ALJDEC

00F-07190-MDX · Board of Medical Examiners · 2000-12-08

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: December 6, 2000. The record closed on January 4, 2001. APPEARANCES: Respondent Hanumaiah Srinarayana, M.D. appeared on his own behalf. Assistant Attorney General Steve Wolf represented the Arizona Board of Medical Examiners. ADMINISTRATIVE LAW JUDGE: Daniel G. Martin _____________________________________________________________________

The question presented by this case is whether Respondent Hanumaiah Srinarayana, M.D. has engaged in unprofessional conduct under A.R.S. § 32- 1401(25)(r), and, if so, whether he is subject to disciplinary action pursuant to A.R.S. § 32-1451. Based on the entire record, the Administrative Law Judge makes the following Findings of Fact, Conclusions of Law and Recommended Order: FINDINGS OF FACT Respondent Hanumaiah Srinarayana, M.D. is the holder of License No. 13138 for the practice of allopathic medicine in the State of Arizona. The Arizona State Board of Medical Examiners (the “Board” or “BOMEX”) is the duly constituted authority for licensing and regulating the practice of allopathic medicine in the State of Arizona. On or about October 6, 1993, the Board received an adverse action report regarding Dr. Srinarayana from Walter O. Boswell Hospital (“Boswell”) in Sun City, Arizona. [Exhibit 1] The substance of Boswell’s report was that Dr. Srinarayana’s clinical privileges had been restricted due to “negative documentation on outside references.” Boswell advised the Board that five of Dr. Srinarayana’s anesthesiology cases would be subject to observation by different anesthesiologists. Board investigator (now compliance officer) Mike Zakrzewski investigated the Boswell report. During the course of his investigation, Mr. Zakrzewski learned that Dr. Srinarayana had refused to permit the Boswell-mandated observations, and that as a result Boswell had suspended his clinical privileges. During the course of Mr. Zakrzewski’s investigation, Mr. Zakrzewski and Dr. Michael E. Brennan, a psychiatrist serving as the Board’s psychiatric consultant, conducted an investigative interview with Dr. Srinarayana. According to Mr. Zakrzewski, he and Dr. Brennan became “concerned” as a result of that interview about whether Dr. Srinarayana could safely engage in the practice of medicine, and asked Dr. Srinarayana if he would voluntarily undergo psychiatric and/or psychological/psycho- metric evaluation. Initially, Dr. Srinarayana agreed to undergo the requested evaluations. However, Dr. Srinarayana failed to schedule appointments for these evaluations, and consequently the evaluations were not conducted. Following Dr. Srinarayana’s failure to submit voluntarily to psychological evaluation, the Board, on March 26, 1997, issued a formal Order (the “Order”) requiring that Dr. Srinarayana “submit to psychiatric and psychological/psychometric evaluations by evaluators approved by Board of Medical Examiners staff. The Board shall pay the cost of the evaluations. The evaluators shall submit written reports to the Board.” [Exhibit 2] In a March 27, 1997 cover letter to Dr. Srinarayana that accompanied the Order, the Board advised Dr. Srinarayana that he had been scheduled to meet with Dr. Brennan on April 11, 1997 for the psychiatric evaluation, and that Dr. Srinarayana was to contact psychologist Phillip Lett, Ph.D., for the psychological/psychometric evaluation. The Board transmitted the Order and accompanying cover letter to Dr. Srinarayana, by certified mail, return receipt requested, to an address in El Campo, Texas at which Dr. Srinarayana was then residing. Dr. Srinarayana signed the certified mail receipt. Dr. Srinarayana did not keep his scheduled appointment with Dr. Brennan, nor did he contact Dr. Lett to schedule the psychological/psychometric evaluation. By certified letter dated April 24, 1997 [Exhibit 3], the Board advised Dr. Srinarayana that he had missed his April 11, 1997 appointment with Dr. Brennan, and that the Board had re-scheduled Dr. Srinarayana to meet with Dr. Brennan on May 30, 1997. The Board’s letter requested that Dr. Srinarayana confirm in writing that he was going to attend the meeting with Dr. Brennan, and also requested that Dr. Srinarayana advise the Board whether he had contacted Dr. Lett concerning the psychological/ psychometric evaluation. Dr. Srinarayana did not confirm his May 30, 1997 appointment with Dr. Brennan, nor did he advise the Board whether he had contacted Dr. Lett concerning the psychological/psychometric evaluation. Regarding Dr. Lett, the evidence was undisputed that Dr. Srinarayana failed to schedule an appointment. On May 29, 1997, Phoenix attorney James Burr Shields II wrote a letter to Mr. Zakrzewski [Exhibit 5] advising that he was assisting Dr. Srinarayana. Mr. Burr Shields acknowledged Dr. Srinarayana’s failure to have confirmed his intent to attend the appointment with Dr. Brennan, and stated “[t]he purpose of this letter is to do so.” However, according to Mr. Zakrzewski, by that time the Brennan appointment had already been canceled. Dr. Srinarayana did not thereafter meet with either Dr. Brennan or Dr. Lett. For reasons not explained at the hearing, this matter lay dormant for almost two years until, on May 13, 1999, BOMEX compliance officer Gail Milner sent a certified letter to Dr. Srinarayana [Exhibit 6] advising him that an audit of his case file had indicated noncompliance with the Order. Ms. Milner wrote, “I caution you that noncompliance with a Board Order may lead to disciplinary action.” Ms. Milner instructed Dr. Srinarayana to submit a written statement “relating to your present medical practice situation and your plans for returning to practice in Arizona.” By letter dated May 20, 1999 [Exhibit 7], Dr. Srinarayana responded to Ms. Milner’s May 13, 1999 letter only as follows: “In order to take extra-caution and to seek attorney assistance allow adequate time.” The undisputed evidence demonstrated that to date, Dr. Srinarayana has not complied with the Order. Dr. Srinarayana currently resides in Knoxville, Tennessee. He has not practiced medicine since 1997. He does not currently hold any active medical licenses in any other jurisdiction. Dr. Srinarayana appears to have undergone significant personal and professional upheavals during the past decade. Dr. Srinarayana testified that during the relevant time period in 1997, he was receiving psychiatric support from a Dr. Osagie in Texas. Dr. Srinarayana described this period of his life as “chaotic.” Dr. Srinarayana stated at the hearing that he is willing to undergo the evaluations ordered by the Board. Dr. Srinarayana acknowledged, however, that he had not communicated this willingness to the Board prior to the hearing date. The Board requested that Dr. Srinarayana’s medical license be indefinitely suspended until he successfully complies with the following conditions: x. Dr. Srinarayana shall submit to psychiatric and psychological/ psychometric evaluations by evaluators approved by Board of Medical Examiners staff. Dr. Srinarayana shall pay the cost of the evaluations. The evaluators shall submit written reports to the Board. y. Dr. Srinarayana shall fully cooperate with any further investigation conducted by the Board, and shall submit to any combination of mental, physical, or oral or written competency examinations required by the Board and successfully complete any rehabilitative retraining or assessment program subsequently ordered by the Board. z. Dr. Srinarayana shall meet with the Board and demonstrate to the Board’s satisfaction that he is medically competent and medically and physically able to safely engage in the practice of medicine. CONCLUSIONS OF LAW In this proceeding, the Board bears the burden to prove, by a preponderance of the evidence, that Dr. Srinarayana has engaged in unprofessional conduct pursuant to A.R.S. § 32-1401(25)(r), and that he is subject to disciplinary action pursuant to A.R.S. § 32-1451. See A.A.C. R2- 19-119. A preponderance of the evidence is “such proof as convinces the trier of fact that the contention is more probably true than not.” Morris K. Udall, Arizona Law of Evidence § 5 (1960). The Administrative Law Judge concludes, on the evidence presented, that the Board sustained its burden of proof. Under A.R.S. § 32-1401(25)(r), a physician engages in unprofessional conduct when he or she “[v]iolat[es] a formal order, probation, consent agreement or stipulation issued or entered into the board or its executive director under the provisions of this chapter.” The undisputed evidence demonstrated that Dr. Srinarayana failed to comply with the Board’s March 26, 1997 Order. Such failure constitutes unprofessional conduct under A.R.S. § 32-1401(25)(r). A.R.S. § 32-1451(K) provides: Any doctor of medicine who after a formal hearing is found by the board to be guilty of unprofessional conduct, to be mentally or physically unable safely to engage in the practice of medicine or to be medically incompetent is subject to censure, probation as provided in this section, suspension of license or revocation of license or any combination of these, including a stay of action, and for a period of time or permanently and under conditions as the board deems appropriate for the protection of the public health and safety and just in the circumstance. . . .

Based on the foregoing statute, Dr. Srinarayana is subject to disciplinary action because he is found to have engaged in unprofessional conduct. The Administrative Law Judge concludes, upon consideration of the evidence, that disciplinary action is warranted and that the discipline requested by the Board (see Finding of Fact No. 23, above) is reasonable and should be adopted. RECOMMENDED ORDER The Administrative Law Judge recommends that the Executive Director enter the following Order: Dr. Hanumaiah Srinarayana’s license for the practice of allopathic medicine in the State of Arizona (No. 13138) is indefinitely suspended until Dr. Srinarayana successfully complies with the following conditions: 1. Dr. Srinarayana shall submit to psychiatric and psychological/ psychometric evaluations by evaluators approved by Board of Medical Examiners staff. Dr. Srinarayana shall pay the cost of the evaluations. The evaluators shall submit written reports to the Board. 2. Dr. Srinarayana shall fully cooperate with any further investigation conducted by the Board, and shall submit to any combination of mental, physical, or oral or written competency examinations required by the Board and successfully complete any rehabilitative retraining or assessment program subsequently ordered by the Board. 3. Dr. Srinarayana shall meet with the Board and demonstrate to the Board’s satisfaction that he is medically competent and medically and physically able to safely engage in the practice of medicine.

Done this day, January 8, 2001.

______________________________________ Daniel G. Martin Administrative Law Judge

Original transmitted by mail this ____ day of ____________, 2001, to:

Claudia Foutz, Executive Director Arizona Board of Medical Examiners ATTN: Amanda Diehl 9545 East Doubletree Ranch Road Scottsdale, AZ 85258

By ___________________________ -----------------------

Office of Administrative Hearings 1400 West Washington, Suite 101 Phoenix, Arizona 85007 (602) 542-9826