Disciplinary Action against
John A. Launius, M.D.
Stephen Barrett, M.D.
In October, 2008, the Texas Medical Board and John Launius, M.D. entered into an agreed order requiring that he (a) pass the special purpose examination within one year, (b) have a chart monitor, and (c) within one year, take the physician prescribing course offered by the University of California-San Diego physician assessment and clinical education (PACE) program or an equivalent course. The action was based on Dr. Launius's management of two patients that he diagnosed with hypothyroidism treated with Armour thyroid despite the fact that their thyroid tests were normal.
LICENSE NO. D-2149
IN THE MATTER OF
THE LICENSE OF
JOHN A. LAUNIUS, M.D.
TEXAS MEDICAL BOARD
On the 10th.day of October, 2008, came on to be heard before the Texas Medical Board (the "Board"), duty in session, the matter of the license· of John A. Launius, M.D. ("Respondent").
On June 12, 2008, Respondent appeared in person, without counsel, at an lnformal Show Compliance Proceeding and Settlement Conference ("ISC") in response to a letter of invitation from the staff of the Board. The Board's representatives were Allan Shulkin, M.D., a member of the Board, and Noe Fernandez, a member of a District Review Committee. Claudia Kirk represented. Board staff.
Upon the recommendation of the Board's representatives and with the consent of Respondent, the Board makes the following Findings of Fact and C'onclusions of Law and enters this Agreed Order.
FINDINGS OF FACT
The Board finds that:
1. Respondent received all notice required by law. All jurisdictional requirements have been satisfied. Respondent waives any defect in notice and any further right to notice or hearing under the Medical Practice Act, Title 3, Subtitle B, Texas Occupations Code (the "Act") or the Rules of the Board.
2. Respondent currently holds Texas Medical License No. B-2149. Respondent was originally issued this license to practice medicine in Texas on August 28, 1987. Respondent is also licensed to practice in Louisiana, License No. 01724-Y.
3. Respondent was primarily engaged .in the practice of emergency medicine, but more recently has been engaged in family practice. Respondent is board certified by the American Board of Emergency Medicine, a member of the American Board of Medical Specialties.
4. Respondent is 51 years of age.
5. Respondent has not received a prior disciplinary order from the Board.
6. This Order addresses Respondent's treatment of two patients: BD and TC.
7. Respondent evaluated patient BD on January 24, 2007. Respondent diagnosed ·BD with possible hypothyroidism and possible Attention Deficit Hyperactivity Disorder (ADHD).
8. On January 24, 2007, Respondent ordered thyroid laboratory studies: BD's thyroid study results were all within the accepted normal ranges. When BD first saw Respondent, he reported a decrease of 15 pounds weight loss since October 2, 2006.
9. On January 25, 2007, Respondent prescribed Armour Thyroid· (thyroid medication) for BD at a dosage of 90 mg, to be increased in two weeks to 180 mg. In a phone message, Respondent stated that BD's thyroid functions were significantly low for a young female.
10. Although, Respondent contends he did repeat thyroid laboratory studies to re-evaluate BD's thyroid function after starting thyroid medication, the records were neither supplemented to the Board prior to the ISC, nor presented to the Panel at the ISC.
11. Respondent prescribed Adderall XR and Adipex for BD for treatment of.ADHD. Respondent did not do a formal screening test for ADHD.
12. Respondent evaluated patient TC on September 4, 2007 and ordered thyroid laboratory studies. Respondent also noted TC had anxiety and depressive symptoms. Respondent prescribed CymbaIta and Klonopin for TC's psychiatric symptoms.
13. On September 6, 2007, the results of TC's thyroid studies were all within accepted normal range. However, the Respondent prescribed Armour Thyroid (thyroid medication) for treatment of thyroid deficiency.
14. On October 10, 2007, the Respondent ordered a repeat thyroid test. The results were documented on October 22, 2007 as elevated T4 (2.0), elevated T3 (1011), and suppressed TSH. Respondent decreased the dosage of Armour Thyroid.
15. On November 5,2007, Respondent re-evaluated TC after TC stated he had a panic attack. Respondent initiated treatment with lithium for a bipolar disorder.
16. Respondent did not do a formal Bipolar Disorder screening on TC. Respondent did not refer TC to a psychiatrist. Respondent stated he has had no formal psychiatric training. The Board determined and Respondent admitted, he was engaging in-depth in practice areas that were beyond the scope of any special expertise or training he had obtained.
17. Respondent also admitted that he was employing his own criteria and thyroid treatment regimen in his practice that is not the practice of medicine as he was taught in medical school. With regard to Respondent's treatment decisions for both BD and TC, the Board concluded that Respondent failed to meet the accepted standard of care, and did not adequately do follow-up monitoring on either patient .
18. Respondent does not admit or deny the Findings of Fact and Conclusions of Law set forth in this Agreed Order. However, Respondent has cooperated in the investigation of the allegations related to this Agreed Order. Respondent's cooperation, through consent to this Agreed Order, pursuant to the provisions of Section 164.002 the Act, will save money and resources for the State of Texas. To avoid further investigation, hearings, and the expense and inconvenience of litigation, Respondent agrees to the entry of this Agreed Order and to comply with its terms and conditions.
CONCLUSIONS OF LAW
Based on the above Findings of Fact, the Board concludes that:
1. The Board has jurisdiction over the subject matter and Respondent pursuant to the Act.
2. Section 164.051(a)(6) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent's failure to practice medicine in an acceptable professional manner consistent with public health and welfare, as further defined by Board Rules: 190.8(1)(A), failure to treat a patient according to the generally accepted standard of care; and 190.8(1 )(C), failure to exercise diligence in professional practice.
3. Sections 164.052(a)(5) and 164.053(a)(5) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent prescribing or administering a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed.
4. Section 164.052(a)(5) of the Act authorizes the Board to take disciplinary action against Respondent based upon Respondent's unprofessional or dishonorable conduct that is likely to deceive or defraud the public or injure the public.
5. Sections 164.052(a)(5) and 164.053(aX6) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent prescribing administering or dispensing in a manner inconsistent with public health and welfare, dangerous drugs as defined by Chapter 483, Health and Safety Code; or controlled substances scheduled in Chapter .481 Health and Safety Code; or controlled substances scheduled in the Comprehensive Drug Abuse Prevention . and Control Act of 1970, (21 U.S.C. 3 801 et seq.).
6.Section 164.001 of the Act authorizes the Board to impose a range of disciplinary actions against a person for violation of the Act or a Board rule; Such sanctions include: revocation, suspension, probation, public reprimand, limitation or restriction on practice, counseling or treatment, required educational or counseling programs;· monitored practice, public service, and an administrative penalty.
7. Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition of this matter through an Agreed Order.
8. Section 164.002(d) of the Act provides that this Agreed Order is a settlement agreement under the Texas Rules of Evidence for purposes of civil litigation.
Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that Respondent shall be subject to the following terms and conditions:
1. For a period of one year following the date of the entry of this Order, Respondent's practice shall be monitored by a physician ("monitor"), in accordance with §164.001(b)(7) of the Act. The Compliance Division of the Board shall designate the monitor and may change the monitor at any time for any reason. The monitor shall have expertise in a similar specialty area as Respondent. The Compliance Division shall provide a copy of this Order to the monitor, together with other information necessary to assist the monitor.
a. As requested by the Compliance Division, Respondent shall prepare and provide complete legible copies of selected patient medical and billing records ("selected records"). The Compliance Division shall select records for at least 30 patients seen by Respondent during each three-month period following the last day of the month of entry of this Order ("reporting period"). The Compliance Division may select records for more than 30 patients, up to ten percent of the patients seen during a reporting period. If Respondent· fails to see at least 30 patients during any three-month period, the term of this Order shall be extended until Respondent can submit a sufficient number of records for a monitor to review.
b. The monitor shall perform the following duties:
1) Personally review the selected· records;
2) Prepare written reports documenting any perceived deficiencies and any recommendations. to improve Respondent's practice of medicine or assist in the ongoing monitoring process: Reports shall be. submitted as requested by the Compliance Division; and
3) Perform any other duty that the Compliance Division determines will assist the effective monitoring of Respondent's practice.
c. The Compliance Division. shall provide to Respondent a copy of any deficiencies or recommendations submitted by the monitor. Respondent shall implement the recommendations as directed by the Compliance Division.
d. The monitor shall be the agent of the Board, but shall be compensated by the Respondent through the Board. Such compensation and any costs incurred by the monitor shall be paid by Respondent to the Board and remitted by the Board to the monitor. Respondent shall not charge the compensation and costs paid to the monitor to any patients.
2. Within one year following the date of the entry of this Order, Respondent shall take and pass with a score of 75 or above the Special Purpose Examination (SPEX) as promulgated by the Federation of State Medical Boards of the United States. Respondent is allowed three attempts to successfully pass this examination.
Respondent's failure to take and pass the SPEX within three attempts within one year following the entry of this Order shall constitute a violation of this Agreed Order. After a committee of the Board or a panel of Board representatives (Board Representatives), has considered the information related to Respondent's violation of this provision and has determined that Respondent has not fulfilled the requirements of this provision, Respondent's medical license shall. be immediately SUSPENDED pursuant to correspondence to Respondent from the Executive Director or Secretary-Treasurer of the Board indicating that Board Representatives have considered the information related to Respondent's violation of this provision and have determined that Respondent has not fulfilled the requirements of this provision. Although Respondent shall be invited to provide information or testimony to the Board Representatives. Respondent specifically waives any administrative due process under the Medical Practice Act, or the Administrative Procedure Act, for the Board Representatives to consider this. information. THIS SUSPENSION SHALL BE EFFECTIVE WITHOUT THE NEED FOR A HEARING AT THE STATE OFFICE OF ADMINISTRATIVE HEARINGS OR. OTHER ADMINISTRATIVE, DUE PROCESS UNDER THE MEDICAL PRACTICE ACT OR THE ADMINISTRATIVE PROCEDURE ACT" AND RESPONDENT SPECIFICALLY WAIVES ANY SUCH HEARING OR DUE PROCESS AND ALL RIGHTS OF APPEAL. Respondent shall be notified of any suspension by certified mail, return receipt requested to Respondent's last known address, on file with the Board. If Respondent's license is suspended on such a basis, the suspension shall remain in effect until such time as Respondent takes and passes the SPEX and subsequently appears before the Board in person and provides sufficient evidence which, in the discretion of the. Board, is adequate to show that Respondent possesses the skills and knowledge to safely practice in Texas and is otherwise physically. and mentally competent to resume the practice in this state.
3. Within one year following the date of the entry of this Order, Respondent shall enroll In and successfully complete the physician prescribing course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program, or an equivalent course approved in advance by the Executive Director. To obtain approval for a course other than the PACE course, Respondent shall submit in writing to the Director of Enforcement for the Board information on the course, to include at least a reasonably detailed description of the course content, faculty, course location, and dates of instruction. Respondent shall submit documentation of attendance and successful completion of this requirement to the Director of Enforcement for the Board on or before the expiration of the time limit set forth for completion of the course.
4. The time period of this Order shall be extended for any period of time that (a) Respondent subsequently resides or practices outside the State of Texas; (b) Respondent's license is subsequently canceled for nonpayment of licensure fees, or (c) this Order is delayed or enjoined by Court Order. If Respondent leaves Texas to live or practice elsewhere, Respondent shall immediately notify the Board in writing of the dates of Respondent's departure from and subsequent return to Texas. When the period of extension ends, Respondent shall be required to comply with the terms of this Order for the period of time remaining on the extended Order. Respondent shall pay all fees for reinstatement or renewal of a license covering the period of extension.
5. Respondent shall comply with all the provisions of the. Act and other statutes regulating the Respondent's practice.
6. Respondent shall fully cooperate with the Board and the Board staff, including Board attorneys, investigators, compliance officers, consultants, and other employees or agents of the Board in ·any way involved in investigation, review, or monitoring associated with Respondent's compliance with this Order. Failure to fully cooperate shall constitute a violation of this order and a basis for disciplinary action against Respondent pursuant to the Act.
7. Respondent shall inform the Board in writing of any change of Respondent's mailing or practice address within 10 days of the address change. This information shall be submitted to the Permits Department and the Director of Enforcement for the Board. Failure to provide such information in a timely manner shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act.
8. Any violation of the terms, conditions, or requirements of this Order by Respondent shall constitute unprofessional conduct likely to deceive or defraud the public, or to injure the public, and shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act. Respondent agrees that 10 days notice of a Probationer Show Compliance Proceeding to address any allegation of non-compliance of this Agreed Order is adequate and reasonable notice prior to the initiation of formal disciplinary action. Respondent waives the 30-day notice requirement provided by §164.003(b)(2) of the Medical Practice. Act and agrees to 10 days notice, as provided in 22 Texas Administrative Code §187.44(4).
9. Respondent shall be permitted to supervise and delegate prescriptive authority to physician assistants and advanced practice nurses and to supervise surgicalassistant
10. This Order shall automatically terminate upon the provision of evidence to the Board demonstrating that Respondent has successfully completed the requirements in Order Paragraph Nos. 1, 2, and 3.
RESPONDENT WAIVES ANY FURTHER HEARINGS OR APPEALS TO THE BOARD OR . TO ANY COURT IN REGARD TO ALL TERMS AND CONDITONS OF THIS AGREED ORDER RESPONDENT AGREES THAT THIS IS A FINAL ORDER
THIS ORDER IS A PUBLIC RECORD.
I, JOHN A LAUNIUS, M.D., HAVE READ AND UNDERSTAND THE FOREGOJNG AGREED ORDER. I UNDERSTAND THAT BY SIGNJNG, I WAIVE CERTAIN RIGHTS. I SIGN IT VOLUNTARILY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEMENT OF ANY KIND, VERBAL, WRITTEN OR OTHERWISE.
DATED: Sept 18, 2008
John A. LAUNIUS, M.D.
SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this 10th day of October, 2008.
Roberta M. Kalafut, D.O., President
Texas Medical Board
This page was posted on February 2, 2009.