ALJDEC - Licensing
23A-23830-MDX · Arizona Medical Board · 2023-08-24
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
In the Matter of
Linda Thull, MD
Holder of License No. 23830
For the Practice of Allopathic Medicine
In the State of Arizona.
No. 23A-23830-MDX
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: June 21, 2023
APPEARANCES: Linda Thull, M.D. failed to appear. The Arizona Medical Board was represented by Assistant Attorney General Elizabeth A. Campbell. Twana Fairbourn, Senior Compliance Officer for the Arizona Medical Board, was a witness on behalf of the Board.
ADMINISTRATIVE LAW JUDGE: Brian Del Vecchio
FINDINGS OF FACT
The Arizona Medical Board (Board) is the authority for the regulation and control of the practice of allopathic medicine in the State of Arizona.
Linda Thull, M.D., (Respondent) is the holder of License No. 23830 for the practice of allopathic medicine in Arizona.
On or about May 2, 2023, the Board issued a Complaint and Notice of Hearing to Respondent alleging Respondent had engaged in unprofessional conduct pursuant to A.R.S. § 32-1401(27)(e), A.R.S. § 32-1401(27)(r), A.R.S. § 32-1401(27)(s), A.R.S. § 32-1401(27)(kk), and A.R.S. § 32-1401(27)(tt).
MD-22-0156A
On or about October 18, 2018, the Board entered into a Stipulated Health Agreement (SHA), a confidential non-disciplinary stipulated agreement, in case number MD-17-0775A.
On or about February 7, 2022, Respondent filed a complaint against another physician regarding that physician’s care of Respondent’s Immediate Family Member (IMF), as defined by A.R.S. § 32-1401(13). During the investigation of Respondent’s complaint, Respondent disclosed to Board staff that she had rendered treatment to IMF after entering into the SHA. In written correspondence to the Board, Respondent denied that she had practiced medicine, but admitted that she had “bridge[d] the care” for IMP while IMF searched for a psychiatrist.
On March 30, 2022, the Board initiated case number MD-22-0156A based on the information received indicating Respondent may have violated the terms and conditions of the October 18, 2018, SHA.
According to the terms of the SHA, the Executive Director and Respondent agreed to the following:
Respondent is currently not engaging in the practice of medicine in the State of Arizona as set forth in A.R.S. § 32-1401(22)
Respondent’s Board approved treating provider, Henry J. Schulte, M.D., issued a report dated October 24, 2017 which made recommendations for Respondent’s return to work including, but not limited to, engaging in practice on a part-time basis. Respondent has chosen not to return to work since the issuance of the October 24, 2017 report.
Prior to engaging in the practice of medicine, Respondent shall provide the Board with a report from her current treating provider regarding her diagnosis, prognosis, current medications, recommendation for continuing care and treatment, and Respondent’s ability to safely practice medicine.
If ongoing treatment is recommended, Respondent shall thereafter continue to engage in treatment with a Board approved psychiatrist and shall comply with any and all treatment recommendations, including taking any and all prescribed medications. [Respondent] shall instruct the treating psychiatrist to submit quarterly written reports to the Board regarding diagnosis, prognosis, current medications, recommendations for continuing care and treatment, and Respondent’s ability to safely practice medicine. [Respondent] shall provide the psychiatrist with a copy of this SHA. [Respondent] shall pay the expenses of all the care and be responsible for paying for preparation of the quarterly reports.
Respondent shall submit quarterly written reports to the Board regarding employment, including her compliance with work recommendations of her treating psychiatrist, if applicable.
Respondent may submit a written request to the Executing Director requesting termination of this SHA. The decision to terminate will be based in part upon Respondent’s treating psychiatrist’s recommendations for continued care and treatment and Respondent’s ability to safely practice medicine.
Upon obtaining employment as a physician, Respondent shall immediately provide a copy of this SHA to Respondent’s employer. Within 30 days from becoming employed, Respondent shall provide the Board with a signed statement of compliance with this notification requirement. Respondent is further required to notify, in writing, Respondent’s employer of a violation of this SHA.
If Respondent fails to comply with the terms of this SHA, Respondent shall promptly enter into an Interim Consent Agreement for Practice Limitation that requires, among other things, that Respondent not practice medicine until such time as Respondent is evaluated, deemed fit to return to practice, and obtains affirmative approval from the Executive Director in consultation with the Lead Board Member of Chief Medical Consultant to return to the practice of medicine. Respondent may be required to undergo any combination of physical examination, psychiatric or psychological evaluation and/or to successfully pass the Special Purpose Licensing Examination and/or participate in interviews with Board staff for the purposes of assisting in determining Respondent’s ability to safely return to the practice of medicine. In no respect shall the terms of this paragraph restrict the Board’s authority to initiate and take disciplinary action for violation of this SHA.
The Executive Director may require any combination of staff approved physical examination, psychiatric and/or psychological evaluations it finds necessary to assist determining whether this SHA should be terminated. Respondent agrees to pay all expenses associated with any additional examination(s) or evaluation(s).
The Board retains jurisdiction and may initiate new action based upon any violation of this SHA.
Beginning in June 2019, Respondent sent emails to Board staff allegedly in compliance with the SHA. In the emails, Respondent asserted she was not practicing medicine on the following dates:
June 19, 2019
December 20, 2019
March 29, 2020
June 26, 2020
September 17, 2020
December 12, 2020
March 30, 2021
June 22, 2021
October 4, 2021
January 10, 2022
June 16, 2022
September 29, 2022
On February 16, 2022, a Phoenix pharmacy, in response to the Board’s subpoena, submitted the following prescriptions signed by Respondent to the Board:
RX Number: 6010716 dated January 1, 2019,
RX Number: 6021166 dated April 12, 2019,
Prescription for Crestor dated May 12, 2019,
Prescription for Flovent dated June 13, 2019,
Prescription for Doxycycline and Atrovent dated March 23, 2021,
RX Number: 6051824 dated April 19, 2021,
Prescription for Losartan dated May 19, 2021,
Prescription for Lamictal and Wellbutrin dated November 10, 2021,
Prescription for Trileptal dated January 16, 2022,
Prescription for Rexulti dated January 17, 2022,
Prescription for Zoloft dated January 19, 2022, and
Prescription for Flowmax dated January 19, 2022.
On or about February 22, 2022, the Board contacted Respondent regarding her potential violations of the October 18, 2018, SHA.
On March 18, 2022, Respondent, through her attorney, submitted a response to the Board’s allegation Respondent violated the October 18, 2018, SHA.
On or about March 22, 2022, Board staff asked Respondent’s counsel if Respondent had any records to support her prescribing of medications to IMF. On or about April 20, 2022, Respondent’s staff replied to the Board’s inquiry indicating that Respondent did not have any medical records for IMF.
On or about March 28, 2022, the Board issued a Confidential Interim Order for Physician Health Program Assessment (Interim Order) requiring Respondent complete an assessment with the Board’s Physician Health Program (PHP) Assessor. The Interim Order warned Respondent that her failure to comply with any aspect of the Assessment or with the recommendations of the Assessor may be considered an act of unprofessional conduct.
On or about March 30, 2022, Respondent and the Board agreed to an Interim Consent Agreement for Practice Restriction (Interim Consent Agreement).
The Interim Consent Agreement detailed the following pertinent facts:
The Board imitated case number MD-22-0156A after receiving notification that Respondent may have violated the terms and conditions of a Stipulated Health Agreement (“SHA”).
Effective October 18, 2018, Respondent entered into an SHA with terms and conditions including a requirement that prior to engaging in the practice of medicine, Respondent is required to provide the Board with a report from her current treating provider that opines that she is safe to practice (“Safety to Practice Letter”).
Between April 12, 2019 and January 19, 2022, Respondent wrote prescriptions for a member of Respondent’s Immediate Family including malarone (for malaria), crestor, flovent, metformin, prednisone, losartan, chlorthalidone, doxycycline, atrovent, propranolol, rexulti 2mg and .5mg with 8 refills (atypical antipsychotic), lamictal, wellbutrin, trileptal (anti-convulsant), zoloft, and Flowmax.
According to the terms of the Interim Consent Agreement, Respondent agreed to comply with the following orders:
Respondent is prohibited from engaging in the practice of medicine in the State of Arizona as set forth in A.R.S. § 32-1401(22) until Respondent applies to the Executive Director and receives permission to do so.
Respondent may request, in writing, release and/or modification of this Interim Consent Agreement. Respondent’s request must be accompanied by information demonstrating that Respondent is safe to practice medicine. The Executive Director, in consultation with and agreement of the lead Board member and the Chief Medical Consultant, has the discretion to determine whether it is appropriate to release Respondent from this Interim Consent Agreement.
The Board retains jurisdiction and may initiate new action based upon any violation of this Interim Consent Agreement, including, but not limited to, summarily suspending Respondent’s license.
Because this is an Interim Consent Agreement and not a final decision by the Board regarding the pending investigation, it is subject to further consideration by the Board. Once the investigation is complete, it will be promptly provided to the Board for its review and appropriate action.
Hearing Evidence
At hearing, Twana Campbell, Senior Compliance Office for the Arizona Medical Board and Arizona Regulatory Board of Physician Assistants, testified that after Respondent signed and submitted the initial SHA, she failed to comply with the terms of the SHA. Ms. Campbell testified Respondent failed to submit the quarterly reports from October of 2018 through June of 2019.
Ms. Campbell further testified Respondent had been sporadically submitting quarterly compliance declarations stating, “I am not currently working and have not worked since last communication.”
Respondent failed to appear and therefore was unable to refute the Board’s evidence.
CONCLUSIONS OF LAW
The Board has jurisdiction over Respondent and the subject matter in this case.
Pursuant to A.R.S. § 41-1092.07(G)(2) and A.A.C. R2-19-119(B), the Board has the burden of proof in this matter. The standard of proof is by clear and convincing evidence. A.R.S. § 32-1451.04.
The legislature created the Board to protect the public. See Laws 1992, Ch. 316, § 10.
A.R.S. 32-1401(2) provides:
“Adequate records" means legible medical records, produced by hand or electronically, containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another practitioner to assume continuity of the patient's care at any point in the course of treatment.
The evidence presented established by clear and convincing evidence that Respondent was engaged in the practice of medicine when she issued numerous prescriptions to IMF while under the terms of the SHA. Respondent had no medical records to support the issuance of those prescriptions. Furthermore, Respondent submitted regular statements to the Board that she was not employed or engaged in the practice of medicine during that timeframe.
Therefore, the Board established that Respondent’s conduct constituted unprofessional conduct pursuant to A.R.S. § 32-1401(27)(e) in that she failed or refused to maintain adequate records for IMF as defined by A.R.S. § 32-1402(2) to support the prescriptions.
Further, the Board established that Respondent’s conduct constituted unprofessional conduct pursuant to A.R.S. § 32-1401(27)(r), specifically A.R.S. § 32-1401(27)(tt), in that she prescribed several medications for IFM without having records of having conducted physicals or other psychological tests prior to prescribing said drugs.
Further, the Board established that Respondent’s conduct constituted unprofessional conduct pursuant to A.R.S. § 32-1401(27)(kk) in that she knowingly made false or fraudulent statements to the Board asserting that she was not engaged in the practice of medicine between October of 2018 and June of 2019, when she was issuing prescriptions of IMF.
Finally, the Board established that Respondent’s conduct constituted unprofessional conduct pursuant to A.R.S. § 32-1401(27)(s), in that she was engaged in the practice of medicine in violation of the signed SHA.
Pursuant to A.R.S. § 32-1451(M), “[t]he board may charge the costs of formal hearings to the licensee who it finds to be in violation of this chapter.”
RECOMMENDED ORDER
Based on the foregoing, it is recommended that on the effective date of the Board’s final order in this matter, the Board revoke Respondent Linda Thull’s License No. 23830 for the practice of allopathic medicine.
It is further recommended that Respondent be assessed the cost of the formal hearing incurred by the Board in this matter.
Pursuant to A.R.S. § 41-1092.08(I), the licensee may accept the Administrative Law Judge Decision by advising the Office of Administrative Hearings in writing not more than ten (10) days after receiving the decision. If the licensee accepts the Administrative Law Judge Decision, the decision shall be certified as the final decision by the Office of Administrative Hearings.
In the event of certification of the Administrative Law Judge Decision by the Director of the Office of Administrative Hearings, the effective date of the Order will be forty (40) days from the date of that certification.
Done this day, August 24, 2023.
/s/ Brian Del Vecchio
Administrative Law Judge
Transmitted by either mail, e-mail, or facsimile to:
Patricia E. McSorley, Executive Director
Arizona Medical Board
Linda Thull, MD
[email redacted]
Elizabeth A. Campbell, Esq.
Office of the Attorney General
Licensing & Enforcement Section
[email redacted]
By: OAH Staff