On September 14, 2006, Respondent appeared in person, without counsel , at an Informal Show Compliance Proceeding and Settlement Conference in response to a letter of invitation from the staff of the Board. Katie Johnsonius represented Board staff. The Board's representatives were Keith E. Miller, M.D., a member of the Board, and Larry Buehler, a member of the District Review Committee. Upon the recommendation of the Board's representatives and with the consent of Respondent, the Board makes the following Findings of Fact and Conclusions of Law and enters this Agreed Order.
FINDINGS OF FACT(1) Respondent received all notice required by law. All jurisdictional requirements have been satisfied. Respondent waives any defect in notice and any further right to notice or hearing under the Medical Practice Act, Title 3, Subtitle B, Texas Occupations Code (the "Act") or the Rules of the Board.
(2) Respondent currently holds Texas Medical License No. F-7054 . Respondent was originally issued this license to practice medicine in Texas on August 24, 1980. Respondent is not licensed to practice in any other state.
(3) Respondent is primarily engaged in the practice of family medicine . Respondent is not board certified.
(4) Respondent is 58 years of age.
(5) Respondent has not previously been the subject of disciplinary action by the Board.
(6) On March 7, 2006, Respondent had an initial appointment with patient CH, and ordered several tests, some of which were particularly requested by CH. On March 22, 2006, CH first requested copies of her lab reports. On March 23, 2006, a member of Respondent's staff reported to CH that the lab results were all in, but that she would have to make an appointment with the Respondent to receive them. CH made several written requests for the records, including a letter quoting the Board's rule regarding a physician's duty relating to release of records .
(7) Respondent did not provide CH with her lab results, or offer her a written statement regarding why Respondent would not produce them. Respondent has offered the complainant and the Board several conflicting explanations as to why she could or would not provide them .
(8) After Respondent learned that CH had filed a complaint with the Board regarding the records, Respondent's office sent CH a bill for $20, with a notice on it that it was overdue. When CH called the office in an attempt to learn what the bill was for, Respondent came onto the line, accused CH of being overly-demanding and rude, and hung up the phone. CH's account was actually paid in full.
(9) After that call, Respondent had CH served with a Criminal Trespass Warning by the Victoria Police Department. Respondent stated that she had become concerned for her own safety where CH was concerned. There is no evidence that CH made or posed any sort of threat whatsoever, except by the filing of the complaint with this Board
(10) In responding to the Board's inquiry into reasons for the delay in producing CH's medical records, the Respondent indicated that it is her practice to hold all test results until complete results have been obtained, and then to require her patients to come into the office to receive test results in person. She indicated in her May 10, 2006, written response to the Board's investigation that she does not believe that it is the best interest of her patients to deviate from this policy.
(11) Respondent explained that her policy regarding holding test results until all results have been received and the patient has come in for a follow-up appointment is not written, but that it is nonetheless known by all her staff and communicated to all patients. However, there is no credible evidence that the complainant was notified of this office policy.
(12) Respondent has cooperated in the investigation of the allegations related to this Agreed Order. Respondent's cooperation, through consent to this Agreed Order, pursuant to the provisions of Section 164.002 the Act, will save money and resources for the State of Texas. To avoid further investigation, hearings, and the expense and inconvenience of litigation, Respondent agrees to the entry of this Agreed Order and to comply with its terms and conditions.
CONCLUSIONS OF LAW Based on the above Findings of Fact, the Board concludes that:
(1) The Board has jurisdiction over the subject matter and Respondent pursuant to the Act.
(2) Section 164.052(a)(5) of the Act authorizes the Board to take disciplinary action against Respondent based upon Respondent's unprofessional or dishonorable conduct that is likely to injure the public, in particular, the disruptive behaviors that could reasonably be expected to impact the quality of her patients' care, as described in Board Rule 190.8(2)(Q).(3) [c04-Vio Rule 165 – Med Recds] Section 164.051 (a)
(3) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent's violation of Board Rule 165.2 relating to the release of medical records pursuant to written request.
(4) Section 164.001 of the Act authorizes the Board to impose a range of disciplinary actions against a person for violation of the Act or a Board rule. Such sanctions include: revocation, suspension, probation, public reprimand, limitation or restriction on practice, counseling or treatment, required educational or counseling programs, monitored practice, public service, and an administrative penalty .
(5) Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition of this matter through an Agreed Order.
(6) Section 164.002(d) of the Act provides that this Agreed Order is a settlement agreement under the Texas Rules of Evidence for purposes of civil litigation.
Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that: [g01-Chart Monitoring]
1. For a period of one year from the date of the Board's entry of this Order, Respondent's practice shall be monitored by a physician ("monitor"), in accordance with §164.001(b)
(7) of the Act.
a. 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.
b. 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 ten 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 of records for a monitor to review.
2. The monitor shall perform the following duties:
a. Personally review the selected records
b. 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
c . Perform any other duty that the Compliance Division determines will assist the effective monitoring of Respondent's practice .
3. 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 .
4. 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.
5. [i08-Specific Subject/Time to Complete]Within one year from the date on which the Board enters this Order, Respondent shall obtain ten hours of Continuing Medical Education (CME) in the area of medical record- keeping, to be approved in advance by the Executive Director of the Board. Upon completion of the required CME, Respondent shall submit proof to the Board. A copy of attendance certificates or a detailed report that can be readily verified by the Board shall satisfy this requirement.
6. [j01-Admin Penalty] Respondent shall pay an administrative penalty in the amount of $500 within 90 days of the date of entry of this Order. The administrative penalty shall be paid in a single payment by cashier's check or money order payable to the Texas Medical Board and shall be submitted to the Director of Compliance for the Board for routing so as to be remitted to the Comptroller of Texas for deposit in the general revenue fund. Respondent's failure to pay the administrative penalty as ordered shall constitute grounds for further disciplinary action by the Board, and may result in a referral by the Executive Director of the Board for collection by the Office of the Attorney General.[i03-Specific Sub/Nos Hrs]
(a) Respondent subsequently resides or practices outside the State of Texas,
(b) Respondent's license is subsequently canceled for nonpayment of licensure fees, or
(c) this Order is stayed or enjoined by Court Order. If Respondent leaves Texas to live or practice elsewhere, Respondent shall immediately notify the Board in writing of the dates of Respondent's departure from and subsequent return to Texas. 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 extended Order. Respondent shall pay all fees for reinstatement or renewal of a license covering the period of extension. (standard paragraph- non-negotiable)
7. 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. (standard paragraph- non-negotiable)
8. Respondent shall inform the Board in writing of any change of Respondent's mailing or practice address within ten days of the address change. This information shall be submitted to the Permits Department and the Director of Compliance for the Board. Failure to provide such information in a timely manner shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act.
9. Any violation of the terms, conditions, or requirements of this Order by Respondent shall constitute unprofessional conduct likely to deceive or defraud the public, and to injure the public, and shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act. Respondent agrees that ten days notice of a Probationer Show Compliance Proceeding to address any allegation of non-compliance of this Agreed Order is adequate and reasonable notice prior to the initiation of formal disciplinary action. Respondent waives the 30 day notice requirement provided by §164.003(b)(2) of the Medical Practice Act and agrees to 10 days notice, as provided in 22 Texas Administrative Code §187.44(4).
10. The above referenced conditions shall continue in full force and effect without opportunity for amendment, except for clear error in drafting, for 12 months following entry of this Order. If, after the passage of the 12 month period, Respondent wishes to seek amendment or termination of these conditions, Respondent may petition the Board in writing. The Board may inquire into the request and may, in its sole discretion, grant or deny the petition without further appeal or review. Petitions for modifying or terminating may be filed only once a year thereafter. (standard paragraph- non-negotiable)RESPONDENT WAIVES ANY FURTHER HEARINGS OR APPEALS TO THE BOARD OR TO ANY COURT IN REGARD TO ALL TERMS AND CONDITIONS OF THIS AGREED ORDER. RESPONDENT AGREES THAT THIS IS A FINAL ORDER. THIS ORDER IS A PUBLIC RECORD. I, Shirley Persons Pigott, M.D. , HAVE READ AND UNDERSTAND THE FOREGOING AGREED ORDER. I UNDERSTAND THAT BY SIGNING, I WAIVE CERTAIN RIGHTS. I SIGN IT VOLUNTARILY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEMENT OF ANY KIND, VERBAL, WRITTEN OR OTHERWIS E. DATED:
____________________________________ SHIRLEY PERSONS PIGOTT, M.D. RespondentSTATE OF __________________ §COUNTY OF ________________ §
SWORN TO AND ACKNOWLEDGED BEFORE ME, the undersigned Notary Public, on this _______ day of____________________, 2007. (Notary Seal)____________________________________Signature of Notary Public
SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this _______ day of____________________, 2007. _______________________________________Roberta M. Kalafut, D.O., PresidentTexas Medical Board