Where does a practitioner’s right to HIPPA privacy end and the Board’s right to disseminate information on a public website begin?
§90 Medicine and Allied Occupations; http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/ByChapter/Chapter_90.html?
14. Patient “B”
15. Patient “D”
16. Patient “E”
17. Patient “C”
NCMB Hearing Exhibits:
Exhibit# NCMB Item
23 NCPHP Report
27 Peter Graham PhD CV
28 Logan Graddy MD CV
29 NCPHP Updated Report
31 8/14/09 Consent Order to PLOC
1. *Ms. Matthews
2. Ms. Kanoy
3. Caregiver of Ms. Kanoy
4. Ms. Caudle
5. Ms. Snow (error on transcript, she was the spouse of, not the patient E)
6. Ms. Chase
7. Deborah Borawski
8. *Charlene Lynette Smith
9. *Theresa Michelle Darosett
10. *Jacqueline Nadine (Naylor)-King MD
11. Robert T. Dickinson PhD
12. Peter Graham PhD
13. Logan Graddy MD
14. Odessa Worthy
*Remote Testimony, which was disallowed by defendant, overruled by President Camnitz, then at the conclusion of the hearing Judge Morelock, advised the panel to disregard the testimony.
As evidenced by the findings, the testimony was not disregarded.
1. Robert T. Dickinson, PhD
2. Odessa Worthy
* Indicates Telephonic Testimony, which was not permitted by the defense; Administrative Judge/Hearing Officer Fred Morelock allowed the testimony. Just before the hearing panel departed to deliberate, Morelock told them to not consider the telephonic testimony (like trying to take the bullet back after squeezing the trigger). This was noted on Transcript 1 page 14/15.
Specific Points to Address;
1. Numerous Federal Statutes were violated;
c. Constitutional amendments
2. Numerous State Statutes were violated, especially Re;
a. 90-14-6; Unprofessional Conduct; committing of any act contrary to honesty, justice, or good morals (kissing an elderly lady on the forehead, helping a very elderly, very debilitated patient undress-something I’ve done throughout my career without complaints, it happens in ED’s all the time—just watch the TV shows where you’ll see physicians and nurses working hand in hand side by side undressing patients!
i. Dr.O has tried to be helpful to my staff over the years. This could be misinterpreted as something other than my missing nonverbal cues secondary to my primary diagnosis of Asperger’s, or it could also simply be behavior within the range of normal).
b. 90-14-(a)15j; After the Board has made a nonpublic determination to initiate disciplinary proceedings, but before public charges have been issued, the licensee requesting so in writing, shall be entitled to an informal nonpublic pre-charge conference. At least five days prior to the informal nonpublic pre-charge conference, the Board will provide to the licensee the following: (i) all relevant information obtained during an investigation, including exculpatory evidence except for information that would identify an anonymous complainant.
i. Dr.O waited 14 months making requests for such a meeting and for charges to be issued—unbelievable behavior on their part, yet their making accusations against me?
c. 90-14-(a)15i; (v) that the Board will complete its investigation within six months or provide an explanation as to why it must be extended; and (vi) that if the Board makes a decision to initiate public disciplinary proceedings, the licensee may request in writing an informal nonpublic pre-charge conference.
i. It took them 14 months to charge Dr.O. The NCMB did not investigate all of these charges within the 6-month timeframe. Jim Wilson sent an Email documenting that they had no evidence in May 2013.
ii. The NCMB never sent any document to Dr. Oenbrink or his legal staff declaring that there was a delay in their investigation and that the process needed more time to be completed.
iii. At the January 2011 meeting of Bruce Jarvis, Mike Weddington & Dr. Oenbrink, Mr. Jarvis admitted that there was no evidence from MAMC despite USPS Mail, Email & Phone calls.
iv. The Application to Northern Hospital was submitted August 2011.
1. It’s safe to assume that the NCMB was notified of the irregularity by 9/1/11.
a. Six months (3/1/12) later would have meant that the investigation would have been concluded, or documentation sent to Dr. Oenbrink/his counsel (Mr. Weddington)
3. Numerous defense objections overruled while Mr. Jimison’s objections are sustained in the majority of instances. It should be noted that after so many frequent overruled objections, it’s human nature to stop trying in an obviously futile endeavor.
a. Objection to Dr. Greene on Panel Overruled
b. Pre-trial stipulations objections Overruled
c. Objection to remote testimony Overruled
d. Ms. Collins Notary/Matthews Overruled
e. Objection Re; Matthews Wife Overruled
f. Difficult to hear witness Overruled
g. Objection as to relevancy Overruled
h. I can’t see what she’s looking at Overruled
i. I object to remote testimony Overruled
j. Objection looking at Overruled
k. Objection unable to hear Overruled
l. Objection letter is not in evidence Overruled
m. Objection letter evidence Overruled
n. Did you receive this letter Overruled
o. Objection, same reason Overruled
p. Objection, describe letter Overruled
q. Objection, not a patient Overruled
r. Why your husband Overruled
s. Treated you Overruled
t. continued objection on record Overruled
u. continuing objection Overruled
v. move to strike witness statement Overruled
w. all remote testimony Overruled
x. Subsequent motions to strike Overruled
y. I will not burden the board Overruled
z. In the first 53 pages of the 745 page transcript, the defense was overruled on twenty-five out of the initial twenty-five objections
a. The panel consisted of 7 physicians, 5 women and 2 men including President Camnitz.
i. The hearing panel was purposely weighted against Dr.O in its composition
b. It was apparent to defense counsel, to Dr. Dickinson and to Dr.O that the panel had been briefed and were prejudiced when they walked into the room.
c. Each time the defendant entered the room the women on the panel glared and scowled at him, from the initial meeting, when they should have been completely ignorant of the facts of the Formal Disciplinary Hearing, they were very clearly prejudiced against me by their posture and facial expressions.
d. This would have been ground for a mistrial in any courtroom.
e. Further, they were likely also advised that a finding of innocent would put the NCMB at great risk of liability regarding the absence of Dr.O from practice for so long a period of time.
f. Dr. Greene’s failure to recuse herself was another error on the part of the NCMB; she works at/for BMC, which is where these complaints originated.
g. This is especially problematic in terms of conflict of interest.
i. Administrative Judge Fred Morelock should have recused her immediately!
h. Any of these items should have caused a mistrial!
5. Potential Consequences of Formal Disciplinary Hearing;
a. Disciplinary actions by the Board are reported to the National Practitioners Database (NPDB), ANY disciplinary action or restriction/limitation imposed by the NCMB against a licensee is reported.
b. Actions by the NCPHP are not reported to the NPDB.
c. Dr.O was already under contract with the NCPHP, a contract that included all of the points that Acumen recommended.
d. The NCPHP contract specifies a chaperone with ALL patient contacts. Dr.O has never had an issue with male patients.
i. A restriction of this nature when Dr.O sees male patients is excessively burdensome
ii. It prevents him from finding practice opportunities.
6. Mental Health Evaluations;
a. Dr. Camnitz ordered another mental health evaluation, but left it unclear as to when that evaluation would be required to be done;
i. Would Dr.O be able to see patients once the evaluation was scheduled?
ii. Dr.O had already had 2 evaluations and formal treatment.
1. The Acumen recommendations were prohibited by the NCMB.
iii. All mental health evaluations indicated that Dr.O should have been practicing medicine already.
b. Why are they allowed to keep referring me for further testing when each time I’m tested, their experts advise my return to practice?
c. After being out of work for more than 20 months, it will be very difficult for Dr.O to find a job.
d. Dr.O would like to at the very least do some volunteer work locally for at least a few weeks so that he can be “actively practicing” when applying for paying jobs. He’d like Dr. Camnitz to verify that this is acceptable. (Note by author; this was never done.)
7. Unnecessary delay in providing documentation after the hearing
a. During which time Dr.O was unable to return to practice.
b. The hearing concluded June 20, 2014.
c. The documents were not provided until September 12, 2014.
d. No reason was given for a nearly 3-month delay.
e. December 1, 2014 Mr. Jimison attempted to place a further restriction requiring a workplace monitor on-site.
i. The hearing panel did not order this.
8. Failures to sequester witnesses for the prosecution:
a. Allowing them to communicate, share information, perhaps conspire.
b. A picture is worth a thousand words, this was taken immediately prior to their testimony at my NCMB formal disciplinary hearing;
d. Potentially, the failure to sequester these witnesses could be viewed as a HIPAA violation itself.
e. Allowing a group of angry women with one common goal to get together in this manner brings about a “mob mentality”
i. This is de facto witness tampering.
9. The violation of their scope of training by the NCMB members is every bit as big as the illegal activities brought in in item #6 (above) regarding testimony from MAMC!
a. Enforcing scope of practice issues is one of their primary charges, yet without a mental health professional on the Board, they disregarded 2 reports from their consultants recommending my immediate return to practice.
b. On the second document, immediate return was essential to therapy planned by Acumen.
c. Dr.O had already spent thousands of dollars at Acumen. Their specific direction was for Dr.O to return in May, August & January to review how things were going with the skills that they taught me. None of that was possible! Dr.O wasted $20K!
d. The NCPHP should have been the agency that mandated Acumen—they are at least mental health professionals, yet my order came directly from the NCMB itself, an agency practicing outside of the scope of their training by doing so, despite having the NCPHP available.
e. Their action in this manner holds them even more liable for not following the recommendations of their consultant—they sent Dr.O directly—they are solely responsible for acting on the outcome. They fumbled it. They practiced outside of the scope of their training, which is a huge liability to them and disservice to every licensed practitioner in the state. If they can get away with it, why can’t everybody?
f. For that matter, the numbers of actions that should have been referred to the NCPHP but were not, were to numerous to count (NCMBVictims.htm).
g. The NCMB holds practitioners liable for errors, yet when they make errors in terms of not referring appropriate cases/actions to the NCPHP, how are they held accountable, what consequences do they face?
h. Either the NCMB practiced outside of the scope of their training, or, the NCMB members were unaware of the steps involved, the attorney(s) chose to keep the members unaware and made decisions without the direct involvement of their overseeing Board members. Thus, the attorneys chose to disregard/over-ride the advice of their consultant (Acumen) and are thus guilty of practicing medicine without a license, thus harming Dr.O.
10. Consequences of the lack of a Bethany Medical Center Investigation;
a. An Eleanor E. Greene MD is employed at Bethany Medical Center where the majority of the complaints originated.
b. It was later determined that the principal/owner of BMC has had 6 BMC personnel before the NCMB. There is a historic pattern of offering his employed physicians their position back at half of the prior compensation after NCMB matters resolve. What are the odds that six licensees from that one practice have disciplinary issues with the NCMB? This is statistically most improbable!
c. One must assume that there is something going on in that practice when looking at such a statistical improbability, yet nothing of the sort was done.
d. Dr. Camnitz overruled the request to recuse Dr. Greene
e. A disciplinary committee requires at least 3 Board Members, this panel had 7; there would have been no risk or harm in recusing Dr. Greene.
f. Despite our requests on this matter, Dr. Greene refused to be recused (below).
a. “…Dr. Camnitz the Board President, authorized telephonic testimony for three witnesses from Tacoma, Washington.”
i. No mention is made that it was also authorized Re; Matthews who is in North Carolina.
b. Transcript page 16; patient was in her latter 60’s, statement by Jimison is out of context, the patient had initiated banter to which Dr.O was responding.
c. “No gloves mean love” was NOT said in front of patients-taken out of context.
d. “…would go and grab the patient by her upper thighs…” to describe positioning a patient for an exam with the chaperone in the room and not a single patient complaint.
i. Dr. King/supervisor never made any comment/objection to Dr.O regarding physical contact at the time of the contact.
ii. No other member of the staff ever made any comment/objection to Dr.O at the time of alleged contact.
1. Allegations of contact—touching somebody on the shoulder to get their attention.
f. “…transitions from a bimanual exam to a rectal exam without any notice…”
i. Patients were notified with the statement of “Now for the final indignity” as examining finger touched peri-anal area
1. The patient could have objected.
2. The assistant would not have been able to perceive where the examining finger was on patients perineum.
g. “…would not discuss these things (touching/type of exam) beforehand
h. “…so with all of these sexual jokes, all these inappropriate touching’s, all of these rectal exams he’s doing, all these inappropriate comments in April of 2010, Madigan says enough.”
i. During the final interview with LC Rosen, she was unable to make any statement more specific than “There have been complaints about you.”
ii. Clearly these complaints were generated after the departure of Dr.O from MAMC
iii. LC Rosen angrily, loudly threatened Dr.O with loss of his medical license when he asked about the purpose of his sudden conference in her office without any part of Article 15 being followed and after his treatment of the burn pit patient and the thorough documentation on the patient’s chart.
i. Jimison immediately transitions to Patients D & E (despite the letter from the medical assistant for patient E stating that the event that E complained of had never happened (Pages 19 & 20).
j. Page 21, 22 Re; PLOC; the audio files had been altered/edited with key material deleted Re; the “Private” vs. “Public” letter of concern discussion at the “Licensure Interview”.
k. Alludes to departure from MAMC as if Dr.O was aware of the suspension on his application to Northern Hospital in Surry County.
l. Jimison paints a vivid picture of a dangerous provider with all of the dishonesty, suspensions of medical staff privileges etc. There’s not a single report to the National Practitioners Data Bank (NPDB), which is required for any of these items.
i. Clearly these alleged disciplinary items were tenuous enough that no reports to the NPDB were made.
m. Referring to licensure renewals, that “on none of those renewals” had Dr.O revealed problems at MAMC & with the FBOME “investigation, when in reality, Dr. O had disclosed these facts on his renewals of 2011, 2012, & 2013.
i. The licensure application and renewals are all done on web-based forms.
ii. There may be an opportunity to further explain and elaborate on answers based on whether a “yes” or a “no” is chosen for a given question.
1. Dr. Saunders instructed Dr.O that he should have put added an explanation to his answer at one point, however there was no opportunity to do so because of the design of the web page.
a. Dr. Saunders then instructed Dr.O to incorrectly answer the question so that he could add the explanation.
2. At another point during the licensure interview, Dr. Saunders chastised Dr.O for not choosing the correct answer for a given question.
3. Dr. Saunders can’t have it both ways; he is instructing Dr.O to answer one question correctly, then another question incorrectly so that self-incriminating evidence can be added to the answer.
4. Dr. Saunders maintained throughout the licensure process, that there was a reduction in privileges by the “intubation only in an emergency” phrase—which was not a limitation as intubation was only done in emergent, not in elective situations.
n. Refers to complaints coming in after July 2012 which, if the NCMB had fully investigated they would have noted the pattern with BMC providers receiving multiple complaints over the years, the only practice that this has been found in a decade of NCMB actions.
o. Regarding Patient “A” (Matthews” complaint: The complainant states that the patient changed practices after this occurrence. Review of the chart at BMC shows that at least one visit happened afterwards. I cannot comment on further visits as I was no longer employed there after the one post-occurrence visit.
p. Regarding Patient “B” (Kanoy), there’s a notarized affidavit from Odessa Worthy, the assistant & chaperone for that visit that validated and verified my version of that visit—this was not disclosed to the panel during the opening statement. It also directly contradicts what Mr. Jimison portrayed to the panel.
i. This patient suffers from dementia.
ii. She testified to Mr. Morrison that she was offended because Dr.O had apologized for having offended her—it was the apology that offended her!
iii. She initially stated that she was not asked about disrobing below the waist, then later admitted that it had happened.
iv. She stated that she didn’t even know if the assistant (Ms. Worthy) was present at the time.
v. Patient “B” stated that the EKG had been done “for my hand”.
vi. The caregiver for Patient “B” also made significant factual errors during her testimony;
1. She stated that she had seen Dr.O examine this patient before that visit
a. Dr.O met the patient for the first time during that visit—he had never previously met nor examined her.
2. She admitted that there was a request for Patient “B” to disrobe below the waist; that Dr.O did not in fact just “take her pants off”.
3. Stated she was “seated in the chair and could see”
a. The chair was positioned directly behind Dr.O
b. The caregiver had a view of Dr.O’s back and shoulders, the patients feet
c. Ms. Worthy was also standing between the patient and the caregiver, further obstructing the caregivers view.
q. Mr. Jimison states that Dr.O was singled out for “one of the first public Non-Practice Agreements we’ve done.”
r. Mr. Jimison makes a big deal of the final complaint involving a patient seen, a complaint that the disciplinary panel recognized was not worthy of any disciplinary action and for which no wrongdoing was found by the panel. He goes on to elaborate that this visit was unchaperoned despite the fact that Dr.O was under no requirement at that point to have a chaperone present (added to the point that the complaint was not legitimate).
s. Page 31-32; Mr. Jimison tells the panel that Dr.O “…has not followed through with Acumen’s recommendations…”. Acumen had recommended follow-up visits after Dr.O had returned to patient care. The NPA would need to be removed for him to do so. Without removal of the NPA it would have been a direct violation of an order from the NCMB if Dr.O had returned to practice. This was not mentioned to the panel!
t. Mr. Jimison tells the panel that the diagnosis “…renders him unfit…”, not that this was the opinion of one treatment center with limited experience based on two visits by Dr.O. The reason for such a limited number of visits was due to the refusal of the NCMB to follow the recommendations of the treatment center that was chosen by the NCMB. This essential information was not disclosed to the panel during the opening statement.
12. Telephonic testimony of the wife of Patient “A” (Matthews) (Telephonic Testimony)
a. Other than the fact that we don’t know who was on the phone there are other problems.
b. The persons initial statement; “I went in to see—went with my husband and he kissed me on the forehead.” (Her statement makes it unclear as to who delivered the kiss, the husband?)
c. She states that the kiss happened at “more at the end” of the visit, it actually happened the moment Dr.O walked in the door.
d. Numerous objections by Mr. Morrison Re; exhibits, especially exhibit #2 which was not presented to defense prior to hearing, all objections overruled by Dr. Camnitz, no comment by Judge Morelock.
e. Subject stated that she felt violated by the apology written by Dr.O.
f. Clearly this was not a credible witness, the entire complaint appears to be manufactured or at least distorted.
a. Continuing objection to all remote testimony being admitted and to exhibits 11, 13,14, 15, & 16.
b. Regarding assisting with removing her pants, patient states that “he just did it”.
c. Admits that “He asked about pulling my clothes down.”
d. Patient denies that the internal exam was discussed-conflicts with testimony/affidavit of Ms. Worthy.
e. Patient states that she didn’t even know if the nurse was present at the time.
f. Patient states she had an EKG done “for my hand” which doesn’t make sense.
i. She was seen that day for her annual physical as documented in the medical record.
g. This is a very poor, confused witness.
h. Caregiver for “Patient B”
i. Admits that there was a request by Dr.O that patient remove her pants.
ii. States she has seen patient examined by Dr.O before, which was untrue.
1. The event that transpired was the only contact Dr.O had with Patient “B”.
iii. States “I was seated in the chair and could see”.
1. Her chair was behind Dr.O’s back.
2. Dr.O & Odessa were between caregiver and patient.
3. The caregiver couldn’t possibly see what was happening with the patient.
a. States she came to office for follow-up visit regarding anti-depressant medication recheck.
b. Didn’t even check the medical record and said my sugar level was high
i. How would anybody know the sugar level was high without checking?
ii. Admits to borderline personality disorder (which she did not disclose during the visit).
iii. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans http://psychcentral.com/lib/characteristics-of-borderline-personality-disorder/ such as happened with the change in therapy regarding her “antidepressant” (Klonopin) which is subject to abuse and addiction issues—it’s not an antidepressant at all.
iv. Witness states “there is no way I could go off the medicine…”
1. Borderline personality disorder is not treated with medicine, medicine has no relationship/effect with this disorder.
v. Witness states that Dr.O told her she would not need her medication if she “believed in God”
1. A ridiculous statement
2. Would have never happened
3. Speaks to the credibility of the witness.
16. Patient “E” (Snow—this is actually the wife of the patient) (This had already been reviewed/released by the NCMB)
a. The patient chart note will reflect that;
i. The patient was fully examined
ii. That all of his medications were renewed
iii. Lab tests were reviewed
iv. A new medication was added
v. Overall, a lot went on during the visit.
b. The wife clearly doesn’t recall any of these events; “if he ever was examined, I didn’t see it”.
c. “He got in between me and my husband” is in direct contrast to the letter written by the medical assistant.
d. Ms. Snow goes on to say “I didn’t say anything to my husband…”
i. He was present the entire time, this happened directly in front of him, why would she need to say anything about it to him?
ii. She speaks of his having dementia, then states that “he wanted me to come back and confront him about it”.
1. This doesn’t sound like something a demented person would say.
2. She characterizes his dementia; “he wasn’t able to comprehend things and, you know, talk with people, explain his-self. He couldn’t get what he wanted to say out.”
iii. States she thinks the exam room was closed, in direct contrast to the letter written by the medical assistant.
e. There was no reason to bring up the case involving Mrs. S;
i. There is a letter dated 1/10/11 from witness/chaperone Carolyn Smith refuting the allegation by that woman in my NCMB file.
ii. The Smith letter was ignored by Mr. Jimison; the event NEVER OCCURRED.
iii. Despite this, Mr. Jimison used the disproven allegation against Dr.O.
f. What could be a more clear violation of the 5th Amendment;
i. Dr.O was being tried twice on an event that the witness stated had not occurred!
a. Patient tells Mr. Jimison; “He proceeded to check my ears. The incident occurred and after that he checked my heart”.
i. The “incident” could not have occurred prior to the ears being checked, the “incident” referred to the instrument needed to check the ears”
ii. Testimony is false right from the start.
b. “He never checked my lungs or anything else”
ii. Her written complaint states that “he couldn’t check my heart” because of the pendant she was wearing around her neck.
iii. She then complains about being told she had a heart murmur
c. Despite stating that “He never checked my lungs or anything else”
d. Clearly this is not a reliable witness or valid complaint
e. The panel did not find Dr.O guilty on this patient
f. NCMB/Dr. Camnitz allows hearsay, over-ruling objections by defense.
a. Dr. Greene states she does not know Mr. Duran
b. Dr. Greene states that she works there 3 days per week, part time
c. States she started working there June 9th “of this year”.
d. Denies hearing of Dr.O’s name mentioned at BMC
e. Mr. Morrison repeats his earlier objection to having Dr. Greene on the panel
i. Objection is overruled by Dr. Camnitz.
a. Defense objection to Exhibit 11 as hearsay; it is not filed as a business records exemption. This is highly prejudicial; the document in question cannot be cross-examined, it’s origin cannot be validated, thus it is hearsay.
i. This is third-hand information that cannot be verified and should not be admitted.
b. Regarding the legitimacy of documents from other entities being introduced into evidence, there is a 7/23/13 document from MAMC stating that there are “No adverse actions in Practitioner Credentials File”.
c. This is further reason as to why non-telephonic testimony and the inability to depose those who have allegedly made statements should be inadmissible and any decisions made based on this inadmissible material should be ignored.
d. There is no evidence that the document was generated “in the normal course of business”. It was generated specifically at or by the request of Northern Hospital and would not have been generated otherwise.
e. Exhibit 13 is the MAMC Performance Assessment (which was withheld and not produced at deposition of Dr.O).
f. Exhibit 14 is referenced.
g. Exhibit 15 is also introduced to Ms. Borawski .
i. Again, this is what Lt. Col. Rosen should have referred to if there was truly any initial, original evidence against Dr.O. During his appearance and subsequent resignation in front of her in her office on 4/20/10 however, she had nothing to say; this document was created after the fact.
h. Exhibit 18 the original Public Letter of Concern given to Dr.O by the NCMB (the one that was to have been private per the lengthy discussion deleted from the original audio recording of the “Licensure Interview”).
i. Exhibit 17; is the MAMC Timeline created by Dr.O.
i. Mr. Jimison states that MAMC told Dr.O that he was not to implement Complementary-Alternative Medicine (CAM) treatments.
ii. In fact Lt. Col. Rosen had previously told Dr.O that he was free to utilize them, but…
iii. In contrast to what her Commanding Officer, Colonel Flynn had asked Dr. O to do… (teach CAM to her residents as her superiors had tasked her to do—a big part of the reason she had hired Dr.O).
iv. Dr./Lt. Col. Rosen would not allow Dr.O to teach the residents CAM, stating that this was…
v. Because MAMC was trying to have them focus on “Evidence-Based Treatments (EBT)”.
1. CAM by it’s very nature is not EBT
vi. If Dr.O had been ordered to not implement CAM;
1. He would not have been able to provide the burn pit soldier with the list of supplements that Dr.O charted and printed out for that poisoned soldier with…
2. His charted advice that the soldier would not be able to obtain the required supplements on Joint Base Lewis-McCord, but…
3. That the poisoned soldier would need to purchase the supplements at any nutritional supplement store off of the base that carried them.
vii. Had these directives not been placed in the chart, Lt. Col. Rosen would have had no reason to threaten Dr.O with her doing whatever she could to ensure he lost his medical license.
viii. Had the threats not occurred, Dr.O would have not resigned his position at MAMC.
1. None of this current testimony would have occurred.
2. Dr.O would not have been suspended from MAMC.
3. The defense needs to request a document from MAMC signed by Lt. Col. Rosen, dated prior to his April 20, 2010 resignation regarding the fact that Dr.O practiced at MAMC with the restrictions alleged above—that document doesn’t exist, it should ideally be signed by Dr.O acknowledging receipt as required the US Code of Military Justice Article 15.
j. Exhibit 20; 5/30/11 Private Letter of Concern Caudle/Snow
k. Exhibit 19; August 8, 2011 appeal to NCMB to remove the Public Letter of Concern (PLOC).
i. During the “Licensure Interview”, a lengthy and hostile portion of the audio recording had been edited/deleted from the purported “original” audio file that Jim Wilson was allowed to review in the offices of the NCMB in Raleigh NC on August 5, 2013.
ii. Exhibit 19 was an appeal to revert to the original agreement prior to the alteration/deletion of the legal document (audio file) that Dr.O & Jim Wilson were permitted to review in the NCMB offices.
iii. During that “Licensure Interview” Dr. Saunders started right out by wanting to know if the “Letter of Guidance” received from the FBOME was “Public or Private”.
1. Dr.O had never heard of any difference between these two terms as was apparent
2. At 1:16:15 there were extraneous noises associated with attempts to edit the legal audio document.
3. The overall tone of the interview was quite hostile.
4. Dr.O was asked about practicing naturopathy & homeopathy, even though those specialties are not recognized, nor licensed in NC.
5. To practice these specialties in NC would be unlicensed & illegal
a. The comments about naturopathy & homeopathy had originated with Joseph Jordan PhD’s NCPHP interview of Dr.O ordered by the NCMB prior to the “Licensure Interview”
b. Dr.O had never used those words in any document or proceeding before the NCMB.
c. Dr.O was forced to defend himself before the committee and didn’t understand why there was so much focus on the subject at the time of the interview.
iv. The transcript of the audio file of the 7/15/09 Licensure Interview reflects a twenty-nine minute recording, although with his wife Cheryl in the waiting room at the time’s testimony, after the meeting the two of them discussed how difficult the forty-plus minute meeting had been.
l. Exhibit 12; Application for Privileges at Northern Hospital/Surry County
i. Dr.O did not disclose the 2009 Public Letter of Concern from the NCMB.
ii. Dr.O did not disclose the FBOME Private Letter of Guidance.
1. This was a letter of guidance, it was not, in the opinion of Dr.O a “formal medical board investigation”.
iii. Dr.O did not disclose the May 30, 2011 Private Letter of Concern Re; Caudle/Snow.
iv. Dr.O did not disclose the August 8, 2010 Appeal to change the Public Letter of Concern of 2009 written by Dr.O.
1. There was no reason to disclose this to Northern Hospital
v. Dr.O did not disclose his resignation from MAMC
1. Dr.O was totally unaware of this when he applied for privileges at Northern Hospital!
m. Exhibit 16; Email to Northern Hospital requesting that staff privileges application be withdrawn.
i. The wording from Ms. Borawski regarding Dr.O withdrawing his application is important;
1. “Since his application is still active at this time, we have two options. Either Dr.O can withdraw his application and request for privileges, or we will process his application through our Medical Executive Committee and Board of Trustees. The outcome will undoubtedly be a denial of his application for privileges and this would be an adverse action reportable by law to the NPDB & the NCMB.
2. During the opening arguments, Mr. Jimison implied that Dr.O had done wrong by not notifying the NCMB of his decision to withdraw his application, which is untrue.
ii. Mr. Morrison, on examination of Ms. Borawski was able to ascertain that Dr.O was concerned about an appeared unaware of the fact that Northern Hospital found that his application was not truthful.
n. President Camnitz tells Mr. Morrison that “all objections are overruled” at the conclusion of the first morning of the hearing immediately prior to the lunch break.
20. Use of ambiguous License Application & Renewal Questionnaires
a. Why should a licensee need to disclose to the NCMB that the NCMB investigated and/or disciplined that licensee in the past?
i. Is the NCMB so incompetent that they don’t already have this information on record?
b. Some questions state
i. “have you ever…”
ii. while others state “since your last renewal…”.
iii. This is a confusing pattern.
c. Missing questions of this nature is hardly reason to keep a practitioner from working for 14 months.
d. This can be attributed to Asperger’s as;
i. An “overlook” matter or
ii. As a matter of “misinterpretation” as to the “intent” of the question.
e. On one occasion Dr.O was asked by an investigative panel member on why he did not answer questions regarding his past as “yes” and provide an explanation.
i. The form was completed on a web page that stated clearly to provide an explanation if a “no’ answer was selected for that question.
ii. If it was answered as “yes”.
1. There was no opportunity on that webpage to answer “yes” and then provide the explanation that the board member chastised me for not supplying on the form!
f. Missing questions at Northern Hospital likewise can be done accidentally without intent to deceive; why would Dr.O intentionally attempted deceit when the information is publicly available on the NCMB site?
a. Curt Ellis was the NCMB director of Investigations for the NCMB who assigned Mr. Jarvis to Dr.O
b. Exhibit 11; Letter from MAMC to Northern Hospital regarding Dr.O.
c. Exhibit 17; The MAMC Timeline created by Dr.O.
d. Mr. Jarvis states that Lt. Col. Rosen had stated that she “didn’t have any documentation” regarding complaints about Dr.O when he appeared in her office 4/20/10 regarding the nature of any complaints she had alleged to Dr.O that she had when Dr.O requested more information regarding the nature of the complaints and the fact that MAMC had a strong CQI program in place.
e. Mr. Jarvis states that Lt. Col. Rosen told Dr.O that he had been doing too many Pap smears.
f. Mr. Jarvis then stated that shortly before his meeting with LC Rosen, Dr.O had treated a soldier who “—for some ill or wrong learning of conditions—destruction of munitions…”
g. Mr. Jarvis went on to testify that he had been told that when Dr.O had asked LC Rosen about the patient who had become ill after being downwind from the burn-pit that the “conversation got heated” and that’s when he resigned.
h. Exhibit 7; NCMB Renewal September 16th 2010 Dr.O did not list his MAMC Suspension
i. The MAMC Suspension was not made known to Dr.O until it was brought to his attention by investigator Jarvis in December 2011 as noted on Exhibit 17; The MAMC Timeline created by Dr.O.
ii. This is obviously just another attempt by Mr. Jimison to confuse the panel and discredit Dr.O.
iii. This continues with the re-introduction of the issues from Florida issues which the NCMB was already aware of, having learned of them during the “licensure interview” of 7/15/09.
iv. These issues were already on the NCMB file for Dr.O, who had not repeated what the NCMB already had on file about him during his 2010 licensure renewal that occurred just a few months after his license was granted in August 2009.
v. Clearly, Mr. Jimison attempts to discredit Dr.O due to the failure of Dr.O to re-disclose what had been disclosed to the NCMB only months earlier.
i. Exhibit 8; 2011 NCMB renewal
i. Further attempts to discredit Dr.O before the panel with information that is already on the NCMB file of Dr.O
ii. Continued attempts to discredit Dr.O Re; his failure to list Asperger’s as a condition that could limit his ability to practice medicine safely
1. Asperger’s had never been a problem for Dr.O in 25 years practicing in FL
2. This would have been the correct response in light of the 25 year history Dr.O had in FL.
j. Exhibit 20; Private letter of Concern May 31, 2011 Re; Caudle/Snow
k. Exhibit 9; NCMB Renewal October 16, 2012
l. Exhibit 19; August 8, 2011 appeal to change the Public Letter of Concern to Private.
m. Other than providing a prior basis for Dr.O making statements regarding the events at MAMC, the only purpose for Mr. Jarvis as a witness was to discredit Dr.O in front of the panel by re-submitting previously presented exhibits that Mr. Jimison had hoped would cast Dr.O in a bad light.
22. Charlene Smith Certified Nursing Assistant (CNA) @ MAMC; (Telephonic Testimony)
a. States she worked with Dr.O on “5 to 10 occasions”
i. Is that 5-10 patients or 5-10 days or half-days working together
ii. Dr.O should be able to review his notes from every one of the visits that she was present at.
i. Each provider was assigned 2 exam rooms
ii. The medical assistant would take the first room where she would start entering the patients reason for visit, vital signs etc. prior to the visit.
iii. The patient would then move to the practitioners room for the visit
1. The provider would step out of the room if the patient needed to undress and gown.
a. The patient would be instructed to leave the door to the hallway ajar when she was gowned and to get on the exam table, the practitioner would wait another moment then walk into the room.
` The provider would instruct the patient to have the gown open in the front or the back as appropriate for the planned exam.
b. Draping was not used for most GYN exams as the gown covered the patient from shoulder to mid-thigh.
c. If the patient was shy/bashful, she merely needed to hold her hands over her abdomen to keep the gown together to preserve modesty.
iv. After the visit the assistant would review with the patient what the practitioners findings, diagnosis and plan was, the prescriptions given etc.
v. The assistant would be summoned into the exam room when she was needed
1. She was typically not present during the practitioners history taking and discussion
2. Rapport with the patient is established during the “talking” phase of the visit, at which time a review of what would be examined and why, what the practitioner was thinking as a diagnostic opinion and what would be looked for during the physical exam.
3. The assistant admits “before I go” that she would finally be called into the exam room after examination of the Head, Eyes/Ears/Nose/Throat, Neck, Lungs, Heart, Abdomen, Neurologic portions of the exam were done if it was necessary to disrobe the patient for further exam of “sensitive” areas;
c. Rectal (on patients of the opposite sex, not typically done for male patients)
4. When an “extra pair of hands” were needed for any part of the visit.
c. States “very unprofessional when it would come to female exams such as PAP, Vaginal Exams, anything that would—mammograms, all of that—all of those kinds of things”.
i. When was a mammogram ever done in the clinic, when was Dr.O ever involved in a mammogram @ MAMC
ii. With their very detailed medical record system that data is reproducible.
d. “He had a tendency not to cover the patient up all the way before he would do an exam such as draping a cloth over her…”
i. Draping/preparing the patient is the medical assistants job
ii. Dr.O is being judged by a CAN who is not doing her job in assisting the patient
iii. Studies have been published in that some patients don’t want the drape, it really doesn’t serve much of a purpose and does get in the way at times.
1. Draping does serve a purpose if creating a sterile field-which is not what happens during a vaginal exam.
iv. She used the word “cloth”; MAMC didn’t use cloth, it used paper.
1. Further suggestion of coaching.
a. She would have been coached to say “drape”
b. “Drape” would be “cloth” to the uninitiated
e. “…not give them a chance to scoot down by themselves> He would grab ahold of their—the top of their thighs and just kind of pull them down in a sexual manner.”
i. Morrison objected to “sexual manner” (whatever that is), Camnitz overruled
ii. Dr.O has always assisted patients into the appropriate position for whatever exam or procedure was contemplated
iii. As a DO who performs a lot of osteopathic manipulative therapy (OMT), not a day goes by that Dr.O won’t position a patient on an exam table for a procedure.
iv. Isn’t it interesting that MAMC was not able to produce a single patient complaint?
i. Was said once when the box of gloves in the exam room was empty to let her know that she needed to get another box of gloves for the room.
ii. She was very hung up on the fact that at times an exam would be done with one glove instead of two gloves.
1. As a CAN she doesn’t understand the reasoning behind how and why procedures are done in certain ways.
2. Dr.O owned his own practice and paid for his own supplies; over the years he learned how to be frugal by not using unnecessary supplies.
a. There’s no need to put on a glove to touch the dry skin of a healthy person.
b. Gloves are needed when touching mucosal or contaminated surfaces and avoiding bodily fluids.
g. “…he would not explain what he was doing before he would start doing so, such as he would already start the exam on them without letting them know that he was entering a speculum or he would sometimes do a rectal exam when it wasn’t really necessary.”
i. Mr. Morrison objected to the above statement & was promptly overruled by Dr. Camnitz
ii. The CNA who doesn’t know when a glove is needed now knows when a rectal exam is indicated?
iii. Patients were informed of what Dr.O was doing when he did procedures, perhaps not in the way she was used to.
1. If the patient watches Dr.O pick up a vaginal speculum, lubricate it, then touch the vulva, there’s a pretty good chance she knows that a speculum is about to be introduced.
2. This is the way that he’s always practiced; 25 years in Florida without incident
3. Prior to doing a rectal exam, the patient feels Dr.O touch the perianal area and announce “now for the final indignity…”, the patient is probably pretty much aware of what is about to happen.
4. Any time a patient objects, an explanation is given as to why the procedure is indicated, if they still object the procedure is abandoned and a note to that effect made in the chart.
h. “We don’t—the provider did not typically do a rectal exam when they’re having a regular Pap…”
i. Once again, a witness who is testifying her opinion of matter that are well above her training
ii. Different providers practice medicine in different ways.
1. All providers do things a bit differently
2. Not all providers do all of the preventive testing that is recommended by certain specialty groups
3. At the time Dr.O was working at MAMC, the Preventative Services Task Force Guidelines included annual rectal exams starting at age 40.
a. Although patients don’t enjoy this exam, it was indicated at the time.
b. Some practitioners don’t bother their patients with it.
c. It’s largely a matter of individual choice and practice style.
4. “…they were very uncomfortable with that and shocked…”
a. Objection by Mr. Morrison that it’s hearsay as to what the patient was feeling was overruled by Camnitz
i. “…he would just automatically help them, by you know, kind of rubbing towards the top of their thighs and kind of just pulling them downward.”
i. At this point she states he helped them, which is what happened.
ii. There’s a better than average chance that with her phraseology, that she was “coached” on what to say by her superiors;
iii. Yet she still states that Dr.O was trying to “help them”.
j. “And he would laugh in a weird way when he would say it. He would kind of hold his hand in the air while he was putting the glove on.”
i. Again, she makes this sound very inflammatory.
ii. She states it was said in front of patients (it was said once, not with a patient in the room, but as a request to re-stock the room)
iii. Where are the patient complaints?
iv. Stating he would hold his hand up while he was putting a glove on
1. How could he be putting a glove on if there were no gloves in the room?
k. “…at least one to two times I would see how they would be, you know, they would kind of tear up a little bit and feel very uncomfortable.”
i. Now this happened “one to two times”.
1. Initial testimony made this seem like an occurrence with every single patient.
ii. They would “kind of tear up a little bit”.
iii. Feel very uncomfortable
1. She knows their feelings?
iv. Where are the patient complaints?
l. “He would just sometimes come up behind you when you were charting and he would, you know, kind of just wouldn’t hear him at first and he would just put his hand on your shoulder and, you know, just start talking to you.”
i. Testimony indicates she hadn’t heard him ask for something, that she was preoccupied.
ii. Placing a hand on somebody’s shoulder to get their attention isn’t exactly a boundary violation.
iii. Where is there any documentation that this was mentioned to me and that Dr.O was aware of it?
1. She never mentioned, had she done so another means of getting her attention would have been discussed.
m. “…besides the times that he was inappropriate with a patient.”
i. With her limited experience, she knows what’s appropriate?
ii. Where are the patient complaints?
n. “…Did you ever express any of your concerns to your supervisors at Madigan about Dr. Oenbrink?” “Yes”.
i. If she had done so, then by MAMC procedures, an investigation and disciplinary actions would have immediately ensued.
ii. Where is that MAMC procedural documentation?
23. Theresa Michelle Darosett LPN MAMC (8 years experience) (Telephonic Testimony)
a. Recalls working with Dr.O on “one occasion”.
i. The date is not given, the date is important
1. If the event happened the day prior to the departure of Dr.O from MAMC and was reported, it may not have had time to work through channels to become a disciplinary issue for him.
2. It’s much more likely, simply given on the time that Dr.O worked at MAMC that this happened long enough prior to his departure, that if it had been reported to a superior, when Lt.Col. Rosen told Dr.O that “there have been complaints”, she would have at least been able to produce one complaint (she wasn’t able to do so).
b. “…I don’t remember what he said exactly, but I do remember him saying something inappropriate when he put his gloves on.”
i. She doesn’t remember what, but she now remembers that her opinion is that whatever was said, it was inappropriate?
c. States “…I told the patient after the exam if she felt that any part of the exam was inappropriate…”
i. There was no patient complaint
ii. Refer to section 17b above about the MAMC Family Clinic Procedures
24. Jacqueline Nadine Naylor-King MD (Telephonic Testimony)
a. Exhibit 15 MAMC Memo Re; inappropriate behavior allegations against Dr.O
b. “Not only did it make me uncomfortable, but it also—I recognized—knowing my patient very well, that it made her uncomfortable”.
i. As is reflected in every notation ever made by Dr.O, the patient was laughing and joking about how she threw her back out having sex with her “much younger” boyfriend.
ii. The patient was bantering back and forth with Dr.O
iii. Where is the documentation of the patient complaint from this “uncomfortable” patient?
1. The only discomfort the patient felt was from the pain that she sought help for
2. The pain that was resolved before she left the exam room.
iv. Where are the complaints from any MAMC patients?
i. “Did the patient joke about having a boyfriend that might have injured her during a sexual act?”
ii. Naylor; “No”.
1. This is absolutely incorrect and perjury as every piece of documentation provided by Dr.O will prove
2. Dr.O maintained records during his travels, including detailed notes that were used in web-publishing a book; Adventures of a Traveling Physician under the pseudonym of Joseph Edwards.
a. The 12th paragraph describes the encounter clearly.
b. Clearly, it is totally at odds with testimony as given
c. The notes for this book were written daily, immediately after the events that occurred.
3. This particular event was so memorable, the patient was so funny and the banter back and forth so enjoyable that even Dr. Naylor-King was chuckling after the patient left the exam room.
a. While laughing, Dr. Naylor-King commented “you really shouldn’t talk to patients like that”
b. Dr.O replied; “why not, she enjoyed it, started the exchange and the laughter helped her relax so that I could achieve a better result for her—it worked!”
c. That was the end of the “formal warning” that occurred in the hallway between patients as Dr. Naylor-King kept laughing.
d. Dr. Naylor-King is guilty of perjury.
e. Dr. Irene Rosen is also guilty of perjury being portrayed as Lt. Col. Irma on the last page or two of that chapter of the book.
i. Where is the complaint from the lady with the back pain who was so uncomfortable?
f. Where are the complaints from any MAMC patients?
g. Re; “inappropriate interactions with Dr.O”
i. “When I was at my desk and I recall Dr. Oenbrink coming up behind me and putting his hand on my shoulder and—in a manner of a massage and I felt uncomfortable.”
1. Dr. Naylor-King commented at the time that she appreciated the shoulder massage.
h. Exhibit 15 MAMC Memo Re; inappropriate behavior allegations against Dr.O was admitted into evidence after a bench conference with both counsels and Dr. Camnitz Re; redacting portions of Exhibit 15.
i. Cross-examination by Mr. Morrison begins:
j. Dr. Naylor-King admits that she did not admonish Dr.O at the time of the incident with the lady with back pain.
k. Dr. Naylor-King states that she admonished Dr.O before this occurred.
i. The time of this alleged admonition? “I don’t recall”.
a. That testimony provided damning content that was untrue; the testimony came from subordinates presumably following the orders of Lt. Col. R.
b. There was no way to ensure who was speaking during this telephonic testimony that originated in the state of Washington. The basis of law in this country mandates that the defendant be able to face their accuser. This was clearly denied in telephonic testimony.
c. Such testimony unfairly prejudiced the panel against Dr.O.
d. At the conclusion of the disciplinary, after Dr.O was found guilty and during the “sentencing” phase, the disciplinary panel was told to “disregard the testimony” that had been illegally given. Such a directive is akin to taking the bullet back after the trigger has been pulled; the damage was already done! This alone would be grounds for a mistrial in any court of law!
i. Although witnessed by others, the directive from Dr. Camnitz, NCMB President, Presider at the Disciplinary Panel Hearing, those comments did not appear on this official transcript.
e. Military subordinates are expected to follow orders from their command. Failure to do so can have serious adverse repercussions to them and their careers.
f. Lt. Col. R clearly was unable to produce a single patient complaint and did threaten me with loss of my license; this is why Dr.O resigned.
i. She could not produce any evidence on the day of resignation.
ii. She was reduced to raising her voice and making threats due to her lack of evidence.
iii. The “evidence” was fabricated “after the fact”.
a. Direct examination begins with Mr. Morrison for Defense.
b. Prior to going to Acumen, Dr.O was bringing comment cards done by his patients without his involvement to enable better insight and coaching in the office to improve his self-awareness and communication abilities.
i. He initially sought care in my office before there was any involvement by the NCPHP
ii. He had an established relationship with me prior to meeting with Peter Hazelrigg MDiv
1. Non-Transcript Note: Dr.O related to me that Mr. Hazelrigg told him that he could continue meeting with me as I was already acting as his life coach.
c. Regarding Acumen Treatment Discharge Summary & ability to practice medicine.
i. Neither Acumen nor Dr. Dickinson think that Dr.O should not be practicing
d. Regarding insight, interpersonal judgment “is poor”, vs. “it’s impaired”.
i. The Acumen outlook is much less optimistic than that of Dr. Dickinson
ii. Dr. Dickinson has spent much more time with Dr.O, spread out over a longer period of time than Dr.O has had with any Acumen provider.
iii. Acumen has a “product to sell” (continued expensive services) that the NCMB can mandate.
1. The NCMB failed to mandate that by allowing the Acumen recommendations to be followed.
2. The NCMB directly interfered with the Acumen treatment plan for Dr.O by not following the advice of their consultant (Acumen) and that of the private psychologist sought out for by Dr.O of his own initiative for his own personal improvement.
e. “…That would tend to indicate he is a sexual deviant or sexual aggressor?”
ii. “…it depends on the eye of the beholder.”””
iii. “…social clumsiness of Asperger’s…”
f. “His familiarity with appropriate behavior in conventional social situations was just merely at the norm.”
i. “That’s why we’re here.”
g. “The problem is that he has never had any proper treatment to formally address the issues raised in this report. He’s always been challenged with, and vulnerable to episodic, vague and ill-defined states of agitation and dysthymia, hypersensitivity and action-oriented impulse control problems that have invariably—that have invariably led to the problems in accurately reading interpersonal situations, maintaining interpersonal attunement and exercising good judgment.”
i. “I don’t disagree with that”.
ii. “If he gets proper treatment, there’s a good chance he can overcome this?”
h. “…Observers in the room whenever possible.”
i. Such as a CNA (medical assistant) would be ideal for future treatment plans.
i. “He and I have also discussed how we want front end people involved.” “The patient comment cards would be foremost and probably the most important piece”.
i. Dr.O had already voluntarily put all of these plans into action of his own initiative when he was at Bethany Medical Center, before the Acumen assessment was ordered by the NCMB.
ii. The actions of the NCMB interfered with the therapeutic plan Dr.O had put into place before he was even sent to Acumen
iii. Dr.O had identified the problem before the NCMB became involved and was working to resolve the problem before the NCMB became involved.
iv. The NCMB prevented his appropriate recovery from whatever damage Asperger’s was causing him.
j. Mr. Morrison questions Dr. Dickinson about the necessity of returning to Acumen vs. another treatment approach closer to home, to which Dr. Dickinson replies that “…I don’t think it’s a make him or break him as you’re saying.”
k. “I think he’s safe to practice medicine. I think he has been. I think that the issue here is insulting or offending patients.
l. “I have been around physicians for 35 years and I’ve seen lots of hurt feelings. So I don’t think that’s a deal breaker myself” (It’s just bad bedside manner).
m. Mr. Jimison begins cross-examination for prosecution.
n. Mr. Morrison is overruled when he objects that Mr. Jimison asks Dickinson about issues at MAMC being boundary complaints.
o. Mr. Jimison again brings up patients D & E regarding boundary issues, comparing them to MAMC allegations as boundary issues.
i. There were no boundary issues @ MAMC
ii. Patients D & E (Caudle & Snow);
1. Were cleared in May 2011
2. Were brought up earlier in this hearing
3. Were only being brought up again to keep throwing it in the faces of the panel.
p. Jimison describes Dr.O pulling patients down the exam table at MAMC, you know he pulled her pants off with the implication in a very inflammatory manner that he apparently made it a habit to pull patient’s pants off at MAMC and this was thus a patient safety issue due to the threat of psychological damage to the patient.
i. First; this is done in a very inflammatory manner
ii. Second, this is very inaccurate; Dr.O never removed pants at MAMC, nor were there allegations that he had.
iii. Best of all, Dr. Dickinson testifies that it’s not a safety issue.
q. Mr. Jimison describes this type of incident as causing “A mistrust in the medical profession” to which Dr. Dickinson responds; “Well, that’s a long reach.”
r. Mr. Jimison then pushes Dr. Dickinson; “Could you imagine any situation where that’s appropriate for a patient you just met?” To which Dr. Dickinson replies; “Probably not unless the patient is jovial with you initially.”
s. Mr. Jimison tried to get Dr. Dickinson to state that Dr.O needed “observers in the room at all times”, to which Dr. Dickinson corrected him, that the recommendation was for “as often as possible”.
t. Mr. Jimison tries to get Dr. Dickinson to agree with the Acumen assessment that Dr.O has a “…risk to offend others and/or potentially disrupt patient care”, or as questioned, to “potentially disrupt patient care, is that a safety issue?” to which Dr. Dickinson replies “I don’t think so.”
u. Mr. Jimison then tries to get Dr. Dickinson to agree that “offending folks” is a measure of professionalism, that to do so would be unprofessional behavior.
i. This really raises a question as to the NCMB’s level of professionalism.
1. Dickinson’s credentials were presented and admitted.
2. Dickinson is a psychologist, psychologists in NC (and pretty much everywhere else) do not prescribe medications; they engage in “talk therapy”.
3. Why would Dr. Bolick ask such a question? Was she paying any attention to testimony?
ii. Dr. Bolick then asks about the reason for the gap in therapy, which had been covered under examination by Mr. Morrison and cross-examination by Mr. Jimison.
w. Panel Member Thelma Lennon asks a series of questions that very clearly portray her as incompetent to serve on this panel, her inability to comprehend the topics of discussion.
x. Dr. Walker-McGill speaks of female patients that “felt violated” by having assistance with removing their pants which are answered by Dr. Dickinson—this line of her questioning happens before the testimony of Odessa Worthy and is thus reasonable.
z. Dr. Greene discusses that Dr.O may have had a misdiagnosis or delay in diagnosis and that despite the diagnosis that he has “mild” Asperger’s, “these were pretty severe stuff from the patients who complained”.
i. Patient “A” (Matthews)
1. The “victim” was demented
2. The “victim” never complained
3. Her son wrote the complaint 2 months after the fact
a. This doesn’t sound like “pretty severe stuff”
ii. Patient “B” (Kanoy)
1. The patient was feeble, fragile, unable to disrobe by herself
2. The patient asked for help disrobing, which was provided by the assistant (Ms. Worthy) & Dr.O
iii. Patient “C” (Chase)
1. Ultimately, the NCMB found in favor of Dr.O on this one case
iv. Patient “D” (Caudle)
1. This had already been reviewed by the panel, which cleared Dr.O in May 2011
v. Patient “E” (Snow’s spouse)
1. This event never happened as evidenced by the letter from the assistant/witness.
2. The entire story of how this complaint came about should have been brought up in detail during this hearing.
1. There was not a single patient complaint from MAMC!
i. He references “…more frequent and more magnified as time goes on, it seems to me.”
1. Investigation of Bethany Medical Center would have shown that this “more frequent and more magnified” was related to the fact that Dr.O was the 6th physician to from BMC to be investigated by the NCMB, and not the first to be offered re-employment at half the prior compensation!
2. Dr. Dickinson reminds the panel of the difference between a “20 year, apparently pretty successful practice in Florida and virtually no complaints or very few to suddenly this barrage that’s occurred here, no, I can’t explain that by saying this is some of Asperger’s.”
bb. Mr. Jimison offers to seal;
i. Exhibit 21 9/28/13 Acumen Assessment DC Summary
ii. Exhibit 22 1/25/13 Acumen Treatment DC Summary
iii. Exhibit 23 NCPHP Report
iv. Exhibit 26 3/31/2014 RJODO Deposition Transcript
v. Dr. Dickinson’s notes, to be labeled as Respondents Exhibit 1 (unavailable at this time)
a. Initial Objections
i. Peter Graham PhD. was tangential to the evaluation & treatment of Dr.O, he was not the primary therapist at either the diagnostic or initial therapeutic session of Dr.O at Acumen.
ii. Scott Stacey PhD. Was the primary therapist who had the most knowledge & information regarding Dr.O.
iii. Dr. Graham states that he believes Dr.O was referred by the NCPHP, in fact he was referred by the NCMB.
iv. Dr. Graham states that collateral information is requested from the referral source.
1. Clearly this is anything but an “independent” evaluation, by his own words.
2. Who is to say that the “diagnostic findings” are not also obtained from the “referral source(s)”?
v. Dr. Graham speaks of the “team based process”.
1. The reality is that the primary therapist spends the majority of the time with the client.
vi. Dr. Graham states that; “I was—did an interview around his developmental history with specific attention being paid to developmental issues…”
1. He states that; “we’re continuously meeting with one another as members of the team…”
a. There were factual errors in obtaining the history.
b. The “historical facts” were used to formulate a diagnosis; there are no significant findings from laboratory, imaging, physical exam used to formulate a diagnosis.
i. There was some psychometric testing and a polygraph.
ii. An independent review of the psychometric testing may be useful.
1. The polygraph tech states that Dr.O passed that particular exam without difficulty; it probably does not need to be reviewed.
2. A 2nd polygraph” done by Dr.O at his own initiative also clearly showed a lack of duplicitous intent.
3. Why would anybody risk a 2nd polygraph if there were any concerns of guilt on their own part?
c. Once the “diagnosis” (however faulty) is made, a “treatment plan” is proposed
d. The treatment plan uses Acumen Treatment Center exclusively to provide “therapy” for their clients.
e. Dr. Graham claimed that Acumen was essentially the diagnostic and treatment center for Asperger’s disorder in the US, despite claiming to having treated “about twenty (20)” patients with the disorder.
i. With all of the other errors and discrepancies, it would be interesting to get a list of who was actually treated so that the actual count was known.
f. Acumen has clients that are more accurately described as “annuities”
i. What other “treatment” centers do they refer to? Any?
ii. They are thus compelled to make diagnosis for conditions that they treat!
3. One must wonder how many other evaluations were going on at the time that Dr.O was being evaluated.
4. There are two major points that have not been addressed by Acumen/Dr. Graham;
a. The patient comment cards from BMC certainly don’t demonstrate that.
i. These comments were collected over a period of several months from all patient encounters.
ii. Dr.O had nothing to do with who did or did not get these cards; the support staff (front office and back office) handled the task.
iii. Cards were given to each and every patient.
b. 25 years practicing in Florida during which the only time Dr.O came to the attention of the FBOME was when he declined to release records to a patient’s spouse without the patient’s knowledge on the eve of HIPAA enactment.
i. His refusal then was illegal due to his misunderstanding of and fear of HIPAA.
ii. What he did would currently be standard of care
iii. If he had released the records currently he would have committed a criminal act.
iv. As a physician, he was unfamiliar with the difference between congress submitting a law to the Executive Branch not being a law until signed by the Executive.
v. Everybody in the medical professions at that time feared the “HIPAA Police” and criminal prosecution for making a HIPAA-related error!
b. Jimison proposed/Panel accepted/Morrison did not dispute credentials in Psychiatry
i. He has not attended a day of medical school, has not done any training in Psychiatry.
c. Exhibit 21; Acumen Assessments Diagnostic Discharge Summary/Fitness to Practice.
i. Dr. Graham describes “…intensive allegations and the treatment indication. The day starts at 9 AM and it ends at 4:30 PM”.
1. He fails to mention that there is a certain amount of “free time” in which nothing is going on as other clients are being evaluated and staff is busy with them.
2. Admittedly however, Dr.O found he had more “free time” during the “therapy” phase at Acumen than he had during the “diagnostic/assessment” phase.
ii. Dr. Graham immediately begins referring to the “therapeutic” sessions
1. It’s not clear to the panel or anybody else in the room that he’s switched from Exhibit 21 to Exhibit 22.
a. This is a confusing switch that was not described.
d. “The team thought that that (Asperger’s) was the most appropriate diagnosis”.
i. A very important consideration, is that there was no consideration of frontal/L frontal lobe pathology by this “Multidisciplinary Team” at Acumen.
1. This contrasted with the findings of Dr. Bundick the Neuropsychologist.
2. Dr. Bundick made much more restrictive recommendations to hamper Dr.O in his ability to find a place to practice
a. Specifically Dr. Bundick recommended a chaperone in the exam room for all patient encounters, not just for female patients.
b. There had never been a complaint from a male patient to warrant this recommendation.
e. Dr. Graham describes a continuum ranging from Autism to Obsessive-Compulsive Personality.
i. He states that Asperger’s falls along the middle of this continuum.
ii. He does not use the term “Obsessive-Compulsive Personality Disorder”.
iii. This theoretically seems to lessen the “danger” of Asperger in a practicing clinician.
1. Many clinicians have OCD—it’s selected for during training.
2. Many clinicians can also be diagnosed with Asperger’s.
3. Aspergerian’s have specific areas of intense interest in which they become expert.
a. There are no published scientific studies of prevalence of Asperger’s among physicians.
b. The traits that embody excellence in a technical skill such as many medical specialties encourage students with mild Asperger traits to pursue those fields of study.
c. Asperger’s does not pose any significant danger other than potentially
i. “May unintentionally hurt somebody’s feelings”.
ii. Due to misperceptions in nonverbal communication.
1. (This was a statement made by Robert Dickinson PhD.)
iv. “…still a lot of argument about this in considering Asperger’s being a manifestation personality.”
v. “…what ends up happening is basically a lack of empathy.”
1. This was not one of Dr. Dickinson’s findings.
2. Dr.O had 36 hours in session with Dr. Dickinson; adequate time to determine a finding as profound as a lack of empathy.
f. Dr. Graham discusses; “…in the context of the rehabilitative treatment that we do, the assumption is and we found this to be the case in other individuals that we have worked with…”
i. Dr. Graham appears to be trying to fit Dr.O into his diagnostic box without actually stating that Dr.O fits this box well.
g. Mr. Jimison questions Dr. Graham on whether Dr.O is responsible for his actions.
i. Accepting responsibility is not the problem with these complaints as much as the fact that they have been skewed and twisted beyond recognition, and in some cases Dr.O has been the victim of blatant perjury for which he’s held responsible.
h. Mr. Jimison questions Dr. Graham about the use of collateral information, which is exactly what Dr. Dickinson was doing so successfully with the use of comment cards and other information from BMC.
i. This happened before the interference of the NCMB into that therapeutic alliance.
ii. Before the NCMB prohibited Dr.O from completing the Acumen Treatment plan by not vacating the NPA, allowing the treatment plan to be conducted.
iii. Ideally, however, Dr.O should have been allowed to continue with Dr. Dickinson’s therapy.
i. Mr. Jimison asks if professionalism is an aspect of the practice of medicine.
i. Mr. Jimison never has adequately defined “unprofessional conduct” in a rational manner throughout these proceedings.
ii. Dr. Graham references; “…maintaining awareness of the patient’s potential experience of—being touched.”
1. This all seems rather blown out of proportion.
2. Anybody going to see a physician, darn well should expect him to touch—it’s called examining the patient!
iii. “…If the doctor isn’t being explicit and articulating why they’re doing what they’re doing…”
1. Why has this not been a problem in 25 years of practice in Florida and in the great majority of his time in NC, Dr.O hasn’t had these issues come up—perhaps these issues are being distorted?
iv. “Just going over and grabbing them and moving them without telling them you’re about to do that…”.
1. This is just harassment in light of the history of Dr.O including his 25 years of practice in Florida without difficulty and the lack of due process in everything that has gone on in the years up to this point.
v. “…he was going to insert his fingers into the vagina and he was putting on his gloves and he says ‘no gloves mean love’.”
1. Which is taken out of context and never happened in front of a patient.
2. Where are there any patient complaints from MAMC?
vi. “And patient C testified that he was an room and was unchaperoned…”
1. Dr.O was under no requirement for a chaperone by NCMB or NCPHP
2. Dr.O had been under a chaperone for most of his time with BMC at his own insistence.
3. The only reasons for a lack of chaperone for that encounter were that;
a. 12/22/12 was a Saturday right before Christmas.
b. “Flue Season” had just hit as a review of clinic records of that day will demonstrate.
c. The clinic was short-staffed due to it being a holiday weekend.
d. The clinic was much busier than usual due to flu season.
4. “…in a few seconds and leaned in again and grabbed the tip of the otoscope.”
a. As he had “leaned in” throughout his career without comment or complaint from any patients.
b. Nothing different happened that day.
j. Mr. Jimison; “Was that something you would not expect him to have done after being with y’all?”
i. Misleading comment;
1. Dr.O had only had his diagnostic assessment done at that point 4 months earlier Exhibit 21.
k. Dr. Graham; “And generally it’s been our experience that physicians during the period between an evaluation and when they come for treatment, during that period of time their—their awareness is heightened and they tend to—are able to—maintain some vigilance for themselves.”
i. This may be true with a legitimate complaint.
ii. The panel itself ultimately saw that this complaint was not really valid.
iii. This is more academic “nit-picking” at the expense of Dr.O in an attempt to portray him as a dangerous character.
l. Dr. Graham; “…there is a fundamental lack of appreciation for those folks and that is an required rehabilitative treatment and education.”
i. The patient comment cards from BMC certainly don’t demonstrate that.
1. These comments were collected over a period of several months from all patient encounters.
2. Dr.O had nothing to do with who did or did not get these cards; the support staff (front office and back office) handled the task.
3. Cards were given to each and every patient.
ii. 25 years practicing in Florida don’t support the comments above; if Dr.O was the type of clinician described in this hearing, there would have been multiple complaints to the FBOME about him!
iii. Beyond the two points enumerated above, this appears to be a blatant hard-sell pitch for their services.
1. “Participants/Clients” of the NCMB/NCPHP have no choice in where they are sent.
2. The same facility that does the “Assessment” also provides the “Therapy”
3. These services are rendered at great cost to the “Participant/Client/Patient” who…
4. Has no choice in the process other than to not participate and never practice medicine again!
m. Dr. Graham; “And emotionally traumatizing.”
i. As above (“l.”)
ii. Does anybody care about the emotional trauma practitioners before the NCMB on bogus charges undergo?
n. Dr. Graham; “I guess what we concluded is that he was not—he was not actively impaired…”
i. And there you have it!
o. Dr. Graham goes on to describe that treatment of Asperger “…needs to be attended to in order to lower the potential risk—to patients that would make him ideally fit to practice.”
i. “…Dr. Stacy specifically states that he is at significant risk to engage in behaviors that upset others.”
1. This does not sound like a high-risk assessment of Dr.O, he may “upset” others.
2. Since Dr.O is apparently not so dangerous that he should not be practicing—per Dr. Graham’s words…
3. What was the NCMB’s justification for keeping him out of practice for 2 years?
p. As soon as Dr. Graham starts to complete his statement including the positive attributes of Dr.O, Mr. Jimison stops him; “Well, let me interrupt you…” to steer Dr. Graham away from positive attributes so that he can once again portray Dr.O as being a “significant risk…”
i. Mr. Jimison proceeds in his question to remind the panel how dangerous the behavior Dr.O exhibits has been
ii. Mr. Jimison conveniently does not inform the panel that Dr.O had his treatment interrupted by the NCMB itself.
1. Acumen wanted Dr.O to return in May 2013, August 2013 & January 2014 after he had been seeing patients on a regular basis to “fine-tune” his treatment (Exhibit 22-final page).
q. Mr. Jimison then has Dr. Graham describe the treatment that the NCMB (Mr. Jimison) interrupted which entail that Dr. O “…enter into a monitoring process with our program.”
i. Another obvious attempt by Dr. Graham of bringing those professional fees back to Acumen.
r. Dr. Graham; “The second recommendation was for intensive specialty treatment and—and that was partly on the basis—one of the things that we look at in considering what level of care is—is necessary is whether or not prior treatments of a lower level of care have been able to address and solve the problem.”
i. The treatment with Dr. Dickinson was interrupted by the NCPHP’s direction to Peter Hazelrigg M.Div.
1. Hazelrigg then reported to the NCPHP on 7/10/12 (page 6) “The theme of the meeting was that the physician does not readily identify any issues that he needs to work on. Mr. Hazelrigg does not feel that he is a good candidate for coaching due to the lack of motivation, in combination with the previously identified Asperger’s diagnosis.”
a. Mr. Hazelrigg had told Dr.O that since Dr.O already had an established relationship with Dr. Dickinson, he should continue seeing Dr. Dickinson, which Dr.O did.
b. Not a candidate with the previously identified Asperger’s.
i. Perhaps he doesn’t recognize that the most common treatment of Asperger’s involves a life-coach!
s. Dr. Graham did not feel that the therapy given by Dr. Dickinson would adequately resolve the issues that Dr.O was having.
i. Graham was not the primary therapist, Scott Stacey was the primary therapist
ii. Nobody from Acumen consulted Dr. Dickinson regarding Dr.O
iii. Acumen did not have an evaluation of the state of Dr.O prior to his therapy with Dr. Dickinson.
iv. What was the rationale behind the above statement without any logical basis from which to form that opinion?
v. This would be a huge problem even without the fact that there were forty errors in the initial Acumen Assessment!
t. “And our treatment program, the Professional Renewal Center and Professional Boundaries Incorporated is another intensive educational process around boundaries that’s available nationally and—and other programs around the country that are quite similar in treatment, all pretty much follow fairly standard content, didactic content.”
i. At the start of his testimony; Dr. Graham claimed that Acumen was essentially the diagnostic and treatment center for Asperger’s disorder in the US, despite claiming to having treated “about twenty (20)” patients with the disorder.
ii. Now he talks about multiple other programs around the country that “pretty much follow fairly standard content, didactic content”.
iii. Which is it?
iv. Why was it so mandatory that Dr.O have the treatment in the same facility he had the assessment?
u. “Part of—part of what we believe is important in rehabilitating professionals is that…”
i. This is not a data-driven process.
ii. This is a belief system.
1. Is it a philosophy or…
2. Is it a religious belief?
iii. There have been innumerable cases of folks who have fought and won against PHP’s that mandated the 12-step recovery program as being like a religious organization or belief system.
iv. Dr.O has been subjected to an unproven belief system as his “treatment” is repeatedly interrupted!
1. Dr.O initiates his own therapy with Dr. Dickinson
2. The NCPHP redirects Dr.O to Mr. Hazelrigg
a. Who recommends that Dr.O return to Dickinson while
b. Telling the NCPHP that he does not feel that (Dr.O) is a good candidate due to lack of motivation.
3. Then the NCMB mandates that Dr.O be assessed at Acumen.
a. Which produces a very slip-shod report with forty errors in the initial Acumen Assessment!
b. Exhibit 21.
c. Which comes up with recommendations that mandate Dr.O continue with Acumen for therapy; which produces Exhibit 22
i. All at great financial expense to Dr.O
ii. A decision in which Dr.O has no say (for which the NCOSA rebuked the NCPHP).
d. Which interrupts the progress Dr.O was making with Dr. Dickinson
i. Using the type of feedback system Acumen recommended
ii. After Dr. Dickinson had already been using it with good success for several months.
4. Then the NCMB mandates that Dr.O attend the treatment at Acumen
a. Further interrupting the progress he was making with Dr. Dickinson
5. After Acumen makes it’s recommendations for follow-up treatment, the NCMB prohibits the therapy it’s consultants recommended.
a. Thus essentially countermanding their consultant
i. Which is either
1. Practicing outside the scope of training if this decision came from the physicians on the NCMB—none of whom were mental health professionals when this was done prior to Dr. Bolick’s arrival at the NCMB, or more likely…
2. This constitutes the legal staff of the NCMB making these decisions without input from the NCMB physicians which makes them guilty of…
3. Attorneys practicing medicine without a license
a. One of the very things a professional board is set up to prevent!
v. Dr. Graham then goes on to confess; “…I don’t even know if what’s—what’s appropriate to discuss or not discuss in doctor-patient interaction.”
i. A very pertinent and honest statement!
w. Immediately after the above statement by Dr. Graham that he doesn’t even know what’s appropriate to discuss not discuss, Mr. Jimison gets him to agree that Dr.O “…disengage himself from the practice of medicine immediately…”
i. Dr. Graham admits that he doesn’t know what’s appropriate to discuss, and yet he’s qualified to state when Dr.O should stop practicing medicine.
x. Dr. Graham reviews the report of Dr. Stacy, referring to recommendations/requests from Dr. Stacy that Dr.O have a neurology evaluation and an MRI, but that those were not available, yet the report was issued despite the lack of this information that was requested.
i. Despite the lack of important information, the report and it’s recommendations were issued.
ii. The MRI & Neurology evaluation did not show any evidence of the pathology that concerned Dr. Stacy as it turned out, but…
iii. In the future, Dr. Bundick try to resurrect these concerns after he discussed Dr.O with the NCPHP.
1. Independent evaluations apparently are not done with the NCMB/NCPHP.
2. These consultants appear to “find” what they’re told to report.
y. Despite all of these discrepancies in the testimony however, Dr. Graham was able to opine that Dr.O would “Continue to be unfit” to practice medicine.
i. Dr. Graham seems to be “all over the place” as he’s being lead by Mr. Jimison.
ii. His future referrals to Acumen depend on this.
iii. It’s still unclear why the primary therapist for Dr.O, which was Dr. Stacy did not appear to testify.
iv. The validity of this testimony is certainly called into question.
z. Dr. Graham then testifies; “…it was our assumption that they should be implemented as quickly as possible”.
i. Clearly the NCMB/NCPHP/Acumen have worked together in the past
ii. With the history between these agencies, it’s understandable that Dr. Stacy would report in Exhibit 22 that the timing for Dr.O to return to work would depend upon the NCMB
1. Clearly Acumen had knowledge that the NCMB tended to keep practitioners from returning immediately returning to practice in the past.
2. With this knowledge, it’s not unreasonable for Acumen to anticipate a delay for Dr.O in his return to practice as noted in the exhibit.
iii. Acumen releases reports without complete data as documented above
iv. What is the reason that “they should be implemented as quickly as possible”, reports be issued without complete data (and with obviously very faulty data as noted in the critique of the 40 errors in the diagnostic report).
v. Is this merely an attempt to “capture” the client before anything else interferes?
aa. Exhibit 25 Non-Practice Agreement;
i. The NCMB “…requested that Dr.O essentially not practice until he left for treatment at Acumen in 2013”.
ii. When asked by Mr. Jimison; “And how did he do in his treatment?”
1. “I—I was part of the treatment team…”
2. Dr. Graham admitted “He had been in my psycho-educational group…”
3. “…in his work with Dr. Stacy (the primary therapist for Dr.O, who had the most knowledge of how Dr.O was doing in treatment and yet was not present at the hearing).”
bb. “And it’s individual with Dr. Stacy that he had a baseline understanding of what he needed to do going back into the work place”.
i. Is this hearsay?
ii. Clearly he’s not the choice witness as he was not the primary therapist.
cc. “…he be allowed to go back to work to begin to implement what he had learned.”
dd. “And then come back to us with longitudinal treatment program…”
i. The essential part of the program, longitudinal treatment.
ee. “But it’s not absolutely medically necessary for him to be working when doing the longitudinal treatment?
i. This witness follows his leader well
ii. Now he’s turned 180’ to follow the direction of what Mr. Jimison wants him to say.
iii. Lengthy questions, short answers when being lead
ff. “…it was authored by Dr. Stacy…”
i. Another declaration that he’s not really responsible.
gg. “Do you have an opinion whether Dr.O is fit to practice without, without these conditions?” “No.” “We—we-without—without this implementation of these recommendations, we did not think he would be fit to…”
of more NCMB complaints than any other practice within North Carolina over the past decade.
iii. Documented feedback from BMC patients showing a 98.6% approval rating.
iv. A complete lack of due process from the NCMB.
v. Contradictory statements by this witness as he’s lead by Mr. Jimison.
hh. Mr. Jimison; “He says: I suspect I have a bit of Asperger’s trends, but I don’t agree with all of the recommendations and findings.”
i. Dr.O agrees with the diagnosis, does not agree with all of the Acumen assumptions and proposals of the treatment plan
1. This is the organization with all of the errors in it’s assessment.
2. There is no due process
3. Dr.O has no choice on where he goes for therapy.
ii. Acumen recommended that Dr.O return immediately to practice with return visits to Acumen in May 2013, August 2013 & January 2014
1. Clearly the NCMB did not agree with the Acumen recommendations either, or they would have returned Dr.O to active practice.
iii. 25 years in Florida without a complaint
iv. Not a single patient complaint from MAMC
Mr. Jimison; “Does that cause you some concern?”
jj. Mr. Jimison; “When you signed the Non—Public Non-Practice Agreement, do you feel that was warranted?”
i. Dr. Graham replies that when Dr.O objected to signing the NPA (after the Acumen Assessment with it’s many errors and before the Acumen Treatment session with its inherent problems) it would cause him “some concern”.
ii. Dr. Graham further states; “…then it sort of throws into question the status of the whole rehabilitative process.”
1. This begs the question as to why Dr.O was prevented from following the Acumen recommendations to return to practice so that he could return to Acumen to review his progress.
2. Why was it necessary for Dr.O to spend >$20,000 of his own money to begin this absolutely necessary beyond any doubt process if he wasn’t allowed to complete it by following the recommendations of the “expert consultants (Acumen)”?
kk. Mr. Jimison; “…the earing accessory joke…”, then stating “…essentially inferring a sexual act.”
i. MAMC testimony was prohibited by the defense, yet is continually brought up.
ii. Dr.O is described as “…essentially inferring a sexual act.”
1. “Inferring” leaves a lot of room for “interpretation”
a. What standard is Dr.O being held to?
iii. Dr. Graham states; “…we specifically educate participants in our groups that sexual jokes in the context of examining and treating a patient is simply inappropriate.”
1. This is coming from a psychologist who has never done a GYN exam in his life, to an attorney who has never done a GYN exam in his life.
2. Both of these parties seem oblivious and ignorant to the fact that patients will initiate such banter to help ease their own discomfort.
3. The best way for a practitioner to help the patient to relax is to “play along” & “mirror the patient”, as Dr.O was taught in medical school, internship & residency training.
a. To not mirror the patient and leave the patient’s attempt at humor hanging without acknowledgement or agreement exacerbates the patient’s anxiety & discomfort when it appears that their attempt at humor “fell flat”.
b. Appreciating and responding to the patients humor has exactly the opposite effect.
c. The patient in question had initiated the banter in the exam room at MAMC as Dr.O has stated and documented at every occasion without discrepancy.
4. This is yet another example in which Dr.O has had experiences that run counter to his experience, experiences that are being contradicted by the “experts” who have never been in the exam room with an undressed & uncomfortable patient.
a. Not all patients respond the same to their discomfort.
b. This is one of the many reasons why medicine is described as a “practice”.
c. The very term “practice” connotes that sometimes, the best intentions are erroneous, but that the skilled & dedicated practitioner will continue to attempt to improve over time.
iv. Perhaps attempting to follow Mr. Jimison’s “lead”, Dr. Graham goes on to declare that “If—if Dr. Oenbrink is not able to see that that type of joke is fundamentally inappropriate at all times, I would have concern about his thought process relative his—especially in his professional role and his intention to understand.”
1. And yet, this type of humor has even been found in the media during fiction and non-fiction programming about the practice of medicine.
2. This must mean that professionals depicted in the act of the performance of their duties are seriously flawed and thus unable to practice medicine.
a. At least in the opinion of Dr. Graham & Mr. Jimison.
ll. Dr. Graham then opines: “…something needs to be re-evaluated there.”
i. This is coming from the same institution (Acumen) that stated Dr.O should return to practice in January of 2013.
ii. Dr. Graham seems to be following Mr. Jimison’s lead very well here.
a. Dr. Graham tells Mr. Morrison that the Diagnostic Assessment of Dr.O took “Three and a half days”.
i. This is a misleading statement;
1. Dr.O was subjected to numerous computerized testing batteries.
a. Dr.O very rarely uses the entire allotment of time required, generally finishing well within the allotted time.
b. When taking standardized exams of several hundred physicians in an exam hall, Dr.O is typically among the first five people to complete the exam and exit the exam room.
2. 9/10/12 0900-1030 Interview with Dr. Stacy
3. 9/10/12 1030-1200 “Computer Testing”
4. 9/10/12 1330-1430 Interview with Dr. Stacy
5. 9/10/12 1430-1600 “Computer Testing”
6. 9/11/12 1100-1200 “Interview with Dr. Stacy”
7. 9/11/12 1300-1500 “Dr. Shapiro”
8. 9/12/12 1100-1200 “Dr. Graham”
9. 9/12/12 1330-1400 “Urine Drug Screen”
a. 30 minutes is a long time allotment to give a urine specimen
10. 9/12/12 1400-1500 “Polygraph”
11. 9/12/12 1500-1600 “Dr. Stacy”
12. 9/13/12 0900-1000 “Dr. Whipple”
13. 9/13/12 1000-1100 “Dr. Stacy”
ii. Total time for “three and a half days” involves
1. 9/10/12 5 hours total
a. 2.5 hours with Dr. Stacy
b. 2.5 hours computer testing
i. This is the allotted time, not the time actually spent
2. 9/11/12 3 hours in interviews
3. 9/12/12 3.5 hours
a. 2 hours in interviews
b. 1.5 hours in testing including
i. 30 minutes to drop a urine specimen
4. 9/13/12 2 hours in interviews
iii. 13.5 hours total spent at Acumen Assessments in September 2012!
1. This 13.5 hours yielded a report of less than 20 pages with 40 errors.
b. Mr. Morrison; “And that was pretty much eight hours every day?”
i. “Yeah, Monday, Tuesday & Wednesday are pretty full days.”
c. Dr. Graham; “…he was grappling with the ideas that…”
i. Dr. Graham’s speech died out “(inaudible”), but whatever seed he was attempting to plant about Dr.O being unwilling and/or unable to fully agree with the Acumen intent was clearly planted in front of the committee.
d. Mr. Morrison; “I noticed you gave him a polygraph test.” “And he didn’t have to take that, did he, he didn’t have to do that, he volunteered to do that right?”
i. Dr.O was never told he was free to refuse any testing
ii. He was given numerous forms to sign.
iii. Refusal to perform any testing would be taken as a very bad sign in such a coercive environment!
e. Dr. Graham; “…he wasn’t being—(inaudible) with his emotions, that he wasn’t subconsciously, intentionally pursuing sexual enjoyment.”
i. This certainly seems like evidence that he’s trying to bolster the NCMB & NCPHP, which send him and Acumen routine business/referrals.
ii. He already blatantly lied about the amount of time spent during the assessment phase.
f. Dr. Graham, answering Mr. Morrison’s questions about Dr. Oenbrink having dedicated himself to overcoming alcoholism issues; “The PRN monitoring program in Florida has very qualitative facilitated groups. They’re not therapy groups but they’re facilitated by a licensed professional who has an understanding of the—of the agenda of the rehabilitation process.” And “…I think Dr. Oenbrink complied with that process. I mean, that—that would be meaningful to us in terms of thinking this.”
i. Dr. Graham is admitting that
1. Dr.O has been “under the microscope” many times by a variety of licensed professionals.
2. Licensed professionals have seen Dr.O from a variety of perspectives, both diagnostically and therapeutically.
3. Dr.O is cooperative and intrinsically driven to self-improvement of his own initiative.
4. Dr.O “wasn’t pursuing sexual enjoyment”, even “subconsciously”.
5. Yet, despite all of this…
g. Dr. Graham states that; “…it presents certain problems with regard to his fitness to practice and that he—that he needs to undergo some type of rehabilitation process.”
i. But not a single comment about the NCMB preventing Acumen’s treatment plan by refusing to allow Dr.O to return to practice as recommended by Acumen.
h. Mr. Morrison; “You indicated as well that you had thoroughly explored relevant psychological factors, relevant psychiatric factors and relevant medical factors for potential to negatively impact on his competency to practice.
i. No mention of left frontal lobe dysfunction despite all of this evaluation as Dr. Bundick would try to present in the future.
i. Mr. Morrison asks Dr. Graham about the fact that Dr.O didn’t fully agree with the Acumen findings and plan to which Dr. Graham replies that “But in that instance there would need to be a detailed conversation about what he means by all.”
i. Mr. Morrison then reminds Dr. Graham that this “detailed conversation” with Dr.O never occurred.
ii. Dr. Graham then goes on to re-state that sexual jokes would not be offensive; “Not in a—not in an evaluation and treatment setting.”
1. It should also be noted that Dr. Graham’s replies are frequently punctuated by a pause in which he repeats himself before and after the pause.
2. This is a known “tell” for dishonesty.
a. Dr. Bolick asks how many patients Acumen has treated for Asperger’s?
i. Dr. Graham answers “About twenty”.
b. Dr. Walker-McGill asks;
i. How are Asperger’s patients supervised?
1. The recommendation for supervision is for the work context.
2. Outside of the work context, ongoing meetings with a psychotherapist as well as ongoing communication of a monitoring programs
ii. Some applications appear to be have filled out with questions answered “no” when they should have been “yes”.
1. Asperger’s and mind-blindness.
a. This is part of what needs to be treated with Asperger’s.
b. This could be a conscious and intentional lie.
c. Dr. Udekwu;
i. “You said that it was not critical for a physician to be working actively involved, while having undergone treatment. But would it be optimal for the physician to be working actively while undergoing treatment?”
a. But Acumen would not do anything to push for Dr.O to return to practice.
ii. “And can you just briefly describe what kind of interaction there is between corporations such as—or companies such as yours and with the medical boards and PHPs, for example, like the Federation of State Medical Boards meeting where there is a similar or actual case?”
a. Sidestepping the question!
i. Why does the “captive client” have no say
as to where they are going?
Why does the same facility do both the assessment and the treatment?
1. This creates a situation in which the facility that diagnoses the client has a vested interest to find something wrong to treat.
2. “And it was up to Dr. Oenbrink, in conjunction with the Physician Health Program(PHP), to decide where he was going to chose to go for that type of treatment”.
a. If there had been a choice, Dr.O would have never gone back to Acumen in light of the errors in the Acumen Assessment.
3. “We think it’s important that the individual be able to go back to where they come from and make an educated decision about where they would like to go to undergo evaluation and treatment.”
a. Dr. Graham goes on to list 4 competing programs that do what Acumen does including one in Nashville that would have been much more convenient for Dr.O to attend.
b. He does not list any programs in NC.
iii. Address the access & costs.
1. Dr. Graham states that cost of a week of therapy is about $3,700, however he did it in a way that made it sound like that amount may have been for 3 weeks of treatment.
2. He did not address access.
d. Dr. Green; “Then why do we consider you an expert?”
i. Dr. Graham; “Well, I mean it’s—you know, a rare condition.”
1. “A 2003 review of epidemiological studies found a prevalence rate ranging from 0.03 to 4.84 per thousand.”
b. This is not a rare condition.
ii. Dr. Graham; “…the strengths of somebody with Asperger’s actually kind of overlaps with what’s necessary to make it in medical school…”
1. This implies that Asperger’s is more common in physicians.
iii. Dr. Greene; “…are they inappropriate in general with all types of patients or do you see the inappropriateness with the female sector?”
1. “…the inappropriateness is—is acted to most strongly by female patients.”
a. This does not say that the practitioner selects female patients.
b. It says that females are more sensitive to being offended.
2. Dr. Graham goes on to explain that other personality traits of the practitioner are more important in this than sex of the practitioner.
e. Mr. Morrison is given the opportunity to further examine Dr. Graham
i. “…each week costs about $4,000?
ii. Dr. Graham; “Yeah. And that wouldn’t include the cost of flying, and traveling and food.”
f. Mr. Morrison states that therapy for 3 weeks would cost about $19,000.
i. Dr. Graham agrees and states that there would be 3 of these sessions and then a “three day wrap up.”
g. Dr. Graham; “Well, our—you know, we’ve made a recommendation that he—that he pursue a certain type of treatment. He—he chose—he chose to undergo that treatment with us. So that it would be our recommendation to finish that with us.”
i. Dr.O had no choice, the NCPHP did not provide that option.
ii. Acumen did nothing to encourage Dr.O return to practice
iii. Yet Acumen continues to recommend that Dr.O return to their facility.
h. Dr. Graham goes on to state that “…there are—there are competent providers in this area of good qualifications with general psychiatry and general clinical psychology.”
i. He then goes on to say, “I don’t know off the top of my head whether or not the components of that could be put together locally.”
1. He then goes to add that there is also a program in Mississippi that he hadn’t mentioned earlier.
a. Dr. Graddy states that “…my first experience actually coming over to the Medical Board was to an investigative interview, that Dr. Oenbrink just came in and then that case was sort of handed off to me by Dr. Pendergast.”
i. Apparently Dr.O was the first client/patient that Dr. Graddy was assigned to.
ii. There has been controversy as to whether or not the NCPHP does “assessment & treatment” or “peer review”.
1. The NCPHP does not meet the criteria for “peer review”.
a. Dr.O was never informed of an intended change of NCPHP psychiatrist after an evaluation by Warren Pendergast MD and earlier evaluation by Joseph Jordan PhD.
b. Transfer of psychiatric care from one physician to another without prior notification of/permission from the patient would not hold up to the ethical standards of the APA.
b. “…Dr. Oenbrink wen tot Acumen for a four day evaluation…”
i. The thirteen and a half hour evaluation was far less than four days.
ii. This doesn’t speak well to Dr. Graddy’s precision, accuracy, honesty.
1. He must have noted that the evaluation was a lot less than 4 days.
2. He must have read hundreds of intensive evaluation reports during his training and career and be able to recognize that an evaluation that truly
3. took 4 days would have generated a lot more information than what he was presented.
c. “Well, we have a role to support physicians…”
i. He states this himself, it’s part of the NCPHP’s mission statement
ii. The level of support provided was; “Mr. Jimison told me that he’s tired of hearing from me, so there’s nothing I can do…(to advocate for your return to practice).
1. Dr. Graddy made this statement to Dr.O during a phone call in late March 2013 after the 3/21/13 “NCMB Investigative Hearing” chaired by Thomas Hill MD).
a. Dr.O was on Church Street in Greensboro received this phone call.
b. The call occurred in the latter part of the morning, around 10-1100.
c. He was driving with his wife, returning to their apartment after running errands.
d. The call was placed on speakerphone when it was received. Dr.O and his wife both heard every word of the call when Dr. Graddy made the above statement.
2. Essentially then, Dr. Graddy told Dr.O that he not provide any advocacy regarding returning Dr.O to practice as recommended by Acumen.
iii. “But in our state, it’s really, as I see it, how to move medical problems, substance abuse issues, out of a disciplinary process and into a process where the state—citizens of this state will be safe, but also physicians can get help.”
1. Which would include keeping a physician with a disability out of work for two years.
2. While allowing false statements to be recorded on the public NCMB website.
3. Allowing Civil Rights and HIPAA violations to occur.
a. This is the level of support provided by the NCPHP.
b. The NCPHP made no comment or objection to the violation of these basic US Federal rights of Dr.O.
c. The NCPHP did not object to violations of state and federal statutes by the NCMB, including violations of his bill of rights guaranteed by US Constitutional amendments.
4. In doing so, this organization charged to advocate for and protect practitioners are also culpable in the multiple violations of the basic rights of Dr.O (presumably other practitioners have experienced such violations as documented.)
d. “PHP’s also function as a third-party to gather data about a physician’s—they gather in sort of—impartial data about how a physician is responding to a medical problem.”
i. Dr. Graddy essentially states here that the PHP has a role in investigating the physician and the allegation made to see how the physician is responding.
ii. The NCPHP uses investigators for a variety of functions;
1. If there are complaints about a disruptive practitioner, the NCPHP sends an investigator to evaluate and interview witnesses to the disruptive behavior.
2. If a practitioner under contract turns in a urine specimen that contains evidence of relapse, an investigator is sent to the practitioner to evaluate the circumstances of the abnormal urine specimen.
3. The NCPHP may use its investigators for other purposes as necessary.
iii. There is no evidence that the NCPHP ever investigated any of the evidence regarding Dr.O (and others) to any degree.
iv. An investigation would have revealed the long-standing and multiple issues with Bethany Medical Center, issues that had gone on for many years
1. BMC is the only practice in the state of North Carolina that has had multiple physicians involved in Board complaints all coming from the same practice over a decade’s worth of review of NCMB actions.
e. Mr. Jimison; “And so, if a physician whether he has some sort of a misconduct as a result of substance abuse or whether this misconduct is the result of Asperger’s or some other medical conditions that’s impairing, it is the Medical Board’s role to hold physicians responsible for that separate misconduct.”
i. Mr. Jimison is describing what is mandated by the US Federal ADA as requiring accommodation, while prohibiting punitive action.
1. Clearly the NCMB undertook punitive action
2. This happened with the knowledge and implied agreement of the NCPHP.
ii. Dr. Graddy should have recognized and corrected Mr. Jimison on this matter.
iii. Per the AMA Guidelines of Medical Ethics, a physician’s priority is first and foremost to their patient.
1. It’s already been established that the NCPHP does not do Peer Review, so thus is performing assessment and directing practitioners to the treatment center chosen by the NCPHP (which the NCOSA April 2014 Performance Audit criticized the NCPHP for).
f. Mr. Jimison; “Ya’ll have contracts that require…”
i. Dr.O was not under any contract until after the last of his alleged wrongdoings
1. His contract was signed 1/28/13.
2. The final patient complaint was from 12/22/12.
3. Dr.O followed every aspect of his NCPHP Contract with the exception of the $125/month fee which he could not afford since he did not receive advocacy from the NCPHP to the NCMB which would have put him back in practice so that he could pay the monthly fee to the NCPHP.
g. Dr. Graddy; “”So we—what we depend on is—we’re a totally voluntary organization and when physicians enter into a contract with us, they are voluntarily saying, I am going to do X, Y and Z to address my medical problem.”
i. The NCPHP was the party in violation of the contract!
h. Dr. Graddy; “One is in support of the Board—we have a role in support of the Board to make sure that the citizens of North Carolina—that citizens of North Carolina have healthy health care providers.”
i. He does not mention that at least 6 physicians in this state have died at the hands of the NCMB and/or the NCPHP.
ii. Jimison; “I don’t know if you were here for all of Dr. Graham’s testimony earlier, but he indicated that he only saw him twice, that he only saw him twice on September 2012 and in January of 2013…”
1. Dr. Graham saw Dr.O at least once per week in January 2013.
i. Dr. Graddy; “…Dr. Oenbrink is not fit to practice medicine unless he adheres to the recommendations of the Acumen reports.”
i. The NCPHP refused to provide advocacy to the NCMB to encourage them to return Dr.O to practice.
ii. How can Dr.O adhere to the recommendations if he is not allowed to practice?
iii. How could a physician unfit to practice medicine…
1. Practice in Florida for 25 years without a problem?
2. Receive an approval rating of 98.6% from his patients at BMC?
a. Dr.O had sought treatment from Robert Dickinson PhD of his own initiative when the complaints began at BMC.
b. Dr.O was making progress in his therapy with Dr. Dickinson
c. This progress by Dr. Dickinson for Dr.O was interrupted indefinitely by the actions of;
i. Peter Hazelrigg
1. Who told Dr.O to return to Dr. Dickinson while he…
2. Wrote in his report to the NCPHP that Dr.O was unable to see his need for help.
ii. The NCPHP
1. Did not investigate the charges against Dr.O
a. As Dr. Graddy indicates (above) is part of the NCPHP role.
2. Did not provide any advocacy for Dr.O to the NCMB to allow his return to practice after he had been through both the faulty “assessment” & “treatment” mandated to him at Acumen.
3. Did not allow Dr.O any choice on where he went for assessment and treatment
1. Performed an “assessment” that contained forty factual errors.
2. Used the flawed assessment to form a treatment plan.
3. Was used as the basis for that treatment plan.
j. Dr. Graddy; “It’s been a huge goal in our organization despite, you know, these things that we’re aware of and—but he is not currently in compliance with his contract as well.”
i. Regarding completion of “longitudinal treatment recommended by Acumen”, “…he’s not.”
1. Dr.O notified the NCPHP in writing, after his return from the Acumen “treatment” in January 2013 and after the “Investigative Hearing” 3/21/13 chaired by Thomas Hill MD that he could not afford to pay the monthly NCPHP fee if he was not working.
a. The NCPHP refused to provide the advocacy that would have allowed his return to work.
2. Dr.O continued seeing Dr. Dickinson until it was clear that there was nothing else that Dr. Dickinson could do to help him.
a. Dr. Dickinson’s role was to help him deal with difficult patient encounters.
b. There were no patient encounters, difficult or otherwise, as long as Dr.O was unable to work.
c. Dr.O reviewed this with Dr. Graddy at the time that he stopped seeing Dr. Dickinson.
3. Dr. Graddy made dishonest statements to the panel, portraying Dr.O as being noncompliant with his NCPHP contract.
4. The reality of this is that Dr.O was doing everything in his power to comply.
5. The NCPHP was not honoring their side of the contract.
ii. Dr. Graddy deliberately lead the Disciplinary Panel to believe that Dr.O was not following the terms of his contract at his own decision.
1. Nothing could have been further from the truth.
2. Dr.O desperately wanted to return to practice and had done everything he could to ensure that he would return as quickly as possible.
3. The purpose of the NCPHP, by its own mission statement, is to return practitioners to practice as quickly as safe & possible.
k. Graddy; “…I think this evolves out of our PHP’s role in terms of treating folks with addiction…”
i. The NCPHP predominantly treats addiction.
ii. Dr.O is undoubtedly the first and only Asperger patient that they have treated
1. This is not their area of expertise
2. They are trying to “fit a round peg in a square hole” and are functioning outside of the realm of their expertise and experience.
l. Graddy; “I think in this situation the limit of our advocacy is at a lower level in that we advocate for successful resolution of this administrative process. But at this point, to go farther—you know, any father in terms of saying that we can predict the future in terms of Dr. Oenbrink’s behavior.”
m. Graddy; “I think the roles are so important, so, you, now, often in referrals we have—we have an assessment role, a pure assessment; like a DWI case, assessment role.”
i. “Assessment” implies “investigation” which was not done.
n. Graddy; “And my—the data that I have gathered indicates that Dr. Oenbrink has not accepted his diagnosis, that he is—I think it is of great concern to PHP and I’ve spoken with my colleagues there, that he’s placed far more effort into fighting this whole process rather than focusing on his own health and safety of his patients and that is of great concern to PHP.”
i. What is the data that he quotes?
1. At the start of the very first contact Dr.O had with the NCPHP in April 209, Joseph Jordan PhD was interviewing him. In the “Interim Status Report” section of the start of that report, Dr. Jordan recorded that; “Physician was open and honest regarding his issues of alcohol abuse and Asperger’s Syndrome.”
a. The first thing Dr.O told the NCPHP/Dr. Jordan was that he was a recovering alcoholic with comorbid Asperger’s.
b. How could this possibly mean that Dr.O “has not accepted his diagnosis”?
2. 7/15/09 During the Licensure Interview with the NCMB Dr.O discloses this on the first page of the transcript of the interview.
3. NCMB Investigative Committee 7/19/12 chaired by Dr. Greene 31 minutes before the end of the audio file Dr.O describes his Asperger’s and the difficulties he had in dealing with a woman who had an abortion the day prior to being seen by him.
4. The first sentence of the second paragraph of the first page of the Acumen Diagnostic Report states that; “Dr. Oenbrink indicates that he has Asperger's Disorder”
a. How does this “…indicate(s) that Dr. Oenbrink has not accepted his diagnosis” ?
5. 3/21/13 during the post-Acumen Treatment “NCMB Investigative Interview” chaired by Thomas Hill Dr. Graddy raised the subject of Dr.O being able to accept his diagnosis of Asperger’s. Dr.O specifically stated “I’m the common denominator” to clarify my acceptance
ii. “…he’s placed far more effort into fighting this…”
iii. “…focusing on his own health…”
1. Dr.O, at his own initiative, started seeing Robert Dickinson PhD about the complaints that arose.
2. Dr.O suggested to the management at BMC the use of comment cards/patient satisfaction surveys to be handled without his involvement by the staff at BMC.
iv. “…safety of his patients…”
1. The patient satisfaction survey’s that were conducted by staff at Bethany Medical Center without the input or involvement of Dr.O belie this statement.
v. “…of great concern to PHP.”
1. Then why did the PHP not advocate that for Dr.O to follow the Acumen recommendations to return to practice February 2013 and continue the follow up care for the plan designed by Acumen?
vi. It’s quite apparent that Dr. Graddy is either completely dishonest or completely incompetent with the frequency of the term “Asperger” appearing throughout all of the records that relate to Dr.O, and frequently coming from Dr.O himself!
vii. The most likely motivation for this behavior by Dr. Graddy is that he’s attempting to;
1. Hide the truth.
2. Discredit Dr.O in front of the disciplinary panel
3. Cover the errors made by
4. All of the above.
a. In reply to Mr. Morrison’s question about NCPHP Fees Dr. Graddy states; “My understanding is that Dr. Oenbrink arbitrarily informed us that he will no longer be paying us any money for fees.”
i. “My understanding…” Dr.O sent an Email to follow-up the discussion he had with Dr. Graddy 10/29/13 regarding the fact that it was impossible to pay the monthly NCPHP fee while he was out of practice; he simply couldn’t afford it while being on EBT for nutritional support after his unemployment had run out.
ii. During this conversation, no mention was made of reducing or removing these fees.
a. Dr. Bolick questions Re; Scholarships with the PHP which Dr. Graddy states are present, have been used by Dr.O and are now administered through the NCMS.
b. Dr. Udekwu questions Re; whether Dr. Graddy would consider himself involved regarding the financial difficulties
i. Dr. Graddy replies that Dr. O is still under contract and
ii. The PHP is concerned that Dr.O has a focus on the upcoming hearing and encouraged him to “consider alternatives to this hearing…” (sign the consent order).
a. Uneventful exam by Mr. Morrison (Defense)
i. Ms. Worthy’s recollection of Patient “B” (Kanoy) was exactly as that of Dr.O.
ii. She never observed any inappropriate behavior/comments by Dr.O
iii. Dr.O did not tell her what to write in her letter to the NCMB.
iv. She enjoyed working with Dr.O
b. Jimison; Review of the Affidavit from Ms. Worthy.
c. Ms. Worthy; “…I’ve asked myself this for the last few years, that one patient stood out in my mind. It was three patients that I used to recall at Bethany that stood out in my mind for the last two years and for some reason she was one of those patients.”
d. Ms. Worthy; “I never. Because normally—generally what happens is, when the patients come in and they are having a well visit exam, we generally go in the room and tell them to undress and they’ll undress and put the drape across the bottom of them and we put them on the exam table.”
i. This is standard procedure in pretty much every primary care setting.
ii. Earlier questions about MAMC and statements of undraped patients.
1. Draping of a patient is done by the medical assistant before the exam.\
2. Not all patients want drapes, some of them, for reasons of personal preference, prefer to see the examiner and make eye contact with them.
iii. Dr.O had been chastised and accusations made Re; MAMC about functions that the assistant would/should have undertaken.
1. These very accusations were made by that medical assistant & LPN
2. MAMC was not able to produce any patient complaints.
e. Mr. Jimison seemed to get quite excited about the different phraseology between bottom and “Did he say butt?”
f. Ms. Worthy then explains; “And scot up with her bottom. And he pulled—he—after we got her up—her bottom up and we got her pants down, he didn’t grab her and pull her, he asked her to start scooting to the bottom of the table. Once she was in the—in the process of scooting, he grabbed her knees and he was==he just gently pulled her and just told her to hold your knees up and he gave her her exam.”
g. Jimison; “So it would be fair to say when he was—how his hand was when he was pulling—when he was sliding her down, he was in between her legs?”
i. Mr. Jimison seems intent on making a routine exam seem like a sexual assault, which clearly from the witness’s description is not what happened at all.
ii. He seems to be trying to lead the witness and distort her statement.
iii. Ms. Worthy is describing the act of Dr.O positioning/assisting the fragile, feeble patient for her pelvic (vaginal bi-manual & rectal) exam.
1. This happens every day in medical offices of many specialties.
h. Jimison; “and it’s written in response to the complaint. I now would like to turn your attention to page 2. Let’s actually start at the bottom of page 1. Do you see the line starting with unfortunately, my medical assistant.”
i. Mr. Jimison then tries to create a schism between Patient “B” (Kanoy”’s consent being verbal or implied, asking Ms. Worthy which it was and what Ms. Kanoy was thinking.
ii. Mr. Morrison objects to this based on the fact that she’s not a mind reader..
1. Predictably, Dr. Camnitz overrules the objection.
iii. Jimison then bullies the witness, asking Ms. Worthy why Dr.O would write “implied” consent in his letter.
i. He then badger’s the witness; “He doesn’t say anything about you helping him slip her pants down.”
1. He continues to harass the witness as to why Dr.O worded the statement in his letter the way he did.
2. The witness would have no idea why Dr.O chose the wording that he used in the letter that he wrote.
3. There is no reason to pursue this other than to attempt to discredit the witness in the eyes of the panel by asking her questions that she cannot possibly answer as was done above.
j. Jimison; “I’ve worked with Dr. Oenbrink from May to July and at no time did I ever see him violate HIPAA.”
i. Worthy; “He kind of—kind of vaguely. It was more just like, you know, I’m in some trouble with the Board and because a patient is saying that he was—he—that he—that he sexually harassed her. And that’s the problem with this and that he wasn’t given the patient’s name and I started asking him…”
k. Ns. Worthy; “That’s what—we would with all the patients, he would kiss them on the forehead or on the cheek…”
i. A simple friendly gesture of affection or good will to further the doctor-patient bond.
l. Jimison; Regarding patient comment cards.
i. Worthy; “If they filled out a card, some of them did and I never was aware—I mean, they filled it out but I never saw what the comments were because they were always filled out and taken to the front for the box up front that they would put the cards in.”
m. Dr. Bolick; “What was the normal protocol if someone was scheduled for a well-woman, what would you all do?”
i. Ms. Worthy describes the normal protocol and with regard to Patient “B” states that “And Patient B, when she came in, I didn’t know” (that she was scheduled for a well-woman exam).
1. At BMC, when a patient was scheduled for an annual physical, that information would be posted on the schedule so that the medical assistant would know how to prepare the patient.
2. Sometimes a patient would come in, and with a review of the chart, it would be evident that they were overdue for an annual physical
3. Dr.O was in the habit of offering to do that exam at the visit that the patient had arrived for so that the patient’s care was complete and up to date; it was done as a courtesy to the patient.
a. It did create extra, unscheduled work for the clinic and staff however.
b. Dr.O always strived to provide the best care to his patients, male or female, regardless of age.
n. Dr. Bolick; “So was the caregiver able to see what was going on with the patient?”
i. Ms. Worthy; “Yeah, she should have been…”
1. The caregiver was in close proximity, however she was directly behind Dr.O who is somewhat broad-shouldered.
a. The caregiver could see the patients face and feet while Dr.O did the pelvic/rectal exam.
b. The caregiver would not have seen the patient’s mid-section, from about the breasts/chest to below the knees as Dr.O was positioned between those parts of the patient and the caregiver.
c. Dr.O was concentrating on examining the patient and may have not looked at the patient’s face during the exam as he was concentrating on another part of her body.
2. On this matter, Dr.O and Ms. Worthy have a difference of recollection.
3. The exam rooms at BMC were quite small.
o. Dr. Bolick; “Is that unusual to have a caregiver stay in the room during an exam?”
i. “So you let the patient make—(the call, exactly)
p. Dr. Bolick; “How about when he did rectal exams?”
i. Worthy; “Yeah, he would—he would always say…”
q. Dr. Bolick; “You mentioned that he would kiss the patients. Was that different from the other physicians that you’ve worked with?”
i. Worthy; “I have seen that done. I mean, all of them don’t do it because some do it now that I work with, but it’s not—it’s—I mean, when I seen him doing it, it’s just a natural thing because it wasn’t sexual or anything. It was just something—I mean, I guess compassion or care, but it wasn’t—it wasn’t sexual.”
r. Lennon; “My question is, you stated that only one lady stayed with you for the past two years of all the patient’s you’ve seen…”
i. Ms. Worthy; “Because of something. I mean, maybe it might be—it might have been divine intervention because that woman stood-there was three patients, three of his patients that stand out in my mind and that was one of them. She was one of the ones and I cannot explain to you this day the reason why.”
s. Dr. Walker-McGill; “She said that she didn’t know she was getting a pelvic. So I’m wondering how did Dr. Oenbrink know that she was getting a pelvic on an annual visit?
ii. Ms. Worthy; “So it may be the fact that she hadn’t been there in an entire year and it was just time for her to have her exam.”
t. Dr. Greene; “So she was fully clothed?”
i. Dr.O recollects that she had either a cape or gown open in the front.
ii. Ms. Worthy; “Because I do know too that the doctors at Bethany, as well as all the medical facilities, they are rushed and then once they get a mind set I have to get this done and get it done and get it—you know, get it out of the way so I can go to my next patient, that could be the case.”
u. Dr. Greene; “And the assistant—personal assistant that was in the room, was she in a position where she could view the patient’s private parts?”
ii. Ms. Worthy; “No.”
v. Dr. Greene; “Did you observe the patient’s reaction to thee exam? The kind of look on her face, her expression was that something you noticed?”
i. Ms. Worthy; “She didn’t seem to be upset or anything. I mean, she just had a normal reaction to the exam. Because after we finished giving her the exam, like I said, he walked out and we cleaned her up---I cleaned her up with the paper or the wipes in the room, sat her up on the bed and helped her get her pants and stuff on.”
w. Meelheim; “I think you just told Dr. Greene that she did not have a gown on; is that correct?
i. Ms. Worthy; “No, she didn’t. She wasn’t—she didn’t have on a gown.”
ii. Dr.O recollects that she had a gown on.
1. It’s possible that she had a blouse on that opened in the front or was easily lifted up for the breast exam.
a. The breast exam was done as it is a routine part of an annual well-woman exam.
x. Camnitz; “What percentage of female patients do you think he has kissed as they were about to leave the room?”
i. Ms. Worthy; “All of them almost.”
y. Camnitz; “Does he ever ask permission?”
i. Ms. Worthy; “Because I hadn’t heard him, so…”
a. Direct exam establishes the basic facts behind the numerous reasons for this hearing.
b. Dr.O; “If I notice the patient has not had the annual physical in more than a year, I offer them; could we not do that for you? Even if they’re not scheduled for such an exam, I offer it because I’m a big believer in preventive medicine.”
c. Dr.O; “That I had not resigned from Madigan.”
i. From this point forward there is a lengthy review of errors made in documentation by Dr.O on applications for staff privileges and other items.
d. Dr.O; “I preview the charts the day before and I know that this particular patient had not been in the office and had not had an annual physical done in well over 12 months.”
i. This is a reiteration of how I knew Patient “B” (Kanoy) was due for an annual physical and why Ms. Worthy did not understand that.
e. Dr.O; “My recollection is when I walked in the room, the cardiogram had been done, the patient had on a paper gown and it was open in the front.”
i. For an EKG to have been done, the front of the patient’s chest had to be exposed.
ii. Generally when a female patient has an exposed chest, a cape or gown opening in the front is used before the doctors entry into the exam room.
iii. The front is left open as that is the area that the practitioner will spend the most time examining.
f. Mr. Morrison; Dr. Oenbrink, where we left off I think we finished talking about individual patients and now I want to go to some other alleged unprofessional conducts is these applications for licensure, applications to Northern Hospital in particular.”
g. Dr.O; “I don’t think I have Asperger’s, I know I have Asperger’s.”
i. This will also put to rest Dr. Graddy’s comments.
h. Regarding finishing the Acumen recommendations; “…I had a conversation with Dr. Stacy who specifically told me in April of 2013, come back here after you’ve seen patients for at least 60 days.”
a. “…at MAMC there was a nurse named Charlene Smith, is that correct?”
i. Charlene Smith was a Certified Nursing Assistant who has much less training than an LPN or RN would have and is thus nowhere near as qualified or trained to understand what a nurse would understand.
ii. Dr.O testified that “…I did not recall her at that time.”
1. Recognizing a voice without knowing the name is not unheard of, as happened in this instance.
b. “Does—does the complainant say; ‘my father is the patient of Dr. Oenbrink, however my complaint refers to my mother, while accompanying my father to this visit on May 29th 2012?’”
i. Prior to that visit, Dr.O had not been the patient’s physician, the patient was normally seen by another provide in the practice, Dr.O was covering that physician 5/29/12 for acute walk-in patients.
ii. There was no established relationship with that patient and Dr.O.
c. “Patient A’s son lives in Georgia, Dr. Oenbrink.”
i. “There was a younger man in the room. I don’t know who he was, I just assumed that it was the son who wrote the complaint.”
d. “I asked you questions regarding that incident. On 155. And you want to scroll down to when you started talking about the joke. At any point in this deposition and it goes for a while, did you ever tell me during your deposition while you were under oath, sworn to tell the truth, that—that the ankle joke was a actually a, quote, blonde joke?”
i. “I don’t recall that I ever told you that. I don’t recall if that was ever asked of me.”
i. “I recall Dr. King saying that. I do not agree with that.”
ii. “And she actually said the patient was married, correct?”
1. “First time I had heard of that, yes, sir.”
f. (On MAMC application) “Have any disciplinary actions or investigations been initiated or any pending issue by any licensing board?
i. Mr. Jimison; “Do you recall writing that letter?”
ii. Dr. O; “When I met with Dr. Saunders in the conference room, verbally we had agreed to a private letter of concern. The Consent Order for the letter of Concern was mailed to me and I signed it with the belief that I was signing what I had agreed to verbally in the board room. Unfortunately, what I didn’t catch was the term Private Letter of Concern had been changed to Public Letter of Concern.”
iii. Dr. O; “And it was toward the end of the visit at the interview that we talked about private versus public letter and where the private letter would be and I was told it would just be in your file, it was no big deal, and if you have problems, the Board will have it to refer back to, but it won’t be on the public website or anything like that and I agreed to it.”
1. Per the request of Dr.O, attorney Wilson requested an original copy of the audio file of the 7/15/09 licensure interview meeting with Dr. Saunders et al.
b. The audio files of the interviews that Dr.O had attended with the NCMB were all reviewed in the company of Mr. Wilson on 8/5/13
c. This constitutes altering a legal document, a fraudulent illegal action that could result in permanent disbarment for any attorney involved.
iv. Mr. Jimison; “I’m sorry, let me stop you there.”
v. Dr.O; “…I missed the word public on that.”
g. Mr. Jimison; “Why did you—what was going through your mind when you affirmatively marked no to that question even though just a week prior you’re asking the Medical Board to remove a public letter from it’s web site?”
i. Dr.O; “All I can tell you, sir, is that with all the different hospitals I’ve been on the staff at doing moonlighting as a resident, doing locum tenens, an active residency in Florida, I had never had a problem of this nature and I glossed over it. I got it wrong. I’m 100 percent guilty about it.”
h. Mr. Jimison; “Have your employment, medical staff appointment, or clinical privileges ever been voluntarily or involuntarily suspended, diminished, revoked, refused, relinquished or limited at any hospital, clinic or other health care facility—facility.”
i. The term “clinical privileges” can refer to all privileges at a facility, or privileges for only one procedure—it can be a confusing item as it is spelled out.
1. With the above being said, Dr.O has clearly contested at all turns that his privileges were ever limited, he did not perform elective intubations, all tracheal intubations were done emergently.
2. There would be room for discussion on the term “relinquished” as Dr.O did resign from MAMC.
ii. Dr.O; “As I’ve said earlier, yes, sir, it’s correct and I made a mistake on that question.”
iii. Dr.O; “Every other place I’ve ever filled out an application for, the answer was no and I just glossed right over it and I blew it.”
1. A cursory review of the Curriculum Vitae of Dr.O will reveal that he has served on the medical staff of a great many institutions.
2. The great majority of these institutions involved his services before he ran into difficulties with the NCMB.
3. Dr.O still contests the initial Public Letter of Concern as being unfair and refers to the deletions of information/alteration of the legal document as evidence of deceit on the part of the NCMB.
4. Dr.O asserts that in light of the bigger picture, his error is more clearly recognized as an error, not as an attempt at nondisclosure.
iv. Mr. Jimison then makes a very big show of pointing out that Dr.O had signed the document for the consent order pertaining to the public letter of concern—which in no way negates the fact that Dr.O had not sought counsel and that he simply missed the fact that the document that had been described very clearly to him as being a “Private” letter had been changed into a “Public” letter—further evidence of the deceit involved in this matter as well as the fact that his 8/8/11 Appeal to make the document private as agreed to on 7/15/09 during the licensure interview would have never been written had this change in the letter/Consent Order not been surreptitiously slipped by him.
i. Jimison; “Wouldn’t that be something you ought to carefully read?”
i. Dr.O; “My agreement was to a private letter of concern during the interview with Dr. Saunders et al.”
ii. Dr.O; “…just as I’m being accused of missing questions and not admitting to things at different hospitals, I missed this one.”
1. Just as Dr.O had erred in the filling out of hospital privilege application forms, made mistakes to his alleged benefit, in this instance, he had erred and made a horrible mistake to his great detriment.
j. Mr. Jimison Re; NCMB License renewal of 12/19/11/Exhibit 16, date of action 4/20/12 (4/20/10??) at MAMC resulting in suspension that was not disclosed on the license renewal documents.
i. Why would Dr.O need to disclose to the NCMB the actions that the NCMB had taken against him? This made no sense to him.
ii. Dr.O assumed that since the NCMB already had this information, it was not necessary to recite it again—he had been made aware of it from the NCMB, not from MAMC.
1. This doesn’t preclude Mr. Jimison from pouncing on it and using it to further discredit Dr.O in front of the disciplinary panel.
iii. Next Mr. Jimison brings up the failure to disclose the Public Letter of Concern as being Public and the Private Letter of Concern Re; Caudle/Snow
1. Which, again, had been sent to Dr.O by the NCMB.
k. Mr. Jimison; “You know what makes the best ear accessories for a redhead and then you answered your own question by saying her ankles, you know, you were essentially referring to a sexual act.”
i. “Ankles behind the ears” also occurs during a variety of yoga poses;
1. Wide-legged forward bend with hands on Namaste
2. Wide-legged forward bend with hands on hips
3. Supported plow pose
4. Wide-legged forward bend with feet grab
5. Supported embryo pose
6. Ear pressure pose
7. Great plow pose
8. Cow pose, left leg and right arm up
9. Pigeon pose
10. Fish out of hero pose
11. Lying diamond pose
12. Upward easy bow pose
13. King cobra pose
14. Locust pose
15. Standing lord of the dance pose
16. Complex locust pose
ii. Mr. Jimison; “And your next answer, the first sentence, is: I don’t know what the context is.”
iii. Mr. Jimison; “…and the patient, you know, is in a supine position and the doctor is making physical contact with a female patient of the opposite sex, should that male doctor be making a sexual joke to a female patient?”
1. This is taken out of context; the reality of the situation is that during the procedure, it would be inadvisable to distract the patient with laughter and risk further injury to the patient.
2. The alleged comment was made to the patient prior to any physical contact by the doctor to the patient during the introduction of the doctor to the patient as the patient was bantering about, providing history, laughing and bragging about how the injury occurred during a sexual act with her “much younger boyfriend”.
3. Mr. Jimison’s portrayal is factually inaccurate.
l. Mr. Jimison; “Is that consistent with what Dr. Peter Graham taught you at Acumen?”
i. Dr.O “No sir, it is not.”
1. Acumen taught that such behavior was never justified.
2. Acumen taught that any relationship with a patient outside of the clinic was an absolutely forbidden boundary violation.
a. It was wrong to receive Candy, cakes, pies, other homemade goodies at any time including Christmas Holidays, birthdays etc.
b. Accepting any such item would be a grievous boundary violation.
3. Acumen taught that any contact with a patient outside of the office for any type of non-clinical event was highly suspect and was probably a boundary violation, and thus unethical at its core.
a. Dr.O had been known to discharge elderly patients from the hospital, finish his rounds and then drive the patient from the hospital back to their home.
b. Patients had been known to bring food into the office for the entire staff to share during post-hurricane periods where there was no electrical power, yet the office was open because Dr.O had purchased an emergency generator so that he could provide care for his patients when no other practices in the area were open.
i. These simple expressions of gratitude and community were absolutely forbidden boundary violations.
c. To worship with patients was another forbidden boundary violation.
i. Dr.O had been invited to and attended patient funerals as a pall bearer, delivered eulogies and been involved in similar events with patient families, as often, the family members were also patients.
d. Dr.O totally disagrees with certain aspects of the fundamentals mandated by Acumen, such as those above.
e. Dr.O was not given the opportunity to explain this during the interrogation by Mr. Jimison.
m. Mr. Jimison; “Have you ever grabbed female patients by the hips when they were on the exam tables and moved them without first announcing your intentions?”
i. Dr.O has worked in many environments including trauma units and in ICU settings where actions are not announced beforehand due to time constraints.
ii. His honest reply; “I may have.”
1. The only statements of this nature, moving patients without prior announcement of intent came from Charlene Smith, Medical Assistant at MAMC.
a. She was fresh out of training and inexperienced.
2. MAMC testimony was telephonic
3. All telephonic testimony at the hearing was forbidden by the defense.
4. MAMC was unable to provide a single patient complaint
5. There were no complaints from anywhere other than MAMC about such alleged actions.
6. There are no other complaints of this nature in North Carolina and have never been any in Florida despite 25 years of practice there.
iii. Mr. Jimison then goes on to question why the physician positions the patient, why doesn’t the medical assistant do so?
1. The medical assistant is not doing the procedure.
2. Responsibility for any procedure falls entirely on the operator, if there is any malfunction, even due to support staff, the operator is at fault (“Captain of the ship” doctrine).
n. (Re; Patient “B” (Kanoy)) Mr. Jimison; “In this letter you made no mention that Ms. Worthy also assisted you…”
i. Mr. Jimison; “And when you’re done, please point me to where you…”
1. Mr. Jimison is now trying to trip Dr.O up by asking him why the exact statements he used in his deposition are not in the letter written by Ms. Worthy.
2. During interrogation of Ms. Worthy, Mr. Jimison tried to prove that she had been told exactly what to write in her letter, now Dr.O is being chastised because her letter is not exactly what he stated in his deposition.
a. What difference does it make on whether Ms. Worthy assisted or not, the room measured ten feet by ten feet, she was within 20 inches of the patient whether her back was toward the patient or toward the counter where the blood tubes were placed, she was in the room, she saw what was going on, she heard what was going on, she testified that the patient never objected and did not appear to be in any distress as Dr.O announced his intentions, gave her options and followed her choices, including assisting her in disrobing at her request.
o. (Re; Patient “C” (Chase)) Mr. Jimison; “And you saw her in the exam room without a chaperone?”
i. Dr.O; “It was the flu season, it was very busy, it was the Christmas holiday, we were short staffed, I had no chaperone available--…”, “I really didn’t have any choice in the matter. This is not an optional situation.”
1. This has already been covered, but Dr.O was not in charge of the clinic
2. Dr.O is merely an employee being told what to do at the clinic
3. The circumstances that day were extraordinary
4. Dr.O was not under any requirement at that time to have a chaperone
5. Dr.O had told the owner of the clinics that he wanted a chaperone at every visit and a chaperone was provided to him >95% of the time (by estimate).
6. Ms. Worthy had testified about how Dr.O used chaperones.
ii. Mr. Jimison; “And your testimony is that you actually did it, correct?”
1. Dr.O; “Sir, I have no recollection of the patient.”
2. Mr. Morrison (defense attorney); “All right. Well, answer yes or no. Her testimony.”
3. Dr.O; “Yes.”
p. Mr. Jimison; “Do you agree with Acumen that—that all the recommendations that it recommended in September 2012 are necessary in order for you to safely practice medicine?”
i. Dr.O; “But then after outpatient treatment, I did not have a prolonged period of outpatient treatment.”
1. Acumen recommended return to practice followed by further evaluation and treatment at Acumen.
2. The NCMB refused to follow their consultants (Acumen) recommendations to dissolve the Non-Practice Agreement to allow Dr.O to practice so that Acumen’s recommendations could be followed.
3. The NCMB countermanded their consultant, despite the absence of a licensed health care professional sitting on the NCMB
a. Or, if the Board Members were not directly involved, Mr. Jimison did so himself which would constitute practicing medicine without a license.
ii. Dr.O; “I know that I don’t necessarily agree with every aspect of what Acumen specified. I tend to go along more with Dr. Dickinson’s recommendations.”
1. Acumen’s diagnostic assessment had at least 40 errors from which they based their recommendations.
2. Mr. Morrison stated that whether Dr.O agrees or not is irrelevant, Acumen is the expert; Dr.O is not qualified to agree or disagree with the finer points of their therapy.
q. Mr. Jimison; “Including that sexualized comments or jokes in a medical setting are not appropriate?”
i. Dr.O; “I believe I need recommendations, yes.”
1. Recommendations are not mandates
r. Mr. Jimison; “What are the portions of that concluding paragraph did you not agree with?”
i. Mr. Jimison; “…you need to be coached perhaps…”
ii. Dr.O; “Well, I disagree with—the deposition was a five-hour endurance test.”
1. Dr.O; “I was tired. I got that answer wrong.”
i. Dr.O; “I am not the first patient (sic) from Bethany or the second person, I am the sixth person from Bethany Medical Center who’s gotten in trouble. I was offered my job back after the Board staff concluded at half of my prior conversation (compensation).”
ii. Dr.O; “I practiced in Florida for 24 years. I had no problems.”
iii. Dr.O; “Acumen recommended I go back to work in January of 2013, a year and a half ago.”
iv. Dr.O; “…I was doing this before anybody ordered me to do so.”
a. Dr. Bolick; “Well, what is the purpose of chaperones?”
i. Dr.O; “Now to keep everything—you know, if I miss something and I inadvertently offend somebody, the chaperones job is to grab me by the nose, pull me out of the room if necessary…”
b. Dr. Bolick; “So if you were given your license back, what are you going to do differently….”
i. Dr.O; “…I don’t walk in the room with a female patient without a chaperone.”
ii. Dr.O; “And on December 22nd, I was not under a mandate to have a chaperone in the room. I was trying like hell to do so.”
a. Mr. Morrison (responding to Dr. Camnitz directing him to start his closing statement); “Yes. I think Mr. Jimison goes first.”
i. Mr. Jimison; “I don’t think Mr. Morrison is familiar with all the procedures. At the Medical Board, the party with the burden goes last.”
1. This is alarming.
2. Per NCGS Chapter 90-14-j “notice that the hearing shall proceed in the manner prescribed in Article 3A of Chapter 150B of the General Statutes and as otherwise provided in this Article;”
3. This sounds like Mr. Jimison is using his own procedures and having the defendant begin closing arguments.
a. Such action will preclude the defense counsel from countering points made by the prosecution panel is his closing argument.
b. Re; Patient “A” (Matthews); “Number 1, he kissed, at the hairline, the wife of a patient, an elderly patient, unannounced in celebration of a medical recovery. Pretty easy. He admits he did that.”
c. Patient “B” (Kanoy); “…Odessa Williams (sic) sounded credible. I wasn’t there. I don’t know what happened. I’m not a mind reader. I can’t find where the truth is. That would not be unreasonable. In which case, the Board has failed to meet it’s burden.”
i. “But in order to get there, you have to just say Odessa was lying or making this up. Or Morrison told her what to say. Or Dr. Oenbrink told her what to say and do and we overcame her will.”
d. Patient “C” (Chase); “He is instantaneously assaulting her, some kind of a sexual act; or he is a busy doctor and that there is a brief touching, clumsy, not best practice, slow down, pay attention to what you’re doing. But it is not a sexual assault.”
e. Re; Acumen, report authored by ten folks, “They find no evidence including with the polygraph that he is a sexual predator or that he would engage in sexual assaults.”
f. Re; MAMC/”redhead joke”; “…make an immediate report and get that patient out of there. And more importantly, get that doctor out of there. Col. Naylor couldn’t remember when she made this report. She didn’t remember. It certainly was not formal.”
i. “There is no patient complaint.” (from any MAMC patient).
g. Re; Reporting and failure to disclose; “Can you make a mistake on something like that when you’re asking have you ever been the subject of an investigation or if you’ve ever been disciplined or whatever, or been reported to the Medical Board. Somehow we got into the—I don’t think that is such a stretch. Certainly, he didn’t indicate any ill intent.”
h. Re; Florida privileges/intubation. “He could have done it in the ER. It’s not a sanction or disciplinary thing. It’s not unlawful conduct. This is the way the hospital worked. Can you make a decent mistake on something like that when it’s not motivated with deception? Certainly.”
i. Re; “…the rest of the documents.” “He didn’t pay attention. He didn’t fill it out the way he was supposed to and you look at those things when you deliberate. It’s what we lawyers call string sites, just one word all in one box. Great.” “And it is easy to miss something.”
j. Re; Asperger. “But if you’ve got a mental illness—wooo-o-o. That’s a different thing and somehow it’s not just a health issue. I think we misperceive it as a character defect. And it is not. It’s just like any other illness. You’ve got to diagnose it, you’ve got to treat it. And he has the responsibility to cooperate and abide with the treatment.”
k. They agree he is safe to practice medicine if—if—this is the 800 pound gorilla in the room here. If he will do what they say. And it’s in your power to make sure that he does do what is safe.”
a. “When you sort of strip away everything, when you get down to what is the basic core, the issue of this case is can you feel safe that Dr. Oenbrink can be left alone with a patient?”
i. 25 years in Florida
ii. 20 patients/d X 50 weeks/year X 3 years = 15,000 patient encounters, 6 patient complaints 6/15,000 = 0.0004 complaints per patient encounter or 1 complaint per 2,500 encounters
1. But these complaints were all blown out of proportion
2. 6 complaints came from one practice—two from patients never even seen
iii. 98.6% patient satisfaction rate based on hard data collected at that last practice
iv. Can you feel safe with that? Mr. Jimison says; “You can’t be.”
b. “And I think Dr. Oenbrink recognizes that. I think no matter how hard he tries to equivocate a lot of his statements about Acumen and the evidence in this case, that even he recognizes that.”
c. “Number 2 is: Did Dr. Oenbrink commit unprofessional conduct within the meaning of the statue with regard to patient “A” (Matthews)?”
i. Is kissing an anxious elderly woman in the forehead really unprofessional conduct, or is just a matter of practice style?
d. “Does Dr. Oenbrink suffer from a medical condition, Asperger’s disorder, which if not treated and managed properly, renders him unable to practice medicine with reasonable skill and safety to patients within the meaning of 90-14(1)(5)?”
i. “No evidence to the contrary. All the evidence and I—even Dr. Dickinson who is Dr. Oenbrink’s witness said he agrees with Acumen in all the substantive ways.”
1. Not exactly; Dr.O was making good progress with Dr. Dickinson before the NCMB interrupted.
2. Dr. Dickinson allowed that there was some value in follow-up appointments at Acumen after Dr.O returned to practice, but...
3. The comment cards and feedback from staff members, both “front office” and “back office” were helping them make rapid progress.
4. The NCMB then hijacked the Acumen plan by refusing the vacate the unnecessary NPA.
e. “Acumen said earlier this morning that without conditions, he is not safe to practice, but that their recommendations and conditions are essential for him to resume practice.”
i. But the NCMB refused to follow the recommendations of Acumen to restore Dr.O to practice so that he could have the therapeutic follow up visits at Acumen
1. The NCMB refused to follow their consultants recommendation in this regard
2. The NCMB refused this despite not having a single mental health professional on the board at the time of the refusal
3. The NCMB thus practiced outside the scope of their training by doing so.
a. Scope of training enforcement is a big part of the mission of the NCMB and any state medical board.
ii. Acumen has a vested interest in keeping it’s business moving by referring as many patients as possible to itself.
1. In any other medical practice, this would be a clear-cut Stark violation.
iii. The relationship between Acumen and other referral centers used by the NCPHP has been called out by the NC Office of the State Auditor in the April 2013 report for the manner in which they use a quid pro quo system with their referral centers paying for the annual NCPHP retreats, among others while stating clearly that this was unacceptable behavior for a state agency.
1. So Acumen’s statement that “he is not safe” is coming from a very tainted source with it’s own vested interests to protect.
iv. The primary therapist who treated Dr.O did not appear before the panel, instead one of the other officers of the Acumen corporation traveled from Lawrence KS to Raleigh NC to visit the source of many of their referrals.
v. This is the same agency that made 40 errors in the initial assessment done on Dr.O, errors that were used to formulate an assessment & treatment plan.
f. “Did Dr. Oenbrink fail to report his departure from the medical staff for Madigan on his annual license renewal form on September 2010 and does that constitute a violation in the statute saying he had to give us correct information on the annual renewal?”
i. The entire MAMC affair is nondiscoverable as the defense notified the NCMB counsel well before the hearing that telephonic testimony was unacceptable, yet it was carried out anyway.
ii. The entire MAMC affair in terms of any violations by Dr.O is a fabrication by Dr. Rosen in an attempt to protect the US Army from the Burn Pit Liability issue.
iii. MAMC was unable to produce a single patient complaint.
iv. When directly questioned about the need to report resignations from positions to the NCMB, such as when a better job offer arises, a locum opportunity concludes or other predictable change in employment happens, Mr. Jimison refused to answer Dr.O at the deposition stating; “I’m not your attorney, you should ask your attorney! You don’t get to ask questions at your deposition!”
1. Clearly, this is yet another fabrication by Mr. Jimison in an attempt to slander Dr.O.
g. Re; Registration (& renewal) questions; “They are trying to get the information to determine whether a doctor might have an issue.”
i. The web-based forms are a poor way to gather that information.
ii. Berating a practitioner for not reporting an action by a board to that board does not foster any trust or good relationship between the practitioner and the board.
iii. Mr. Jimison is commenting well beyond his issue of expertise in discussing whether a practitioner “might have an issue.”
1. He is also dealing in a ham-handed manner with a delicate subject with many nuances that he ignores completely.
2. His statements are clearly inflammatory and slanderous.
3. His actions constitute civil rights and ADA violations.
a. The NCMB via their legal department routinely post Protected Health Information on the NCMB public website without consent of his victims.
h. “Sometimes when they answer these questions, you know, if they are affirmative, we get information basically to answer the question, what happened here. And the answer to that question is fairly benign. Not much, there was a misunderstanding or I just left or I changed jobs or whatever.”
i. Had this issue been reported in 2010 the report given to the NCMB would have likely been that it was fairly benign.
ii. The problem with MAMC didn’t appear until the application was made to Northern Hospital in Surry County in 2011.
1. If Mr. Jimison had gotten the information at that time, it would have made no difference.
2. To reiterate, the problem at MAMC was fabricated.
3. The problem at MAMC was inadmissible due to the defense teams refusal to allow telephonic testimony.
iii. Mr. Jimison’s entire line of reasoning in this closing argument is flawed and unnecessarily inflammatory; he’s wrong, but using this error of his to slander the defendant.
i. “If we hadn’t—if he had answered that question correctly, then maybe he could have identified the issue long before he goes to Dr. Lori Coe’s office in 2010 and he grabs patient “D” (Caudle) and grabs her midsection and shakes it, or he kisses Patient “E” on her way out. We don’t get that information. We may have stopped it then.”
i. To repeat, reporting the resignation/departure from MAMC in 2010 would have not disclosed anything actionable by the NCMB.
ii. Bringing up incidents regarding Patient’s “D” & “E” is a violation of the 5th Constitutional Amendment in terms of double jeopardy.
1. Dr.O had already been to a hearing and the NCMB had already notified him of their decision on that matter.
iii. The interaction with Patient D, at the time, as he reported in his response;
1. Dr.O addressed the patient’s glycemic, blood pressure, lipid and weight issues
2. The patient was demanding longer-duration supplies of higher-doses of Klonopin, which is a potential dangerous and addictive medication
a. She could not very well complain to the NCMB that Dr.O refused to give her the quantity and dose of controlled substances she wanted.
b. Dr.O appropriately counseled her on the benefits of adjunctive medications, prayer, exercise, and meditation and offered her a trial of additional medication.
c. The physical examination was carried out in a medically appropriate manner.
d. The patient withheld other information during the visit, information that would have altered the outcome of the visit
e. The patient has the unrealistic idea that sedatives treat borderline personality disorder.
i. Mr. Jimison is certainly unfamiliar with psychopharmacology
3. Patient “E” (Snow)’s wife made a false claim Re; allegations of a kiss from Dr.O.
a. Dr.O responded to the NCMB that the allegation was false.
b. The patient’s wife had tried to get Dr.O to complete a ten-page form for social security disability due to the patient having had a “normal” cardiac cath three days earlier.
c. The visit was adversarial due to the attitude of Naomi Snow, wife of Henry Snow.
d. The chaperone’s letter verified the version of Dr.O regarding the events; that the “kiss” had never happened.
j. Mr. Jimison goes to great length to defend the purpose of licensure renewal questions to the NCMB members; “We are not just asking a question for the sake of asking a question. There is an underlying public health, public safety purpose to that question.”
i. This line of statement is irrelevant to the case of Dr.O
ii. He continues to discuss the 2010 renewal on this statement, which has been adequately addressed already.
k. Did Dr.O commit unprofessional conduct within the meaning of the statute with regard to his application for privileges at Northern Hospital?”
i. Dr.O had already answered this in the affirmative
1. He had a public and private letter from the NCMB that should have been disclosed
2. He disagrees stridently with the public letter
a. Legal documents at the NCMB were illegally altered Re; this matter.
b. There was no change in privileges regarding intubation.
c. The “investigation” by the FBOME never required any action on his part, the letter was termed “Private Letter of Guidance.”
3. He had not been made aware of the MAMC debacle at that point.
l. “…and Dr. Oenbrink actually admits to kissing her on the cheek or the forehead.”
i. Consoling an extremely anxious, stressed elderly female is supposedly unprofessional conduct worthy of punitive action?
ii. Dr.O had been out of practice for two years related to these matters
iii. The ADA mandates accommodation not discipline for a disability
iv. Asperger’s is a disability covered by the ADA.
v. The patient’s spouse never appeared to testify, all of the testimony was telephonic
vi. The testimony was basically hearsay, as the complainant was not the patient, the patients spouse, it was a third party, possibly the son of the patient
vii. The fact that the complaint was made 2 months after the event should speak to something.
viii. The patient’s wife, the elderly female is also quite demented and was offended by the apology by Dr.O.
m. “The reasons that Patients “B” (Kanoy) & “D” (Caudle) testified and you saw the Public Letter of Concern. And the Public Letter of Concern said, well, you know, we kind of can’t sort out who is telling the truth here, but if we did find that this happened, if we did find that he shook her belly, or we did find that you kissed her on the way out of the exam room and left a big wet spot on her cheek, we would find that to be unprofessional conduct.”
i. The Public Letter of Concern was due to
1. A mis-interpretation of intubation privileges
2. A disagreement on “investigation” Re; a “Private Letter of Guidance” from the FBOME
3. Illegally altering legal documents
ii. Patient’s B&D
1. Did not happen as noted by the Chaperones in the room at the time.
iii. “shook her belly”
1. A matter of practice style, certainly not unprofessional conduct
a. If that ever occurred
b. It didn’t.
n. “And then he continued to do what? Complaints came after that. He was put on notice.”
i. The only complaint not covered chronologically at this point was chase.
ii. “Complaint” is not plural, there was one complaint.
1. Which the panel later ruled Dr.O to not be at fault.
o. “I’m somewhat sympathetic to Ms. Worthy that the first job she had, that her physician mentor was Dr. Oenbrink”
i. Could that be more inflammatory/defamatory?
p. “They did joke about, hey, you just had a heart attack. Patient B was not misleading about that, she was not untruthful about that. She was not disrobed. She was not prepared for a pelvic exam.”
i. They did not joke
1. Dr.O asked in a light-hearted way so as to avoid alarming the patient, if the patient had ever had a heart attack.
a. Not “you just had a heart attack” which Dr.O would have no way of knowing.
b. Mr. Jimison doesn’t practice medicine and would not know that.
c. This doesn’t stop him from trying to sway and mislead the panel.
2. The patient stated she had an EKG “because of my hand”.
ii. The patient is clearly demented.
1. She is an unreliable witness, as her many misstatements, contradictory statements above clearly demonstrate.
iii. “She was not disrobed. She was not prepared for a pelvic exam.”
1. She was disrobed from the waist up.
2. It’s the medical assistant (Ms. Worthy’s) job to prepare the patient for the exam.
3. As “Captain of the ship”, Dr.O has some culpability for not making it clear to Ms. Worthy prior to the patient walking into the exam room that she was to be given her annual physical that day.
a. Some days are quite busy in a clinical setting.
b. Details can be missed.
c. There was no patient harm at the time.
d. After the fact, this “harm” seems to have been fabricated by NCMB counsel.
q. “Oenbrink does remove her pants. It is unprofessional at that point. He did not prepare her for a pelvic exam. He gave her no advance notice. She wasn’t disrobed, She wasn’t draped. And when he did ask her if he needed help—if she needed help removing her pants, this is what he should have done.”
i. Providing the patient with the assistance that she requested is now unprofessional conduct?
ii. The witness concurs completely as to the events that transpired.
iii. He actually did prepare her for a pelvic exam
iv. He actually did give her advance notice.
v. She wasn’t disrobed-that was Ms. Worthy’s job.
vi. She was draped.
vii. Does Mr. Jimison have any clue to how ridiculous this is?
viii. The only reason for this is defamation/slander.
1. He’s deliberately mischaracterized everything that occurred
2. As testified by both Dr.O & Ms. Worthy.
r. “Y’all have a better idea of what is appropriate than I would ever know. This is it. Let me step out of the room while you disrobe.”
i. She was unable to disrobe due to her debility
ii. If Dr.O stepped out of the room, she would not have been able to disrobe.
s. “Given that he wrote a letter describing the event, he did not say Ms. Worthy assisted in removing her pants.”
i. Now he’s complaining about one detail missing from my explanation of the events of that day.
1. Monday Morning Quarterback syndrome.
ii. He goes on to repeat that “it’s still unprofessional conduct” to assist a patient at her request.
t. “Patient “C” (Chase). Patient C, as you may recall is a patient, a long-term patient of that clinic. She goes for an exam at urgent care. It is the first time she ever saw Dr. Oenbrink. Then he leans up and presses his crotch against her knee. He doesn’t recall that. His testimony is I could not have never done that because when you have the otoscope, you walk around. Like every other practitioner does, you walk around and you take the otoscope off the wall and you look in the ear. That was not his testimony. His testimony was I may have done it. I just can’t recollect.”
i. Should the term be “allegedly” leans up and presses?
ii. Acumen had already proven that there is no sexual pathology.
1. That does not stop Mr. Jimison from attempting to fabricate such pathology.
iii. Mr. Jimison has been trying to paint Dr.O as pathologically dishonest throughout the hearing.
1. Dr.O now honestly states that he has no recollection of the event, it’s possible that it occurred…
a. If it occurred it was a misunderstanding at best
b. It would be like walking around a blind corner and bumping into somebody.
u. “She made a complaint to the Medical Board and that visit was unchaperoned, despite being put on notice, time and time again. And we can show you this if you want to. That he engages in—he habitually engages in unacceptable, offensive, intolerable unprofessional conduct even after being put on notice time and again.”
i. He was not required to have a chaperone
1. Despite this he made every attempt to have a chaperone at every visit
ii. He was not in charge of providing a chaperone.
1. He was just another employee in a busy clinic.
2. “…put on notice, time and time again.”
a. He was advised at Acumen
i. Once, not time and time again.
iii. “…habitually engages in unacceptable, offensive, intolerable unprofessional conduct…”
1. MAMC—didn’t happen
a. No patient complaints
b. Clear motive to discredit Dr.O
i. Burn pit patient
ii. US Army liability for burn pit harm
c. No documentation
d. No formal investigation
e. Article 15 ignored
f. Telephonic testimony
2. Patient “A” (Matthews)
b. Telephonic testimony
c. Complaint not made by patient
3. Patient “B” (Kanoy)
a. Poor witness
b. Poor 2nd witness (caregiver)
i. States it wasn’t first visit with Dr.O
1. It was
ii. States she saw everything
1. She couldn’t have from her perspective
c. Chaperone present
i. Chaperone concurs with Dr.O Re; what happened
4. Patient “C” (Chase)
a. Dr.O honest
i. Unclear if it ever happened
ii. He has no recollection
b. Had a 2nd polygraph showing honesty about the entire event
c. Polygraph done at his own initiative
i. Done at his own expense
d. Acumen demonstrated no sexual pathology
e. Any contact was strictly accidental
5. Patient “D” (Caudle)
a. Dishonest patient per her complaint
b. Dr.O has addressed issues in his earlier comments
c. Dr.O addressed initially in response to the NCMB
d. 5th Constitutional Amendment violation
6. Patient “E” (Snow)
a. Dishonest per her complaint
b. Chaperone letter supports Dr.O
c. Dr.O has addressed issues in his earlier comments
d. Dr.O addressed initially in response to the NCMB
e. 5th Constitutional Amendment violation
iv. The entire Formal Disciplinary Hearing involves;
1. Errors in reporting to Surry County
a. “Public” & “Private” Letters of Concern from NCMB
b. “Letter of Guidance” from FBOME
c. Yet these were addressed by the Greene Committee
2. Patient “D” (Caudle) & “E” (Snow)
a. Addressed and resolved
b. Any further proceedings are “double jeopardy”
a. See “u-iii-1”
4. Patient “A” (Matthews)
a. See “u-iii-2”
5. Patient’s “D” (Caudle) & “E” (Snow)
a. See “u-iii-5 & 6”
6. Patient “C” (Chase)
a. See “u-iii-4”
7. FBOME “Letter of Guidance”
a. Addressed with the “Licensure Interview”
b. Which involved illegal alteration of legal documents
8. Items already addressed by the NCMB
a. 1, 2, 5, 7
9. Items inadmissible
a. 3, 4
10. Items to be resolved
a. 6 Patient “C” (Chase)
b. The entire purpose of this Formal Disciplinary Hearing actually can only involve one patient
c. Dr.O would be absolved of wrongdoing for that incident
d. Dr.O still suffered
i. 2 years out of work
ii. NPDB report
iii. Severely tarnished professional record
iv. Undue punitive actions
1. Civil rights violations
a. ADA Violations
b. HIPAA violations
2. Basic Bill of Rights violations
a. Numerous US Constitutional & Amendment rights
3. Numerous violations of statutes in NCGS Chapter 90
v. “And finally Madigan, getting into more of Dr. Oenbrink’s credibility. They testified to what they saw firsthand. They testified to what they saw firsthand. And one of the components of the defenses always should get worse. People should run out of the exam room and yell and jerk people out and immediately fire them on the spot. That is now how real life works.”
i. Actually, this is how real life works.
1. This is especially true in large, rigid organizations such as the Dept. of Defense
ii. See all points on item “u-iii-1” above Re; MAMC
w. “Sexualized jokes. He doesn’t really disagree with them. He doesn’t really disagree with them. Now he does dispute Dr. King’s version, saying, well, she had a boyfriend. No, she was married. She was joking around with me. No. She was my patient. This was the first time you ever saw her and there was no joking, there was no banter going on at all.”
i. See “u-iii-1”
ii. She told Dr.O she threw her back out with her much younger boyfriend.
1. Marital infidelity happens
iii. She was joking around
iv. She did not file a complaint
v. No MAMC patient filed a complaint
1. MAMC could not produce even one patient complaint.
x. “In the end you will have seven issues.”
i. “u-iv” shows 1 issue.
y. Dr. Graham said that you can be emotionally traumatized by this conduct. This is more than a case of hurt feelings. This is a case about this Board protecting the Citizens of North Carolina.”
i. There is some truth to this statement.
1. Patients who are so emotionally & mentally unstable that the slightest touch can cause them to decompensate could be harmed by the alleged behaviors.
a. For that matter, such patients also routinely decompensate on their own.
b. Predisposed patients can misperceive certain behaviors as well.
i. Patient “C” (Chase) felt she had been sexually assaulted by a practitioner bumping into her.
ii. Dr.O has Asperger’s, which can cause misperception.
1. Of his own free will and volition, Dr.O started seeing Dr. Dickinson and was making progress until the NCMB interfered.
2. Acumen recommended immediate return to work and follow-up visits.
a. The NCMB countermanded their consultant
i. Practicing outside the scope of their training or…
ii. Their attorneys practicing medicine without a license.
a. 1. Unprofessional Conduct at US Army Hospital
b. 2. Northern Hospital Application
c. 3. Non-Disclosure Board Annual license Renewal 9/6/10
d. 4. Patient “A” Spouse (Matthews); Inappropriate Touching
e. 5. Patient “B” (Kanoy) Inappropriate Contact
f. 6. Patient “C” (Chase) Inappropriate Contact
i. I would simply suggest to you that the root of this is Asperger’s and that he should be allowed to return to the practice of medicine under the supervision of Dr. Dickinson and the close cooperation with PHP, of course, as such that you think are necessary, and he will strictly abide by what Dr. Dickinson says. Thank you.
i. “…there are three options…”, “I think the Board has to deal with the Asperger’s issue, but I also believe that the unprofessional conduct as you found with regard to the wife of Patient “A”, Patient “B” and Patient “C”
ii. “I think with regard to the non-closures, the Madigan application and the renewal, I think that those have to be dealt with, separate and apart from the Asperger’s issue. “I’ve thought about this and I think the following should happen”.
iii. “That his license should be indefinitely suspended with the following options to be considered.”
1. “One, which is a straight-up indefinite suspension and he has to go through the application process. During the application process, I would think that as a pre-requisite, he would have to be assessed, reassessed by Acumen or Acumen type program. And then y’all can evaluate that information and see what conditions at that point would be necessary to protect the public.”
a. “I think there was some testimony from Dr. Graham that would indicate that maybe the recommendations that were mentioned before are applicable, but there may be a need for reassessment.”
2. “Another option would be indefinitely suspended because I think an indefinite suspension takes into account the Asperger’s and all of the others together. And these would be the conditions that once he goes and gets the assessment that he can apply for a stay, a stay of the indefinite suspension. That is option two.”
a. “Instead of going through the application process, he would just apply for a stay. I would disfavor number two. We have done that and I would disfavor that.”
i. -Where was that done?
3. “Or an indefinite suspension that is immediately stayed, that you would immediately stay with the following conditions”
a. “That he maintain, sign, and maintain a current contract with the PHP…”
b. “…That he follows all PHP’s and Acumen’s recommendations as they currently appear…”
c. “…That he restrict his work week to forty (40) hours per week;”
i. –What is the rationale for this?
d. “…that prior to resuming practice, he has to notify the Board and obtain practice site approval…”
i. –What is the rationale for this?
e. “…he has to notify the Board and obtain practice site approval, and any changes of that practice site would have to be approved by the Board President and the Office of the Medical Director and you would be under no obligation to grant those changes.”
i. –What is the rationale for this?
ii. –This is quite restrictive and potentially problematic.
1. –If Dr.O/his attorney sends notice “to the NCMB” of what Dr.O plans, this is a loophole in which Dr.O can undergo further prosecution because notice was not served specifically to the President and the Medical Director of the NCMB.
f. “Dr. Oenbrink shall ensure that a chaperone is physically present for all patient encounters, male and female; and regardless of the nature of the patient visit.”