These regulations govern procedures for disciplinary and licensing matters before the Board of Physicians. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administrative action” means an order issued by the Board for reasons other than the disciplinary grounds under Health Occupations Article, §14-404, Annotated Code of Maryland, and that is not considered a disciplinary action. “Administrative expungement” means the classification of a record by the Board as confidential, not for public release, and removed from the licensee’s public individual profile. “Administrative law judge (ALJ)” means a hearing officer delegated the duty of conducting evidentiary hearings for the Board or disciplinary panel. “Administrative Procedure Act” means State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. “Administrative prosecutor” means the attorney assigned from the Office of the Attorney General to prosecute administrative charges. Administrative Reinstatement. “Administrative reinstatement” means the reactivation of an inactive or expired license. “Administrative reinstatement” does not include postdisciplinary reinstatement. “Advisory letter” means a nonpublic letter issued by a disciplinary panel which informs, educates, or admonishes an individual licensed by the Board in regard to the practice of medicine or an allied health profession. “Allied health professional” means an individual who is licensed by the Board under: Health Occupations Article, §§14-5A—14-5F, Annotated Code of Maryland; or Health Occupations Article, Title 15, Annotated Code of Maryland. “Applicant” means an individual who has submitted an application to: The Board for initial licensure, for administrative expungement, or for administrative reinstatement; or Disciplinary panel for postdisciplinary reinstatement. “Board” means the Maryland State Board of Physicians. “Board counsel” means the attorney assigned from the Office of the Attorney General for the purpose of advice on legal matters before the Board or a disciplinary panel. “Cease and desist order” means an order of the Board issued under Health Occupations Article, §14-206(e), Annotated Code of Maryland, prohibiting an individual from practicing medicine without a license or from taking an action for which there are grounds for discipline under Health Occupations Article, §14-404, and which poses a serious risk to the health, safety, and welfare of a patient. “Charging document” means written notification that sets forth the grounds upon which the Board or a disciplinary panel is taking administrative action against the respondent or applicant. Complaint. “Complaint” means an allegation or report that: A Board licensee has committed a prohibited act for which a disciplinary panel can take disciplinary action or impose a fine; An individual is practicing medicine without a license; or A licensed physician has acted necessitating a Board action under Health Occupations Article, §14-206(e)(2), Annotated Code of Maryland. “Complaint” includes, but is not limited to, the following: Issuance of a certificate of merit in a malpractice claim; A report from a hospital or related institution, or an alternative health system, pursuant to Health Occupations Article, §14-413 or 14-414, Annotated Code of Maryland; A law enforcement report; A report from another country, state, or jurisdiction or the armed services of the United States; A malpractice insurance report; A report from another federal or state agency or court in any country, state, or jurisdiction; Consumer complaints; Media publications; Statements on applications for licensure, renewal, or reinstatement; and Other information, from whatever source, which warrants investigation. “Contested case” has the meaning stated in State Government Article, §10-202(d), Annotated Code of Maryland. “Disciplinary panel” means a panel established under Health Occupations Article, §14-401, Annotated Code of Maryland, which: Is composed of 11 Board members; and Addresses: Complaints and disciplinary actions against licensed physicians and allied health professionals; and Postdisciplinary licensure reinstatements. “Disposition agreement” means a formal nonpublic agreement by which the health care provider agrees to comply with certain conditions and the disciplinary panel stays further investigation or forgoes further action on a matter based on compliance with those conditions. “Final order” means: The final written decision of the Board or disciplinary panel which results from a contested case proceeding or other formal proceeding and which contains findings of fact, conclusions of law, and a disposition which: Denies a license; Sanctions by reprimand, probation, fine, consent order, suspension, or revocation; Dismisses charges; Accepts a surrender of a license; or Denies administrative reinstatement of a license; An order that denies postdisciplinary reinstatement of a license; or An order to cease and desist from the practice of medicine. “Fine” means a monetary penalty. “Imperatively requires” means that an action shall be undertaken pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland, as a result of factual contentions which raise a substantial likelihood of risk of serious harm to the public health, safety, or welfare before an evidentiary hearing governed by the Administrative Procedure Act is likely to be completed and result in a final order. Investigation. “Investigation” means the gathering of the information necessary for the Board or a disciplinary panel to determine one or more of the following: Whether there is reasonable cause to charge the respondent with a violation of the Medical Practice Act or another statute which gives a disciplinary panel disciplinary authority; Whether an applicant is eligible for licensure or administrative reinstatement; The facts necessary for the Board to issue a declaratory ruling; or Whether an individual has complied with any disciplinary panel order. “Investigation” includes: A preliminary investigation; and A full investigation. “Involved medical specialty” means the area of medical specialty whose practitioners, in the disciplinary panel’s opinion: Treat the medical or surgical ailment, symptom, or problem in question; and Would likely be familiar with the risks and benefits of treatments provided for that ailment, symptom, or problem. “Licensure” means permission to engage in a health care profession regulated by the Board. “Medical Practice Act” means Health Occupations Article, §§14-101—14-702, Annotated Code of Maryland. “Peer review” means an evaluation by a physician or physicians with special qualifications to judge the matter at hand, based on professional involvement within the involved medical specialty or specialties, of an act or acts of medical or surgical care, or other acts connected with medical practice, by an applicant or licensee. “Post deprivation hearing” means a disciplinary panel hearing scheduled after the disciplinary panel has issued an order for summary suspension pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland, and at which the respondent has the opportunity to explain why the disciplinary panel should rescind the order of summary suspension. “Postdisciplinary reinstatement” means: The reactivation of a revoked or suspended license; or The reactivation of a license surrendered while the licensee was under investigation or subject to disciplinary charges. “Predeprivation hearing” means a disciplinary panel hearing at which the respondent has the opportunity to explain why the disciplinary panel should not issue an order for summary suspension pursuant to State Government Article, §10-226(c)(2), Annotated Code of Maryland. “Preliminary investigation” means the initial review of a complaint or application irregularity which is the basis for the decision on whether to assign the case to a disciplinary panel for a full investigation or whether to close the investigation due to lack of jurisdiction or because, even if there were a full investigation, there still would not be a legal or factual basis for the issuance of a charging document. “Prohibited act” means any conduct for which the Board or a disciplinary panel can issue a sanction. “Proposed decision” means the proposed findings of fact and, where required by the delegation order from the Board or a disciplinary panel, the proposed conclusions of law and proposed disposition issued by the administrative law judge. “Public individual profile” means the licensee profile maintained by the Board in accordance with Health Occupations Article, §14-411.1, Annotated Code of Maryland. “Recusal” means disqualification by a Board or disciplinary panel member from participating in a proceeding because of a legal interest or prejudice in the case before the Board or disciplinary panel. “Respondent” means an individual who has been: Given notice to answer allegations concerning violations of a statute over which the Board or a disciplinary panel has jurisdiction; Notified as to a potential summary suspension pursuant to State Government Article, §10-226(c), Annotated Code of Maryland; or Given notice to answer allegations concerning violations of a Board or disciplinary panel order. “Revocation” means the removal of a health care provider’s license to practice a health occupation. “Sanction” means an action by the Board or a disciplinary panel which: Reprimands; Places on probation; Fines; Suspends or revokes a license; Disciplines by a consent order; or Accepts a letter of surrender in lieu of charges or further investigation or prosecution. “Sanctioning guidelines” means guidelines set out in Regulation .10 of this chapter, indicating the minimum and maximum penalty associated with each ground for discipline and mitigating or aggravating circumstances which could result in imposition of a penalty below the minimum or above the maximum. “Show cause” means a demand by letter or order issued by a disciplinary panel, which directs the respondent to: Respond either in writing or by an appearance before the Board or a disciplinary panel; and Present reasons and argument why a particular order should not be entered. “Special qualifications to judge the matter at hand” means those credentials which qualify a peer reviewer as a member of the involved medical specialty in a particular case. “Stay” means the withholding of disciplinary panel action against a health care provider. “Stet” means the act of staying further action in a proceeding, subject to the proceeding being reopened at a later date. “Summary suspension” means a denial for an indefinite period of the right to use a license. “Surrender” means the voluntary relinquishing of a Board license to a disciplinary panel. “Suspension” means a denial of the right to use a license. This regulation applies to: Proceedings under Health Occupations Article, §1-307, 14-405, 14-5A-17(b), 14-5B-14(b), 14-5C-17(b), 14-5D-15, 14-5E-16(b), 14-5F-18(b) or 15-315, Annotated Code of Maryland; and To the extent specifically provided in this regulation, cease and desist orders. This regulation does not apply to procedures pursuant to Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), or 14-5F-18(c) or 15-314(b), Annotated Code of Maryland. Investigation of Complaints. Designated staff shall undertake a preliminary investigation regarding an allegation of grounds for disciplinary or other action brought to the Board’s attention before the allegation is assigned to a disciplinary panel. A complaint concerning alleged grounds for discipline of a Board licensee shall be assigned to a disciplinary panel which: Shall review a complaint in light of the preliminary investigation; and May direct further investigation, referral for peer review, closure without charges, or closure with an advisory letter. Participation in the complaint review process is not ordinarily a basis for recusal of a disciplinary panel member from further proceedings in the case. Investigative Subpoenas. Except as provided in §C(4)(b) of this regulation, upon the receipt of a timely written request from a psychiatrist who is the subject of a complaint concerning the quality of the psychiatric care provided by that psychiatrist, a quorum of a disciplinary panel shall review a subpoena for mental health records made or held by that psychiatrist before the subpoena is enforced. Section C(4)(a) of this regulation does not apply to: Any subpoena other than an investigative subpoena; A subpoena issued in response to an investigation opened based upon a patient complaint; A subpoena issued as a result of a complaint or action by a law enforcement agency; A subpoena issued as a result of a complaint from a health care professional; A subpoena for records if the executive director or the deputy director determines that there is a reasonable possibility that the records will be destroyed, secreted, lost, or altered if the subpoena is not promptly enforced; or A subpoena if the executive director or deputy director determines that there is a reasonable possibility of imminent harm to the public health, safety, or welfare, including the health, safety, or welfare of an individual patient. Section C(4)(b) of this regulation does not affect any rights which an individual may have under Health-General Article, Annotated Code of Maryland, to contest a subpoena in court. Review by the Peer Reviewers. After being assigned a complaint, a disciplinary panel shall have the matter reviewed by peer reviewers if the complaint concerns an allegation that a physician failed to: Meet the standards of quality medical care; or Keep adequate medical records. The disciplinary panel shall obtain reports from at least two different peer reviewers in each case for each allegation referred for peer review. If one or both peer reviewers conclude that a violation of the standard of care has occurred, the disciplinary panel shall make the final peer review report, consisting of the reports of each individual peer reviewer, available to the respondent for review before the disciplinary panel considers whether to issue charges. The disciplinary panel shall redact the names of the peer reviewers before making the report available under this section. The respondent may provide a written response to the peer review report within 10 business days after the report was sent to the respondent by electronic mail or 13 business days if the report was sent via U.S. postal service. The disciplinary panel shall: Consider both the final peer review report and any written response submitted within the time period specified in §D(4) of this regulation; and Determine whether there is reasonable cause to charge a respondent with failure to meet appropriate standards of quality care. Prosecution of Complaint. Except as provided in §E(2) of this regulation, a disciplinary panel may not bring charges against a licensee based solely on events contained in a complaint the disciplinary panel received more than 6 years after: The day the complainant actually discovered the facts that form the basis of the complaint; or The day when a reasonable person exercising due diligence should have discovered the facts that form the basis of the complaint. The prohibition in §E(1) of this regulation does not apply to complaints that are based on any of the following: Criminal convictions; Sexual misconduct; Other boundary violations; Reciprocal actions under Health Occupations Article, §14-404(a)(21), Annotated Code of Maryland; Ongoing substance abuse; Fraudulent concealment of material information; or Acts that occurred while a patient was a minor. After reviewing the completed investigative information and reports, a disciplinary panel shall make its determination to: Close a complaint investigation without charges; Take informal action by issuing a nonpublic advisory letter; Request the respondent to enter into a disposition agreement with the disciplinary panel if the respondent suffers from substance abuse or a physical, mental, or emotional condition which may otherwise jeopardize medical care; Except as provided in §E(1) of this regulation, vote to charge a respondent with a violation of a ground under Health Occupations Article, §14-404, Annotated Code of Maryland, or COMAR 10.32.07, or another statute which gives the Board or disciplinary panel authority; Vote to deny administrative reinstatement; or Accept a surrender on terms acceptable to the disciplinary panel. Summary Suspension. In addition to charging, the disciplinary panel assigned to the complaint may vote to summarily suspend or vote an intent to summarily suspend the license of the respondent pursuant to State Government Article, §10-226(c), Annotated Code of Maryland. A vote to summarily suspend the license of the respondent may be taken before the disciplinary panel charges the respondent. After a vote to take formal action under §E(3)(d) or (e) and (4) of this regulation, the disciplinary panel shall refer the matter to the administrative prosecutor for prosecutorial action. Based upon a review of the case, the prosecutor may refer the matter back to the disciplinary panel for further consideration. If the disciplinary panel issues charges, the disciplinary panel shall serve it upon the respondent by regular mail or hand delivery at the address the respondent maintains for purposes of licensure notice. The disciplinary panel may delegate the issuance and service of the charges to the administrative prosecutor. The disciplinary panel, in the notice of administrative reinstatement, shall provide the respondent with an opportunity to request a hearing within 30 days from receipt of service. Disciplinary Committee for Case Resolution (DCCR). After service of the charging document, the respondent and the complainant shall be offered a meeting with the disciplinary panel that was originally assigned the complaint and which sits as a DCCR. The meeting is a voluntary, informal settlement, proceeding to explore the possibility of a consent order or other resolution of the matter. The proceedings concerning a summary suspension are governed by Regulation .08 of this chapter and do not entail a meeting before a DCCR. If the respondent and the administrative prosecutor each do not agree with the proposed settlement offered by the DCCR, the matter proceeds to a hearing before the Office of Administrative Hearings. Except for the DCCRs consideration of a proposed resolution of a case achieved through the conference with the DCCR, the disciplinary panel, the parties, and the complainant may not make use of any commentary, admissions, facts revealed, or positions taken, including any disposition recommended by the DCCR, in the subsequent stages of the disciplinary proceedings unless the subject matter is available from other sources or is otherwise discovered. The respondent, administrative prosecutor, and complainant are prohibited from revealing this material. The complainant and respondent may attend and participate as authorized by statute. The complainant may be accompanied by Board staff but not by any other person. Representation; Parties. The respondent may appear in proper person or be represented by counsel in any matter before a disciplinary panel and during any stage of the disciplinary proceedings. The respondent may be represented only by an attorney admitted to the Maryland Bar or specially admitted to practice law in Maryland under Rule 14 of the Maryland Rules Governing Admissions to the Bar found in the Maryland Rules. The administrative prosecutor shall present evidence and argument at an evidentiary hearing on the charges and arguments before a disciplinary panel in the exceptions process as specified in Regulation .05 of this chapter. The administrative prosecutor is a party to the administrative proceedings: As soon as formal charges are issued; and Until a disciplinary panel’s final decision is issued. The Board or a disciplinary panel is not a party to the proceedings before an administrative law judge. The Chair, or the Chair’s designee, of a disciplinary panel assigned the complaint may issue orders necessary to regulate the proceedings under this regulation. Application. This regulation applies to cases under Health Occupations Article, §§1-307, 14-405, 14-5A-17(b), 14-5B-14(b), 14-5C-17(b), 14-5D-15, 14-5E-16(b), 14-5F-18(b) and 15-315 Annotated Code of Maryland. This regulation does not apply to cases under Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), or 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, or to cease and desist orders issued under Health Occupations Article, §14-206(e), Annotated Code of Maryland. Delegation. If the charges are not resolved with the DCCR, the chair of the DCCR shall refer the case to the other disciplinary panel which shall delegate to an administrative law judge responsibility to make: Proposed findings of fact; Proposed findings of fact and proposed conclusions of law; or Proposed findings of fact, proposed conclusions of law, and proposed disposition. If the disciplinary panel has delegated the case to the Office of Administrative Hearings for the issuance of proposed findings of fact only, the following apply: The delegation to the Office of Administrative Hearings is limited to making proposed findings of fact on allegations which are disputed; The disciplinary panel may rescind the delegation if: The parties jointly notify the disciplinary panel prior to the prehearing conference, or the administrative law judge notifies the disciplinary panel prior to the occurrence of the factors set out in State Government Article, §10-205(d)(2), Annotated Code of Maryland, that there are no substantial factual allegations in dispute; The notification recites the facts which are undisputed; and The disciplinary panel determines that the facts agreed upon are sufficient to decide the issue; and If a delegation to the Office of Administrative Hearings has been rescinded pursuant to §B(2)(b) of this regulation, the disciplinary panel shall set the case on the disciplinary panel docket for the disciplinary panel to issue conclusions of law and a disposition based on the undisputed material facts, after giving the parties a reasonable opportunity for written and oral argument. If the disciplinary panel has delegated the case to the Office of Administrative Hearings for the issuance of proposed findings of fact and conclusions of law only, the following apply: The delegation to the Office of Administrative Hearings is limited to making proposed findings of fact and conclusions of law on allegations which are disputed; and The disciplinary panel may rescind the delegation if: The parties jointly notify the disciplinary panel prior to the prehearing conference, or the administrative law judge notifies the disciplinary panel prior to the occurrence of the factors set out in State Government Article, §10-205(d)(2), Annotated Code of Maryland, that there are no substantial factual allegations or conclusions of law in dispute; The notification recites the facts and conclusions of law which are undisputed; and The disciplinary panel determines that the facts and conclusions of law agreed upon are sufficient to decide the issue. If a delegation to the Office of Administrative Hearings has been rescinded pursuant to §B(3)(b) of this regulation, the disciplinary panel shall set the case on the disciplinary panel docket for the disciplinary panel to issue a disposition based on the undisputed material facts and conclusions of law, after giving the parties a reasonable opportunity for written and oral argument. The disciplinary panel may rescind a delegation to an administrative law judge if prior to the start of the evidentiary hearing: The parties execute a proposed consent order settling all aspects of the case; and The disciplinary panel initially assigned the complaint agrees to that proposed consent order. Discovery. Discovery on Request. In addition to any disclosures required by §C(2) or (3) of this regulation, by written request served on the other party and filed with the administrative law judge, a party may require another party to produce, within 15 calendar days, the following: A list of witnesses to be called; and Copies of documents intended to be produced at the hearing. Mandatory Notice of Specific Defenses in Cases Involving the Standard of Quality Care. The respondent shall notify the administrative prosecutor not later than 45 days after the issuance of charges of any statement made to the respondent by the patient which was not recorded in the respondent’s medical record of the patient, and which affected the patient’s course of treatment, including but not limited to: Any refusal of hospitalization or treatment; Any report of symptoms; Any report of the effects of medication; Any report by the patient of consultations or treatment by other health care providers; and Any expressions by the patient of a preference for one course of treatment over another. The respondent shall notify the administrative prosecutor not later than 45 days after the issuance of charges of: Any consultation concerning the patient, formal or informal, with any other health care provider, which is not recorded in the patient’s medical record; or Any communication with family members of the patient which affected the patient’s course of treatment, and which is not recorded in the patient’s medical record. The notices required by §C(2)(a) and (b) of this regulation shall be in writing and shall state: The name of the declarant or consultant; The substance of the declaration or consultant report; and The date on which each communication took place. Unless the respondent has provided the notice required by §C(2) of this regulation, the administrative law judge shall exclude from the hearing any evidence described in §C(2)(a) or (b) of this regulation. Mandatory Discovery. Each party shall provide to the other party not later than 15 days prior to the prehearing conference or 45 days prior to the scheduled hearing, whichever is earlier: The name and curriculum vitae of any expert who will testify at the hearing; and A detailed written report prepared and signed by the expert summarizing the expert’s testimony, which includes the opinion offered and the factual basis and the reasons underlying the opinion. If the administrative law judge finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the administrative law judge shall exclude from the hearing: The testimony of the expert; and Any report of the expert. The administrative law judge shall consider and decide arguments concerning the sufficiency of the report at the prehearing conference and may require that the report be timely amended, if insufficient, to allow the opposing party ample opportunity to prepare for hearing. If an expert adopts the written report of the disciplinary panel’s peer reviewer or reviewers, or adopts a sufficiently specific charging document as the expert’s report, that adoption is considered to satisfy the requirements set forth in §C(3) of this regulation. Parties are not entitled to discovery of items except as listed in §C(1), (2), or (3) of this regulation. Subject to §C(7) of this regulation, both parties have a continuing duty to supplement their disclosures of witnesses and documents. Absent unforeseen circumstances which would otherwise impose an extraordinary hardship on a party, witnesses or documents may not be added to the list subsequent to: The prehearing conference, if scheduled; or If no prehearing conference is scheduled, 15 days prior to the hearing. The prohibition from adding witnesses subsequent to the prehearing conference does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Hearing. Unless the delegation has been rescinded according to §B(2), (3), or (4) of this regulation, the administrative law judge shall conduct an evidentiary hearing governed by the Administrative Procedure Act and COMAR 28.02.01. Evidence otherwise admissible under COMAR 28.02.01 may not be excluded solely on the ground that the evidence is not recited in the charging document. During these proceedings, the administrative law judge shall treat all records except for a charging document as confidential and sealed. Construction. In hearings conducted by an administrative law judge of the Office of Administrative Hearings, §C of this regulation shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. In the event of a conflict between §C of this regulation and COMAR 28.02.01, §C of this regulation shall apply. The administrative law judge shall issue to the disciplinary panel, that delegated the case to the ALJ, a written proposed decision including, where applicable, proposed findings of fact, proposed conclusions of law, and a proposed disposition after the conclusion of the hearing. Application. This regulation applies to cases under Health Occupations Article, §§1-307, 14-405, 14-5A-17(b), 14-5B-14(b), 14-5C-17(b), 14-5D-15, 14-5E-16(b), 14-5F-18(b) and 15-315 Annotated Code of Maryland. This regulation does not apply to cases under Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-14(c), 14-5D-14(b), 14-5E-16(f), or 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, or to cease and desist orders issued under Health Occupations Article, §14-206(e), Annotated Code of Maryland. Exceptions. Written Exceptions. Any party may file with the disciplinary panel, that delegated the case to an administrative law judge, exceptions to a proposed decision of an administrative law judge within 15 days of its issuance. A party may file a response to any exceptions within 15 days of the date the exceptions are filed. The disciplinary panel may extend the period for filing exceptions and responses. The disciplinary panel may grant a party filing exceptions the opportunity to file a reply to a response within a stated period of time as determined by the disciplinary panel in any specific case. No further exceptions or responses of any kind may be accepted. Format. Written exceptions and responses to exceptions are limited to 15 pages in length, double-spaced and in at least 12-point type, and with margins of at least 1 inch. Any reply to responses to exceptions is limited to five pages in the same format. If a party attaches any part of the record to the exceptions, response, or reply, the attached pages are not to be encompassed within the applicable page limit. The disciplinary panel may require the attachment of those parts of the record cited in the exceptions in a form designated by the Board. Exceptions, responses, and replies may refer to the record by citing the exhibit number or the transcript page. The disciplinary panel chair or the disciplinary panel chair’s designee may in each case rule on specific procedural issues with respect to written exceptions. The disciplinary panel may not accept additional evidence through the written exceptions process. Oral Exceptions Hearing. If either party files exceptions, the disciplinary panel shall schedule a hearing, ordinarily 30 days after the receipt of responses to the exceptions, after which the disciplinary panel shall issue an order containing the disciplinary panel’s findings of fact, conclusions of law, and disposition. The presiding disciplinary panel member, usually the disciplinary panel chair, shall: Determine all procedural issues that are governed by this section; Make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing; and Ordinarily limit oral presentation by the respondent and the administrative prosecutor to 20 minutes each. The party who filed the first exceptions shall ordinarily proceed first. Additional Evidence. At the oral exceptions hearing, the disciplinary panel may not accept additional evidence unless: Both parties consent to the admission of additional documentary evidence and the disciplinary panel determines that acceptance of the additional evidence would promote the just and efficient completion of the process; or The disciplinary panel determines that either: A compelling reason exists that would create an obvious injustice if the additional documentary evidence were not considered and the evidence can be admitted without compromising the rights of the other party, including the other party’s opportunity to see the proffered evidence in a timely manner or cross-examine the source of the proffered document and present evidence to the contrary; or The evidence has been timely proffered before the administrative law judge and the administrative law judge abused his or her discretion in refusing to admit the evidence. If the parties do not file exceptions, the disciplinary panel shall consider the record, including the proposed decision of the administrative law judge, and issue its order based on the disciplinary panel’s findings of fact and conclusions of law. A Board staff member who testified at the hearing before the administrative law judge may not be present during disciplinary panel deliberations. Board Action. Final Order. The disciplinary panel shall issue a final order within 90 days after the conclusion of: An exceptions hearing; or Other formal disciplinary panel proceedings. Effect of Revocation Order. When a time period is not stated in an order for revocation, the disciplinary panel may not entertain an application for postdisciplinary reinstatement until at least 3 years after the date of the order. A revocation of a license may not be for less than 1 year and may be permanent. The disciplinary panel may not entertain an application for postdisciplinary reinstatement after an order of revocation unless: Any time period stated in the order has expired; The conditions set out in the order have been fulfilled; The applicant has filed a formal application and paid the fee; and The applicant meets all of the requirements for reinstatement set out in COMAR 10.32.01.10. The disciplinary panel that issued the final order revoking or suspending the respondent shall entertain applications for reinstatement pursuant to the procedures and standards of Regulation .06B of this chapter. Tolling. Except as a disciplinary panel order directs otherwise in a specific case, if a licensee subject to probation or suspension fails to renew a license: The failure to renew the license does not remove the suspension or probation from the licensee’s disciplinary record during the period of nonrenewal; Any condition of probation or condition precedent to terminating a suspension that is dependent on possessing a license is tolled until the probationer or suspended licensee again possesses a license; and The time period of probation or suspension, if any, is tolled until the probationer or suspended licensee again possesses a license. Section C(3)(a) of this regulation does not: Apply to fines; or Require the disciplinary panel to reinstate any former licensee. Postdisciplinary reinstatement after an order of suspension is subject to the following conditions: If an order suspends a license for a certain period of time, the respondent may petition the disciplinary panel that issued the order to suspend for postdisciplinary reinstatement only pursuant to that order; The disciplinary panel may not entertain early termination of the suspension; If termination of a suspension is made contingent on the happening of an event, the respondent shall establish the occurrence of the event to the satisfaction of the disciplinary panel; and If a health care practitioner whose license is suspended fails to renew the suspended license when that license expires, the health care practitioner may petition the disciplinary panel for termination of suspension only after applying for and meeting the requirements for reinstatement set out in COMAR 10.32.01.10. Postdisciplinary reinstatement of a revoked or surrendered license is subject to the following conditions: A petitioner for postdisciplinary reinstatement of a revoked or surrendered license shall submit the following: A written application for reinstatement on a form prescribed by the Board; The appropriate fee; Written responses to any questions the disciplinary panel may propose concerning the reasons the license was revoked or surrendered and the petitioner’s current fitness to practice; and Evidence of the completion of continuing medical education credits to the same extent as if the petitioner had been continuously licensed; If a license was revoked or surrendered while the licensee was under investigation or subject to disciplinary charges, the disciplinary panel may not consider the application for postdisciplinary reinstatement unless: If the letter of surrender indicates that the surrender or the revocation order is for a certain length of time, the time period has expired; or If the letter of surrender or revocation order does not indicate a time certain, 3 years have passed since the date of the order; and If the letter of surrender makes reinstatement contingent on certain conditions, those conditions have occurred; The disciplinary panel may grant postdisciplinary reinstatement of a revoked or surrendered license only in accordance with the terms of the order of revocation or the letter of surrender; The disciplinary panel may grant postdisciplinary reinstatement subject to any terms and conditions the disciplinary panel considers appropriate for public safety and the protection of the integrity and reputation of the profession; The disciplinary panel that issued the order to revoke or suspend may convene a reinstatement inquiry panel which: May conduct an informal inquiry which shall include, if requested, an opportunity for the petitioner to have a personal interview with the panel; May consider the petitioner’s history; and May consider presentations from both the petitioner and the administrative prosecutor’s office. The disciplinary panel shall consider the application form, the petitioner’s responses to the written questions, and the supporting documentation and written arguments, if any, submitted by the petitioner and the administrative prosecutor’s office, as well as the reinstatement inquiry panel’s recommendation; The disciplinary panel shall determine in its discretion if postdisciplinary reinstatement is in the interest of the health and welfare of the general public and consistent with the best interest of the profession; and A disciplinary panel decision denying reinstatement may set out when, if ever, a subsequent petition may be submitted. The disciplinary panel shall issue a final written order on the postdisciplinary reinstatement application that: Reinstates the license of the petitioner without conditions; Reinstates the license of the petitioner with one or more of the following conditions: Probation; Requirements for supervision; Further review of competence or performance; Limitations on practice; or Other conditions that the disciplinary panel considers necessary; or Denies reinstatement. An order granting or denying postdisciplinary reinstatement is an order resulting from formal disciplinary action. A petition for postdisciplinary reinstatement may be withdrawn only with the permission of the disciplinary panel. The disciplinary panel may not refund the fee except for extraordinary cause. In this regulation, “health care provider” means an individual who is a: Licensed physician; Licensed respiratory care practitioner; Licensed radiographer; Licensed nuclear medical technologist; Licensed radiation therapist; Licensed radiologist assistant; Licensed polysomnographic technologist; Licensed athletic trainer; Licensed perfusionist; Licensed naturopathic doctor; or Licensed physician assistant. Health Occupations Article, §§14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), 14-5F-18(c) and 15-314(b), Annotated Code of Maryland, govern mandatory actions of the suspension or revocation of a license on the filing of certified docket entries, if the health care provider is convicted of or pleads guilty, including by an Alford plea, or a plea of nolo contendere to a crime involving moral turpitude. Procedures. The Office of the Attorney General through Board counsel shall provide to the disciplinary panel assigned to the case certified docket entries of the criminal court proceeding and the following documents from the court record: For a conviction, at least: The indictment, information, or other formal statement of the charges; and Documentation of the verdict and sentencing; and For a plea of guilty, including an Alford plea, or a plea of nolo contendere, at least one of the following: Stipulated statement of facts or statement of facts on the record; Plea agreement containing agreed facts; Transcript of plea agreement proceedings; or Written or transcribed opinion or statement of the judge accepting the plea. When the disciplinary panel determines that documents provided to it indicate that the respondent comes within the language and intent of Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b), 14-5E-16(c), 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, and the disciplinary panel has a basis for finding preliminarily that it applies to the respondent, the disciplinary panel shall vote to issue an order requiring the respondent to show cause why the disciplinary panel should not take action under this section. After the vote to issue the show cause order, the disciplinary panel shall refer the matter to the administrative prosecutor for prosecutorial action. Based upon a review of the case, the prosecutor may refer the matter back to the disciplinary panel for further consideration. Service. The disciplinary panel shall serve the respondent by regular mail or hand delivery at the address the respondent maintains for purposes of licensure notice. The disciplinary panel may choose to serve the respondent personally. Opportunity to be Heard. The respondent, after service of the show cause order, has 30 days in which to respond. The respondent may show cause in writing on the following issues: Lack of conviction or plea; Whether the crime is one involving moral turpitude; Misidentity of the respondent with the defendant in the criminal matter; and Other relevant issues, if any, other than mitigation. The respondent may also, within 30 days of service of the show cause order, request an opportunity to address the disciplinary panel by a limited evidentiary hearing on the same issues. However, this argument may not be as of right, but is discretionary based on the existence of genuine issues of material fact or law as determined by the disciplinary panel. The presiding disciplinary panel member, usually the disciplinary panel chair, shall determine all procedural issues that are governed by this section, and may impose reasonable time limitations. The presiding disciplinary panel member shall make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing. Ordinarily, the respondent and the administrative prosecutor shall limit their oral presentation to 20 minutes each. The respondent shall proceed first. The presiding disciplinary panel member shall allow for consideration of documents the presiding disciplinary panel member determines relevant and material. The presiding disciplinary panel member may not admit oral testimony or witnesses. Disciplinary panel members may ask questions of any party appearing before the disciplinary panel. Representation. The respondent may appear in proper person or be represented by counsel. The administrative prosecutor shall present argument in support of the proposed sanction. Burdens of Production and Persuasion. The respondent may argue issues as set out in §E(2) of this regulation and has the burden of producing argument or evidence in response to the show cause order. The administrative prosecutor bears the burden of persuasion by a preponderance of the evidence that the respondent was convicted of or pled guilty or nolo contendere to a crime of moral turpitude. Disciplinary Panel Action. After consideration of the respondent’s answer, either in writing or at a hearing, the disciplinary panel shall deliberate and determine whether the crime is a crime involving moral turpitude, and then shall issue an appropriate order. A pending appeal of the conviction or plea does not operate as a bar to the disciplinary panel’s acting under Health Occupations Article, §14-404(b)(1), 14-5A-17(c)(1), 14-5B-14(c)(1), 14-5C-17(c), 14-5D-14(b)(1), 14-5E-16(c), 14-5F-18(c) or 15-314(b), Annotated Code of Maryland. A respondent suspended pursuant to Health Occupations Article, §14-404(b), 14-5A-17(c), 14-5B-14(c), 14-5C-17(c), 14-5D-14(b)(1), 14-5E-16(e), 14-5F-18(c) or 15-314(b), Annotated Code of Maryland, shall be reinstated immediately upon the filing of a certified docket entry that the conviction has been reversed. The reinstatement does not terminate any other disciplinary action or investigation pending against the respondent. State Government Article, §10-226(c), Annotated Code of Maryland, governs consideration of summary suspension of a license. Notice of Intent to Summarily Suspend. Based on information gathered during an investigation, the disciplinary panel may determine that there is a substantial likelihood of a risk of serious harm to the public health, safety, or welfare by the health provider, and vote an intent to summarily suspend the license of the respondent. If the disciplinary panel votes an intent to summarily suspend, the Board shall refer the matter to the administrative prosecutor for prosecutorial action. Based upon a review of the case, the prosecutor may refer the matter back to the disciplinary panel for further consideration. Notice to the respondent includes a: Proposed order for summary suspension; and Show cause notice letter providing an opportunity to the respondent to show cause why the order should not be issued. The proposed order for summary suspension includes but is not limited to: The statutory authority upon which the order is based; Notification that the respondent may request a full hearing to appeal the summary suspension, if executed by the disciplinary panel; and Statements of investigatory information which serve as a basis for the order. Service. The disciplinary panel shall serve the respondent: At least 5 calendar days before a predeprivation hearing; and By regular mail or hand delivery at the address the respondent maintains for purposes of licensure notice. The disciplinary panel may choose to serve the respondent personally. A show cause notice may not be required in extraordinary circumstances. The disciplinary panel, after consultation with the Board’s counsel, may suspend a license without prior notice and opportunity to be heard, if: The disciplinary panel determines that the health, welfare, and safety of the public or the physician imperatively requires immediate suspension; Notice and opportunity to be heard before the action is not feasible; and The respondent is provided with a postdeprivation opportunity to be heard within 15 days by the disciplinary panel, that voted to summarily suspend the license. Representation. The respondent may appear in proper person or be represented by counsel in any matter before the disciplinary panel. If represented at an evidentiary hearing, the respondent shall be represented only by an attorney admitted to the Maryland Bar or specially admitted to practice law in Maryland under Rule 14 of the Rules Governing Admission to the Bar found in the Maryland Rules. The administrative prosecutor shall appear in prosecution of the case. Predeprivation Hearing Before the Disciplinary Panel. The disciplinary panel, that voted to issue a show cause order, shall hold the predeprivation hearing on whether to summarily suspend the license. The presiding disciplinary panel member shall determine all procedural issues that are governed by this section, and may impose reasonable time limitations. The presiding disciplinary panel member may make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing, and shall limit the oral presentation by the respondent and the administrative prosecutor to 20 minutes each. The respondent shall proceed first. The presiding disciplinary panel member: Shall allow for consideration of oral presentations and documents considered by the presiding disciplinary panel member to be relevant and material to the proceeding and not unduly repetitious; and May not admit oral testimony or witnesses. The disciplinary panel members may ask any questions of any party appearing before the disciplinary panel. If the disciplinary panel proceeds under §B(7) of this regulation, the disciplinary panel shall hold a postdeprivation initial hearing. The disciplinary panel shall conduct the hearing in accordance with §D of this regulation unless the parties waive this hearing and proceed to the summary suspension appeal. Burdens of Production and Persuasion. The respondent may present argument in opposition to allegations presented in the proposed order for summary suspension. The administrative prosecutor bears the burden to show by a preponderance of the evidence that the health, welfare, and safety of the public imperatively requires the disciplinary panel to issue an order to suspend the respondent’s license. After the predeprivation hearing, the disciplinary panel shall vote to: Order a summary suspension; Deny the summary suspension; Enter any order to which the parties may agree; or Enter any interim order which the circumstances of the case warrant. After the postdeprivation hearing, the disciplinary panel shall vote to: Reaffirm the summary suspension; Rescind the summary suspension; Enter any order to which the parties may agree; or Enter any interim order which the circumstances of the case warrant. The respondent may demand a full evidentiary hearing on the merits within 10 days of the issuance of a summary suspension order, and the Office of Administrative Hearings shall set a hearing within 30 days of the demand. Evidentiary Hearing Before the Administrative Law Judge. The appeal from a summary suspension shall be an evidentiary hearing under the Administrative Procedure Act. After a full evidentiary hearing, the administrative law judge shall issue a proposed decision with findings of fact, conclusions of law and disposition. The administrative prosecutor and respondent may file exceptions in accordance with Regulation .05B of this chapter. If a party files exceptions, unless the exceptions hearing is waived, an exceptions hearing, on the record, shall be held before the disciplinary panel that had not issued the order of summary suspension. After the disciplinary panel issues its final order, the respondent may appeal this decision in accordance with Regulation .12 of this chapter. General Application of Sanctioning Guidelines. Sections A and B of this regulation and Regulation .10 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation. Except as provided in §B of this regulation, for violations of Health Occupations Article, §§14-404(a), 14-504 and 1-302, Annotated Code of Maryland, the disciplinary panel shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria for §A(3)(b) of this regulation is ranked as a reprimand. A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. The addition of a fine does not change the ranking of the severity of the sanction. The disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines: The sanction with the highest severity ranking should be used to determine which ground will be used in developing a sanction; and The disciplinary panel may impose concurrent sanctions based on other grounds violated. Notwithstanding the sanctioning guidelines set forth in Regulation .10 of this chapter, in order to resolve a pending disciplinary action, the disciplinary panel and the licensee may agree to a surrender of license or a consent order with terms, sanction, and fine agreed to by the disciplinary panel, the administrative prosecutor, and the licensee. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §B(5) and (6) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. If the disciplinary panel imposes a sanction that departs from the sanctioning guidelines set forth in Regulation .10 of this chapter, the disciplinary panel shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §B(5) and (6) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines. Nothing in this regulation requires the disciplinary panel or an administrative law judge to make findings of fact with respect to any of these factors. A departure from the sanctioning guidelines set forth in Regulation .10 of this chapter is not a ground for any hearing or appeal of a disciplinary panel action. The existence of one or more of these factors does not impose on the disciplinary panel or an administrative law judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the incident; The offender voluntarily admitted the misconduct, made full disclosure to the disciplinary panel and was cooperative during the disciplinary panel proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The misconduct was not premeditated; There was no potential harm to patients or the public or other adverse impact; or The incident was isolated and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The offense was committed deliberately or with gross negligence or recklessness; The offense had the potential for or actually did cause patient harm; The offense was part of a pattern of detrimental conduct; The offender committed a combination of factually discrete offenses adjudicated in a single action; The offender pursued his or her financial gain over the patient’s welfare; The patient was especially vulnerable; The offender attempted to hide the error or misconduct from patients or others; The offender concealed, falsified or destroyed evidence, or presented false testimony or evidence; The offender did not cooperate with the investigation; or Previous attempts to rehabilitate the offender were unsuccessful. Fines for Unauthorized Practice of Medicine. The Board may impose a fine as provided in §C(3) of this regulation for: Practicing medicine without a license in violation of Health Occupations Article, §14-601, Annotated Code of Maryland; or A violation of an order of cease and desist from practicing medicine without a license. Factors in determining the amount of a fine include, but are not limited to the following: The extent to which the respondent derived any financial benefit from the improper conduct; The willfulness of the improper conduct; The extent of actual or potential public harm caused by the improper conduct; and The deterrent effect of the fine. Range of Fines Imposed. Except as specified in §C(3)(b) of this regulation, the Board may impose fines as follows: For the first violation, not less than $1,000 and not more than $30,000; For the second violation, not less than $10,000 and not more than $40,000; and For the third violation, not less than $15,000 and not more than $50,000. If the conduct resulted in harm to any patient, the Board may consider each patient seen to be a separate violation when imposing a fine listed in §C(3)(a) of this regulation. The Board shall pay all monies collected pursuant to this section into the Board’s fund. Other Fines. The disciplinary panel shall impose a fine of $100 for a violation of Health Occupations Article, §14-505, Annotated Code of Maryland, and a fine of $100 for a violation of Health Occupations Article, §14-316(f), Annotated Code of Maryland. The disciplinary panel shall pay all monies collected pursuant to §D(1) of this regulation into the Board’s fund. Offenses Related to Continuing Medical Education Credits. First Offense of Failure to Document Credits. Except as provided in §E(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the disciplinary panel may impose a civil fine under Health Occupations Article, §14-316(d)(5), 14-5A-13(d)(2), 14-5B-12(d)(2), 14-5D-12(g), or 15-307(f), Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §14-404, 14-5A-17, 14-5B-14, 14-5D-14, or 15-314, Annotated Code of Maryland. Section E(1)(a) of this regulation does not limit the Board’s or disciplinary panel’s authority to require completion of the missing continuing medical education credits. Willful Falsification. If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate: Health Occupations Article, §14-404(a)(3), 14-5A-17(a)(3), 14-5B-14(a)(3), 14-5C-17(a)(3), 14-5D-14(a)(3), 14-5E-16(a)(3), 14-5F-18(a)(19), or 15-314(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-404(a)(11), 14-5A-17(a)(10), 14-5B-14(a)(10), 14-5C-17(a)(10), 14-5D-14(a)(10), 14-5E-16(a)(10), 14-5F-18(a)(9), or 15-314(a)(11), Annotated Code of Maryland; and Health Occupations Article, §14-404(a)(36) or 15-314(a)(36), Annotated Code of Maryland. Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-404(a), 14-405.1, 14-5A-17, 14-5B-17, 14-5C-17, 14-5D-14, 14-5E-16, 14-5F-18, 15-314, or 15-316, Annotated Code of Maryland, and the sanctioning guidelines. Licensees Previously Disciplined Under §E(1) or (2) of this Regulation. If a licensee has been previously fined or otherwise disciplined under §E(1) or (2) of this regulation, the disciplinary panel may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate: Health Occupations Article, §14-404(a)(3), 14-5A-17(a)(3), 14-5B-14(a)(3), 14-5C-17(a)(3), 14-5D-14(a)(3), 14-5E-16(a)(3), 14-5F-18(a)(19) or 15-314(a)(3), Annotated Code of Maryland; Health Occupations Article, §14-404(a)(11), 14-5A-17(a)(10), 14-5B-14(a)(10), 14-5C-17(a)(10), 14-5D-14(a)(10), 14-5E-16(a)(10), 14-5F-18(a)(9), or 15-314(a)(11), Annotated Code of Maryland; and Health Occupations Article, §14-404(a)(36) or 15-314(a)(36), Annotated Code of Maryland. Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-404(a), 14-405.1, 14-5A-17, 14-5B-17, 14-5C-17, 14-5D-14, 14-5E-16, 14-5F-18, 15-314, or 15-316, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense. The disciplinary panel may not apply the sanction described in §E(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits. The disciplinary panel shall pay all monies collected pursuant to this section into the State’s General Fund. Payment of Fines. An individual shall pay to the disciplinary panel any fine imposed under this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed by the disciplinary panel pursuant to this regulation. If an individual fails to pay, in whole or in part, a fine imposed by the disciplinary panel pursuant to this regulation, the disciplinary panel may not restore, reinstate, or renew a license until the fine has been paid in full. In its discretion, the disciplinary panel may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. Subject to provisions of Regulation .09A and B of this chapter, the disciplinary panel may impose sanctions as outlined in §B of this regulation on physicians for violations of Health Occupations Article, §§14-404(a), 14-504, and 1-302, Annotated Code of Maryland. Range of Sanctions. This regulation applies to proceedings under Health Occupations Article, §14-205(b)(1)(iii), 14-206(e), 14-307, 14-405, 14-606(a)(4)(ii), 14-5A-17(a), 14-5A-09, 14-5A-23(b), 14-5B-09, 14-5B-14(a), 14-5B-19(b), 14-5C-09, 14-5C-17(a), 14-5C-23(b), 14-5D-08, 14-5D-14(a), 14-5D-18(b), 14-5E-09, 14-5E-16(a), 14-5E-23(b), 14-5F-11, 14-5F-18(a), 14-5F-29(b), 15-313, or 15-403, Annotated Code of Maryland. The final decision in the proceedings in this regulation is made by the full Board. Denial of Application for Initial License. When an individual files an application for a license with the Board, the applicant shall be investigated to determine whether the Board will: Issue a license; or Deny the application. The Board may vote for the issuance of an intent to deny application for an initial license to practice medicine or an allied health profession for one or any combination of the grounds for denial, including: Failing to meet the minimal qualifications or requirements of licensure; Committing an act or an omission constituting grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland; Failing to complete the application or failing to provide additional information requested by the Board in connection with the application; Submitting false or misleading information in connection with the application; or Failing to cooperate with the Board’s investigation of the application. If the Board votes to issue a notice of an intent to deny an application for an initial license, the notice shall be served upon the applicant by regular mail or hand delivery to an address the applicant identified on the applicant’s application. After service of the notice of intent to deny application for initial license, the applicant shall be offered an informal meeting with a panel of the Board to explore whether the matter can be resolved with a consent order. The administrative prosecutor also may attend the meeting. The panel may recommend a consent order granting a license, denying a license, or granting a license with appropriate terms and conditions including probation. If the applicant and the administrative prosecutor agree with the panel’s proposed resolution, the applicant shall sign a consent order with the proposed resolution, and the Board shall vote on whether to approve the resolution. If the applicant and the administrative prosecutor do not agree with the panel’s proposed resolution, the Board shall delegate the matter to the Office of Administrative Hearings for a contested case hearing. If the matter proceeds to a hearing before the Office of Administrative Hearings, the administrative prosecutor shall present evidence before an administrative law judge in support of the denying the initial licensure application. The applicant shall be given an opportunity to present evidence in support of granting the license. The administrative law judge shall conduct an evidentiary hearing in accordance with: The Administrative Procedure Act; COMAR 28.02.01; and COMAR 10.32.02.04C, which shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. The administrative law judge shall issue a proposed decision. Within 15 days of the issuance of the proposed decision, the applicant and the administrative prosecutor may file exceptions to the proposed decision with the Board. A response to the exceptions may be filed within 15 days of the filing of the exceptions. If exceptions are filed, the Board shall hold a hearing on the exceptions. The exceptions hearing is based upon evidentiary record established before the Office of Administrative Hearings. The Board shall vote and issue a final decision and order on whether the initial license application is granted or denied. An individual whose application for initial licensure has been denied by a final decision and order by the Board may petition for judicial review of the final decision and order as provided by Health Occupations Article, §14-408(a), Annotated Code of Maryland. Unauthorized Practice and Misrepresentation as a Licensed Practitioner. The Board may vote for charges that an individual has practiced medicine or an allied health profession without authorization or that an individual has misrepresented one’s self as a practitioner of medicine or as an allied health professional. If the Board votes to charge an individual for practicing medicine or an allied health care profession without authorization or with misrepresenting one’s self as a practitioner of medicine or as an allied health professional, the notice shall be served upon the respondent by regular mail, certified mail, or hand delivery to the individual. After service of the charges, the respondent shall be offered an informal meeting with a panel of the Board to explore whether the matter can be resolved with a consent order. The administrative prosecutor may attend the meeting. The panel may recommend a consent order. If the respondent and the administrative prosecutor agree with the panel’s proposed resolution, the respondent shall sign a consent order with the proposed resolution, and the Board shall vote on whether to approve the resolution. If the applicant and the administrative prosecutor do not agree with the panel’s proposed resolution, the Board shall delegate the matter to the Office of Administrative Hearings for a contested case hearing. If the matter proceeds to a hearing before the Office of Administrative Hearings, the administrative prosecutor shall present evidence before an administrative law judge to prove the charges. The applicant shall be given an opportunity to present evidence in defense. The administrative law judge shall conduct an evidentiary hearing in accordance with: The Administrative Procedure Act; COMAR 28.02.01; and COMAR 10.32.02.04C which shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. The administrative law judge shall issue a proposed decision. Within 15 days of the issuance of the proposed decision, the applicant and the administrative prosecutor may file exceptions to the proposed decision with the Board. A response to the exceptions may be filed within 15 days of the filing of the exceptions. If exceptions are filed, the Board shall hold a hearing on the exceptions. The exceptions hearing is based upon evidentiary record established before the Office of Administrative Hearings. The Board shall vote and issue a final decision and order. If the Board determines that the respondent has practiced a health care profession without authorization or misrepresented one’s self as a practitioner of medicine, the Board may fine the respondent as authorized by statute and regulation. An individual who is aggrieved by a final decision and order by the Board may petition for judicial review of the final decision and order as provided by Health Occupations Article, §14-408(a), Annotated Code of Maryland. Cease and Desist Orders An initial Board order to cease and desist issued under §14-206(e) of the Medical Practice Act from the unauthorized practice of medicine or from taking any action for which there are grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland, and which pose a serious risk to the health, safety, and welfare of a patient: Is a public document; and Is effective immediately unless the order states otherwise. The Board shall serve the initial order by hand delivery, certified mail, or first-class mail. Challenge. A respondent may challenge the factual or legal basis of the initial order by filing a written opposition within 30 days of its issuance, and may include a request for a hearing. The Board shall consider that opposition and shall provide a hearing if requested. After considering the written opposition and the presentation at the hearing, if any, the Board may issue a final order to rescind, modify, or affirm the cease and desist order. The Board shall serve the final order by hand delivery, certified mail, or first-class mail to the last known address of the respondent. The respondent may seek judicial review of the Board’s final order as provided in the Administrative Procedure Act. Violations of a Cease and Desist Order. The Board may impose a fine as provided in Regulation .09C of this chapter on any individual who violates a cease and desist order. Before imposition of a fine for violation of a cease and desist order, the Board shall give notice of the alleged violation, and an opportunity for a hearing. The hearing may not concern issues: That were not raised under §E(3) of this regulation; or That were raised under §E(3) of this regulation, but for which the Board did not grant the relief or modification requested. The only issues to be considered at the hearing are: Whether the individual violated the cease and desist order; and The amount of any fine to be imposed. The Board shall issue a final order stating whether a violation occurred and if so, the amount of the fine. The respondent may seek judicial review of the Board’s final order as provided in the Administrative Procedure Act. Nothing in this regulation prohibits the Board from delegating any hearing to the Office of Administrative Hearings as permitted by State Government Article, §10-205, Annotated Code of Maryland. A respondent whose license has been sanctioned by a final order of the disciplinary panel after a contested case proceeding under Health Occupations Article, §14-404, 14-5A-17.1, 14-5B-14.1, 14-5C-17(b), 14-5D-15, 14-5E-17, 14-5F-23, or 15-315(b), Annotated Code of Maryland, may seek judicial review of the disciplinary panel’s decision as provided under Health Occupations Article, §14-408(a), Annotated Code of Maryland. An individual whose application for administrative reinstatement has been denied by a final disciplinary panel order after a contested case proceeding under Health Occupations Article, §14-205(a)(1)(iii), 14-5A-17.1, 14-5B-14.1, 14-5C-17(b), 14-5D-15, 14-5E-17, 14-5F-23, or 15-315(b), Annotated Code of Maryland, may appeal the decision as provided under Health Occupations Article, §14-408(a), Annotated Code of Maryland. A Board or disciplinary panel member may not participate in an investigation or a proceeding in which the impartiality of the Board or disciplinary panel member might reasonably be questioned, including but not limited to proceedings and investigations in which the Board or disciplinary panel member has or appears to have: A personal bias or prejudice concerning a party; or Personal knowledge of disputed evidentiary facts concerning a proceeding. The recusal shall be stated on the record. In a hearing before the Board or disciplinary panel, the parties may waive the recusal. Nothing in this chapter prohibits the issuance of a charging document with a proposed order which will go into effect if the respondent fails to request a hearing. Nothing in this chapter prohibits a disciplinary panel from conducting a show cause hearing to determine if there has been: A violation of probation; A violation of a condition under which any portion of a disciplinary order was stayed; or Any other violation of a Board or disciplinary panel order. A disciplinary panel may terminate a show cause hearing if it determines that there are material facts in dispute which cannot reasonably be determined in that venue. The disciplinary panel may then convene an evidentiary hearing or delegate such a hearing to an administrative law judge. Except for formal charging documents, notices of intent to deny, or as otherwise provided by law, the proceedings of the Board and the disciplinary panels are confidential, and the confidentiality of the proceedings cannot be waived by the parties. The recommended decision by an administrative law judge is confidential, and the respondent cannot waive the confidentiality of the contested case proceedings or of the patients whose care is reflected in the record of the proceedings. To the extent possible, even after a final order is entered by the Board or a disciplinary panel, the parties shall refrain from revealing legal documents or oral statements or information that would reveal the identity of any patients referenced in the order. The Board and the disciplinary panels may consider the Principles of Ethics of the American Medical Association, but these principles are not binding on the Board or the disciplinary panels. The Board and the disciplinary panels may consider the “Guideline for Prescribing Opioids for Chronic Pain” published by the Centers for Disease Control and Prevention, but this guideline is not binding on the Board or the disciplinary panels. Administrative Expungements. The Applicant may file with the Board an application for administrative expungement to have records of an administrative action by a disciplinary panel classified as confidential, not for public release, and removed from the licensee’s public individual profile, if: The application is submitted more than 3 years after the imposition of an administrative action by the Board or after administrative reinstatement or termination of suspension of the license, whichever is later; The licensee had no incidents of a public sanction since the administrative action identified in the application occurred; and The licensee is not currently under probation or investigation by the Board. An application for administrative expungement shall only be granted for the following administrative actions: Failure to pay taxes or unemployment insurance contributions under Health Occupations Article, §1-213(b), Annotated Code of Maryland; Failure to complete continuing medical education requirements under Health Occupations Article, §14-316(d), Annotated Code of Maryland; Failure to renew a license on time under Health Occupations Article, §14-606(a)(5), Annotated Code of Maryland; or Failure to notify the Board in writing of change of name or address within the time required under Health Occupations Article, §14-316(f). An administrative expungement shall not be considered for any license denials, reprimands, probations, suspensions, and revocations issued pursuant to Health Occupations Article, §14-404, Annotated Code of Maryland. Application for Administrative Expungement. The application for administrative expungement shall be filed in writing on a form provided by the Board. The application fee shall be $450. The application fee is non-refundable. Disposition of Application. If the applicant meets the requirements specified in §§A and B of this regulation, the Board shall inform the applicant when to expect the records to be removed from the applicant’s public practitioner profile as required in Health Occupations Article, §14-411.1, Annotated Code of Maryland, and when all Board records will be classified confidential. If the applicant does not meet the requirements specified in §§A and B of this regulation, the applicant will be deemed ineligible and the Board shall notify the applicant in writing. An applicant whose application is ineligible under §C(2) of this regulation may reapply when they meet the criteria. The Board is not required to report an administrative expungement to any national database. Nothing in this regulation shall prohibit the Board from using a Board record, previous sanction, or disciplinary action for any regulatory purpose or from releasing records to law enforcement or other governmental body as permitted by law. Health Occupations Article, §§1-307, 1-402, 1-602—1-604, 1-606, 14-205, 14-317, 14-404, 14-405, 14-405.1, 14-406—14-409, 14-411, 14-505, 14-5A-03, 14-5A-13(d), 14-5A-16, 14-5A-17, 14-5A-17.1, 14-5A-19, 14-5B-03, 14-5B-12(d), 14-5B-13, 14-5B-14, 14-5B-14.1, 14-5B-16, 14-5C-03, 14-5C-14(h), 14-5C-16, 14-5C-17, 14-5C-19, 14-5D-12(d), 14-5D-12(g), 14-5D-13—14-5D-16, 14-5E-03, 14-5E-13(h), 14-5E-15, 14-5E-16, 14-5E-17, 14-5E-19, 14-5F-04, 14-5F-15(e), 14-5F-17, 14-5F-18, 14-5F-23, 14-5F-24, 14-601, 14-606, 15-205(b), 15-307(f), 15-311, 15-312, 15-314, 15-315, 15-316 and 15-403; State Government Article, §§10-206, 10-216, and 10-226; Annotated Code of Maryland Effective date: September 30, 1973 Regulations .01—.10, Hearing Procedures, repealed effective November 7, 1994 (21:22 Md. R. 1877) Regulations .01—.09, Hearing Before the Board of Physician Quality Assurance, adopted effective November 7, 1994 (21:22 Md. R. 1877) Regulation .03C amended effective March 22, 1999 (26:6 Md. R. 486) Regulation .03E amended effective January 24, 2000 (27:1 Md. R. 76); June 24, 2002 (29:12 Md. R. 927) Regulation .04 amended effective August 19, 2002 (29:16 Md. R. 1288) Regulation .10 adopted effective September 11, 1995 (22:18 Md. R. 1399) Chapter revised effective January 21, 2013 (40:1 Md. R. 20) Chapter revised effective March 2, 2015 (42:4 Md. R. 433) Regulation .02B amended effective March 17, 2025 (52:5 Md. R. 237) Regulation .03F amended effective August 7, 2023 (50:15 Md. R. 682) Regulation .10 amended effective August 7, 2023 (50:15 Md. R. 682) Regulation .17 adopted effective October 23, 2017 (44:21 Md. R. 983) Regulation .18 adopted effective March 17, 2025 (52:5 Md. R. 237)