Case Number 2012-0497 FINAL DECISION AND ORDER License Number

IN THE MATTER OF * BEFORE THE *
JOHN L. YOUNG, M.D. * MARYLAND STATE BOARD
* OF PHYSICIANS
Respondent * Case Number 2012-0497
License Number D23121 ********

**** FINAL DECISION AND ORDER

On February 13, 2013, the Maryland State Board of Physicians (the "Board"), under §

10-226(c)(2) of the State Government Article, issued an Order for Summary Suspension of

License to Practice Medicine regarding John L. Young, M.D.'s license to practice medicine in

Maryland. The order of summary suspension relates to Dr. Young's treatment of nine patients

(Patients A - I). On March 28, 2013, after a post-deprivation hearing before the Board, held on

March 20, 2013, the Board continued the summary suspension.

On February 27, 2013, the Board issued Charges under the Maryland Medical Practice
Act 1 (the "charges") against Dr. Young. The charges alleged that Dr. Young's actions with

regard to Patients A - I constituted unprofessional conduct in the practice of medicine. See

Health Occ. § 14-404(a)(3)(ii). The charges also alleged that, in treating these patients with Mark

R. Geier, M.D., whose license to practice medicine in Maryland was suspended, Dr. Young

practiced medicine with an unauthorized person or aided an unauthorized person in the practice

of medicine. See Health Occ. § 14-404(a)(18). The Board also charged Dr. Young with

unprofessional conduct in the practice of medicine, see Health Occ. § 14-404(a)(3)(ii), and with

willfully making a false representation on an application for licensure, see Health Occ. § 14-

I The Maryland Medical Practice Act is§§ 14-101 - 14-702 of the Health Occupations Article.

404(a)(36), for responding falsely to a question on an application he filed with the Board in 2011
for the renewal of his medical license.

Dr. Young requested an evidentiary hearing on both the order of summary suspension
and the charges. The Board delegated to the Office of Administrative Hearings the cases for
evidentiary hearings and proposed decisions. OAH consolidated the cases, and the evidentiary
hearing was held before an administrative law judge ("ALJ") on August 27, 29, September 3,
and October 4, 2013.

On December 26, 2013, the ALJ issued a proposed decision. The ALJ recommended that
the summary suspension order be upheld. Concerning the charges under the Maryland Medical
Practice Act, the ALJ recommended the dismissal of the charge that Dr. Young was guilty of
unprofessional conduct, Health Occ. § 14-404(a)(3)(ii), concerning his treatment of the nine
patients. The ALJ, however, found that Dr. Young practiced medicine with an unauthorized
person or aided an unauthorized person in the practice of medicine, Health Occ. § 14-404(a)(18).
In addition, the ALJ found that Dr. Young was guilty of unprofessional conduct in the practice of
medicine, Health Occ. § 14-404(a)(3)(ii), and willfully made a false representation on an
application related to the practice of medicine, Health Occ. § 14-404(a)(36), concerning the 2011
license renewal application he filed with the Board. The ALJ found Dr. Young intentionally
falsely answered "no" to the question of whether there was any pending investigation against
him by any licensure board, despite the fact that Dr. Young had been notified that the State of
Washington Medical Quality Assurance Commission was conducting an investigation into his
conduct as the medical director of a clinic in Washington. Based upon the ALJ's findings that
Dr. Young violated the Maryland Medical Practice Act, the ALJ recommended the revocation of

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Dr. Young's license to practice medicine in Maryland. Both Dr. Young and the State filed
exceptions.

Dr. Young filed exceptions concernmg the ALJ's recommended affirmance of the
summary suspension order, the ALJ's proposed finding that Dr. Young practiced medicine with
an unauthorized person or aided an unauthorized person in the practice of medicine, and the
ALJ's recommendation that Dr. Young's Maryland medical license be revoked. Dr. Young did
not file exceptions concerning the ALJ' s proposed finding that he was guilty of unprofessional
conduct in the practice of medicine and willfully filed a false application concerning the 2011
license renewal application. The State filed an exception concerning the ALJ's finding that Dr.
Young had not committed unprofessional conduct concerning his treatment of the nine patients.

On May 28, 2014, a hearing on the parties' exceptions was held before Board
Disciplinary Panel B.2

FINDINGS OF FACT
Unless otherwise specifically noted in this decision, Disciplinary Panel B (which is also
referred to as the "panel") adopts the findings of fact and discussion set forth in the ALJ's
Proposed Decision (pages 9-93). The adopted parts of the ALJ's proposed decision are
incorporated by reference into the body of this document. The ALJ' s proposed decision is
attached as Exhibit 1. The findings of fact were proven by the preponderance of the evidence.
a. Summary Suspension
The ALJ found that the summary suspension of the Respondent's license to practice
medicine was imperatively required to protect the public health, safety or welfare. The ALJ

2 On May 2, 2013, the Maryland Medical Practice Act was amended to have disciplinary cases
decided by Board disciplinary panels instead of by the full Board. See Health Occ. § 14-401
(2013 Supp.).

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explained that the summary suspension was needed due to the lack of medical judgment inherent
in Dr. Young's actions. As explained by the ALJ, Dr. Young did not evaluate or have contact
with any of the patients or their parents prior to prescribing medication to any of the patients. Of
the nine patients at issue, Dr. Young did not evaluate or have any contact with three of the
patients (B, D, and E) or their parents at any time. Concerning Patients A, C, F, G, H, and I, Dr.
Young did not personally meet any of them, and his evaluations took place over the telephone or
by Skype, which, in the majority of cases, involved talking with the parents, as opposed to any
interaction with or examination of the patients. The ALJ found that Dr. Young "did not know in
any meaningful sense who he was prescribing for or why." (ALJ's Proposed Decision ["PD"] at
69.) Dr. Young was not able to explain why he increased dosages, sometimes by 300 percent.
"He just did what Dr. Geier, or somebody on Dr. Geier's behalf, told him to do." Id. Dr. Young
does not dispute or even address these findings by the ALJ other than to assert that the ALJ' s
findings, concerning Dr. Young's "failure to examine the patients, failure to document the reason
for triple dosing Lupron,3 failing to justify the use of Lupron, failure to use Tanner staging in
prescribing Lupron," were not relevant. According to Dr. Young, these issues are irrelevant
because he was not charged with a violation of the standard of care, see Health Occ. § 14-
404(a)(22), and the ALJ found that a standard of care violation does not constitute
unprofessional conduct, see Health Occ. § 14-404(a)(3)(ii). Dr. Young also argues that there was
no evidence of actual harm and that Dr. Young's prescriptions posed no risk of harm to the
patients, even at triple previous dosages.

3 Lupron is the trade name for leuprolide acetate. It is an anti-androgen and suppresses the
production of testosterone. Whether prescribed as Lupron, leuprolide, leuprolide acetate, or
Lupron Depot (extended-lasting injection), this decision refers to the medication as Lupron.

4

Dr. Young's failure to perform any real evaluation of his patients and his failure to
ascertain why he was prescribing the medications and why he increased the dosages are relevant
to the summary suspension. Whether or not he was charged with failing to meet the appropriate
standards of quality medical care, see under § 14-404(a)(22), has no bearing on whether a
summary suspension, pursuant to State Gov't § I 0-226( c)(2), was imperatively required. Dr.
Young was unaware of the medical justifications for the prescriptions. His prescriptions, on
multiple occasions, were based solely upon the fact that Dr. Geier asked him to do so.

Dr. Young claims that his testimony during the hearing before the ALJ, in which he
explained some of his prescribing decisions, shows that he understood why he prescribed as he
did. His testimony before the ALJ, however, does not negate his testimony during the Board
interview in which, for many prescriptions, he was unable to explain why he prescribed as he did
other than to state that Dr. Geier requested that he do so. The only reasonable conclusion is that
Dr. Young ascertained the reasons for the prescriptions after he was interviewed by the Board. It
is not safe for a physician to prescribe medication or to increase the medication when the
physician does not know the medical justification for those prescriptions.

Concerning Dr. Young's argument that the summary suspension was unwarranted
because there was no evidence of actual harm, the ALJ correctly noted that a summary
suspension does not require actual harm. The Board does not have to wait for a patient to be
harmed before issuing an order of summary suspension. The purpose behind an agency's
authority to summarily suspend a license is to prevent actual harm. A licensing agency abdicates
its role when it sits idly by waiting for someone to be harmed before taking action.

And the Board, like the ALJ, does not accept Dr. Young's contention that Lupron, even
at triple Dr. Geier' s dosages, posed no risk. The ALJ found, "the medication was given to some

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patients at an age when it would interfere with or reverse normal pubertal development without
any indication in the medical records that this factor was considered or discussed, and that it was
in one case being given to a child with a diagnosis of a 'hot temper."' (ALJ's PD at 69.) The
ALJ also found that Dr. Geier's and Dr. Young's use of Lupron has not been supported by
medical and scientific studies. The ALJ also noted that, when prescribed at recommended
dosages, Lupron generally has low adverse side-effect consequences when compared to
psychotropic medications. However, Dr. Young's prescribed dosages were '"dramatically higher
than the recommended doses' for CPP [Central Precocious Puberty]. 'The baseline doses and
the increased doses are at or above the most extreme doses that were used to test for substantial
side effects in adults .... There have been no comparable tests of dangers in children because
the doses are so dramatically out of range of what you would use even legitimately in a child."
(Grossman, Tr. 226.)

Dr. Young's willingness to prescribe medications when unfamiliar with his patients and
when unfamiliar with the reasons for the prescriptions, and his willingness to triple the usual
dosages without knowing the reason for doing so, constituted sufficient bases for the order of
summary suspension. Dr. Young's exception is denied.
b. Dr. Young's Motion to Exclude Testimony of State's Expert Witness

Dr. Grossman was designated by the State as an expert witness. Prior to the evidentiary
hearing at OAH, Dr. Young filed a motion to exclude Dr. Grossman from testifying as an expert,
arguing that the Board did not allege that Dr. Young violated § 14-404(a)(22) (failure to meet the
appropriate standards for quality medical care) or § 14-404(a)(40) (failure to keep adequate
medical records). Under the Board's statutory provisions, Health Occ. § 14-401 (2009 Repl.
Vol.) (recodified on May 2, 2013, as§ 14-401.1), the Board is required to obtain physician peer

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review reports prior to alleging violations of§ 14-404(a)(22) and § 14-404(a)(40). Dr. Young
based his motion on the theory that, because there was not an allegation of a violation of § 14-
404(a)(22) or§ 14-404(a)(40) and the Board did not obtain the peer review reports as set forth in
§ 14-401, the Board was precluded from presenting the testimony of an expert. The ALJ denied
the motion. Dr. Young has taken exception to the ALJ's denial of his motion.

To begin, Dr. Young's argument contains a logical gap. Just because the Board is
required, under § 14-401, to obtain peer reviews for allegations of violations of§ 14-404(a)(22)
and § 14-404(a)(40) does not mean, in cases in which there is not an allegation of a § 14-
404(a)(22) or§ 14-404(a)(40) violation, that expert testimony is prohibited. In this case, because
it was not alleged that Dr. Young violated § 14-404(a)(22) or (40), the Board was under no
obligation to comply with the peer review process as set forth in § 14-401. As to whether the
Board may present an expert witness, § 14-401 is inapposite, if not entirely irrelevant.

Next, Dr. Young fails to provide any legal authority to support his theory. And there are
cases in which a violation of§ 14-404(a)(22) or § 14-404(a)(40) was not alleged and expert
testimony was appropriately used and relied upon. For example, in Salerian v. Maryland State
Board of Physicians, 176 Md. App. 231 (2007), there was no allegation of a violation of§ 14-
404(a)(22) or (40). The Board charged Dr. Salerian with immoral and unprofessional conduct in
the practice of medicine, under Health Occ. § 14-404(a)(3), id at 242, alleging that Dr. Salerian,
a psychiatrist, improperly disclosed confidential patient information, which he obtained during
the course of his forensic evaluation of a defendant in the criminal proceeding, and that Dr.
Salerian improperly treated the defendant/evaluee, id Before the ALJ, both the State and Dr.
Salerian called expert witnesses. Id The State's expert witness testified on the role of a forensic
psychiatrist and the duty that a forensic psychiatrist owes an evaluee. Id at 243-44. The State's

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expert also gave his opinion that Dr. Salerian's treatment of the evaluee and his disclosure of

medical information obtained from his evaluation were unprofessional. Id. at 244. And the

State's expert also testified that there was no "moral imperative exception" to the confidentiality

of medical information. Id. at 259. Dr. Salerian's expert gave the opinion that Dr. Salerian's

activities did not occur "in the practice of medicine." Id. The Board found Dr. Salerian guilty of

unprofessional conduct in the practice of medicine. Id. at 245-46. Then, relying upon the

testimony of the State's expert witness, the Board's decision was affirmed on appeal.

In Finucan v. Maryland Board of Physician Quality Assurance, 380 Md. 577, 581 (2004),

the Board of Physician Quality Assurance charged Dr. Finucan with immoral and unprofessional

conduct in the practice of medicine, under Health Occ. § 14-404(a)(3). He was not charged with

violating § 14-404(a)(22) or (40). The Board alleged that Dr. Finucan had a "series of sexual

relationships with several female patients while maintaining, at the same time, a physician-

patient relationship with them." Id. at 580. As recounted by the Court of Appeals:

Herbert L. Muncie, Jr. M.D., Chair of the Department of Family
Medicine at the University of Maryland School of Medicine and an
expert in physician-patient boundary issues and the ethical practice of
medicine, testified as the Board's witness before the ALJ. Dr. Muncie
testified that boundaries are important in the physician-patient
relationship, in part because of the powerful role that the physician plays
in that relationship. He observed that a patient may develop warm
feelings for the physician and consequently be unable to perceive clearly
the proper role to which the physician must adhere ethically and
medically. The physician, therefore, must take care not to exploit the
advantage he or she naturally may gain over his or her patients. [Id. at
585.]

***

At the administrative hearing, the Board's medical expert, Dr. Muncie,
was asked how long ago the prohibition on patient-physician sex was
established. He testified that "it is mentioned basically in the
Hippocratic Oath that you should not take advantage of your patients,

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certainly not have sexual contact with your patients. It goes back
thousands of years." [Id at 594.]
The Board found Dr. Finucan guilty of immoral and unprofessional conduct in the practice of
medicine, and, relying upon the testimony of the expert witness, the Board's decision was
affirmed. Expert testimony often plays a critical role in Board disciplinary hearings, even when
neither a violation of§ 14-404(a)(22) or§ 14-404(a)(40) is alleged.
Dr. Young's exception becomes even more puzzling because Dr. Young presented
Jerrold Kartzinel, M.D. to testify as an expert witness. Dr. Young even offered Dr. Kartzinel as
an expert in the "standard of care" as well as the diagnosis and treatment for autism and autism
spectrum disorders. The ALJ qualified Dr. Kartzinel as an expert in those areas. Like Dr.
Grossman, Dr. Kartzinel testified on many topics appropriate for and relevant to the
unprofessional conduct allegations and the summary suspension. Dr. Young's exception is
denied.
c. Jurisdiction of the Board when Patients are in another State
Dr. Young takes exception to the ALJ' s finding that the Board had jurisdiction over Dr.
Young when Dr. Young was in Maryland treating patients who were in other states. Dr. Young's
position is that the Board does not have jurisdiction over physician's physically in Maryland and
licensed by the Board when they are engaged in telemedicine if the patient is in another state, as
was the case here with Dr. Young. According to Dr. Young, only the state where the patient is
located has jurisdiction over the physician. Dr. Young does acknowledge, however, that, under
Maryland law, specifically COMAR 10.32.05.03, a physician needs a Maryland license when the
physician is in Maryland treating a patient who is not in the state. COMAR 10.32.05.03 reads, in
relevant part:

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an individual shall be a licensed Maryland physician in order to practice
telemedicine if one or both of the following occurs:
A. The individual practicing telemedicine is physically located m
Maryland;
B. The patient is in Maryland.
Dr. Young argues that the Board's regulation is wrong. As the ALJ stated, "The Respondent is
dissatisfied with the State's telemedicine regulations." (ALJ's PD at 51.)
To support his contention that the Board's regulation is wrong, Dr. Young quotes a law
review article, which states: "A general consensus emerged that the practice of medicine
occurred wherever the patient was located, notwithstanding the physician's location in another
state." Carl F. Ameringer, Ph.D., J.D., "State-Based Licensure of Telemedicine: The Need for
Uniformity but not a National Scheme," 14 J. Health Care L & Pol'y 55, 58 (2011). The text of
the article does not disclose how the author arrived at his conclusion that there is a general
consensus nor mention who is included in the general consensus. The author has a footnote,
which refers to another law journal and a quotation with another footnote cited. This second
footnote contains two sources: another law journal article and an update of trends from the
American Medical Association. Ultimately, though, the information and data that the original
text is based upon is unclear. In any event, the quoted law journal article is not controlling legal
authority in Maryland and does not override Maryland's regulations.
Dr. Young then quotes Chairman of Board of Trustees v. Waldron, 285 Md. 175 (1979),
contending that COMAR 10.32.05.03 is unconstitutional. Waldron contains dictum indicating
that a Maryland statute prohibiting a retired Maryland judge from practicing law in another state
while receiving his judge's pension is unconstitutional. According to Waldron, "the General
Assembly of Maryland has no power to regulate whom our sister jurisdictions may authorize to

10

engage in the practice of law within their borders." But, as the ALJ correctly explained, Waldron
is inapposite. (ALJ's PD at 53.) Waldron does not address the issue in Dr. Young's case:
whether a Board has jurisdiction over a professional when the professional is licensed by
Maryland, is physically in Maryland, and conducts all of his professional acts in Maryland, while
the patient is in another state.

The lack of Waldron's relevance is made even more apparent by the fact that Dr. Young
was not licensed in jurisdictions in which patients were located. Patients A, C, D, and I were in
Missouri, but Dr. Young treated these patients before he was licensed to practice medicine in
Missouri. Patient E was in Virginia, but Dr. Young was not licensed to practice medicine in
Virginia during the relevant period when he treated patient E. Dr. Young does not explain how
he was authorized to practice in Missouri and Virginia without a license in either of those
jurisdictions. Dr. Young's exception is denied.
d. Practicing Medicine with an Unauthorized Person or Aiding an Unauthorized Person to

Practice Medicine
The Board charged Dr. Young with practicing medicine with an unauthorized person or

aiding an unauthorized person to practice medicine. See Health Occ. § 14-404(a)(18). The charge
was based upon Dr. Young's involvement with Mark Geier, M.D. in the treatment of the nine
patients at issue. On April 27, 2011, however, Dr. Geier's license to practice medicine in
Maryland was summarily suspended. Dr. Geier was, thus, not authorized to practice medicine in
Maryland for any period after that.

Dr. Young was licensed to practice medicine in the State of Washington. Dr. Geier had a
license to practice medicine in Washington but that license was suspended on May 26, 2011.
Patients F, G, and H were in Washington. The ALJ determined that, after May 26, 2011, Dr.
Young practiced medicine with Dr. Geier to treat Patients F, G, and H. According to the ALJ:

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This is particularly clear for Patient F. The Respondent had a
consultation with Patient F on June 13, 2011. In his notes from that
encounter he marked certain items that he would "check w/ MG." MG
stands for Dr. Mark Geier. By that point Dr. Geier was suspended in
Maryland and in Washington State.
The ALJ found that the State proved the charge that Dr. Young practiced medicine with
an unauthorized individual or aided an unauthorized person to practice medicine, in violation of
Health Occ. § 14-404(a)(18), with regard to Dr. Young's and Dr. Geier's treatment of Patients F,
G, and H. The ALJ did not find a violation of Health Occ. § 14-404(a)(18) with regard to the
other patients. The ALJ reached this conclusion on the basis that Dr. Geier was licensed in the
states in which those other patients were located.
Dr. Young's exception asserts that each of the patients was in a state in which Dr. Geier
was licensed: "the patients involved resided in foreign states where Dr. Geier was licensed to
practice." This exception ignores the fact that the ALJ found that Dr. Geier was not licensed in
Washington and, on that basis, found that Dr. Geier practiced medicine without authorization to
treat the patients in that state. As the ALJ correctly found, Dr. Geier's license was suspended in
Washington, yet he still treated Patients F, G, and H.
Dr. Young also contends that Dr. Geier was not practicing medicine,4 and the ALJ refers
to Dr. Geier's involvement as "consulting" with Dr. Young. The panel does not accept Dr.
Young's assertion that Dr. Geier was not practicing medicine nor the ALJ's characterization of
Dr. Geier's involvement as merely "consulting." The patients at issue had been patients of Dr.
Geier while Dr. Geier had a medical license, and Dr. Geier and Dr. Young were partners in a
medical practice before Dr. Geier's license was suspended. After Dr. Geier's license was
suspended, Dr. Geier still made treatment decisions for these patients, except under the guise of

4 Dr. Young's exception vaguely states that he just "talked to Dr. Geier about his patients."
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Dr. Young's license. With some patients, Dr. Young's actions were based solely upon Dr.
Geier' s direction. And Dr. Young did not have any real background in treating the conditions of
these patients. Further, under section 14-302(2) of the Health Occupations Article (2009 Repl.
Vol.), a consultation may only occur with someone without a Maryland license if that unlicensed
individual is licensed by another State and resides in another jurisdiction. The evidence indicates,
and the panel finds, that Dr. Geier was residing in Maryland when he was directing Dr. Young's
treatment of these patients. The panel finds that Dr. Geier was practicing medicine and finds that
Dr. Young practiced medicine with an unauthorized person and aided an unauthorized person to
practice medicine, in violation of§ 14-404(a)(18) of the Health Occupations Article, with regard
to patients F, G, and H.5
e. Unprofessional Conduct Involving Medical Treatment

The Board charged Dr. Young with unprofessional conduct in the practice of medicine,
see Health Occ. § 14-404(a)(3)(ii), related to the treatment of the patients. The Board did not
charge Dr. Young with failing to meet the appropriate standards for the delivery of quality
medical care, see Health Occ. § 14-404(a)(22). The State argued, essentially, that Dr. Young's
conduct in treating these patients was so egregious that it extended beyond a standard of quality
care violation and reached the unprofessional conduct level.

The ALJ, however, determined that the Board could not prove unprofessional conduct,
see Health Occ. § 14-404(a)(3)(ii), for conduct that is "steeped" in the quality of care. (ALJ's
PD at 89-91.) According to the ALJ, "[w]hen the Board is considering whether it should bring
charges of a violation of the standard of quality care, the Board is required to obtain review by at

5 The panel does not find it necessary to decide whether Dr. Young was in violation of Health
Occ. § 14-404(a)(18) concerning patients other than F, G. and H.

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least two peers.l 1" (ALJ's PD at 90.)6 In addressing the State's argument that Dr. Young's

treatment was so egregious as to amount to unprofessional conduct, the ALJ "decline[d]" to find

Dr. Young's "shortcomings in medical care and recordkeeping were so egregious that they

reached the point of misconduct." Id. The State took exception.

The State quotes a previous final decision by the Board, In the Matter of Richard G.

Yeron, Case No. 2006-0479, https://www.mbp.state.md.us/bpgapp/Orders/D4171 l.249.PDF, at

page 4, which states, "There may also be other circumstances where a physician's medical

treatment of patients is so unsound that a finding of unprofessional conduct would be

warranted."

The panel finds that Dr. Young's actions involved in treating the patients were so

unsound as to constitute unprofessional conduct. The ALJ described the conduct at issue as

follows:

failing to physically examine any of the patients; failing to contact the
patients or their families; starting, stopping, and adjusting medications
without any rationale or documentation; writing Lupron prescriptions
with instructions for injecting tripled doses when that was not, in fact,
the intended dose; failing to document any aspect of the tripling - i.e. -
no medical rationale, no discussion with the patients or parents; the
administration of Lupron therapy to individuals who fit neither Dr.
Geier' s nor the Respondent's profile of an appropriate candidate;
inadequately monitoring patient progress; and carrying on the unsafe
practices for which the Board had just suspended Dr. Geier.

While each of these actions individually may not rise to unprofessional conduct, taken together,

Dr. Young's action are disturbing. But what makes Dr. Young's conduct so unsound that it

reaches the unprofessional level is that Dr. Young was simply following the orders of Dr. Geier,

6 The ALJ also wrote, on page 60 of her proposed decision, "On the one hand, the Board cannot
fairly avoid the peer review process by charging a physician with unprofessional conduct and
offering as proof evidence of poor recordkeeping and poor care when there has been no peer
review." The panel does not adopt this sentence. As is explained in this decision, Dr. Young's
actions cannot be accurately described as simply "poor recordkeeping care and poor care."

14

as he stated multiple times when he was interviewed. Dr. Young allowed his license to be used
to allow Dr. Geier to continue making the treatment decisions. Making the conduct even worse,
is that Dr. Young did not have any real background in the area of medicine he was practicing,
and he was, thus, in no position to question Dr. Geier's directions. And Dr. Geier had his license
suspended for the same deficient treatment methods involved here. Thus, the unprofessional
conduct does not derive solely from the practices that would generally result in a violation of the
standard of quality care. The unprofessionalism is mostly a result of Dr. Young acting without
using any real medical judgment. Dr. Young blindly followed Dr. Geier's directions, allowing
his license to be used to effectuate Dr. Geier's treatment decisions.

This case also has critical similarities to Mesbahi v. Maryland State Board of Physicians,
201 Md. App. 315 (2011). The Board found Dr. Mesbahi guilty of unprofessional conduct and
with aiding unauthorized individuals in the practice medicine for allowing her unlicensed and
unauthorized sisters to perform laser hair removal surgery. Dr. Mesbahi was not charged with
violating the standard of quality medical care. While Dr. Mesbahi' s actions were "steeped" in
issues pertaining to the quality of medical care, the charge of unprofessional conduct was
appropriate in that case, as well, due to the degree to which she deviated from acceptable medical
practices.

Lastly, when a physician's actions rise to the level of unprofessional conduct, the Board
1s not required to comply with the pre-charge peer review procedures for violations of the
standard of quality medical care or inadequate medical records, so long as the physician is not
charged under one or both of those grounds.

For the reasons stated above, the Board rejects the ALJ's findings concerning her
conclusion that the Board could not sustain a finding of unprofessional conduct in the practice of

15

medicine for conduct related to the quality of medical care. The State's exception is accepted.
Dr. Young is guilty of unprofessional conduct in the practice of medicine related to medical
treatment he provided.

CONCLUSIONS OF LAW
Disciplinary Panel B concludes that, under § 10-226(c)(2) and COMAR 10.32.02.09,
Dr. Young's conduct presented a substantial likelihood of risk of serious harm to the public
health, safety, or welfare, imperatively requiring the summary suspension of his license to
practice medicine in Maryland; that Dr. Young is guilty of unprofessional conduct in the practice
of medicine, in violation of Health Occ. § 14-404(a)(3)(ii), for his actions related to his treatment
of Patients A - I; that Dr. Young practiced medicine with an individual unauthorized to practice
medicine in the State and aided an unauthorized person to practice medicine, in violation of§ 14-
404(a)(l 8), concerning Patients F, G, and H; and that Dr. Young is guilty of unprofessional
conduct in the practice of medicine, Health Occ. § 14-404(a)(3)(ii), and willfully made a false
representation when applying for licensure, in violation of Health Occ. § 14-404(a)(36), based
upon his 2011 application to the Board for license renewal.

Sanction
The ALJ recommended the revocation of Dr. Young's medical license. Dr. Young took
exception. According to Dr. Young, "There is simply no justification for revoking his license to
practice in his specialty of obstetrics and gynecology. Why it never occurred to the ALJ to
recommend a sanction less than revocation to permit Respondent to continue his practice in
prenatal genetics can only be explained by her desire to do the State's bidding." Dr. Young's
argument highlights one of the panel's main concerns, which is that Dr. Young was practicing in
an area of medicine in which he did not have any real background. This demonstrates that Dr.

16

Young leaned toward helping his former medical partner rather than ensuring that the patients
received care from a physician qualified and competent in treating pediatric patients with their
medical conditions. That being said, the panel believes that Dr. Young can properly practice in
the areas in which he has specialized under the terms set forth in the order. The panel thus
terminates the summary suspension and places Dr. Young on probation for a minimum period of
one year during which time his practice will be limited to obstetrics and gynecology and prenatal
genetics. To that extent, the Board accepts Dr. Young's exception. 7 Dr. Young's actions
demonstrated severe lapses in judgment, but the Board is mindful that his license has been
suspended since February 13, 2013. The Board is also ordering Dr. Young take a panel-approved
ethics tutorial and that he be subject to a chart and/or peer review.

ORDER
It is, on the affirmative vote of a majority of the quorum of Disciplinary Panel B, hereby
ORDERED that the summary suspension of Dr. Young's license to practice medicine in
Maryland is AFFIRMED; and it is further
ORDERED that the summary suspension of Dr. Young's license to practice medicine in
Maryland is TERMINATED; and it is further
ORDERED that, upon the reinstatement of Dr. Young's expired license,8 Dr. Young will
be placed on PROBATION for a minimum period of ONE YEAR, and during the probationary
period, Dr. Young shall comply with the following probationary terms and conditions:

7 The panel, of course, rejects Dr. Young's contention that the ALJ was doing the "bidding" of
the State.
8 Dr. Young had not applied for the renewal of his license, thus, his license expired on September
30, 2013. Dr. Young will thus have to have his expired license reinstated, meaning he will have
to apply for the reinstatement of his expired Maryland license and meet the minimum
requirements for reinstatement in order to practice medicine in Maryland.

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1. Dr. Young shall enroll in and complete a Board-approved tutorial in medical
ethics. Dr. Young is responsible for providing Disciplinary Panel B with documentation that he
has successfully completed the tutorial. The tutorial may not be used to fulfill any continuing
medical educational credits required for licensure renewal;

2. Dr. Young's medical practice under his Maryland license is limited to obstetrics
and gynecology and pre-natal genetics;

3. Dr. Young's medical practice in Maryland is subject to a peer and/or chart review
by agents or designees of Disciplinary Panel B;

4. Dr. Young shall comply with the Maryland Medical Practice Act, Health Occ. §§
14-101 - 14-702, and its corresponding regulations, COMAR Title 10, Subtitle 32; and it is
further

ORDERED that, after one year from the date probation is commenced, Dr. Young may
submit a written petition to the Board requesting termination of probation. After consideration
of the petition, the probation may be terminated, through an order of Disciplinary Panel B. The
panel will grant the termination if Dr. Young has fully and satisfactorily complied with all of the
probationary terms and conditions; and it is further

ORDERED that, if Dr. Young violates any term or condition of probation, Disciplinary
Panel B, after notice and an opportunity for a show cause hearing before the panel or, if there is a
genuine dispute as to any material facts, an evidentiary hearing before an administrative law
judge of the Office of Administrative Hearings, may impose any further sanction authorized
under sections 14-404(a) and 14-405.1 of the Health Occupations Article, including a reprimand,
further probation, further suspension or the revocation of Dr. Young's license to practice
medicine and/or a fine; and it is further

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ORDERED that Dr. Young is responsible for the costs incurred in complying with this
order; and it is further

ORDERED that this is a public document.

q/14/l()Jt/ Christine A. Farrell , x
Maryland State Board of
Dati I

NOTICE OF APPEAL RIGHTS
Pursuant to section 14-408(a) of the Health Occupations Article (2013 Supp.), Dr. Young
has the right to seek judicial review of this Final Decision and Order. Any petition for judicial
review must be filed within 30 days from the date this Final Decision and Order is mailed. The
date of the cover letter to this Final Decision and Order indicates the date that this Final Decision
and Order was mailed. The petition for judicial review must be made as directed in the
Maryland Administrative Procedure Act, Md. Code Ann., State Gov't § 10-222, and Maryland
Rules 7-201 et seq.
If Dr. Young petitions for judicial review, the Board is a party and should be served with
the court's process. In addition, Dr. Young should send a copy of his petition for judicial review
to the Board's counsel, David Wagner, Assistant Attorney General, Office of the Attorney
General, 300 W. Preston Street, Suite 302, Baltimore, Maryland 21201. The administrative
prosecutors are not involved in the circuit court process and do not need to be served or copied
on pleadings filed in circuit court.

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