# COMAR Title 10 — Maryland Department of Health ## Subtitle 40 — Board of Podiatric Medical Examiners ### Chapter 11 — Sanctioning Guidelines **Authority:** Health Occupations Article, §§1-606, 16-205, and 16-311, Annotated Code of Maryland **Administrative History:** Effective date: April 16, 2012 (39:7 Md. R. 494) #### Regulation .01 Scope. *COMAR 10.40.11.01* This chapter establishes standards for use as a guide for the imposition of disciplinary sanctions against any Maryland licensed podiatrist, if after a hearing the Board finds that there are grounds under Health Occupations Article, §16-311, Annotated Code of Maryland, to place a licensee on probation, reprimand, suspend, fine, or revoke a license. The Board may consider aggravating and mitigating factors in determining sanctions. #### Regulation .02 Definitions. *COMAR 10.40.11.02* A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Board” means the Board of Podiatric Medical Examiners. (2) “Licensee” means an individual who holds a license or a limited license to practice podiatry in Maryland. #### Regulation .03 General Application. *COMAR 10.40.11.03* A. This chapter shall be used by the Board as a guide for sanctioning licensees. B. The Board is not required to make findings of fact with respect to any of the factors for determining the sanction indicated by the sanctioning guidelines. C. A departure from the sanctioning guidelines alone is not a ground for any hearing or appeal of a Board action. D. Notwithstanding this chapter, in order to resolve a disciplinary matter, the Board and the licensee may agree to a surrender of license or a consent order with terms, conditions, and sanctions agreed to by the Board and the licensee. E. In a case where there are multiple and distinct violations, the Board may impose a sanction greater than the maximum indicated in Regulation .04 of this chapter for each individual violation. F. If probation is imposed, the Board may impose appropriate terms and conditions of probation, and if a licensee violates the terms or conditions of probation, the Board may take further disciplinary action against the licensee. G. In the event the licensee’s violation does not fall within the sanction range, the Board shall so indicate and use its best judgment to determine the appropriate sanction and shall consider, to the extent possible, the factors in Regulation .05 of this chapter. #### Regulation .04 Range of Sanctions. *COMAR 10.40.11.04* Tier Conduct Sanction Range Minimum Maximum A. Sexual misconduct (1) Sexual misconduct with a patient Suspension with conditions Revocation (2) Lewd and immoral conduct within practice Suspension with conditions Revocation B. Minimal standards of care (1) Departure from or failure to conform to appropriate standards of care Reprimand with conditions, subsequent probation as appropriate Revocation (2) Failure to keep adequate medical records Reprimand with conditions, subsequent probation as appropriate Revocation (3) Failure to educate a patient about appropriate alternative methods of treatment in violation of law or the standard of care. Reprimand with conditions, subsequent probation as appropriate Revocation (4) Failure to obtain informed consent Reprimand with conditions, subsequent probation as appropriate Revocation (5) Incompetence Reprimand with conditions Revocation C. Knowingly submitting to a third party any claim form, bill, or statement which contains any misleading, deceptive, false, incomplete, or fraudulent representation asserting a fee which is greater than the fee usually accepted as payment in full for any given procedure or service (1) Overutilization of billing and/or false claims reporting Reprimand with conditions, subsequent probation as appropriate Revocation (2) Billing fraudulently Reprimand with conditions, subsequent probation as appropriate Revocation (3) Health care fraud Reprimand with conditions, subsequent probation as appropriate Revocation D. DEA or controlled dangerous substance violation, or improper prescribing, dispensing or administering of drugs (1) Prescribing, dispensing, or administering of controlled substances for excessive periods of time and/or excessive amounts Probation 6 months with conditions Revocation (2) Improper prescribing, dispensing, or administering of any drug Reprimand with conditions Revocation (3) Prescribing, dispensing, or administering of controlled substances without appropriate examination Reprimand with conditions, subsequent probation as appropriate Revocation (4) Failure to keep adequate patient records of substances prescribed, dispensed, or administered Reprimand with conditions, subsequent probation as appropriate Revocation (5) Failure to use acceptable methods in selection of drugs or other modalities Reprimand with conditions, subsequent probation as appropriate Revocation (6) Selling, prescribing, giving away, or administering of any drugs for illegal or illegitimate medical purposes Suspension 6 months with conditions, subsequent probation as appropriate Revocation (7) Prescribing, dispensing, or administering of any drugs without medical indication to detriment of the patient Reprimand with conditions, subsequent probation as appropriate Revocation (8) Prescribing, dispensing, or administering of drugs for sexual favors Suspension 1 year with conditions, subsequent probation as appropriate Revocation (9) Taking back any drug from a patient that was prescribed Reprimand with conditions, subsequent probation as appropriate Revocation E. Unprofessional or unethical conduct (1) Willfully betraying a professional confidence Reprimand with conditions, subsequent probation as appropriate Revocation (2) Abandoning a patient Reprimand with conditions, subsequent probation as appropriate Revocation (3) Failure to provide a patient’s medical record as required by law Reprimand with conditions, subsequent probation as appropriate Revocation (4) Failure to cooperate with a Board investigation Reprimand with conditions, subsequent probation as appropriate Revocation (5) By corrupt means, threats, or force, intimidating, influencing, or attempting to influence a person to change or withhold testimony in hearings or before the Board or the Office of Administrative Hearings Suspension with conditions, subsequent probation as appropriate Revocation (6) By corrupt means, threats, or force, hindering, preventing, or otherwise delaying a person from making information available to the Board in the furtherance of a Board investigation. Suspension with conditions, subsequent probation as appropriate Revocation F. Substance abuse (using any narcotic or controlled dangerous substance or other drug that is in excess of therapeutic amounts or without valid medical indication) (1) Self-referral Reprimand with conditions Revocation (2) Complaint initiated Reprimand with conditions, subsequent probation as appropriate Revocation (3) Impaired ability to practice by reason of substance abuse Reprimand with conditions Revocation G. Other Acts (1) Practicing outside scope Reprimand with conditions, subsequent probation as appropriate Revocation (2) Practicing while Maryland podiatry license is suspended or revoked Suspension Revocation (3) Committing or having committed a felony Suspension with conditions Revocation (4) Willfully making a false report or record in the practice of podiatry Reprimand with conditions Revocation (5) Knowingly filing a falsified license renewal or falsifying a license renewal Reprimand with conditions Revocation (6) Practicing with a condition, illness, or disease that may impair the ability of the individual to perform podiatric services Reprimand with conditions Revocation (7) Credentialing fraud Probation with conditions Revocation (8) Other violations of the Act Reprimand Revocation #### Regulation .05 Mitigating and Aggravating Factors. *COMAR 10.40.11.05* Depending upon the facts and circumstances of each case, and to the extent that they apply, the Board may consider the following mitigating and aggravating factors in determining whether the sanction in a particular case should fall outside of the range of sanctions established by the guidelines. These factors may include, but are not limited, to the following: A. Mitigating factors: (1) Absence of a prior disciplinary record; (2) The licensee having reported the violation to the Board; (3) The licensee having voluntarily admitted violation, provided full disclosure to the Board, and cooperated during Board proceedings; (4) The licensee having implemented remedial measures to correct or mitigate harm arising from the violation; (5) The licensee having made a timely good-faith effort to make restitution or otherwise rectify the consequences of the violation; (6) Evidence of rehabilitation or potential for rehabilitation; (7) Absence of premeditation to commit the violation; (8) Absence of potential harm to or adverse impact on the public; (9) Isolated incident and not likely to recur; and (10) The licensee’s prior community service and present value to the community; and B. Aggravating factors: (1) Previous criminal or administrative disciplinary history; (2) The violation was committed deliberately or with gross negligence or recklessness; (3) The violation had the potential for, or caused, serious patient harm; (4) The violation was part of a pattern of detrimental conduct; (5) The licensee was motivated to perform the violation by his or her financial gain; (6) The vulnerability of the patient; (7) The licensee attempted to conceal the violation, falsified or destroyed evidence, or presented false testimony or evidence; (8) The licensee failed to cooperate with the Board’s investigation; and (9) Previous attempts at rehabilitation were unsuccessful.