med board report

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2010 - 2011 ANNUAL REPORTMedical Board of California

2005 EvergreenStreet, Suite 1200, Sacramento, CA95815 (916) 263-2389 www.mbc.ca.gov

Executive SummaryThe Medical Board is a special-fund entity, which meansit operates solely on revenues received from its licensingand enforcement authority. During the 2010-2011 fiscalyear, the Board faced restrictions from a general hiring-freeze mandate. With vacancies increasing, due inpart to the large number of employees opting to retire,staying current with all Board responsibilities was achallenge - but a challenge we ambitiously met.One important and ever-present challenge the Boardfaces is maintaining the lowest applicant processingtimes possible, with a goal to be lessthan half theregulatory maximum. A valuable service the Boardprovides to teaching hospitals and physician recruiters,through its educational outreach program, has provento be a great success. This program responds torequests from hospitals throughout the state to assistresidents, fellows, and incoming physicians with theBoard's licensing process. This fiscal year the Board

visited 40 teaching hospitals and spoke with morethan 2,000 potential applicants. The licensing processcan be daunting and the Board views this program asmission critical knowing that assistance is helpful andencouraging to applicants.Physicianwell-being and access to care continue to bean important focus of this Board - enough so to formcommittees of the same names. Eachquarterly issue ofthe Board's MBC Newsletter includes an informationaland educational piece on physician well ness and shareswarning signs and suggestions to overcome the manyobstacles that can arise from the stressful life of amedical doctor. The Access to Care Committee's focus ison collaborative practice models in medicine to addresssome of the health care shortage issues, and the Boardviews accessto quality health care as a high priority toreinforce and promote with collaborators across thestate and the nation.

Current Physician and Surgeon Licenses by CountyData reflects physicians with a renewed and current license excluding those in an inactive, retired, or disabled license status.The breakdown of those license statuses is: California - 2,291, Out of State - 3,981, Total- 6,272.Alameda 4,531 Inyo 43 Monterey 870 San Luis Ob is po 777 Trinity I'. " ! i _ 7Alpine , 2 Kern 1,108 Napa 476, San Ma te o 2,690' Tulare ' ": 486"Amador , 65 Kings " .! 136 Nevada ~~~ 298 San ta Ba rba ra 1,196 Tuolumne !, . 123Butte < t; : ~ 471 Lake "< " ,j 77 Orange "' : 9,240 Santa C la ra 7,140 Ventura 1,687Calaveras ;;],,;' 55 Lassen r r 36 Placer 1,015 Sant a C ruz 691 Yolo ~'~ 502~ 'I ; , , ,~nColusa I; 10 Los Ange les 27,704 Plumas 39 Shasta , 428 Yuba 41Cont ra Co st a 3,004 Madera 201 Riverside " 2,777 Sierra ' i to . 1 . - 0 CaliforniaDe l No rt e 42 Marin I , , ' 1 1,449 Sacramento 4,380 Siskiyou ..~,~'"~l:''' 81 total 100,544EI Do rado 289 Mariposa -, 10 San Benit o 41 Solano 895 Out-of-StateFresno 1,830 Mendocino ~ 203 San Be rna rd ino 3,665 Sonoma 1,334 total 23,854Glenn 10 Merced 231 San D ie go 9,559 Stanislaus 934 CurrentHumboldt 290 Modoc ., 4 San Franc is co 5,935 Sutter 187 l icensesImperial 134 Mono 30 San Joaqu in 1,045 Tehama 't 49 total 124,398~

The mission of the Medical Board of CaliforniaThe mission of the Medical Board of California isto protect health care consumers through proper licensing and regulationof physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of theMedical Practice Act, and, to promote accessto quality medical care through the Board's licensing and regulatory functions.
http://www.mbc.ca.gov/http://www.mbc.ca.gov/


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Medical Board of California 2010-2011 Fiscal Year

Revenues ReimbursementsPhysician & Surgeon Renewals $43,571,000 84.5%Application & Initial License Fees 5,481,000 10.6%Reimbursements 1,628,000 3.2%Other Regulatory Fees, Delinquency/Penalty/Reinstatement Fees, Interest on 860,000 1.7%Fund, MiscellaneousTotal Receipts ' .. $51,540,000

Budget DistributionEnforcement Operations $22,660,000 43.7%Legal & Hearing Services 15,060,000 29.1%Licensing 5,045,000 9.7%Information Systems - 3,118,000 6.0%Executive 1,944,000 3.8%Probation Monitoring 1,735,000 3.3%Administrative Services 1,688,000 3.3%Operation Safe Medicine 577,000 1.1%Total

.,$51,827,000

84.5%

Licensing ProgramThe Medical Board of California's licensing Program continues to achieve its mission of protecting the health care oconsumers through the proper licensing of physicians and surgeons and certain allied health care professionals. TheLicensing Program also issuesfictitious name permits, and licenses non-nurse midwives, research psychoanalysts,spectacle and contact lens dispensers, and registered dispensing optician businesses. It also approves accreditationagencies that accredit outpatient surgical centers in which general anesthesia is being used.During the last fiscal year, the licensing Program received 6,047 new physicians' and surgeons' applications andissued 5,272 licenses. The Licensing Program also conducted one international medical school site visit for a schoolapplying for recognition and recognized two English language international medical school programs. In addition,all physicians' and surgeons' applications were reviewed well below the 60 working days regulatory time frame.These accomplishments were achieved despite multiple staff vacancies. Staff continues to identify opportunities tostreamline and improve the application process, and improve the Program's outreach efforts.

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Licensing Program Activity~ ,~. FY09-10 FY10-11

Physician Applications Received 5,964 6,047Phys ic ia n L ic en se s I ss ued ,~"FLEX/USMLE1 4,357 4,419NBMEl 266 302Reciprocity with other states 487 551Total new licenses issued 5,110 5,272Renewal licenses issued - with fee 56,066 57,663Renewal licenses issued - fee exempt! 4,748 4,993Total licenses renewed 60,814 62,656Phys ic ia n L ic en se s I n E ff ec t3California address 98,816 100,544Out-of-state address 23,635 23,854Total 122,451 124,398F Ic titio us Name Perm its III ~Issued 1,118 1,2884Renewed 4,968 4,943Total number of permits in effect 12,549 13,094

~ .~~ ; 1 ' FY09-10 FY10-11Special Faculty Permits , ~ o i' .{ :~ ,-,Permits issued 2 ermits renewed 5 11Total active permits 14 14LicensingEnforcement Activity FLicensesIssued with Public Letter ofReprimand 7 13Probationary license granted 19 23License denied (no hearing requested) 3 3Statement of Issuesto deny license filed 2 6Statement of Issuesgranted (license denied) 3 1Statement of Issuesdenied (license granted) 3 tatement of Issueswithdrawn 1 11 FLEX: Federation licensing Examination

USMLE: United States Medical licensing ExaminationNBME: National Board Medical Examination

2 Includes physicians with disabled, retired, military, or voluntary servicelicense status

3 Reporting for FY10/11 excludes physicians with inactive, retired,or disabled license status

4 Includes 22 FNPsissued on behalf of the Board of Podiatric Medicine

Appl ic at io n S ta tu s Ve ri fic at io nsVerification & Reporting Activity Summary

FY09-10 FY10-1139,405 98,996

'"15,371 29,08170,334 51,4342575 490

2,331,033 2,631,3857,702,498 6,458,77011,791 11,706,~, 'r,I,995 946532 3195477 4868

WAAS application look-up'L icense Status Ve ri fi ca tions 1 .~ .,.;;,Telepj'lone verif ications 'Non~verification telephone callsAuthorized LVS3 Internet usersOnline LVS3access.ver if icat ionsWeb I,tense look-upCei"tif ication"letters and Letters of Good StandingReporting A ctiv ities ' ,.B&P Code 805 reports of health facility discipline receivedDisciplinary reports mailed to health facilities upon written request pursuant to B&P Code 805,5Adverse Actions reported to the NPDB4

Allied Health Care ProfessionsLicenses/Registrations

" ' . " '_. ~ ." tr Issued Current" , .,Licensed Midwife 40 252Dispensing Optician 69 1,161Contact Lens Dispenser 73 902Non-Resident Contact Lens Seller 11Spectacle Lens Dispenser 196 2,182Research Psychoanalyst 8 92Accreditation Agencies for Outpatient 4SettingsPodiatrist 58 2,0869

Medical Board of California 2010-2011 ANNUAL REPORT

1 WAAS:Web Applicant AccessSystem- reporting started 1/28/102 Doesnot include the 19,355 listed under Consumer Inquiries on pagev3 LVS:licensing Verification System4 NPDB:National Practitioner Data Bank5 Includes 99 MDs and 0 Podiatrists Includes 93 MDs and 1 Podiatr ist1 Includes 473 MDs, 9 Podiatrists, 26 PhysicianAssistants, 21 Registered

Dispensing Optician Program Registrants, 7 licensed Midwives and 11Denials by licensing Program

8 Includes 417 MDs, 19 Podiatrists, 31 PhysicianAssistants, 4 RegisteredDispensing Optician Program Registrants, 1 licensed Midwife and 14Denials by licensing Program

Includes fee-exempt licenses

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2010 Licensed Midwife Annual Report Summaryl.'. u, ,. ~ 2009 2010Clients served as primary caregiver at the onset of care 3,023 3,115Clients served with collaborative care available through or given by a licensed physician and surgeon 1,461 1,802Clients served under the supervision of a licensed physician and surgeon 285 203Planned out-of-hospital births at the onset of labor 1,974 2,245Planned out-of-hospital births completed in an out-of-hospital setting: 1,621 1,840Twin Births 8 5Multiple Births (other than Twin Births) 2 0BreechBirths 11 13VBAC(vaginal births after the performance of a Cesareansection) 90 109

Complications - Resulting in the mortality of the mother prior to transfer ,0 0Complications - Resulting in the mortality of the mother after transfer _, 1 0Complications - Resulting in the mortality of the infant prior to transfer , 2 0Complications - Resulting in the mortality of the infant after transfer ~ r 2 2Antepartum - Primary care transferredto another health care practitioner (elective) 209 240Antepartum - Urgent or emergency transport of expectant mother 56 49Intrapartum - Elective hospital transfer v 282 333Intrapartum - Urgent or emergency transfer of an infant or mother i, ~ I 1 1 ' ~ 42 53\,Postpartum - Elective hospital transfer of mother 32 28Postpartum - Elective hospital transfer of Infant 27 22Postpartum - Urgent or emergency transfer of a mother 27 21Postpartum - Urgent or emergency transfer of an infant 24 37

primary caregiver.1 Conclusions should not bedrawn from this summary asdata does not specify whether the death isfetal, intrapartum or neonatal; whether the affected perinate

had congenital anomalies incompatible with life; or whether the perinate was born in or out of a hospital. Births are attended bythe licensed midwife asthe

During the fiscal year, the EnforcementProgram focused on identifying areas ofconcern and best practices to improvecasetime lines and was successful inthe implementation of several processimprovements, including: updatingmanuals; reviewing policies andrecommending changes to the Board;and, reconcil ing data and statistics ona monthly basis to track time lines andtrends.Although the Enforcement Programwas again faced with operationalchallenges including staffing shortages,the average Complaint Unit timeframe was reduced despite receiving583 more complaints than last year.The Notice to Consumer Regulation,requiring physicians in California toinform their patients that they arelicensed by the Medical Board ofCalifornia and provide the Board'scontact information, was a large factorin the nearly 10 percent increasein complaints and is anticipated tocontinue to increase the amount ofiv

Enforcement Programcomplaints received in the future.Facedwith a substantial increase inconsumer complaints, the reductionof the investigative time frameremained a high priority throughout theyear. The Enforcement Program wassuccessfully able to reduce the overalltime frame to complete an investigationby 5 percent. This decrease is, inpart, due to the extensive trainingprovided to Enforcement Programinvestigators including training for timemanagement, multi-tasking skills, andutil izing technological tools to improveindividual tracking methods.SB700 (Negrete McLeod, Chapter 50S,Statutes of 2010), became effectivethis year, requiring the Board to createa new reporting form pursuant to805.01 of the California Business andProfessions Code and to post an 80S(Peer Review Process) Fact sheet onthe Board's website. The law requireshospitals to inform the Board of aformal investigation within 15 days and

2010-2011 ANNUAL REPORT

allows the Board accessto relevantdocuments upon the notificationversus having to wait until the hospitaldisciplinary hearing has been held.SB700will enable theEnforcementProgram to process 80S cases in a moreexpedited manner resulting in betterconsumer protection.The Board's Operation Safe Medicine(OSM) was responsible for seizing morethan $100,000 of contraband contactlenses and arresting several unlicensedindividuals who were illegally sellingthem. OSM was largely responsiblefor the 41 cases referred to the DistrictAttorney or City Attorney resulting in animpressive 23 criminal complaints beingfiled. The volume and seriousness ofthe cases investigated and submittedfor prosecution continues tounderscore the importance of havinga unit dedicated solely to the issue ofunlicensed practice and demonstratesthe Enforcement Program's goal ofprotecting the consumers of California.

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Malpractice Settlement ReportsReceived per Business and Professions Code

section. 801.01 by Specialty Practice

No. o f No . o fSpecialty/Subspecialty } Reportsl Physlclans zAllergy and Immunology 2 665Anesthesiology 34 5,093Cardiology 19 3,064Colon and Rectal Surgery 4 161Critical Care 1 1,12~Dermatology 4 1,908Emergency Medicine 13 3,753Gastroenterology 11 1,541General/Family Practice 51 8,376General Surgery 39 4,311Geriatric Medicine 1 741Gynecology 16 .5,337Infectious Disease 1 777Internal Medicine 53 24,684Neonatal/Perinatal Medicine 7 599Neurological Surgery 11 550Neurology .. 7 1,882Obstetrics 28 5,337Oncology 3 1,589Ophthalmology 9 2,699Orthopedic Surgery 32 3,200Otolaryngology 8 1,472Pain M~dicine 2 530Pathology 7 3,501Pediatrics 9 9,818Physical Medicine & 2 923Rehabilitation'Plastic Surgery 31 927Psychiatry 6 6,450Pulmonology 4 1,402Radiation Oncology 1 537Radiology 29 5,322Rheumatology 1 626Sleep Medicine 1 196Thoracic Surgery 1 670Urology 13 1,260Vascular Surgery 6 2531 The procedure was performed in the practice speciattv/subspeclaltv: however, the

physician mayor may not have been certified in the specialty/subspecialty area2 California physicians certified in specialty according to the American Board of

Medical Specialties 2010 Certificate Statistics report


Internal

Other37%

General/FamilyPractice11%

General Surge8%

Anesthesiology7%Obstetrics

6% Radiology6%

Orthopedicastic Surgery Surgery.7% 7%

Reports perBusiness and Professions Code

section 805T ot al R e po rts R ec eiv ed i. 'j~'; H 93

P ee r R ev ie w B od y Typ e i.Health Care Facility/Clinic 58Hospital/Clinic 0Surgical Center 0Health Care Service Plan 19Professional Society 0Medical Group/Employer 16O utc om es o f R ep orts R ec eiv ed ~; ; , I,'Accusation Filed 1Pending Disposition 61Cases Closed 31

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Enforcement Program Action SummaryPhysicians & Surgeons

Complaints Received by Type & SourceY 09-10 FV 10-11C~mplaints/lnvestigationslComplaints received 6,539 7,122Complaints closed byComplaint Unit 5,251 5,670

Investigations ~ ' "Cases opened 1,312 1,338Cases closed 1,290 1,411Cases referred to theAttorney General (AG) 569 594Cases referred forcriminal action 35 41Number of probationviolation reportsreferred to the AG 32 35

Consumer Inquiries"ii Q llo III . .Consumer inquiries 20,447 19,355Jurisdictional inquiries 11,246 10,645

Enforcement Processing Time FramesAverage and median time (calendar days) in processing complaintsduring the fiscal year, for all cases,from date of original receipt ofthe complaint, for each stage of discipline, through completion ofjudicial review:FY09-10 FV 10-11

Complaint Unit #processing 76 63 74 77Investigation 328 292 312 283AG Processing topreparation of anaccusation 106 66 107 72Other stages of thelegal process (e.g., aftercharges filed) 368 312 417 324

Enforcement Field Operations Caseload2FV 10-116 Statewide PerInvestigator,Active 1,205' 16investigationsAG assigned cases" 660 9

Probation Unit Sta~wide I.~

Caseload4 Per Inspector~ , III oMonitoring Cases" 402 25

Some casesclosed were opened Ina prior f iscal yearIncludes physicians and surgeons, licensed midwives, researchpsychoanalysts, dispensing opticians, podiatrists, physicianassistants, psychologists, and osteopathic physicians andsurgeonsa These casesare at various stagesof AGprocessing and mayrequire supplemental investigative work, such as subpoenaservices, interviewing new victims or witnesses, testifying athearings, etc. Includes physicians and surgeons, licensed midwives, researchpsychoanalysts, and dispensing opticians5 103 additional monitoring caseswere inactive because theprobationer was out of state asof June 30, 20116 Average isdetermined by using the total number of authorizedpositions, including vacant positions.vi

'"_ . . .. . . iij e u 'tj> C U e : : : J0 C'" iij. e u e u o u,!! - e lIDu 0 C C _ o uIII = s ._ C lID 0 0 o u l ! !II - e u e u u 'iii'" l ID . . . . "'''' e u e u~ .;: e u e u III iij ,!!'tj "' . .: : : J ZD. U C c.!!!o u . . ~ '" E . . . 0 O : : : J e u l l De u " ' o u ~ l ! !::J iij C '" 0 e D.cu ~II e u 0 . . e u Co cc. . :z : Z ... C 0 Q. :lu :l:l Total.I. ~-

Public 42 68 1,047 2,427 0 55 1,041 138 4,818S&P Code6 0 1 0 787 0 86 25 0 899Licensee/ 11 13 20 50 0 42 137 32 305Prof. Group7Government 8 20 7 84 64 247 401 96 927AgencY'Misc./ 20 15 11 29 0 13 45 40 173AnonymousTotals 81 117 1,085 3,377 64 443 1,649 306 7,122

. .1 Health and Safety complaints, e.g., excessiveprescriblng, sale of dangerous drugs, etc.Z Non-jurisdictional complaints are not under the authority of the Board and are referred toother agencies such asthe Department of Health CareServices, Department of ManagedHealth Care, etc.

] Gross Negligence/Incompetence complaints are related to the quality of care provided bylicensees

4 Personal Conduct complaints, e.g., licensee self-abuse of drugs/alcohol, conviction of acrime, etc.

5 Unprofessional Conduct complaints include sexual misconduct with patients, discipline byanother state, failure to release medical records, etc.

6 Reference isto B&PCode 800 and 2240(a) and includes complaints initiated based uponreports submitted to the Medical Board by hospitals, insurance companies and others, asrequired by law, regarding instances of health facility discipline, malpractice judgments/settlements, or other reportable activities

7 Licensee/Professional Group includes the following complaint sources: other Licensee,Society/Trade Organization, and Industry8 Governmental Agency includes the following complaint sources: Internal, LawEnforcementAgency, other California State Agency, other State, other Unit of Consumer Affairs, andFederal or other Governmental Agency

Reports Received Based Upon Legal Requirements~ FY09-10 I,qaFVio-11" ,. . -J< !l~ ..... '1,; ,~ " .~Medical Malpractice I I : l I "Insurers: B&P Code 801.01 556 0 482IAttorneys or Self-Reported or Employers: aB&P Code 801.01 253 .. 224Courts: B&P Code 803 8 4Total Malpractice Reports 817 all 710

Coroners' Reports: B&P Code 802.5 18 o lSCriminal Charges & Convictions: "B&P Code 802.1 & 803.5 122 74Health Facility Discipline ReportsMedical Cause or Reason: B&P Code 805 99 II 93Outpatient Surgery Settings ReportsPatient Death: B&P Code 2240(a) 6 "" S ,

2010-2011 ANNUAL REPORT Medical Board of California


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Enforcement Program Action Summary

minis ra Ive u comes 'y ase iypeProbation ProbationarySuspension with License Public Other TotalRevocation Surrender Only Suspension Probation Issued Reprimand Action ActionsNegligence/Incompetence 4 13 0 1 35 0 70 2 12

appropriate Prescribing 6 5 0 4 8 0 7 0 3l icensed Activity 0 0 0 0 1 0 1 0xual Misconduct 7 6 0 2 3 0 2 0 2ntal/Physical I llness 6 2 0 0 1 0 1 0 1lf-Abuse of Drugs/Alcohol 0 4 0 2 12 0 1 0 1

0 1 0 0 0 0 11 0 1onviction of a Crime 10 8 0 6 9 0 2 0 3professional Conduct 5 7 0 0 9 23 13 1 5scellaneous Violations 0 0 0 0 4 0 0 2otals by Discipline Type 38 46 0 15 82 23 108 5 31

FY FY09-10 10-11

Administrat ive Actions " 'rAccusation 276 265Petit ion to Revoke Probation 24 35Amended Accusation/Peti tion to Revoke Probation 62 78Number of completed investigations referred to the AG 156 173awaiting the filing of an Accusation as of June 30, 2011Number of cases over 6 months old that resulted in the 224 213f il ing of an AccusationAdministrat ive OutCQmes '1~Revocation 34 38Surrender (in l ieu of Accusation or wi th Accusat ion 71 46pending)Suspension Only 0 0Probation with Suspension 13 15Probation 93 82Probationary License Issued 19 23Public Reprimand 116 108Other Actions (e.g., exam required, educational course, etc.) 3 5Accusation Withdrawn1 11 14'Accusation Dismissed 8 7Dispositions o f Probation FIlingsProbation Revoked or License Surrendered 14 11Additional Suspension and Probation 2 1Additional Suspension or Probation 9 3Public Reprimand 0 1Other 1 1Petition Withdrawn/Dismissed 1 1Referra l and Compliance ActionsCitation and Administrative Fines Issued 111 65

Ad o tt

Accusations withdrawn for the following reasons: physician passed a competencyexam; physician met stipulated terms and conditions; physician was issued acitation/fine instead; physician died, etc.Penalty Relief includes Petitions for Modification of Penalty and Petitions forTermination of ProbationPursuant to B&PCode 2220.05(c), ISOsand TROswere granted in the followingpriority categories: 2-gross negligence/incompetence resulting in death or seriousbodily injury, O-drugor alcohol abuse involving death or serious bodily injury,2-excessive prescribing, 2-sexual misconduct with a patient, and O-practicingunder the influence of drugs/alcohol


FY FY09-10 10-11

Petition ActivityPetition for Reinstatement of License Filed 16 20Petition for Reinstatement of Licensed Granted 5 5Petition for Reinstatement of License Denied. 6 7Petition for Penal ty Rel ief2 Granted 26 26Petit ion for Penal ty Rel ief2 Denied 9 8Petition to Compel Exam Filed 20 19Petit ion to Compel Exam Granted 20 11Petit ion to Compel Exam Denied 0 0License R~strlct lons/Suspenslons Imposed WhileAdminist rative ActIon PendingInter im Suspension Orders 19 213Temporary Restraining Orders 0 1Other Suspension Orders 31 384License Restrlctlons/Suspenslons/Temporary RestrainingOrders Sought and Granted by Case TypeNote: Some orders granted were sought in prior f iscal year . Sought GrantedGross Negligence/Incompetence 12 13Inappropriate Prescribing 6 6Unlicensed Activity 1 2Sexual Misconduct 6 7Mental/Physical Illness 3 11Self-Abuse of Drugs or Alcohol 6 6Fraud 4 4Criminal Charges/Conviction of a Crime 2 7Unprofessional Conduct 5 4Total 45 60

b c 5T

4 Includes 4-Automatic Suspension Orders per B&P Code 2236, lO-licenserestrictions per Penal Code 23, 20-out-of-state suspension orders per B&P Cod23l0, l-stipulated agreement to suspend or restrict the practice of medicine,and 3-suspension orders issued bythe Chief of Enforcement for violation ofprobation condition

5 Pursuant to B&P Code 2220.0S(c), diSCiplinary actions were taken in thefollowing priority categories: 38-gross negligence/incompetence resulting indeath or serious bodily injury, O-practicing under the influence resulting in deator serious bodily injury, 13-excessive prescribing, l6-sexual misconduct with apatient, and l-practicing under the influence of drugs/alcohol

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Enforcement Action SummaryAllied Health Care Professionals1

FY09-10 FY 10-11Complaints/Investigations '{_.,~.

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