Is There Such A Thing As A "Bad" Fact In A Case?

Clients ask me all the time, is this a "bad" fact?

My response may sound a little "zen" rather than lawyer-like in that I tell them just to tell me ALL the facts and not worry for now if it's good or bad.  In a case, the only truly "bad" fact is one I do not know as I cannot prepare for it, anticipate it or explain it.

Often there are damaging facts that get worse if we do not own them and explain them or gain credibility with the judge and jury by bringing them out ourselves and owning them. I will be the one to tell the judge or jury this damaging fact. Every case has a mixed set of facts - or else we would not be in court or have a legal dispute.

When you meet with me or your lawyer, write out an attorney-client privileged chronology. Do your best to remember everything and tell your lawyer everything. Sometimes what you may think in your own judgmental head is a "bad" fact is something that helps explain what happens or that we can use to our advantage.

Posted by Tracy Green, Esq. 

How We Prepare For Your Administrative Hearing & 3 Basic Tips We Give Our Clients to Help Prepare for Hearings

Administrative and Board hearings are similar to trials, but some differences exist in procedure and practice. There is no jury and the administrative law judges (ALJ) must follow statutes, regulations, administrative procedure act (APA), constitutional requirements of due process and consider guidelines from the regulating agency. 

We encourage our clients to understand the administrative rules and procedures that will govern the conduct of the hearing since this is not simply making your "case" to the judge as if it were a jury that decides "guilty" or "not guilty." There are very different standards.

This is one of the reasons that individuals and businesses that represent themselves in pro per have a very difficult time and usually do not do well. Although the paperwork sent out by the agencies indicates that they can represent themselves it is almost universally a bad idea. At a minimum, if a client has financial restrictions and limitations, they should try to work out a payment plan with an attorney or at least pay for a consultation and find out what they need to do to prepare for their case at hearing or settlement.  

What else do you need to know if you are preparing for a State of California administrative hearing? Here are 3 things you need to know. There are many more levels but here are three basic things to know and consider:

First, you must know that if the ALJ reaches a decision that the board or bureau will not approve, that bureau or board does not have to adopt it. It is therefore important as an advocate to suggest a result and create a strong record that the board or bureau at issue will adopt. Otherwise, our client will have to start over again. 

Thus, if you have a recent felony conviction for fraud, the likelihood of going to a hearing and persuading an ALJ to dismiss the Accusation and impose no discipline would be difficult to achieve. But if it were achieved, it would be very unlikely that the board or bureau will adopt it unless the circumstances are so unusual and the record is well-established. Then you have to go through another hearing. In other words, trying a "Hail Mary" pass.

Second, we are creating a "record" with admissible evidence including administrative hearsay. We want a strong record for a couple of reasons: to have the ALJ adopt the findings we want and to have a record that will allow the board or bureau to adopt it. We push our clients to obtain evidence and expert testimony that they sometimes do not think is important but they do not understand that we want something other than their own testimony just in case the ALJ says our client is "not credible." Preparation is key. In most cases, witness testimony, without more, is not sufficient to prove your case. Exhibits, including documents and other forms of evidence such as expert witness reports, are often necessary.

This is where we seek to be creative when there are challenging facts or why we will seek to introduce a great deal of evidence in the record that can support our suggested level of discipline or findings of no discipline. This is also important for creating a record on appeal.  

Third, we help our clients know the ALJ. We gather information from other advocates about the particular practices of the hearing officer or administrative law judge if we have not previously appeared before him or her. We want to know the following:

How active a role does the ALJ or hearing officer play in taking testimony from witnesses? Some will ask questions or clean up weaknesses in the government's case. Some let you try your case.

How does the ALJ handle exhibits and administrative hearsay introduced by declaration? 

Does the ALJ or hearing officer apply any evidentiary rules? 

Is the hearing officer knowledgeable about the substantive law? 

What is the hearing officer’s attitude toward clients, witnesses, and advocates? 

Should you be prepared for anything unusual about the hearing officer’s conduct during hearings?

Make sure you practice good "Hearing Etiquette." Always arrive at the hearing on time or early. Be polite to the hearing officer and all of the parties. Comport yourself in a professional manner. No eye rolling, head shaking or displays of emotion when the judge or hearing officer is speaking or a witness is testifying. You want to show your professionalism and never compromise your credibility or that of your client by lowering your standards of professionalism or courtesy. And when we are acting professionally, understand that it will help you in the long run. Banging on the table or shouting is just for TV lawyers - an ALJ will stop listening. 

We make good records with witnesses, exhibits and persuasive testimony. We let the facts speak for themselves and that also creates good records on appeal.

For your case, you can call or schedule a complimentary 15 minute consultation. Call 213-233-2260 or email tgreen@greenassoc.com.

Posted by Tracy Green, Esq. 

San Diego Doctor Who Took Photos of Patients On Cell Phone Agrees to Interim Suspension Order Pending Accusation or Criminal Filing

A San Diego physician agreed to an interim suspension order by the California Medical Board as reported by the San Diego Tribune in its article that was effective October 31, 2014. The physician admitted that he took photos and videos of female patients using the camera on his smart phone. The patients were unclothed in some of the photos. In addition, the patients alleged inappropriate touching or photographing. This interim suspension order will require the Medical Board to file an Accusation within 30 days but it appears there is also a criminal investigation as well.

Any physician who takes photos of patients whether clothed or not should be careful to obtain proper consent forms, use a camera for office use only where the photos will be HIPAA compliant and that there is a medical reason for the photos or videos.

Posted by Tracy Green, Esq.

California Board of Pharmacy Obtains Interim Suspension Order Against Pharmacy and Pharmacist Due To Counterfeit Drugs and Violations of Pharmacy Law

Over the past seven years, there has been increased investigations on illegal drug diversion at pharmacies and the sale of counterfeit prescription medications at pharmacies. There have been companies and individuals which have been accused of buying back prescription medications from patients and selling them to distributors who create false records of authenticity or selling them to pharmacies at a reduced price.  

In a recent California Pharmacy Board case, the Board sought and obtained an Interim Suspension Order against a pharmacy, Adams Square Pharmacy in Glendale, California, arising from the pharmacy returning counterfeit Cialis to Eli Lilly through a pharmaceutical reverse distributor. This was pursuant to Business and Profession Code Section 494(a)(2) on the grounds that the pharmacy posed a danger to the public health, safety and welfare. the judge also found that the return of the counterfeit Cialis was dishonesty, fraud or deceit. Here is a copy of the decision on the interim order.  The order shut down the pharmacy. The order also precludes the pharmacist owner Margarita Kazarian from working as a pharmacist in charge.  The Los Angeles Times also reported on this matter.  The Pharmacy Board has indicated that it will file an Accusation against Ms. Kazarian by July 1, 2014.

The primary ground for the suspension was that the pharmacy had counterfeit Cialis tablets in its stock. This was discovered when  the Cialis returned by the pharmacy was found to be counterfeit Lilly drug product and were returned in a genuine Lilly packaging and container. The Pharmacy Board conducted an inspection on November 11, 2013 and found more counterfeit Cialis in the pharmacy and numerous other Pharmacy Board violations.

Pharmacies need to be vigilant in their ordering and be careful when ordering from distributors who are selling trade name drugs at prices below the manufacturers. There are currently federal criminal cases filed throughout the country regarding the operation of businesses dealing in counterfeit drugs or drugs that have been recycles through the system through pharmacies or patients. In the Los Angeles area, there were groups who bought prescription drugs from patients and then repackaged them with fake certificates and resold them into the stream of commerce. This is considered illegal drug diversion.

Pharmacies should check their stock, their suppliers and make sure this does not happen to them.  In addition, the pharmacies should be ready for inspections without the issues that this pharmacy faced which included failing to maintain adequate records of sales, disposition, and acquisition of medications; expired medications on the shelf; overfilled containers; etc.  This is also considered unprofessional conduct.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Phone: 213-233-2260
Email: tgreen@greenassoc.com

Recent Success Story: Nursing Student With Recent DUI Given Unrestricted RN License After Appealing Denial Of License

Last summer we had a victory in an appeal of a denial of an RN application before the Board of Nursing. This cases are more common now since the Boards are much stricter on rejecting license applications if there is a prior conviction - especially one for driving under the influence.  

A summary of the facts and strategy will show how these cases are handled and can be guided to a successful result or "win."  Although this was a RN application, the process is similar to other types of licensees when they are denied licenses and appeals are filed.

Factual and Procedural Background Surrounding 
Appeal from Denial of a License. 

• In December 2010 while in an RN program, the nursing student was convicted of driving under the influence of alcohol and placed on 3 years probation. There were no other convictions or other alcohol or drug-related problems in his background.
• In September 2011, while still in his RN program, he filed an application to take NCLEX-RN. He did not have counsel and submitted his own letter regarding the DUI conviction. I often find that early representation by counsel helps create a better package and record of mitigation and rehabilitation. 
• In November 2011, the Board of Nursing asked for more information regarding the criminal conviction. The nursing student still did not have counsel and handled the response himself. While he did his best, it was not how we would have recommended proceeding.
• In December 2011, the Board of Nursing denied the application for licensure by examination based on the recent DUI conviction with a high blood alcohol content. At this point, we were hired and filed a timely Notice of Appeal. 
• We immediately began to work with our client and prepared a significant mitigation package that had a lot of different moving parts, letters, reports and documentation. We began negotiations with the Deputy Attorney General assigned to the case on behalf of the Board of Nursing. 
• It took four months to get the mitigation package completed that we wanted and it was submitted to the Board through the Deputy Attorney General. The typical settlement for this type of case is a provisional license that requires the licensee to be on probation once the NCLEX is passed, and those terms are negotiated. 
• Due to the strength of the mitigation package and work we did and had our client do, in May 2012 the Board of Nursing declined to pursue any discipline against the client and he was approved to take NCLEX and the case was transferred to the licensure department. 
• In July 2012, our client was notified that he had passed his NCLEX and became a licensed RN. 

This was a great win since it would have been very difficult for our client to get hired if he had been on probation. It would have cost him a great deal of money over three years in lost income while on probation and would have been a permanent mark on his record that would have hurt his career. We estimated there would have been more than $100,000 in lost income and saved expenses over 10 years. Every case is different and this client was willing to work hard and do all the things needed for us to make him shine before the Board. 

Posted by Tracy Green, Esq. Please email Ms. Green, a very experienced nurse attorney, license attorney, and board hearing attorney at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation. 

New Rules Require Revocation Of Physician Assistant License If Registration As Sex Offender Required - Critical To Have Chaperones And Be Careful Of Plea Agreements Involving Sexual Issues

Over the years I have represented physicians, physician assistants, nurses and other health care professionals who have been accused of unlawful "touching" by a patient. In a number of these cases, the allegations were false. For example, one high profile gynecologist was accused of sexual touching when he conducted a breast exam of a 55 year old woman with fibroid breasts both with her laying down and sitting up. Since she had never had a breast exam where she was sitting up, she made a complaint. The complaint was dismissed but it was an unpleasant interview for the physician to go through simply because he was being thorough.

A few years ago, a physician assistant was accused of sexual touching because he placed the stethoscope just under the area near the breast while he listened to the heart -- very standard routine exam. The complaint was dismissed but only after an interview and investigation.

Recently, I was asked to consult on a case where a physician was charged criminally with a violation of Business & Profession Code 726 which prohibits sexual contact with patients since the physician had consensual oral sex with a patient.

Currently, I am representing a health care professional who is accused of touching a woman's breasts over the clothes during an exam. The case has been filed criminally since the same complaint was made by two different women and the present plea offer is a misdemeanor but with a requirement that he register as a sex offender. The sex offender registration is part of the regular plea offer. In his case, it would not be a bar to practice but if he were a physician assistant it would be a bar.

The Physician Assistant Committee in California has decided to increase the level of discipline for any physician assistant who has had sexual contact with a patient or who has been convicted of  a sex offense as defined in Section 44010 of the Education Code. Under the revised California Code of Regulation 1399.523 there is a finding that any proposed decision "shall contain an order revoking the license" and that "[t]he proposed decision shall not contain an order staying the revocation of the license."

What does this mean? First, if a physician assistant has sexual contact with a patient in violation of Section 726 or is convicted of any sex offense defined in Education Code Section 44010 which includes any registration as a sex offender -- the physician assistant's license will be revoked and is not eligible for probation.

For those unfortunate enough to be charged with any offenses related to sexual touching or gratification, any defense or plea of such charges needs to consider this important change.

For those that are practicing, it is critical that the use of chaperones -- especially for male PAs -- be considered as a routine policy. It should be essential during physical exams especially during breast and pelvic exams. However, all the patient needs to allege are things like touching a breast over clothes, rubbing a penis against a leg during a physical exam -- and there can be a critical issue. I have seen such allegations and they seem to be increasing for a variety of reasons and most of the cases I have handled have been false or exaggerated claims.


Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.
Any questions or comments  should be directed to Tracy Green, a very experienced California physician assistant attorney, health care attorney, and California Board attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers in California and throughout the country. Their website is: http://www.greenassoc.com/

Sample Victories in Administrative and Licensing Cases - Many Which Followed Criminal Investigations Or Convictions

Often I get asked the question about what kind of results we obtain in cases. I might jokingly say that lawyers are like gamblers: you only hear about their winnings. However, we have obtained some excellent results even though every case is different. 

Some cases are true damage control cases while others clearly should not rise to the level of discipline. Quite a few are in the middle. I am a believer in working on the mitigation side of the case as early as possible, securing experts and creating good facts for the client. This often takes educating a client about what it takes to get a case closed without discipline especially as Board's have gotten harsher on the discipline these past 5 years. 

The following true cases are examples of our dedication to our clients and the quality of our work:

Medical Board of California

Petty Theft Arrests And Dispositions Results in No Disciplinary Action (2011)

Doctor client had been charges twice with shoplifting. In the first case, the doctor completed a diversion and the misdemeanor charge was dismissed. In the second criminal case, in which we represented her, she was charged with felony theft and we were able to reduce the charge to an infraction after a diversion. After assisting client with disclosures to the Board, the matter was closed without any discipline. 

Four Misdemeanor Convictions Results in Probation With No Suspension Time (2011)

Doctor client had been convicted of DUI in 2011, disturbing the peace in 2010, DUI in 1995 and DUI in 1994. Aggravating factors were an arrest for DUI with no charges filed after refusal to take a blood or breath test and an arrest for public intoxication with no charges filed. We worked on creating a sobriety program with the doctor after the 2011 DUI arrest but before the Accusation was filed. Once the Accusation was filed we worked with the client on the mitigation package. The matter was settled before hearing for probation with no suspension time. 

Criminal Conviction Mandated Reporting Results in No Disciplinary Action (2010)

Doctor client had been charged with Medi-Cal fraud and we represented her in the criminal case. After the preliminary hearing, we filed a motion to dismiss and the charges against her were dismissed but one of her nonmedical corporations plead to a criminal count since there was billing for services not provided and she was an officer of the corporation. After assisting client with mandated disclosures to Board and an interview and submission of mitigating evidence, matter was closed without discipline.

Felony Criminal Conviction For Fraud Results in Probation With No Suspension Time (2010)

Doctor client had been charged with Medi-Cal fraud with over $300,000 in restitution and we represented him in the criminal case. There was devastating evidence as the clinic was run by managers who used the doctor's license to commit fraud (prescriptions for power wheelchairs, hospital beds and unnecessary diagnostic tests). After assisting client with mandated disclosures to Board and an interview, we sought to settle the matter. The Board insisted on revocation of license. After a hearing with excellent mitigation evidence and an expert witness, the hearing officer imposed probation with no suspension time and the Board adopted the decision. 

Workers Compensation Complaint Results in No Disciplinary Action (2010)

Internist doctor client had seen a workers' compensation patient for a limited purpose (high blood pressure). The patient did not have any health insurance and had other health issues for which he was not authorized to be seen by the workers' compensation doctor. The doctor's charting was problematic, the referrals to other providers were not documented and the notes were minimal. We had the doctor sign up for a charting class before the Medical Board interview, submitted mitigating evidence regarding the role of a workers' compensation doctor in treatment, and presented other mitigating evidence.  The matter was closed without discipline. 

Nursing Board of California

Texas Probation Results in No Disciplinary Action On California License (2011)

Nurse maintained her California license after she moved to Texas. Nurse was placed on probation in Texas and successfully completed probation. California opened a complaint here in California for failure to report her Texas discipline and for the underlying case in Texas. We submitted a detailed response and mitigation package requesting that the case be closed without any discipline in California. After assisting client with disclosures to the Board, the matter was closed without any discipline. 

DUI Conviction and Failure to Comply With Diversion Program Resulted in Board Filing Petition to Revoke Probation - Probation Reinstated After Hearing (2011)

Nurse was convicted of DUI and placed on probation with required participation in diversion program and drug/alcohol testing. Nurse missed numerous testings. Board filed petition to revoke probation. We reached a settlement reinstating probation with an additional year of probation after submitting an extensive mitigation package. The Board of Nursing refused to adopt the settlement and demanded we go to hearing. The Board sought revocation of the license. After a hearing, the hearing officer issued a decision reinstating the license with an additional year of probation.   

Physician Assistant Board of California

Medical Marijuana Compliant Results in No Disciplinary Action On California License (2011)

Physician Assistant was performing physical examinations on patients for medical marijuana recommendations. Physician Assistant Board's position was that only a medical doctor can perform such examinations and that the examinations cannot be delegated. After assisting client with submissions to the Board and an interview, the matter was closed without any discipline. 

Inserting Non-FDA Approved IUDs Results in No Disciplinary Action On California License (2009)

Physician Assistant was inserting IUDs on low income patients in the Medi-Cal program which turned out to be non-FDA approved and made in Canada. After assisting the client with an audit by Medi-Cal, making disclosures to patients, we helped him respond to the Board complaint. After assisting client with submissions to the Board and an interview, the matter was closed without any discipline. 

Physical Therapy Board of California

Misdemeanor Conviction for Carrying Firearm in Public Place  Results in Public Reproval (2011)

Physician Assistant was convicted of misdemeanor of carrying a firearm in a public place and had the added fact of being in the possession of marijuana legally with his medical marijuana recommendation due to a disability.  After presenting the legal arguments, mitigation package and a settlement conference, the matter was resolved with a public letter of reproval.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 15-minute consultation. 

Any questions or comments  should be directed to Tracy Green, a very experienced administrative law attorney, licensing attorney, and board and bureau investigations and hearing attorney at tgreen@greenassoc.com. 

What To Do When A Board Or Government Investigator Requests Records Or Comes To Your Office: What To Do And What NOT To Do - Part 1

If a board investigator from an administrative agency a criminal investigator contacts you or comes to your place of business or requests records in writing, the first step you need to take is contacting an attorney experienced in this area of the law. Tracy Green has given lectures to many professional associations indicating what an individual should do (and not do) when contacted by an investigator or when there is a request for records. Even a one or two hour consultation will help you prepare and not make critical mistakes that can harm you later.

A board representative may claim to have your best interests in mind and may tell you that “you don’t need an attorney.” Unfortunately, their job is not to protect your rights. They prefer to catch you off-guard before you have had time to prepare or think about the issues. For this reason, they do not usually make appointments. They just “show up” at your office.  In addition, they do not usually tape your interviews but have a second person there and they take down “notes” and create a report that is difficult to challenge later. 

It is much easier to be proactive and handle the cases properly from the beginning than to defend an Accusation or other proposed charges. Good beginnings make good ends.

Let's begin with general points to understand about the process. This is Part 1. Look for upcoming articles on this topic.

7 GENERAL POINTS TO UNDERSTAND 

ABOUT REQUEST FOR RECORDS OR INTERVIEWS

1.  The probability of getting a board complaint or being investigated by a state licensing board is increasing for several reasons. First, the longer you practice, the greater chance that you will receive a complaint. Second, there is greater political pressure on the boards and bureaus in California to be aggressive and harsher on the discipline. Third, common sources of complaints are patients/clients, competitors, insurance companies and disgruntled ex-employees. People are more inclined to complain in today's world especially since it is easy for them to find out how to do it on the Internet and the forms are downloadable. 

2.  It is important to know what is being investigated and the nature of the complaint(s) before there are interviews or responses to records are submitted. An experienced attorney knows how to find out this information in a professional manner that will make you look competent and responsible.

For example, I have had numerous cases where a new complaint reactivated an old complaint that my client did not even know existed because it was closed out at the intake level. This is why it is important to know what is being investigated before there are interviews or responses to records. This is also necessary so an overall defense strategy can be implemented. 

In one case, an OB-GYN was visited by a Medical Board investigator and asked to interview him about a patient who alleged a sexual touching. Investigator told him he didn't need an attorney. Sexual allegations are the MOST difficult to get rejects on if they get filed. OB-GYN called me and I spoke to the Board investigator, explained that I am his health care law attorney and I want to be present at the interview. Investigator told me "if it were me, I'd want an attorney present." Before the interview, I made reasonable demands to find out which patients were going to be at issue in the interview so we could ensure that proper releases had been signed and we could review the files beforehand. Turns out that in prior years there were two prior sexual touching complaints that had been closed out at the intake level but my client did not even know about them. All three complaints were completely false: one was complaining about a clitoral examination when the patient had elephantitis of the vagina and was at risk for tumors which was explained to her; another was complaining about having a woman with fibrous breasts sit up and lay down during the breast exam; and the other was equally absurd. Before the interview, all files were reviewed, a summary of each patient's treatment was provided, statements were obtained by staff from those that were present during the examinations, and the doctor was prepared to answer the questions without being offended, upset or too emotional. The investigator was also presented with the OB-GYN's policies and procedures for examining all women with a chaperone present. The case was closed after the interview and presentation of records. 

3.  If  you receive is a request for records or interview, it means that it has passed the intake process and a case has been opened.  That case will be either closed or it will be forwarded to the Attorney General's Office with a recommendation for filing disciplinary action. The GOAL is to get the case closed or to minimize the allegations that are forwarded to the Attorney General.  There is a range of cases ranging from meritless ones to questionable ones to difficult ones. Even with difficult cases, the goal is to have damage control and to determine how to achieve the best result possible even when the facts are not in my client's favor. The investigators have discretion and it may be that I need to help my client build good facts showing in various ways how my client is an outstanding professional

4.  The board or government representatives are NOT your friends. They are often very friendly and one of the biggest mistake my clients make is talking to them since they seemed "so nice" or because they were afraid of "making them mad." This is a very unsophisticated approach. Investigators are trained how to minimize in order to obtain more information. Just imagine that there is an Accusation filed and we are going to hearing, but you tell me "well, Tracy, I think the investigator liked me at the interview." There is a very easy way not to antagonize the investigator and have your attorney assert your rights. A good attorney knows how to make you look good while asking to be present at the interview. 

5. Be professional and respectful even while exercising all your rights. Now this does NOT mean that we fail to be aggressive in your defense but it means that we do not antagonize the investigator or Deputy Attorney General. As much as you want me to write a nasty letter threatening to sue the State, in the beginning I'll recommend instead a letter that focuses on the facts and why this investigation does not have merit. 


It means that we are very cordial -- respecting the power that they can wield over your license -- but we are strong and professional at the same time. The fact is that they know the details of the complaint and we know nothing. This means that we need to learn as much as the investigator to the extent possible before any interview. In addition, the investigator only knows one side of the investigation and we want to educate them as much as possible. I have gotten involved in cases after my client has threatened to sue the Board, the invetigator and that did not help their case. I am aggressive about defending my clients but smart about how to approach the Board and the investigators.  

6. Do NOT take investigations or requests for records lightly even if you are confidant that you did not do anything wrong. For example, assume there is a complaint by a former patient/client that you committed malpractice. The records are clear that there is no malpractice and, in fact, it was a good result. However, a review of the records shows that the recordkeeping is poor -- a surgical report is missing, the notes are skimpy, the handwriting is illegible and/or some other required information is not recorded. 

7.  The time to seek advice is before the records are produced or before there is any type of interview. It may be decided that a letter summarizing the treatment or client history is a good idea. It may also be decided with the help of the attorney that the missing record should be recreated but with a clear indication that the record was unexplainably missing and was recreated in order to give a complete record. Declarations or statements may be obtained from employees or other witnesses.

Some of my clients made serious missteps by backdating records or sending less than ideal records to the investigator without transcribing or summarizing them. Or they think that if the records are disorganized it will help them. To the contrary, if there are good facts, you want to make the job easier for the investigator and give him or her good reasons to close the case. Often the investigator may be sending the files to an expert witness and you want the expert to be able to read and understand the records, especially if there are good facts. A good summary from your attorney can help that process significantly. The advantage of the letter coming from the attorney is that it is not evidence from you.    

Your professional future, the value of a clean license and your rights are of critical importance to our firm.  We know what is at stake when licensees face a California governing body without the aid of an experienced attorney. How you initially respond to a state licensing board investigation or request for records may determine if you get sanctioned, get placed on probation, lose your license, or lose your livelihood. Now that all discipline is on the website, sanctions can adversely affect insurance plans, client/patient confidence and your reputation.


Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.

Any questions or comments  should be directed to Tracy Green, a very experienced administrative law attorney, licensing attorney, and board and bureau investigations attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed providers and in administrative board and discipline matters in California and throughout the country. Their website is: http://www.greenassoc.com/

Frequently Asked Questions: Should I Expunge My Conviction If I Am A Licensed Professional Or Want To Apply For A State License? What Is Expungement? Can I Get A Felony Reduced To A Misdemeanor?

Here is the second in a series of posts on frequently asked questions regarding misdemeanor and state felony convictions, expungements of those convictions and how expungements can affect licensed professionals during California Board or Bureau proceedings. This post will also assist other professionals and persons for whom a state conviction would affect their employment opportunities.

Question 2: What is an expungement?

Answer 2:  In California, the law regarding expungements is governed by Penal Code Section 1203.4 and 1203.4a.  An expungement reopens your criminal case, dismisses and sets aside the conviction or plea (of guilty or no contest), and re-closes the case without a conviction. In effect, you are no longer a convicted person. However, the case record itself will still exist, and the expungement will appear on your record.  There are three types of expungements:

(1)  Penal Code 1203.4 allows the court to expunge cases in which probation was part of the sentence. For example, straight probation cases or those with probation and county jail. The court must grant these expungements if you are not on probation, have completed all terms of your probation (including restitution and fines) and do not have a current crimnal case.

(2) Penal Code 1203.4a  allows the court to exercise its discretion and expunge cases in which there was no probation. In these cases, it is important to submit a declaration with setting forth your rehabilitation, the reasons you want expungement, and other relevant information. We often represent clients in these type of expungements where the court has discretion to deny the expungement.

(3) Penal Code 17 allows the court to reduce certain felony conviction to a misdemeanor. The misdemeanor can then be dismissed or expunged.  If you received state prison as your sentence, you are not eligible for a reduction to a misdemeanor. You will need to file paperwork for a Certificate of Rehabilitation instead.

This will be addressed in a subsequent post but if you had a felony conviction it it is important to have the conviction reduced to a misdemeanor before it is expunged. In determining whether to enter into a plea agreement, having a "wobbler" felony which can later be reduced to a misdemeanor is often a key negotiating point.

An expungement does not seal or destroy a client's criminal record, but it allows the client to state to a private employer (not to government or state licensing agencies or to certain  publicly funded employers like the lottery) that he or she has not been convicted of a crime.  Expungement of a client's record helps increase the likelihood that the client will be able to obtain employment and shows increase his or her family's financial stability.

Question 3: I am going to apply for a license (law, medical, nursing, real estate, etc.) and I had a criminal conviction in my past.  Should I have it expunged before I begin  the application or license renewal process or will it make any difference?

Answer 3:  Yes. Have it expunged since the expungement can be used as mitigating evidence by the Board or Bureau. As noted in my prior post on this topic (Do I Need To Disclose Convictions That Have Benn Expunged In Professional License Or Government Applications?), the expungement does not relieve you of the requirement to report the expunged conviction but is useful in order to obtain a license or obtain a lesser amount of discipline.   

I recommend that everyone have their convictions expunged since it also allows you to answer "no" to the question of whether you have ever been convicted of a felony or misdemeanor in any job application. However, remember that many employers conduct background checks and the conviction will still show up in background checks along with the expungement.

Question 4: Once my conviction is expunged, can I answer "No" to questions about convictions on job applications?

Answer 4: Legally, you may answer "No" to these types of questions. Keep in mind, though, that background checks typically go back 10 years, and employers can see that you had a conviction dismissed.

I have had calls from frustrated job applicants realizing they were losing employment opportunities after the background checks. Thus, if you know it is a large company that will run a background check, you may decide that answering "No" could look dishonest. A better response for some employers may be "Yes in 2005, but case dismissed and expungement granted in 2009."You could also attach a letter of explanation to explain the circumstances and how you have turned your life around and what you learned from that experience.

If you are applying for a government job, a job that requires security clearance, or a job that requires a government-issued license, certificate or permit, the conviction will be discovered during the standard background check. You should disclose the conviction and expungement in these situations.

If you are applying for a government-issued license, certificate, or permit, you must disclose your conviction and expungement.

As I noted in a prior post, the California Boards and Bureaus have gotten a lot tougher over the past five years and failure to invest adequate time and effort into this process (including proper expunegment and reduction to a misdemeanor) can cost someone a lot of lost income due to delay or denial of licensing. Spending $1,000 to $5,000 in putting together a mitigation and expungement package and explanation can often save clients hundreds of thousands of dollars over a few years.  It is in investment that is often well spent. 

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Any questions or comments  should be directed to Tracy Green, an experienced California board, administrative and licensing attorney with more than 25 years' experience at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed professionals in California and throughout the country. Their website is: http://www.greenassoc.com/

California Physician Charged With Sexual Crime Against A Patient: When Do Physicians & Other Licensed Professionals Have To Report Criminal Charges Or Convictions To Their Board?

 

Here is a recent case which I will use as a case study to discuss when do arrests and charges need to be reported. Although this case uses the Medical Board, the same analysis applies to other licensing agencies even though each agency's rules are slightly different.

On December 30, 2010, the Ventura County District Attorney's Office filed charges against Dr. Barry Lefkovitch of Thousand Oaks, California.  Dr. Lefkovitch has been charged with two felony violations of Penal Code Section 289(d) (4), forcible sexual penetration by fraud, perpetrated upon a patient of the defendant and one count of sexual battery. 

 
The allegations in the felony complaint are that Dr. Lefkovitch assaulted one of his patients during a routine visit at his medical practice on Dec. 13, 2010.  Each charge carries a maximum possible prison term of eight years. The case was investigated by the Ventura County Sheriff's Department.

Dr. Lefkovitch appeared for arraignment on these charges on December 30, at which time the arraignment was continued to February 1, 2011. Dr. Lefkovitch was released on his previously posted $250,000 bail bond with the condition that he not treat female patients without a third person, a medical/health professional, present. This was an interesting term of bail and is much better than the Medical Board seeking to close his practice while charges are pending.

This case is unusual in that the Medical Board of California is working with the investigating agency and participated in the execution of search warrants at Dr. Lefkovitch's home and medical offices.


The charge in Penal Code Section 289(d)(4) requires that the government prove beyond a reasonable doubt that the patient "was not aware, knowing, perceiving, or cognizant of the essential characteristics of the act due to the perpetrator's fraudulent representation that the sexual penetration served a professional purpose when it served no professional purpose."


Investigators have publicized the doctor's arrest and filing of criminal charges claiming they "are concerned there may be other patients who have been victims of similar acts by Dr. Lefkovitch and encourage anyone with information" to contact the assigned detective. In such cases, one is always concerned that false claims could be reported by individuals seeking attention. However, law enforcement could use other acts by the doctor to help prove its case even if there were no charges filed.


Using this doctor's case as a case study, when does he have to report to the Board that he has been charged with an offense? Assuming that the Medical Board is not involved, he would not have to report the arrest at this point. Nor would he need to report the filing of a state criminal complaint. He would, however, have to report the charge after a preliminary hearing when he has been held to answer and after a document known as an "Information" is filed in his criminal case. In the majority of state cases, there are no "indictments." However, in federal cases, "indictments" are the norm. Thus, if he had been indicted on a federal felony charge, he would have had to report it within 30 days.


When Do You Have To Inform The Medical Board That You Have Been Arrested Or Charged With A Crime?  In this doctor's case, the Medical Board was aware of the investigation from its inception and thus a file has already been opened. In typical criminal cases, the Medical Board is not aware of the filing of criminal charges whether a misdemeanor or felony. When do you need to self-report and how do you do it? What are your options assuming the Board is not aware of your case?


There is a statute that governs the reporting of criminal charges (California Business & Profession Code Section 802.1) to the Medical Board in California.  The Medical Board also has a form on which you self report where required. (Click on this link to go to the form.) Have your attorney review the form so you do not make any mistakes or unintentional misrepresentations.


1) If you have been arrested for a misdemeanor, you do not need to report the arrest. However, this means that your main goal should be to get the misdemeanor dismissed so there is no conviction. Physicians and other licensed professionals need to be aware that misdemeanor convictions will result in discipline in today's world. Five or ten years ago it may have been only a public reprimand but the world has changed in this regard. The licensing boards and agencies are under greater public scrutiny and are more aggressive in pursuing discipline even when it is not a "patient or client related" offense. The catch all "moral turpitude" ground is used to justify discipline against the professional.


Case Study On Felony Shoplifting Case Resolved Prior To Preliminary Hearing  For example, I  recently represented a physician for shoplifting in a state case. Since the loss was over $400 (and she had a prior arrest for shoplifting) it was filed as a felony. Although she was offered a plea involving no jail time and a reduction to a misdemeanor, we aggressively represented the case and negotiated an agreement before any preliminary hearing (which would have triggered the reporting requirement). The plea involved community service, attending a program on shoplifting, payment of fines and the charge was reduced to a traffic infraction. Thus, there were no reporting requirements.


If she had been convicted of even a misdemeanor, she would have been subject to probation by the Board. The cost of her criminal defense was far less than the money she would have lost had she been placed on probation by the Medical Board since she would have lost many of her insurance contracts and the probation would have been reported on the Medical Board website. This is why we represent the physician in both the criminal and administrative case - so there is unified  strategy (and it is more cost efficient for the client).


2) If you have been convicted of a misdemeanor, you are required to report the conviction within 30 days after the conviction.


3) If you are arrested on a felony charge in state court, you do not need to report the charge until after a preliminary hearing has been held (or you agree to waive preliminary hearing) and you are held to answer on an "Information."


4) If you are arrested on a felony charge in federal court after being Indicted, you are required to report the charge within 30 days after the Indictment is filed. If you have agreed to a plea agreement in federal court that involves an "Information" you are required to report within 30 days after the filing of that Information.


Case Study - Felony Charge in State Court:  Given the reporting requirements for felony convictions, we seek to be creative while at the same time minimizing the risk to our client's license. For example, in a couple of recent Medi-Cal fraud case where there was billing for services not provided or billing for non-FDA approved devices, we were able to have corporations (rather than the individual physician) plea guilty to the offense before the filing of an Information to avoid physician conviction reporting requirements.


4) If you are convicted on a felony charge in state or federal court, you are required to report the conviction within 30 days after the conviction.


5) If you have not followed the reporting requirements, you will need to report when you renew your license. Remember that even if your conviction has been expunged, you will need to answer "yes" that you have been convicted of a misdemeanor or felony. 


I have seen numerous cases where licensees answered "no" to the conviction question for misdemeanors and the "no" answer caused more problems than the "yes" answer would have done in the first place. We work with physicians and licensed professionals to help them answer "yes" and submit a package in the beginning to minimize the damage that can result from a conviction. I cannot repeat enough that these cases need to be handled properly from the beginning. Most of the hard cases we have are where professionals tried to handle it themselves and made a bigger mess of the matter before they hired counsel. Often a lot of damage has been done by that point. Even a two hour consultation can prevent a professional from making a mistake that will ultimately cost them tens of thousands of dollars in lost income.


6) Are there times when physicians do not self-report? What happens then? We have had cases where physicians (or other professionals) know they are going to lose their license due to the conviction and are seeking to work as long as they can before they lose the license. They seek to delay out the process and in those cases, we respect their decisions but advise them of the risks and consequences. We also seek to help them with the damage control since there are many times when even a felony conviction will result in probation, some suspension time but they will be able to keep their license in the long run. Once reporting or discovery of the conviction occurs, we handle the reporting and Board defense. We respect our client's decisions but will push them if we believe a mistake is going to be made that will hurt them in the long run.


Big Picture Analysis - Seek Professional Advice & Remember That When You Must Disclose, Honesty Is The Hallmark of Professionalism: One reason it is often a good idea to at least obtain a consultation with an attorney is that you may not be thinking clearly and you need to see the big picture and what is going to occur in your case over the next few years. Short-term or rash actions can harm you in the future. If you have been convicted of an offense, it is a matter of time before the Board is aware of your conviction and you want to show that you are an honest professional. Dishonesty regarding your offense can harm you and be used as evidence that you are not rehabilitated.


One of the reasons you must be careful is that all the professions (whether physicians, nurses, attorneys, accountants) require a level of honesty that others rely upon. Thus, from the Board's perspective, if you are perceived as dishonest or not forthcoming it makes the Board believe you cannot be trusted and cannot be rehabilitated. Now does this mean that you have to report when not required? No, but if and when you do report, you must be hypervigilent.  The old saw that "good beginnings make good endings" is very true here.


Written Explanations Should Be Reviewed By An Experienced Attorney: In addition, you will be asked to provide a written explanation or be interviewed at some point about the offense and you need an objective third party to assist you so that you position yourself for the imposition of the least amount of discipline possible. Do not send your written explanation without an experienced attorney reviewing your explanation and submission. 


This is an important early step and mistakes made here can harm your Board case. So often I see that professionals get defensive, are worried about the impact of the conviction and write in a manner that will hurt them. By rewriting their letters and submitting a lot of evidence regarding rehabilitation at the same time (letters of support and proof of rehabilitation) it can make a huge difference on how the case is handled from the beginning.


For Non-Physicians: If you are a licensed professional other than a physician, you need to research the rules applicable to your Board or Bureau since each agency's rules are somewhat different. The one consistency is that do not misrepresent any fact in your reporting since that can be a separate ground for discipline.  However, the same principles and thinking apply to everyone here. Some boards do not have a form for reporting while others do. Contact an attorney for advice or at a minimum research the website for your applicable licensing agency or call the agency to find out the applicable rules.


Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation. 

Any questions or comments  should be directed to Tracy Green, a very experienced California board attorney, administrative attorney, and litigation attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers in California and throughout the country. Their website is: http://www.greenassoc.com/

Attorney Tracy Green Quoted By San Diego Union-Tribune On Medical Board Investigation Of Doctor For San Diego Chargers

Attorney Tracy Green was quoted in a December 19, 2009 article in the San Diego Union-Tribune about the longtime doctor for the San Diego Chargers entitled "Complaint Filed Against Chargers Doctor." Ms. Green was interviewed about the Medical Board investigation into Dr. Chao. Ms. Green was quoted as follows:

“All the boards are on high alert because of the scrutiny that’s been placed on the nursing board,” said Tracy Green, an attorney with expertise representing professionals in health care. “They are getting alert to anything with drugs or alcohol or any convictions. The boards are being more aggressive than they used to be.”

Green is not involved in this case but said she doubted it would result in serious punishment. She said the board’s intent is to “look at it and see if he has an alcohol problem.”

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.