i(/ri!J(4patientsafety.org/documents/Reddy, Janardhana Penagaluru... · 2017. 8. 9. · 1 3. On or...
Transcript of i(/ri!J(4patientsafety.org/documents/Reddy, Janardhana Penagaluru... · 2017. 8. 9. · 1 3. On or...
-
BEFORE THE MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
In the Matter of the Accusation ) Against: )
) )
J anardhana Penagaluru ) Reddy, M.D. · )
) Physician's and Surgeon's ) Certificate No. A 24449 )
) Respondent )
File No. 800-2016-026742
DECISION
The attached Stipulated Settlement and Disciplinary Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.
This Decision shall become effective at 5:00 p.m. on August 4, 2017 •
IT IS SO ORDERED July 7, 2017.
MEDICAL BOARD OF CALIFORNIA
By: ~ ~ /i(/ri!J(.P Michelle Anne Bholat, M.D., Chair Panel B
-
XAVIER BECERRA Attorney General of California
2 JANE ZACK SIMON Supervising Deputy Attorney General
3 CAROL YNE EvANS (State Bar No. 289206) Deputy Attorney General
4 455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102-7004
5 Telephone: (415) 703-1211 Facsimile: (415) 703-5480
6 Attorneys for Complainant
7
8
9
BEFORE THE MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
10 11-----------------------------· 11 In the Matter ofthe Accusation Against Case No. 800-2016-026742
12 JANARDHANAPENAGALURUREDDY, STIPULATED SETTLEMENT AND M.D. DISCIPLINARY ORDER
13 400 SE 1ST STREET, SUITE B MINERAL WELLS, TX 76067
14
15
16
17
Physician's and Surgeon's Certificate No. A24449
Respondent.
18 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above-
19 entitled proceedings that the following matters are true:
20 P~TIES
21 1. Kimberly Kirchmeyer (Complainant) is the Executive Director of the Medical Board
22 of California (Board). She brought this action solely in her official capacity and is represented in
23 this matter by Xavier Becerra, Attorney General of the State of California, by Carolyne Evans and
24 Brenda P. Reyes, Deputy Attorneys General.
25 2. Respondent Janardhana Penagaluru Reddy, M.D. (Respondent) is represented in this
26 proceeding by attorney Tom Garberson, of the firm Low McKinley Baleria & Salenko, LLP,
27 whose address is: 2150 River Plaza Dr., Suite 250, Sacramento, California 95833.
28 Ill
1
STIPULATED SETTLEMENT (800-20 16-0267 42)
-
1 3. On or about November 28, 1988, the Board issued Physician's and Surgeon's
2 Certificate No. A24449 to Janardhana Penagaluru Reddy, M.D. (Respondent). The Physician's
3 and Surgeon's Certificate was in full force and effect at all times relevant to the charges brought
4 in Accusation No. 800-2016-026742, and will expire on July 31,2018, unless renewed.
5 JURISDICTION
6 4. Accusation No. 800-2016-026742 was filed before the Board, and is currently
7 pending against Respondent. The Accusation and all other statutorily required documents were
8 properly served on Respondent on November 22, 2016. Respondent timely filed his Notice of
9 Defense contesting the Accusation.
10 5. A copy of Accusation No. 800-2016-026742 is attached as Exhibit A and
11 incorporated herein by reference.
12 ADVISEMENT AND WAIVERS
13 6. Respondent has carefully read, fully discussed with counsel, and understands the
14 charges and allegations in Accusation No. 800-2016-026742. Respondent has also carefully read,
15 fully discussed with counsel, and understands the effects ofthis Stipulated Settlement and
16 Disciplinary Order.
17 7. Respondent is fully aware of his legal rights in this matter, including the right to a
18 hearing on the charges and allegations in the Accusation; the right to confront and cross-examine
19 the witnesses against him; the right to present evidence and to testify on his own behalf; the right
20 to the issuance of subpoenas to compel the attendance ofwitnesses and the production of
21 documents; the right to reconsideration and court review of an adverse decision; and all other
22 rights accorded by the California Administrative Procedure Act and other applicable laws.
23 8. Respondent voluntarily, knowingly, and intelligently waives and gives up each and
24 every right set forth above.
25 CULPABILITY
26 9. This stipulation is the result of a compromise between the Board and Respondent.
27 Respondent understands and agrees that the charges and allegations in Accusation No. 800-2016-
28
2
STIPULATED SETTLEMENT (800-2016-026742)
-
·-
026742, if proven at hearing, constitute cause for imposing discipline upon his Physician's and
2 Surgeon's Certificate.
3 10. Respondent stipulates that the Board has jurisdiction to impose a public reprimand
4 upon his certificate to practice medicine pursuant to section 2227 of the Business and Professions
5 Code. Respondent agrees to be bound by the Board's imposition of discipline as set forth in the
6 Disciplinary Order below.
7 CONTINGENCY
8 11. This stipulation shall be subject to approval by the Medical Board of California.
9 Respondent understands and agrees that counsel for Complainant and the staff of the Medical
10 Board of California may communicate directly with the Board regarding this stipulation and
11 settlement, without notice to or participation by Respondent or his counsel. By signing the
12 stipulation, Respondent understands and agrees that he may not withdraw his agreement or seek
13 to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails
14 to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary
15 Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal
16 action between the parties, and the Board shall not be disqualified from further action by having
17 considered this matter.
18 12. The parties understand and agree that Portable Document Format (PDF) and facsimile
19 copies of this Stipulated Settlement and Disciplinary Order, including PDF and facsimile
20 signatures thereto, shall have the same force and effect as the originals.
21 13. In consideration of the foregoing admissions and stipulations, the parties agree that
22 the Board may, without further notice or formal proceeding, issue and enter the following
23 Disciplinary Order:
24 DISCIPLINARY ORDER
25 A. PUBLIC REPRIMAND
26 IT IS HEREBY ORDERED that Respondent Janardhana Penagaluru Reddy, M.D.,
27 Physician's and Surgeon's Certificate No. A24449, shall be and hereby is publically reprimanded
28 pursuant to California Business and Professions Code section 2227, subdivision (a)(4). This
3
STIPULATED SETTLEMENT (800-2016-026742)
-
public reprimand which is issued in connection with Respondent's unprofessional conduct, as set
2 forth in Accusation No. 800-2016-026742, is as follows: On or about August 26,2016, the
3 Texas Medical Board issued an Agreed Order (Texas Order). The Texas Order found that
4 Respondent engaged in unprofessional conduct in that his care fell below the standard of care in
5 performing a thoracotomy for a patient. Specifically, Respondent violated the standard of care in
6 that he did not fully discuss the risks to the patient of proceeding with surgery and he failed to
7 document both the patient's understanding that surgery could leave the patient unable to breathe
8 without assistance and the patient's decline of other options such as chemotherapy. As a result of
9 the unprofessional conduct, the Texas Board ordered that Respondent enroll and successfully
10 complete eight (8) hours of continuing medical education (CME) in medical recordkeeping, and
11 at least eight (8) hours of CME in pulmonary masses and indications for and against surgical
12 intervention, approved for Category I credits by the American Medical Association, approved in
13 writing in advance by the Executive Director or their designee. These CME requirements were in
14 addition to all other CME required for licensure maintenance.
15 B. EDUCATION COURSE
16 Within 60 calendar days of the effective date of this Decision, Respondent shall submit to
17 the Board or its designee for its prior approval an educational program or course related to the
18 evaluation and treatment of lung cancer and/or other pulmonary masses. The educational
19 program or course shall be aimed at correcting any areas of deficient practice or knowledge and
20 shall be Category I certified. The educational program or course shall be at Respondent's
21 expense and shall be in addition to the Continuing Medical Education (CME) requirements for
22 renewal of licensure. Following the completion of the program or course, the Board or its
23 designee may administer an examination to test Respondent's knowledge of the course.
24 Respondent shall provide proof of attendance in the course or seminar in satisfaction of this
25 condition and ofthe hours ofCME credit received. Respondent shall participate in and
26 successfully complete the program or course not later than six (6) months after Respondent's
27 initial enrollment.
28
4
STIPULATED SETTLEMENT (800-2016-026742)
-
1 Failure to successfully complete the educational program or course outlined above shall
2 constitute unprofessional conduct and grounds for further disciplinary action.
3 ACCEPTANCE
4 I have carefully read the above Stipulated Settlement and Disciplinary Order and have fully
5 discussed it with my attorney Tom Garberson. I understand the stipulation and the effect it will
6 have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Settlement and
7 Disciplinary Order voluntarily, knowingly, and intelligently, and agree to be bound by the
8 Decision and Order ofthe Medical Board of California.
9
10
11
12
HANA PENAGALURU REDD Respondent
13 I have read and fully discussed with Respondent Janardhana Penagaluru Reddy, M.D. the
14 terms and conditions and other matters contained in the above Stipulated Settlement and
15 Disciplinary Order. I approve its form and content.
16
17
18
19
DATED:
20 Ill
21 Ill
22 Ill
23 Ill
24 Ill
25 Ill
26 Ill
27 Ill
28 Ill
, ,
5
STIPULATED SETTLEMENT (800-2016-026742)
-
1 ENDORSEMENT
2 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully
3 submitted for consideration by the Medical Board of California.
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Dated:
6
XAVIER BECERRA Attorney General of California JANE ZACK SIMON
:&;A:~~ Deputy fttn;~2(~~eral Attorneys for Complainant
STIPULATED SETTLEMENT (800-2016-026742)
-
Exhibit A
Accusation No. 800-2016-026742
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
KAMALA D. HARRIS Attorney General of California JANE ZACK SIMON Supervising Deputy Attorney General CAROL YNE EvANS Deputy Attorney General State Bar No. 289206
455 Golden Gate A venue, Suite 11000 s·an Francisco, CA 94102-7004 Telephone: (415) 703-1211 Facsimile: (415) 703-5480
Attorneys for Complainant
FILED STATE OF CALIFORNIA
MEDICAL BOARD· OF CALIFORNIA SACRAMENTO N l) ( :> .>-20 J...Y. BY )')" . 3, ~~ G~~-- ANALYST
BEFORE THE MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA
In the Matter of the Accusation Against:
Janardhana Penagaluru Reddy, M.D. 400 SE 1st Street, Suite B Mineral Wells, TX 76067
Physician's and Surgeon's Certificate No. A24449,
Respondent.
Case No. 800-2016-026742·
ACCUSATION
17 Complainant alleges:
18 PARTIES
19 1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official
20 capacity as the Executive Director of the Medical Board of California, Department of Consumer
21 Affairs (Board).
22 2. On or about November 28, 1988, the Medical Board issued Physician's and Surgeon's
23 Certificate Number A24449 to Janardhana Penagaluru Reddy, M.D. (Respondent). The
24 Physician's and Surgeon's Certificate was in full force and effect at all times relevant to the
25 charges brought herein and will expire on July 31, 2018, unless renewed.
26 JURISDICTION
27 3. This Accusation is brought before the Board, under the authority of the following
28 laws. All section references are to the Business and Professions Code unless otherwis~ indicated.
1
(JANARDHANA PENAGALURU REDDY, M.D.) ACCUSATION NO. 800-2016-026742
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
II
4. Section 2227 of the Code provides, in part, that the Board may revoke, suspend for a
period not to exceed one year, or place on probation, the license of any licensee who has been
found guilty under the Medical Practice Act, and may recover the costs of probation monitoring.
5. Section 2305 of the Code provides, in part, that the revocation, suspension, or other
discipline, restriction or limitation imposed by another state upon a license to practice medicine
issued by that state, or the revocation, suspension, or restriction of the authority to practice
medicine by any agency of the federal government, that would have been grounds for discipline
in California under the Medical Practice Act, constitutes grounds for discipline for unprofessional
conduct.
6. Section 141 ofthe Code states:
"(a) For any licensee holding a license issued by a board under the jurisdiction ofthe
department, a disciplinary action taken by another state, by any agency of the federal government,
or by another country for any act substantially related to the practice regulated by the California
license, may be a ground for disciplinary action by the respective state licensing board. A
certified copy of the record of the disciplinary action taken against the licensee by another state,
an agency of the federal government, or another country shall be conclusive evidence of the
events related therein.
"(b) Nothing in this section shall preclude a board from applying a specific statutory
provision in the licensing act administered by that board that provides for discipline based upon a
disciplinary action taken against the licensee by another state, an agency of the federal
government, or another country."
CAUSE FOR DISCIPLINE
(Discipline, Restriction, or Limitation Imposed by Another State)
7. On or about, August 26, 2016, the Texas Medical Board issued an Agreed Order
(Texas Order). The Texas Order found that Respondent engaged in unprofessional conduct in
that his care fell below the standard of care in performing a thoracotomy for a patient.
Specifically, Respondent violated the standard of care in that he did not fully discuss the risks to
the patient of proceeding with surgery and he failed to document both the patient's understanding
2
(JANARDHANA PENAGALURU REDDY, M.D.) ACCUSATION NO. 800-2016-026742
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
II
that surgery could leave the patient unable to breathe without assistance and the patient's decline
of other options such as chemotherapy. As a result of the unprofessional conduct, the Texas
Board ordered that Respondent enroll and successfully complete eight (8) hours of continuing
medical education (CME) in medical recordkeeping, and at least eight (8) hours of CME in
pulmonary masses and indications for and against surgical intervention, approved for Category I
credits by the American Medical Association, approved in writing in advance by the Executive
Director or their designee. These CME requirements were in addition to all other CME required
for licensure maintenance.
8. Respondent's conduct and the actions of the Texas Medical Board as set forth in
paragraph 7, above, and within the actual Texas Medical Board's Order attached as Exhibit A,
constitute cause for disciplinepursuant to sections 2305 and/or 141 of the Code.
PRAYER
WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,
and that following the hearing, the Medical Board of California issue a decision:
1. Revoking or suspending Physician's and Surgeon's Certificate Number A24449,
issued to Janardhana Penagaluru Reddy, M.D.;
2. Revoking, suspending or denying approval of Janardhana Penagaluru Reddy, M.D.'s
authority to supervise physician assistants, pursuant to section 3527 of the Code;
3. Ordering Janardhana Penagaluru Reddy, M.D., if placed on probation, to pay the
Board the costs of probation monitoring; and
4. Taking such other and further action as deemed necessary and proper.
DATED: November 22, 2016
Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant
SF2016202002
3
(JANARDHANA PENAGALURU REDDY, M.D.) ACCUSATION NO. 800-2016-026742
-
EXHIBIT A
-
NAME
LIC # IDNUM
ISSUE DATE
EXPIRATION DATE
BIRTH DATE
BIRTH PLACE
REGISTRATION STATUS
REGISTRATION STATUS DATE
DISCIPLINARY STATUS
DISCIPLINARY STATUS DATE
LICENSE STATUS
LICENSE STATUS DATE
MEDICAL SCHOOL
GRADUATION YEAR
LICENSURE METHOD
PRIMARY SPECIALTY
SECONDARY SPECIALTY
MAILING ADDRESS
PRIMARY PRACTICE SITE
Texas Medical Board Mailing Address: P.O. Box 201 S • Austin, Tx 7&768-201 8
Phone (512) 305-70 I 0
PUBLIC PHYSICIAN VERIFICATION AS OF 10/13/2016
REDDY, JANARDHANA PENAGALURU, MD
E5310
55122
12/11/1972
02/28/2018 1940
INDIA
ACTIVE
01/01/1978
UNDER.BOARD ORDER
08/26/2016
GUNTUR MED COLL, UN IV OF HL TH SCI, GUNTUR, ANDHRA PRADESH, INDIA .
.1963
ENDORSEMENTWITH CALIFORNIA
THORACIC SURGERY
VASCULAR SURGERY
400 S E 1ST STREET SUITE B
MINERAL WELLS, TX 76067
400 SE 1ST STREET SUITE B
MINERAL WELLS, TX 76067
-
·~P ~ 1!'. en= t r. 1"" ,~. COUNTY 0~ iro1Vt3
c.~~ce:11ty !h~P i. ~'~"' "m of'flt'.
-
LICENSE NO. E531 0
IN THE MATTER OF BEFORE THE
THE LICENSE OF
JANARDHANA REDDY, 1vLD. TEXAS MEDICAL BOARD
AGREED ORDER
On the c:L{p day of ~ jUsf: , 2016, came on to be heard before the Texas Medical Board (the Board), duly in session, the matter of the license of Janardhana Reddy
M.D. (Respondent).
On January 11, 2016, Respondent appeared in person, with counsel James Stouffer at an
Informal Show Compliance Proceeding and Settlement Conference in response to a letter of
invitation fi·om the staff of the Board. The Board's representatives were Margaret McNeese,
M.D., a member of the Board, and Michael Cokinos, a member of a District Review Committee
(Panel). Amy Swanholm represented Board staff.
BOARD CHARGES
Board Staff alleged that Respondent fell below the standard of care in performing a
thoracotomy for the patient.
BOARD HISTPRY
Respondent has not previously received a disciplinary order from the Board.
Upon the recommendation of the Board's representatives and with the consent of
Respondent, the Board makes the following Findings and Conclusions of Law and enters this
Agreed Order.
The Board finds the following:
Paoe 1 of7 b
-
a. Respondent received all notice required by law. All jurisdictional requirements
have been satisfied. Respondent waives any cleCect in notice and any further right
to notic,e or hearing under the Medical Practice Act, Title 3, Subtitle B, Texas
Occupations Code (the Act) or the Rules of the Board. ·'
b. Respondent currently holds Texas Medical License No. E53!0. Respondent was
originally issued this license to practice medicine in Texas on December 17, 1972.
c. Respondent is primarily engaged in the practice of thoracic and vascular surgery.
Respondent is board certified by the American Board of Surgery and the
American Board of Thoracic Surgery, members of the American Board of
Medical Specialties.
d. Respondent is 76 years of age.
2. Specific Panel Findings:
a. Respondent violated the standard of care in that he did not fully discuss the risks
to the patient of proceeding with surgery.
b. Respondent failed to document the patient's understanding that surgery could
leave the patient unable to breathe without assistance and the patient's decline of
other options such as chemotherapy.
3. Mitigating Factors:
a. In detem1ining the appropriate sanctions in this matter, the Panel considered the
following mitigating factors:
i. Respondent has no prior Board History.
11. The Panel acknowledged that this was a complicated patient.
111. Respondent has cooperated in the in~estigation of the allegations related to
this Agreed Order. Respondent neither admits nor denies the information
given above. To avoid further investigation, bearings, and the expense
and inconvenience of litigation, Respondent agrees to the entry of this
Agreed Order and to comply with its terms and conditions.
IV. Respondent stated at the !SC that he no longer performs thoracic surgery.
Page 2 of 7
-
CONCLUSIONS. OF LAW
Based on the above Findings, the Board concludes that:
1. The Board has jurisdiction over the subject matter and Respondent pursuant to the
Act.
2. Section 164.051(a)(3) ofthe Act authorizes the Board to take disciplinary action
against Respondent based on Respondent's violation of a rule adopted under this Act,
specifically Board Rules 165.l(a), failure to maintain an adequate medical record;
3. Section 164.05l(a)(6) of the Act authorizes the Board to take disciplinary action
against Respondent based on Respondent's failure to practice medicine in an acceptable
professional manner consistent with public health and welfare, as further defined by Board Rules
190.8(1)(A), failure to treat a patient according to the generally accepted standard of care;
190.8(1 )(C), failure to use proper diligence in one's professional practice; 190.8(1 )(D), failure to
safeguard against potential complications;
4. Section 164.001 ofthe Act authorizes the Board to impose a range of disciplinary
actions against a person for violation of the Act or a Board nrle.
5. Section 164.002(a) of the Act authorizes the. Board to resolve and make a
disposition of this matter through an Agreed Order.
6. Section 164.002(d) of the Act provides that this Agreed Order is a settlement
agreement under the Texas Rules of Evidence for purposes of civil litigation.
ORDER
Based on the above Findings and Conclusions of Law, the Board ORDERS that Respondent
shall be subject to the following terms and conditions:
I. Within one year from the date of the entry of this Order, Respondent shall enroll
in and successfully complete at least eight (8) hours of continuing medical education CCME") in
medical recordkeeping; and at least eight (8) hours. of CME in pulmonary masses and indications
for and against surgical intervention, approved for Category I credits by the American Medical
Association, approved in writing in advance by the Executive Director or their designee. To
obtain approval for the course, Respondent shall submit in writing to the Compliance
Page 3 of 7
-
Department information on the course, to include at least a reasonably detailed description of the
course content and faculty, as well as the course location and dates of instruction. Respondent
shall submit documentation of attendance and successful completion of this requirement to the
Conipliance Department on or before the expiration of the time limit set foi·th for completion of
the course. The CME requirements set forth in this paragraph shall be in addition to all other.
CME required for licensure maintenance.
2. At all times while Respond~nt is under the terms of this Order, Respondent shall
give a copy of this Order to all hospitals, nursing homes, treatment facilities, and other health
care entities where Respondent has privileges, has pending an application for privileges, applies
for privileges, or otherwise practices. Within 30 days of being first contacted by the Compliance
Division of the Board following entry of this Order, Respondent shall provide to the Compliance
Division of the Board documentation, including proof of delivery, that the Order was delivered
to all such facilities.
3. Respondent shall comply with all the provisions of the Act and other statutes
regulating the Respondent's practice.
4. Respondent shall fi.illy cooperate with the Board and the Board staff, including
Board attorneys, investigators, compliance officers, consultants, and other employees or agents
of the Board in any way involved in investigation, ·review, or monitoring associated with
Respondent's compliance with this Order. Failure to fully cooperate shall constitute a violation
of this order and a basis for disciplinary action against Respondent pursuant to the Act.
5. Respondent shall inform the Board in writing of any change of Respondent's
office or mailing address within 10 days of the address change. This information shall be
submitted to the Registration Department and the Compliance Department ofthe Board. Failure
to provide such information in a timely manner shall constitute a basis for disciplinary action by
the Board against Respondent pursuant to the Act. Respondent agrees that I 0 days notice of a
Probationer Show Compliance Proceeding to address any allegation of non-compliance of this
Agreed Order is adequate and reasonable notice prior to the initiatio11 of formal disciplinary
Page 4 oC7
-
action. Respondent waives the 30-day notice requirement provided by § l64.00J(b)(2) of the
Medical Practice Act and agrees to I 0 days' notice, as provided in 2:2 Texas Administrative Code
§187_4
-
I, JANARDHANA REDDY, M.D., HAVE READ AND UNDERSTAND THE FOREGOING AGREED ORDER. I UNDERSTAND THAT BY SIGNING, I WAIVE CERTAIN RIGHTS. I SIGN IT VOLUNTARILY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEMENT OF ANY KIND, VERBAL, \VRITTEN OR OTHERWISE.
DATED: 8) 'L'L \
STATE OF I£Xt9 5
COUNTY OF /ku; !!@
'2016.
Jru~:ii2L~ Respondent
§ § §
SWORN TO AND §tCKNOWLEDGED BEFORE ME, the undersigned Notary Public, on this ;12 day of fft!Gti.?T . , 2016.
Page 6 of7
-
SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this _i?{P . day of @JUS{ , 2016.
-~\ Michael Arambula, M.D., Phci"?iTLO., President Texas Medical I3oard
STATE OF TEXAS COUNTY OF TRAVIS lc hvt.1 certify ttl at r am an official assistant custodian of ~:cords for the Texas fv1etiical Board and that this is a true and correct Copy of the original, as it appears on the file in this office.
Page 7 of7