have ~e.t:?n 'approved by the Boar.d .or its desigriee had 'the course been taken aftyr. the effective date of this Decision.. · - · · · · ·
Respondent shall submit a· certificationofsuccessful cmnplet~on to the Board or its designee not later than 15 Calendar da}'s_after successfully completing the course, or not later than 15 calendar days after the ,effective date of the Deci.sion~ whichevyr is later. - · - ·
Medical R~ccird K~eping Coµr~~ . _.
Within 60 cal~ndar days of the effective a'ate .of this DeciSiort, ·respondent shall enroll in a course iri medical record keeping approved in advance by the Board or its designee. Respondent sh:ill provide the· approved course provider with any informatipnand docuiMpts thc1.t the approved cour~e provider may deem perti11ent. :Respondent shalfparticipate in and successfully complete the classr66m component of the course not later than six months after respondent's initial enrollm~I1t. Respol1dent shall su'ccessfully complete any other component of the course within one year of enrollment. The medical record keeping course shall be at respondent's expense and shall be in addition to the CME requirements for renewal oflicensure.
A medical record keeping course taken after the acts that gave rise to the charges in the 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 if the course would have been approved by the Board or its designee had the course been taken after the effective date of this Decision. -
8
Respondent shall submit a certification of successful completion to the Board or its designee·not later tha:n-15 calendar days-after successfolly completing the course, or not later than 15 calendar days after the effective date of the Decision, whichever is later.
5. Professionalism Program (Ethics Course)
Within 60 calendar days of the effective date of this Decision, respondent shall enroll in a professionalism program, that meets the requirements of title 16, California Code of Regulations (CCR) section_1358.l. Respondent shall participate in and successfully complete that program. Respondent shall provide any information and documents that the program may deem pertinent. Respondent shall successfully complete the classroom component of the program not later than six months after respondent's initial enrollment, and the longitudinal component of the program not later than the time specified by the program, but no later than one year after attending the classroom component. The professionalism program shall be at respondent's expense and shall be in addition to the CME requirements for· renewal oflicensure.
A professionalism program taken after the acts that gave rise to the charges in the Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board or its desigriee, be accepted towards the fulfillment of this condition if the program would have been approved by the Board or its designee had the program been taken after the effective date of this Decision.
Respondent Shall submit a certification of successful completion to the Board -or its designee not later than 15 calendar days after successfully completing the program or not later than 15 calendar days after the effective date of the Decision, whichever is later.
6. Clinical Competence Assessment Program
Within 60 calendar days of the effective date of this Decision, respondent shall enroll in a clinical competence assessment program approved in advance by the Board or its designee. Respondent shall successfully complete the program not later than six months after respondent's initial enrollment unless the Board or its designee agrees in writing to an extension of that time.
The prograi:n shall consist of a comprehensive assessment ofrespondent's physical and mental health and the six general domains of clinical competence as defined by the Accreditation Council on Graduate Medical Education and American Board of Medical Specialties pertaining to respondent's current or intended area of practice. The program shall take into account data obtained from the pre-assessment, self-report forms and interview, and the Decision(s), Accusation(s), and any other information that the Board or its designee deems
9
relevant. The program shall require respondent's on~site participation for a minimum of three and no more, than five days as determined by the program for the assessment and clinical education evaluation. Respondent shall pay all expenses associated with the clinical competence assessment program.
At the end of the evaluation, the program will submit a report to the Board or its designee which unequivocally states whether the respondent has demonstrated the-ability to practice safely and independently. Based on respondent's performance on the clinical competence assessment, 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, evaluation or treatment for ariy me.dical condition or psychological condition, or anything else affecting n~spondent's practice of medicine. Respondent shall comply with the progrfiln'~ recommendatiOns. ·
Det~rminatiOn as_ to wb.ether:respcmde,nt successfully completed the clinical competence assessnient progt3JI?-Js solely .within the prngram's jurisdiction.
If responde11t fails tQ enroll, participate in, or sw::cessfull y complete the clinical comp~'tenc'e. assessmep~ program within the designated time period, respondent sli~il :r~c~i\re ~ nq.tificatlon fr9ni t4e · BO~rcl ()r its designee to cease the practice of m~dicine with.irithr.ee calenc;Iar.days aftef being so notified.
_ Respondent sha}l not. resume. the practice qf medicine until enrollment or participation i:ri the outstandillg portions of the clin:lcal competence assessment program have been ~ompleted. If respon~~:I1t did not ~uCcessfully complete the ~l:inical _competence ·ass~ss1Ileht prograµI, respop.d~nt sh_all not resume the
'practice ofm~di,cine until a #1rnl4ecisicm has been:rendered on, the accusation arid/or a p~tition· to revoke. probation. the.cessation of practice shall not apply to the reduction of the probationary time period. · ·
7. Monitoring -: Practice
Within 30 calendri~ days of the effective date of this Deeision, respondent shall submit to the Board or its designee for prior approval as a practice, monitor, the name and qualifications of one or more licensed physicians and surgeons whose licenses are valid and in good standing, and who are preferably American Board of Medical Specialties (ABMS) certified. A monitor shall have no prior or current business or personal relationship with respondent, or other relationship that could reasonably be expected to compromise the ability of the monitor to render fair and unbiased reports to the Board, including but not limited to any form of bartering, shall be in respondent's field of practice, and must agree to serve as respondent's monitor. Respondent shall pay all monitoring costs.
10
The Board or its designee shall provide the approved monitor with copies of the Decision(s) and Accusation(s), and a proposed monitoring-plan. Within ·15 calendar days of receipt of the Decision(s), Accusation(s), and proposed monitoring plan, the monitor shall submit a signed statement that the monitor has read the Decision(s) and Accusation(s), fully understands the role of a monitor, and agrees or disagrees with the proposed monitoring plan. If the monitor disagrees with the proposed monitoring plan,-the monitor shall submit a revised monitoring plan with the signed statement for approval by the Boarp or its designee.
Within 60 calendar days of the effective date of this Decision, and continuing throughout probation, respondent's practice shall be monitored by the approved monitor. Respondent shall make all records available for immediate inspection and copying on the premises by the monitor at all times during business hours and shall retain the records for the entire term of probation.
If respondent fails to obtain approval of a monitor within 60 calendar days of the effective date of this Decision, respondent shall receive a notification from the Board or its designee to cease the practice of medicine within three calendar days after being so notified. Respondent shall cease the practice of medicine until a monitor is approved to provide monitoring responsibility.
The monitor(s) shall submit a quarterly written report to the Board or its designee which includes an evaluation of respondent's performance, indicating whether respondent's practices are within the standards of practice of medicine, and whether respondent is practicing medicine safely. It shall be the sole responsibility of respondent to ensure that the monitor submits the · quarterly written reports to the Board or its designee within 10 calendar days after the end of the preceding quarter.
If the monitor resigns or is no longer available, respondent shall, within five calendar days of such resignation or unavailability, submit to the Board or its designee, for prior approval, the name and _qualifications of a replacement monitor who will be assuming that responsibility within 15 calendar days. If respondent fails to obtain approval of a replacenient monitor within 60 calendar days of the resignation or unavailability of the monitor, respondent shall receive a notification from the Board or its designee to cease the practice of medicine within three calendar days after being so notified respondent shall cease the practice of medicine until a replacement monitor is approved and assumes monitoring responsibility. ·
In lieu of a monitor, respondent may participate in a professional enhancement program, approved in advance by the Board or its designee, that includes, at minimum, quarterly chart review, semi-annual practice assessment, and semiannual review of professional growth and education. Respondent shall participate in the professional enhancement program at respondent's expense during the- term of probation.
11
8. Solo Practice Prohibition,
- 9.
Respondent is prohibited from engaging in the solo practice of medicine. Prohibited solo practice includes, but is not limited to, a practice where: 1) respondent merely shares office space with another physician but is not affiliated for purposes of providing patient c;are, or 2) respondent is the sole physician practitioner at that location.
If respondent fails to establish a practice with another physician or secure employment in an appropriate practice setting within 60 calendar days of the effective date of this Decision, respondent shall receive a notification from the Board. or its designee to cease the practice· of medidne within three calendar days after·be!rig so notified .. 'Respondent shall 'nofre~ume practice until an . apl?rnpfiate pradiee ;setting is, established, ... · · · · ·
If, .dt!fing ti1e 'course of the ptobation, resp9~gent's pr~9tice setting changes . ~~d'resppndentis no lo~ge.rpr~tfic~ng ina~9~t!I1g in.~6mpllance with this · J)eci~ion; respql1deptshall n9tify th~ :Boar~~Odts cieS,ign~e within five calendar . d,~Y~ ~f the practic(~e.ttilig c~arige.~ If r~sporident f~ils:.'to. establish a practice with ~no th er physician or secure el11pl_oyl11en,t in ·an appropriate practice setting within 60 calenda~ c}ays of the practice.s,6,ttinkcha11ge;,~espo'ndent shall receive a nC?,tificatio,11 frpll1the Bo~rd_ ·or its design~e.Joc~~se.t_~e practice of medicine witpin three C(lle.ndarc days after being SQ)lO~fied; ;£\espondent shall not restiriie practic~ unti_l an appropriate. pra'ctice setting is esta}Jlished.
N()tification .··
\\fi.tbin seven·· days of the effective' date of this Decisioll, respondent shall provide a tme copy,of_this Decision anc,IAccl1sation tothe Chief of Staff or the Chief Executive Officer at every hospital \.Vhere privileges qr membership are exte~ded io respondent, at arty ,other facility where responde.nt engages in the practice of medicine, includiiig all physieian and locum fonehs registries or other sitnilar agendes, and to the' Chi'ef Exetutive Officer at every insurance can'ier which extends malptadice insurance coverage to respondent. Respondent 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 carrier.
10. Supervision of Physician Assistants
During probation, respondent is prohibited from supervising physician . assistants and advanced practice nurses.
12 -
11. Obey All Laws
Respondent 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.
12. Quarterly Declarations
Respondent 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.
Respondent shall submit quarterly declarations not later than 10 calendar days after the end of the preceding quarter. ·
13. General Probation Requirements
Compliance with Probation Unit: Respondent shall comply with the Board's probation unir.
Address Changes: Respondent shall, at all times, keep the Board informed of respondent's business and residence addresses, email address (if available), and telephone number. Changes of such 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, subdivision (b ).
Place of Practice: Respondent shall not engage in the practice of medicine in respondent's or patient's place of residence, unless the patient resides in a skilled nursing facility or other similar licensed facility. ·
License Renewal: Respondent shall maintain a current and renewed California physician's and surgeon's license. ·.
Travel or Residence Outside California: Respondent 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 respondent should leave the State of California to reside or to · practice respondent .shall notify the Board or its designee in writing 30 calendar days prior to the dates of departure and return.
13
14. Interview with the Board or its Designee
Respondent shall be available in person upon request for interviews either at respondent's place of business or at the probation unit office, with or without prior notice throughout the term of probation.
15. Non-practice While on Probation
Respondent 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 respondent's reh1rn t<;> practice. Non-practice is defined as any period of time respondent is not practicing medicine 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 activlty or teaching, or other activity as approved by the Board. If respondent resides in California and is considered to be in non-practice, respondent shall comply with all terms and conditions of probation. All time spent in an intensive trai11ing program which has been approved by the Board or its designee shhll 11gt be considered nonpractice and does not relieve respon.dent from coinply.ing. \Vith ·au the terms and conditions of probation. Practidng medicine ill anot.her state of the United States or Federal jurisdiction while on probation w~th the medical licensing autho.rity of that.state or juriSdiction shall not be considereq rion:-practice. A B~C\rd-orderedsuspen.sion of pra~tice shall ~o·t be co~sklere~ as a period of non:--practice.
' . . . .
In: the event resp01ident's period ofnon~practice while Qn probation exceeds 18 calendar months, responclent shail succe~sfully complete the Federation of State Medical Board's Speci.al Pt.1rpose Examinati¢n, cit,' at the Board"s · discretion, a clinical competence assessment prograll1 that meets the criteria of Condition 18 of the current version· of the Board's "Manual· of Model Disciplinary Ord~rs and Disciplinary Gl.1idelLnes" pri~r to res1{ining the practice of medicine. . · . ·
Respondent'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 for a respondent residing outside of California, will · relieve respondent 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; General Probation Requirements; Quarterly Declarations; Abstain from the Use of Alcohol and/or Controlled Substances; ·and Biological Fluid Testing.
14
16. ·Completion of Probation
Respondent 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, respondent's ce1iificate shall be fully restored.
17. Violation of Probation
Failure to fully comply with any term or condition of probation is a violation of probation. If respondent violates probation in any respect, the Board, after giving respondent notice and the opportunity to be heard, 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 respondent 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.
18. License Surrender
Following the effective date of this Decision, if respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy the tenns and conditions of probation, respondent may request to surrender his or her license. The Board reserves the right to evaluate respondent'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, respondent shall within 15 calendar days deliver respondent's wallet and wall certificate to the Board or its designee and respondent shall no longer practice medicine. Respondent will no longer be subject to· the terms and conditions of probation. If respondent re-applies for a medical license, the application shall be treated as a petition for reinstatement of a revoked certificate. ·
19. Probation Monitoring Costs
Respondent 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 Medical Board of
15
California and delivered to the Board or its designee no later than January 31 of each calendar year.
DATED: February 22, 2018
~DocuSigned by:
p;tt $ol.-tidi:f-~ D00970940B484D9 ...
JILL SCHLICHTMANN Administrative Law Judge Office of Administrative Hearings
16
1 XAVIER BECERRA Attorney General of California
2 JANE ZACK SIMON . Supervising Deputy Attorney General
3 CAROLYNE Ev ANS Deputy Attorney General·
4 State Bar No. 289206 455 Golden Gate Avenue, Suite 11000
5 San Francisco, CA 94102-7004 Telephone: (415) 703-1211
6 Facsimile: (415) 703-5480 Attorneys for Complainant
BEFORE THE
FILED STATE OF CALIFORNIA
MEDICAL BOARD OF CALIFORNIA
SA~¥EN10~ 20.fl BY: 1!" X' \CNAL YST
7
8
9·
MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS
' STATE OF CALIFORNIA
10
11
12
13
14
15
16
17
18
19
In the Matter of the Accusation Against:
Courtney Ricardo Morgan, M.D. 8806 N. Navarro St. Suite 600/#296 Victoria, TX 77904-1427
Physician's and Surgeon's· Certificate No. C129554,
Respondent.
20 Complainant alleges:
Case No. 800-2017-032367
ACUSATION
21 PARTIES
22 1. Kimbe~ly Kirchmeyer (Complainant) brings this Accusation solely in her official
23 capacity as the Executive Director of the Medical Board of California, Department of Consumer
24 Affairs (Board).
25 2. On or about March 29, 2014, the Medical Board issued Physician's and Surgeon's
26 Certificate Number C129554 to Courtney Ricardo Morgan, M.D. (Respondent). The Physician's
27 and Surgeon's Certificate .was in full force and effect at all times relevant to. the charges brought
· 28 herein and will expire on March 31, 2018, unless renewed.
1
(COURTNEY RICARDO MORGAN, M.D.) ACCUSATION NO. 800-2017-03236
1
2 ,., .) .
JURISDICTION
This Accusation is brought before the Board, under the authority of the following
3 laws. All section references are to the Business and Professions Code unless otherwise indicated.
4 4. S~ction 2227 of the Code provides, in part, that a licensee who is found guilty under
5 the Medical Practice Act may have his or her license revoked, suspended for a period not to
6 · exceed one year, placed on probation and required to pay the costs of probation monitoring, be
7 publidy reprimanded, or such other action taken in relation to discipline as the Board deems
· 8 proper.
9 5. Section 2305 of the Code states:
1 O The revocation, suspension, or other discipline, restriction or limitation imposed by another
11 state upon a license or certificate to practice medicine issued by that state, or the revocation,
12 suspension, or restriction of the authority to practice medicine by any agency of the federal
13 government, that would have been grounds for discipline in California of a licensee under this
14 chapter shall constitute grounds for disciplinary action for unprofessional conduct against the
15 licensee in this state.
16 6. Section 141 of the Code states:
17 "(a) For any licensee holding a license issued by a board under the jurisdiction of the
18 departn;ent, a disciplinary action taken by another state, by any agency of the federal government,
19 or by another country for any act substantially related to the practice regulated by the California .
20 license, may be a ground for disciplinary action by the respective state licensing board. A
21 certified copy of the record of the disciplinary action taken against the licens~e by another state,
22 an agency of th~ federal government, or another country shall be conclusive evidence of the
23 events related therein.
24 "(b) Nothing in this section shall preclude a board from applyi~g a specific statutory
25 provision in the licensing act administered by that board that provides for discipline based upon a
26 disciplinary action taken against the licensee by another state, an agency of the federal
27 government, or another country."
28
2
(COURTNEY RICARDO MORGAN, M.D:) ACCUSATION NO. 800-2017-03236
1
2
3 7.
CAUSE FOR DISCIPLINE
(Discipline, Restriction, or Limitation Imposed by Another State)
On or about March 3, 2017, the Texas Medical Board issued a final order (Texas
4 Order) that found that Respondent engaged in unprofessional conduct in that he inappropriately
5 prescribed a controlled substance to six (6) patients; inappropriately prescribed a controlled
6 substance to himself; allowed a non licensed health care provider to have access to his
7 prescription pad and physician signature stamp; and engaged in inaccurate and inadequate
8 medical recordkeeping. As a.result of Respondent's u~professional conduct, the Texas Medical
9 Board placed Respondent on ten (10) years probation with the requirement that he surrender his
1 O Drug Enforcement Administration controlled substance registration; that he not engage in solo
11 practice; that he not treat chronic pain; not perform as a physician for himself; that he be
12 ~valuated by. the Texas A&M Health Science Center Knowledge, Skills, Training, Assessment,
13 and Research program; that he have a physician practice monitor; and that he complete
14 continuing medical education in prescribing controlled substances, medical recordkeeping, risk
15 management, obesity treatment, treatment of low testosterone, and treatment of erectile
16 dysfunction.
17
18
19
20
21
22
23
24
25
8. Respondent's conduct as set forth in paragraph 7 above, and as described within the
Texas Order, attached as Exhibit A constitutes unprofessional conduct and cause for discipline
pursuant to sections 2305 and/or 141 of the Code.
PRAYER
WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,
and that following the hearing, the Medical Board of California issue a decision:
1. Revoking or suspending Physician's and Surgeon's Certificate Number Cl29554,
issued to Courtney Ricardo Mo.rgan, M.D.;
2. Revoking, suspending or denying approval of Courtney Ricardo Morgan, M.D.is
26. authority to supervise physician assistants and advanced practice nurses;
27 3. Ordering Courtney Ricardo Morgan, M.D., if placed on probation, to pay the Board
28 the costs of probation monitoring; and
3
(COURTNEY RICARDO MORGAN, M.D.) ACCUSATION NO. 800-2017-03236
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
4. Taking such other and further action as deemed necessary and proper.
SF2017203757
Executive Director Medical Board of California
·Department of Consumer Affairs State of California Complainant
4
(COURTNEY RICARDO MORGAN, M.D.) ACCUSATION NO. 800-2017-03236
EXHIBIT A
HEARING CONDUCTED BY THE TEXAS STATE OFFICE OF ADNIINISTRATIVE HEARINGS
SOAHDOCKET NO. 503-15-1303.MD TEXAS MEDXCAL LICENSE NO. M-8195
, IN THE MATTER OF THE
· COivIPLAINT AGAJNST
BEFORE THE
COURTNEY RICARDO MORGAN, M.D. TEXAS MEDICAL BOARD
FINAL ORDER
During an open meeting at Austin, Texas, the Texas Medical Board (Board) considered . the Proposal for Decision (PFD) issued by Administrative Law Judge Sara G. Ramos (the ALJ)
of the State Office of Administrative Hearings. On November 29, 2016, the ALJ issued the PFD
in this matter, which contained findings of fact and conclusions of law as to the violations
alleged by the staff of the Board. The PFD was properly served on all parties, and all parties
. were given an opportunity to file exceptions and replies as part of the record herein. Respondent
filed exceptions, and the staff of the Board filed ·replies to the exceptions. The ALJ issued her
ruling on the exceptions on December 28, 2016. The ALJ made minor changes to citations in the
PFD but did not grant any of Respondent's exceptions.
After review and due consideration of the PFD, the Board a~opts the Findings of Fact and
Conclusions of Law of the ALJ.
FINDINGS OF FACT
Factual Background
1. Courtney Ricardo Morgan, TyLD. is a physician licensed by the Texas Medical Board (Board).
2. Dr. Morgan was first licensed to practice medicine in Texas in 2007.
3. Dr. Morgan has owned and operated two medical clinics: Drive Thru Doc, located at 302 W. Rio Grande, Victoria, Texas, and Hop IVIedical Services, located at 2710 Hospital Drive Victoria, Texas.
Procedural History'
4. Staff filed the initial Complaint in this contested case on November 21, 2014, and the
P8ge 1 of 13
First Amended Complaint on February 26, 2016.
5. The Complaint and First Amended Complaint stated the nature of the hearing, the legal authority and jurisdiction under which the hearing was to be held, the particular sections of the statutes and rules involved, and the factual matters asserted.
6. Administrative Law Sarah G. Ramos convened the hearing on July 11, 2016, in the William P. Clements Building, 300 West 151
h Street, Austin, Texas. Attorney Ann ·Skowronski represented Staff, and attorney Marcus Stevenson represented Dr. Morgan. The record closed on September 29, 2016.
Pain Management Clilzic for One lvfontlz
7. During the month of March 2013, Dr. Morgan treated 252 patients at Hop Medical Services. Of those, 159, or 63%, received prescriptions for an opioid, benzodiazepine, or carisoprodol.
8. Dr. Morgan treats patients within his area of specialty.
9. With the issuance of some prescriptions, Dr. Morgan personally uses other forms of treatment, including surgery.
10. Dr. Morgan did not prove that for the patients to whom he issued prescriptions for an opioid, benzodiazepines, or carisoprodol, that he also provided other forms of treatment.
11. Dr. Morgan was required to register as a pain management clinic after the month of March 2013.
12. There was' ·no evidence that Dr. Morgan issued prescriptions for an opioid, benzodiazepine to a majority of his patients for any month other than March 2013.
Standard of Care and Non-therapeutic Prescribing
13. Patient A was treated at Hop Medical Services on December 26, 2012.
14. Dr. Morgan performed a comprehensive physical examination for Patient A; recorded Patient A's medical, social, and family history; ordered appropriate lab results; renewed certain medications; and after receiving lab results, prescribed Marino] to stimulate the underweight patient's appetite.
15. Even though Marino] is ·an FDA-approved for nausea related to chemotherapy for cancer, it can be used for other patients who need to have an increased appetite.
l 6. . Dr. Morgan did not record lab results for Patient A or list risk factors for her medications.
l 7. Patient B was treated at Hop Medical Services on February 26, 2013.
l 8. Dr. Morgan took Patient B's medical history and vital signs, performed a physical examination, and prescribed a cough syrup with codeine to treat the patient's cough.
Page 2 of J 3
19. Although Dr. Morgan complied with the standard of care for Patient B, he did not list the risk factors for taking co9eine in the patient's record.
20. In 2013 at Drive Thru Doc, Dr. Morgan prescribed phentermine for Patients. C, D, E, G, H, and I to treat obesity.
21. Patients C, D, E, G, H, and I had body mass indexes over 27.
22. Phentermine is a Schedule IV drug that works as an appetite suppressant.
23. Phentermine is a psychostimulant, can cause cardiovascular complications, and has a potential for abttse.
24. For Patients C, D, E, G, H, and I, Dr. Morgan did not:
• record an adequate patient history or any lab results;
o record the patient's family, medical, or social histories;
• obtain informed consent or a treatment agreement;·
• except to record prior use of phentermine, list medications the patients were taking;
attempt other treatments before prescribing a controlled substance or confirm that such treatments were provided and were found ineffectual;
·• create a treatment objective and state how the prescribed medications would achieve the intended objective;
• at follow-up appointments, document whether the medication prescribed at the previous visit was therap.eutic for the patients' conditions.
25. Although Dr. Morgan had more informatio11 for the patients in his electronic medical record.s (ErvrR) system, he did not offer that illformation into evidence.
26. Patient F first visited Dr. Morgan's office on April 15, 2013, ~here he complained of erectile dysfunction:
27. Dr. Morgan examined Patient F, ordered Jab results, and prescribed Viagra for him.
28. Dr. Morgan advised Patient F to see his primary care physician before taking the medication if he was already on cardiovascular medications and advised him to see his primary care physiciar1 or go to the emergency room for any unusual symptoms.
29. Patient F's lab results showed low testosterone, and op. April 23, 2013, Dr. Morgan diagnosed Patient F with testicular hypofunction, provided patient education, and prescribed the transdermal gel, AndrogeL
Pnge 3of13
30. · Dr. Morgan did not document Patient F's history, establish treatment objectives, obtained informed consent and a treatment agreement, or discuss other available treatments for prescribing Viagra and Androgel.
Prescribing to Se(ffor Jo.fore than 72 Hours
31. Dr. Morgan prescribed himself at thirty day supply of phentermine, a controlled substance, and filled the prescription· on November 28, 2012, at a Victoria pharmacy.
32. A physician can only prescribe· controlled substances for himself when he has an immediate need, which can be no longer than 72 hours.
Accessible Prescription Pad and Signature Stamp
33. Dr. Morgan had a standing delegation order that authorized employee, Kayla Cady, to perform administrative functions.
34. Dr. Morgan allowed his employee, Kayla Cady, who was not a licensed health care provider, to have access to his prescription pad and signature stamp.
35. When Dr. Morgan was not in the office at Drive Thru Clinic, he sometimes dictated prescriptions to Ms. Cady, including those for controlled substances, and Ms. Cady wrote the prescription on Dr. Morgan's pad and stamped the prescription with his signature stamp.·
Aggravating and JYfitigating Factors
36. Dr. Morgan committed one or more violations that involve more than one patient.
37. Dr. Morgan's conduct increased potential harm to the public.
3 8. As demonstrated by hi~ testimony about proper medical care that should be provided for patients, Dr. Morgan is capable of rehabilitation.
39. No evidence showed actual harm to any patient.
CONCLUSIONS OF LAW
1. The Board has jurisdiction over this matter. Tex. Occ. Code Title 3, Subtitle B (2013 vers.).
2. SOAH has jurisdiction over the hearing in this proceeding, including the authority to a proposal for decision with proposed findings of fact and conclusions of law pursuant to Tex. Government Code Ch. 2003.
3. Dr. Morgan was adequately and timely apprised of the hearing and the allegations against him. Tex. Gov'.t Code §§ 2001.051-.052.
Page 4 of 13
4. Staff had the burden of praying the elements of its case by the preponderance of the evi.dence, while Dr. Morgan had the burden of proving the elements of any claimed exemption under the law. 1 Tex. Admin. Code§ 155.427.
5. The Board has authority to take disciplinary action against a licensee who violates the statutes or rules regarding physicians. Code§ 164.001.
6. A pain management clinic is a publicly or private;ly owned facility for which a majority of patients are issued, on. a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone. Code § 168.001(1); 22 Tex. Admin. Code§ 195.1(2).
7. A pain management clinic may not operate in Texas unless it is registered as a pain management clinic with the Board. Code § 168.101(a); 22 Tex. Admin. Code § 195.2(a)(1).
8. Surgery includes procedures described in the surgery section ofthe common procedure coding system as_ adopted by the Health Care Financing Administration of the United States Department of Health and Human Services. Code§ 151.002(14). ·
9. The owner or operator of a pain management clinic is responsible for registering the clinic. Code§ 168.102(a); 22 Tex. Adn}in. Code§ 195.2(a)(l).
10. After the month of March 2013, Dr. Morgan failed to register Hop Medical Services as a pain management clinic, as defined by Code § 168.001(1); 22 Tex. Admin. Code § 195.1(2).
11. By not obtaining a pain management clinic certification for Hop Medical Services, Dr. Morgan violated Code§ 168.lOl(a), 1.68.102(a) and 22 Tex. Admin. Code§ 195.2(a)(1), and may be sanctioned for the violation. Code§ 164.05l(a)(3).
12. For Patients C, D, E, G, H, and I, Dr. Morgan is s_ubject to disciplinary action under Code § ~64.05l(a)(6) because he failed to practice medicine in an acceptable professional manner consistent with public health and welfare, as further defined by 22 TAC § 190.8(1).
J3. For Patients A and C-I, Dr. Morgan is subject to disciplinary action under Code § 164.015(a)(3) because he violated a Board rule, specifically, 22 TAC§ 165.l(a), when he did not properly document his treatment of the patients.
14. Dr. Morgan is subject to discipline for prescribing phentermine to himself for more than 72 hours. Code§ 164.05.1(a)(3)(2013 vers.); 22 TAC§ 190.8(1)(M).
15. Dr. Morgan violated Texas Department of Public Safety rule 37 TAC§ 13.185(b)(4) that prohibited a physician from leaving an official prescription blank in a location where the practitioner should reasonably believe another person could steal or misuse a prescription.
Pag~ 5of13 ·
16. Dr. Morgan is subject to discipline under Code § 164.053(a)(l), which authorizes the Board to take disciplinary action against a physician who commits an 'ac't that violates any state or federal law connected with the physician's practice of medicine.
17. In accessing a sanction, the Board may consider the aggravating factors that Dr. Morgan committed one or more violations that involved more than one patient and his conduct increased potential for harm to the public. 22 Tex. Admin. Code§ 190. lS(a).
18. In accessing a sanction, the Board may consider, the mitigating factors that no patient was harmed and Dr. Morgan is capable of rehabilitation. 22 Tex. Admin. Code § 190.1 S(b ).
ORDER
The Board hereby adopts the Findings of Fact a11d Conclusions of Law as proposed by
the ALJ and ORDERS the following:
1. Respondent's Texas license is hereby REVOKED; however, the revocation is
STAYED and Respondent is placed on PROBATION under terms and conditions of this Order - .
for 10 years from the date of entry of this. Order. This provision is subject to the tolling provision
in Ordering Paragraph No. 12.
2. Respondent shall surrender his Drug Enforcement Administration . (DEA)
controlled substances registration no later than the tenth calendar day from the entry of thi~
Order. Respondent shall provide to the Director of Compliance evidence of the surrender or
cancellation within seven calendar days after the date of surrender.
3. Respondent is PROHIBITED from obtaining a DEA controlled substances
registration until Respondent has received written auth~rization from the Board. Authority .to
apply for a DEA controlled substances registration may be granted only after Respondent makes
written petition and a personal appearance before the Board, a committee of the Board, or
authorized Board representatives. The decision to grant or deny such peti,tion is in the full
discretion of the Board. Respondent shall not petition the Board for authorization to reapply for a
DEA controlled substances registration for five years from the date this Order is entered by the
Board. This provision is subject to the tolling provision in Ordering Paragraph No. 12,
Page 6of13
4. Respondent practice as a physician is RESTRICTED to a pre-approved group
practice or institutional setting. Respondent shall submit the name of the practice along with
identification of the physicians who own the practice (or if an institutional setting, the name of
the corporation or agency responsible for the management of the practice) to the Compliance
Division for pre-approval. The practice shall not be owned, in part or whole; by Respondent.
Respondent shall not serve in a managerial role nor be responsible for employment decisions
made with regard to medical staff The physicians employing Respondent shall not have prior
disciplinary history with the Board. This restriction shall be in place for five years from the date
this Order is entered by the Board, without any opportunity to modify or terminate the
restriction. This provision is subject to the tolling provision in Ordering Paragraph No. 12.
5. Respondent is RESTRICTED from treating chronic pain. Respondent shall refer
all patients seeking treatment for chronic pain to other providers. This restriction shall be in place
for five years from the date this Order is entered by the Board, without any opportunity to
modify or terminate the restriction: This restriction shall be in place for five years from the date
this Order is entered by the Board, ~ithout any opportunity to modify or terminate the
restriction. This provision is subject to the tolling provision in Ordering Paragraph No. 12.
6. Respondent is RESTRICTED from performing as a physician for himself, family
members, or close personal acquaintances. Respondent shall refer all family members and close
personal acquaintances to other providers. Respondent shall refer his own medical care to
another provider and provide documentation of such to the Co:npliance Division within 30 days
from the day the Order is entered by the Board.
7. Within 30 days from the date of the entry of this order, Respondent shall contact
the Texas A&M Health Science Center Knowledge, Skills, Training, Assessment, and Research
(KSTAR) program to schedule an assessment. Upon Respondent's acceptance into the KSTAR
program, Respondent shall execute a written request and authorization to KST AR representatives
to provide a complete copy of the final assessment, report to the Compliance Division within 15
days of its completion. Respondent shall successfully complete the assessment, and any and all
retraining, remedial measures, and/or other recommendations ·made by KST AR based upon the
assessment,· within one year of the date of the entry of this Order. Respondent shall submit
Page 7of13
documentation of attend~nce and successful completion_ of this requirement to the Compliance ,
Division of the Board on or before the expiration of the time limit set.forth for completion of the
course.
8. After the completion of all retraining, remedial measures, and/or other
recommendations made by KST AR based upon the assessment required in Ordering Paragraph
No. 7, Respondent shall be subject t.o the following terms and conditions for 12 consecutive
monitoring cycles (defined below). Respondent'~ practice shall be monitored by a physician
(monitor), in accordance with Section 164.00l(b)(7) of the Act. The Compliance Division of the
· Board shall designate the monitor and may change the monitor at any time for any reason. The
monitor shall have expertise in a similar specialty area as Respondent. The Compliance Division
shall provide a copy of this Order to the monitor, together with other information necessary to
assist the monitor.
a. As requested by the Compliance Division, Respondent shall prepare and provide
complete legible copies of selected patient medical and billing records (selected
records). The Compliance Division shall select records for at least 30 patients
seen by Respondent during each three-month period following the last day of the
month of entry of this Order (reporting period). The Compliance Division may
select records for more ·than 30 patients, up to 10 percent of the patients seen
during a reporting period. If Respondent fails to see at least 30 patients during
any three-month period, the term of this Order shall be extended until Respondent
can submit a sufficient number ofrecords for a monitor to review.
b. The monitor shall perform the following duties:
1) Personally review the selected records; .
2) Prepare written reports documenting any perceived deficiencies and any
recommendations to improve Respondent's practice of _medicine or assist
in the ongoing monitoring process. Reports shall be submitted as
requested by the Compliance Division; and
3) Perform any other duty that the Compliance Division determines will
assist the effective monitoring ofRespondent's practice.
Page 8 of l 3
c. The Compliance Division shall provide to Respondent a copy of any deficiencies
or recommendations submitted by the monitor. Respondent shall implement the
recommendations as directed by the Compliance Division. If the chart monitor
recommends that Respondent restrict or sqspend his or her practice of medicine,
Respondent shall be required to personally appear before a panel of Board
representatives, upon written request mailed to Respondent1s last known address
on file with the Board at least 10 calendar days before the requested appearance
date. Such appearance shall be for the purpose of consideration of the chart
monitor's recommendations of restriction or suspension and held in accordance
with 22 Tex. Admin. Code, §187.44. Based upon the panel's findings and
recommendations, the Bo.ard may modify this Order so that Respondent's practice
is restricted or suspended, rn accordance with the chart monitor's
recommendations, or take any other action that may be appropriate to resolve the
issues presented.
d. The monitor may recommend that Respondent complete a competency evaluation.
A monitor's recommendation for a competency evaluation must be reviewed by
the Chair of the DiscipJinary Process and Review Committee (DPRC) for the
purpose of making a determination of whether a competency evaluation is
warranted. The Chair may approve or deny the monitor's recommendation. If the
Chair approves the recommended competency evaluation, then the following
terms shall apply and shall be a requirement of this Order:
1) Within 10 calendar days of being notified by the Compliance Division of
the Board that the Chair has approved the monitor's recommendation,
Respondent must contact a program approved by the Board and schedule
an assessment of at least two days in length to determine Respondent's
competence and ability to practice medicine. ·
2) Respondent shall authorize the approved program to send a written report
regarding Respondent's performance. and results of the compet.ency
evaluation directly to the compliance officer.
3) Upon completion of the competency evaluation: and based upon its
results, Respondent· must personally appear before a panel of Board
Page 9of13
representatives, upon written request mailed to Respondent's last known
address on file with the Board at least 10 calendar days before the
requested appearance date. The panel may make recommendations for
appropriate action, including that Respondent foIIow all the program
recommendations, comply with other necessary re~training or r~-education
measures, and may impose any other restrictions or suspension of
Respondent's practice. 22 Tex. Admin. Code § 187.44 (relating to
Probationer Show-Compliance Proceedings) applies to such appearances.
4) TheBoard may temporarily restrict or suspend Respondent's license based
upon the results of the competency evaluation or Respondent's failure to
follow any and all requirements set forth. in subsection ( c) of this section.
22 Tex. Admin. Code, Chapter 187 (1'elating to Temporary Suspension and
Restriction Proceedings) applies to such proceedings.
e. The monitor shall be the agent of the Board, but shall be compensated by the
Respondent through the Board. Such compensation and any costs incurred by the
monitor shall be paid by Respondent to the Board and remitted by the Board to
the monitor. Respondent shall not charge the compensation and costs paid to the
monitor to any patients.
f A "monitoring cycle" begins when the Compliance Division selects patient
records for review, and concludes when Respondent receives the monitor's report
for that group of records and has made payment for the costs of that monitoring
cycle.
8. Within one year following the date of the entry of this Order, Respondent shall
enroll in and successfully complete at least 24 hours of continuing medical education (CME) to
be divided as follows:
a. 8 hours in the prescribing of controIIed substances;
b. 8 hours in the topic of medical recordkeeping;
c. 4 hours in the topic of risk management;
d. 4 hours in the topic of obesity treatment;
e. 4 hours in the treatment of low testosterone; and
P<ige 10of13
f 4 hours in the treatment of erectile dysfunction.
The CME shall be approved for Category I credits by the American Medical Association
and approved in writing in advance by the Executive Director or their designee. To obtain
approval for the course, Respondent shall submit in writing to the Compliance Division of the
Board information on the course, to include· at least a reasonably detailed description of the
' course content and faculty, as well as. the course location and dates of instruction~· Respondent
sha!J submit documentation of attendance and successful completion of this requirement to the
Compliance Division of the Board on or before the expiration of the time limit set forth for
completion of the course. The CME requirements set forth in this paragraph shall be in addition
to all other CME required for Jicensure maintenance.
9. Within one year following the date of the entry of this Order, Respondent shall
take and pass with a score of 75 or above the Medical Jurisprudence Examination ("JP Exam")
given by the Texas Medical Board. Respondent is allowed three attempts to successfully pass
this examination. Respondent's failure to take and pass the JP Exam within three attempts within
one year following the date of the entry of this Order shall constitute a violation of this Order.
10. At all times while Respondent is under the terms of this Order, Respondent shall
give a copy of this Order to all hospitals, nursing homes, treatment facilities, and other health
care entities where Respondent has privileges, has pending an application for privileges, applies
for privileges, or otherwise practices. Within 3 0 days of being first contacted by the Compliance
Division of the Board following entry of this Order, Respondent shall provide to the Compliance
Division of the Board documentation that the Order was delivered and received by such
facilities.
11. The time period of Ordering Paragraphs Nos. 1, 3, 4, and 5 shall be extended for
any period of time that: (a) Respondent subsequently practices exclusively outside the .State of
Texas; (b) Respondent's license is subsequently cancelled for nonpayment of licensure fees; (c)
this Order is stayed or enjoined by Court Order; or (d) for any period of time longer than 60
consecutive days that Respondent . does not actively practice medicine. If Respondent leaves
Texas to practice elsewhere or ceases active practice for more than 60 consecutive days,
Respondent shall immediately notify the Board in ~vriting. Upon Respondent's return to active
Page 1 J of 13
practice or return to practice in Texas, Respondent shall notify the Board in writing. When the
period of extension ends, Respondent shall be required to comply with the terms of this Order for
the period of time remaining on the Order. Respondent shall pay all fees for reinstatement" or
renewal of a license covering the period of extension or tolling.
12. Respondent shall comply with all the provisions of the Act and other statutes
regulating the Respondent's practice.
13. Respondent shall fully cooperate with the Board and the Board staff, including
Board attorneys, investigators, compliance officers, consultants, and other employees or agents
of the Board in any way involved in . investigation, review,. or monitoring associated with
Respondent's compliance with this Order. Failure to fully cooperate shall constitute a violation of ·
this order and a basis for disciplinary action against Respondent pursuant to the Act.
14. Respondent shall inform the Board in writing of any change of Respondent's
office or mailing address. within 10 days of the address change. This information shall be
submitted to the Registration Department and the Complian~e Department of the Board. Failure
to pr~vide such information in a timely manner shall constitute a basis for disciplinary action by
the Board against Respondent pursuant to the Act.
15. Any violation of the terms, conditions, or requirements of this Order by
Respondent shall constitute unprofessional conduct likely to deceive or defraud the public, or to "-·
injure the public, and shall constitute a basis for disciplinary ·action by the Board against
·Respondent pursuant to the Act.
16. Order constitutes a restriction on Respondent's license and Respondent shall not
be permitted to supervise or delegate prescriptive authority to a physician assistant or advanced
practice nurse or supervise a: surgical assistant.
17. The above referenced conditions shall continue in full force and effect without
opportunity for amendment, except for clear error in drafting, for one year followin_g the date of
the entry of this Order. If, after the passage of the one year period, Respondent wishes to seek
amendment or termination of these conditions, Respondent may petition the Board in writing.
The Board may .inquire in~o the request and may, in its sole discretion, grant or deny the petition
Page 12of13
without further appeal or review. Petitions for modifying or terminating may be filed only once
a year thereafter. Respondent shall not seek modification or termination of Ordering Parag~aphs •
Nos. 1, 3, 4, and 5 until the passage of five years from the date this Order ~s entered by the
Board.
SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this
3 day of iY/#1.£/J, 2017.
. ST/: .... ~~~:;;:.,.::.~-.~~.-~ .. ~; .
Sheri a an, M.D., President Texas Medical Board
CO!,JNTY.rn= lK.A\::s
1.:J~\(0\ ~ Ct_S. G::?rtifJ n~at ! 2:-'.1 an cffic~;:l assistant cu~r~ocEan of rn~-9-rds fv~· t~··r,;: 1·::J(~S r~·ieU·fcul Boart.~ and that this is a true and corm ct Copy c;f tiie criglnal, as it appears on t!1e file ia this office.·
Witness my official hand and seal of the BOARD.
This \Lbfl 2ofl_
Page 13of13