KENTUCKY BOARD OF MEDICAL LICENSURE Hurtoourne Office Part Matt Bevin ‘3x0 Whitington Parkway, Suit 18 Preston P. Nunneliey, M.D. Governor au, Kents 40222 resident ‘Riopone (som) 129-7260 van stn FED Jane 8, 2016 FLED oF RecoRD JUN 08 206 David A, Dao, MD. License No. 22439 ae 14657 Shepherdsville Rovd Elizabethtown, KY 42701 RE: Approval to Progress to “Onsite Consultation” Phase Dear Dr. Daot Having reviewed your Amended Agresd Order; a Jeter ffom sour counsel, Clay B. ‘Worthan dated Tune 6 2016; letter from Mary Minobe of CPEP, dated June 1, 2016, ¢ ser sen itinm I, Godfiey, M.D, dated May 11, 2016; and records from the Secretary of Sate Fogg Heaniand Medica Clinic {hereby approve your request to proyress tothe next Phase Sryour Educational Intervention Plan, Preeepted Edueation, during which you must 1+ Meet wit your preceptor, Dr. Godfrey, twice monthlys | Camtinue i review and adéress your learning goals with your preceptor including frypotbetcl ease ciscusson, medical iteratze reviews, and chart reviews/ease-based discussions; ‘+ Continue to submit patent chars to CPEP for reviews and Integrate feedbeck from your preceptor and CPEP into your practice. sincerely, C Wadlirm Brcine to €, WILLIAM BRISCOE, MD. CHAIR, HEARING PANEL A Mary D. Minobe, CPEP. William J. Godttey, M.D. Clay B. Wortham, Esq. UCKY An Eq! Oppartunty Employer EDFILED OF RECORD commonweattaorxenrucky MAR 02 2015 BOARD OF MEDICAI. LICENSURE CASE NO. 917 aan INRE:THE LICENSE TO PRACTICE MEDICINE IN THE COMMONWEALTH OF KENTUCKY HELD BY DAVID A. DAO, MD, LICENSE NO. 22439, 4657 SHEPHERDSVILLE ROAD, ELIZABETHTOWN, KENTUCKY 42701 AMENDED AGREED ORDER Come now the Kentucky Board of Medical Lisensure (the Boar’), acting by and ttrough its Hearing Pane! A, and David A. Dao, MLD. (‘he licensee”), and, based upon theit sutal desire fo allow the license to resume the practice of medicine, hereby ENTER INTO the following AMENDED AGREED ORDER: STIPULATIONS OF FACT ‘The parties stipulate the following facts, which serve asthe factal bases for this Amended Agreed Order: 1. AC all relevant tines, David A. Dao, MD, was licensed by the Board to practice medicine within the Commonwealth of Kentucky. 2. The licensee's media! spcily is Pulmonary Disease. 3. On or about July 30,2003, Sergeant Bill Sivers contacted the Board and advised that the licensee had been anested fr drug-related offenses afer an undercoveriavestgtion 4. In October 2003, the licensee was indicted by the Jefferson County Grand Jury for criminal acts of Teffickng in Controlled Substance, Obtaining Drags by Froad and Deceit, and Unaxthorized Preseribing, Dispensing or Administering of Controlled Substances. 5. On or about Octoser 16, 2003, the Board filed a Complaint and Emergency Order of Suspension agains the licensee’s Kentucky medical license,6. In or around March 2004, the licensee was indicted in Nelson County, Kentucky with igh (8) felony counts of Obtaining Controlled Substances by Fraud and Deceit and eight counts of Complicity to Obtain Controlled Substances by Fraud and Deceit, At or round the same time, the licensee was re-ndicted in Jefferion County, Kentucky with ‘twenty-one (21) felony counts of Trafficking in a Controlled Substance, Obtaining Drugs by Fraud and Deceit, and Prohibited Activities Relating to Controlled Substances. 7. On or about May 11, 2004, the Board issued an Amended Complaint and Amended Emergency Order of Suspension, 8. During the Boar's investigation int the criminal charges against the licensee, the Board Yeamed thatthe licensee had become sexually intrested in a patient who had been refered to his practice, Patient A; during the inal evalustic, the licensee performed a complete physical examination, including a genital examination, for Patient A who had been refered for collapsed lungs and chest pin; shorty afer his ist appointment, the licensee made Patent A his office manager; acording to Patent A, he quit that job ‘because of inappropriate remarks made by the licensee; fer he uit the license pursued him aggressively, finally arranging o provide controlled sutstance prescriptions to him in exchange for sexual acs ths continued for sometime, with Patient A andthe licensee ‘meeting at hotel rooms and some of these meetings were recorded; at some point, the licensee began spliting some of the prescriptions with Pant A. and gave Patint A money to fill the presritions; the licensee also assisted Paint A to fil the controlled substances prescriptions in a variety of names of other persons; police were abe to identify approximately 33 fraudulent preseri ss as part of their investigation; with Patient A's assistance, the police were able to put together a sufficient case to amest the:licensee and bang charges agains him in two counties; around the same time, the licensee was plhced on a conectve action plan by Hardin Memorial Hospital due to disruptive conduct and refered to the Kentucky Physicians Heath Foundation (“te Foundation") fer evaluation and anger management after his amet, the licensee vas ‘ested bythe hospital and ested postive for Utramy/Tramadol; and as esl ofthe dug ‘est results and the criminal charges, the licensee's hospital privileges became suspended on September 13,2003. 9. On or about Noversber 9, 2004, after a jury trial in Jefferson County, the licensee was convicted on ss (6) felony counts of Obtsning Drugs by Fraud and Deceit. The jay ‘evommende a sentence of two (2) years and eight (8) months on each felony count 10. On or about Janary 6,200, the licensee was sentenced in Jefferson Circuit Couto two ) years aad cight (8) months on each felony conviction. The Court granted te licensee's request for probation and placed the licensee on five (5) years supervised probation. 11,0n or aboot February 17,200, the sense surrendered his iense to practice medicine in the Commonvealth of Kentucky by entering nto an Agreed Order of Surender. 12, Atthe time the Lcense surrendered his Kentucky medial liens, he was awaiting tial on the indents in Nelson County. In April 2005 the Nelson County charges were dismissed, withoxt prejudice, based in part ypon the other felony convictions in Jeferson Couny. 13.n or around May 2007, the licensee completed a clinical sis assessment in the specialty of pulnonology at the Center for Personalized Education for Physicians (CCPEP"). The Assessment Summary included the following information:A. Medical Knowledge ‘During this Assessment, Dr. Dao demonstrated medical knowledge that was ‘outdated and also contained gaps that would not likely be fully explained by his time away from practice. His areas of relative strength included ‘occupational lung disease and pulmonary embolism. Dr. Dao's knowledge of current pharmacology was deficient, He demonstrated some deficits that were surprising based on the common nature ofthe disorders; this was true in the areas of COPD, asthma, and the solitary pulmonary nodule. Other areas of identified need pertained to ly be relatively infrequent, especially in a rural practice, such as pulmonary vasculitis or interstitial lung disease, In the area of critical care, Dr. Dao showed that he lacked! competence with ‘acid-base disorders, ventilator management, —_ventilator-associated ‘pneumonis, and current evaluation and treatment of shock. It will be ‘important for Dr. Dao to address these particular areas prior to resuming practice inthe inpatient setting Dr, Dao's performance in discussions pertaining to procedures was mixed He did well in discussing techniques for bronchoscopy. While he was also able to do this regarding central venous catheter insertion, he was not able to easily discuss potential complications ofthis procedure. His discussion of ‘Swan-Ganz catheter insertion was good, except for a minor point. Dr. Dao ‘Volunteered that transtrachael needle aspiration was a personal limitation, B. Clinical Reasoning During the Assessment, Dr. Dao demonstrated clinical judgment and reasoning that were generally sound, though with some areas for improvement. In most hypothetical eases, he demonstrated the ability 10 ‘gather information in a logical, organized, and complete fashion. While his knowledge deficits sometimes impacted his ability to navigate through the cases, his general approach was logical. At times his formulation of differential “diagnoses lacked the structure that would assist. him in formulating more thorough lists. Dr. Dao requized a moderate amount of ceueing from the consultant to consider certain diagnoses as well as lueatments. In a few instances, Dr. Dao did not recommend plans that seemed adequately aggressive for the scenario, for example, the case of respiraory filure and acidosis; thus it was not clear if he properly perceived the acuity of illness Dr. Dao demonstrated awareness of some of his limitations, and indicated that he would refer to a colleague or referal center in those instances; 4hhowever, it was not clear if he understood the breadth of his limitations. In light ofthe fact that no charts were available for review and the duration of time away from practice, CPEP cannot comment about Dr. Dao’s application of knowledge in practice. D. Documentation Dr. Deo performed acceptably on the SP documentation exercise, indicating that he understands the important components of an adequete ‘note. His documentation was evaluated solely on the basis of notes written at CPEP, as charts from his former practice were not available, For this reason, no assessment of his ability to manage and organize « complete chart can be made, F, Summary Overall, Dr. Dao's knowledge was outdated and contained gaps. His clinical judgment and reasoning were generally sound, with some areas for improvement. Dr. Dao’s communication skills were good with peers and SP's; although the SP’s had difficulty understanding his accent. His documentation for the SP encounters was adequate. His cognitive finction sereen was within normal limits. It snot clear whether Dr, Dao has a health condition that could impact the practice of medicine. tthe licensee's direction, CPEP developed an Educational Intervention Plan. 14,1In or around October 2007, the licensee completed the “Maintaining Proper Boundaries” program atthe Vanderbilt University Medical Center 15. In or around November 2007, the Panel considered a request by the licensee to reinstate his license and voted to defer action until the licensee completed any evaluation(s) Tecommended by the Kentucky Physicians Health Foundation ("the Foundation”). In ‘dition, the Panel asked the licensee to outline his employment history since 2003 and to provide a detailed work plan, The Panel voted that practice location approval would be a condition required ifthe licensee were ever permitted to resume practice,16.1n or around March 2009, the Foundation refered the icensee to Keystone Center for a psychological assessment, where he received Axis I diagnoses of R/O PTSD and R/O ‘MDD and it was noted Dr. Dao’s objective assessment indicated that he was resistant to being forthright and honest about his sexual relationship with B.C. and indicated ‘an overall pattern of guardedness. This is understandable considering his desire to keep secret the exact nature of his relationship with B.C. During ‘and after the polygraph exam, Dr. Dao disclosed the sexual nature of his relationship with B.C. and appeared over whelmed with emotion. He acknowledged that he possibly disclosed at ths time because he could no longer carry the secret due to the emotional and physical tol t placed upon hhim. Projective testing suggests that Dr. Dao has difficulty processing his feelings and tends toward not being emotionally vulnerable. He can also be interpersonly naive. Physically, Dr. Dao is poorly managing his diabetes and isin need of increased self care and medical management. ‘Several inconsistencies were noted in the records provided. They have been noted throughout the report. For example, according to the Order of ‘Surrender, there was significant evidence that Dr. Dao was engaged in a sexual relationship with B.C. inchuding video surveillance of Dr. Dao with BC. with his “shirt off and pants undone.” Additionally, Dr. Dao éenied drug use as part of the allegations. Yet, his testing indicated otherwise on September 7, 2003. He was positive for Ultram. Finally, even while at Keystone, Dr. Dao denied paying for sex. Yet he indicated that he deducted monies owed to him by B.C. for sexual favors. Dr. Dao denied trading drugs for sex while admitting to prescribing narcotics for B.C. while they engaged in a sexual relationship. Dr. Dao continues to maintain a pattern of {deception that is inconsistent with the level of accountability necessary for a practicing physician, Upon completion of the assessment process, Dr. Dao was encouraged 10 take time to address his traumatic experiences in childhood and as an adult ‘coming to America in 1995. He was encouraged to address his denial and the assault to his integrity related tothe events with B.C. It is the opinion of the assessment team that Dr. Dao is nat safe to practice medicine at this time. This opinion is offered within reasonable certainty and based upon availabe information. 17. Two years later, the licensee retumed to the same evaluator, but at Pine Grove Behavioral Health, where he received an Axis I diagnosis of Mood Disorder NOS and the evaluator reached the following conclusions and recommendations:‘Mary Gannon, MD noted that Dr. Dao “lacked the foundation to navigate iffcult situations, both interpersonally and in a complex profession”. Dr. Gannon noted a need to contro, avoidance, withholding information and ‘magical thinking as problematic. She also opined reinstatement of Dr. Dao's medical license as the primary motivation for therapy. 1 believe that fundamentally this remains unchanged and despite Dr. Dao's verbalization that he wants to obtain his license, his investment in therapy was less than ‘enthusiastic and other factors may be the source of his motivation. His choice to travel to Vietnam instead of continuing to address therapeutic issues is conceming. During this evaluation Dr. Dao stated that regaining his medical license was a matter of “family honor.” Despite this statement, his investment appears less than robust. After Dr. ‘Dao stopped treatment with Dr. Gannon in February of 2010, there appeared to be little investment with his new therapist. Dr. Dao said that he did not participate in therapy while in Vietnam and bas only seen Dr. Kaveh ‘Zamanian once since his return to the US and that appears to be in effort to ‘objain a letter in suppor of license re-instatement Dr. Montgomery noted that Dr. Dao appeared to have difficulties with information processing. Neuropsychological screening did not suggest ‘70ss difficulties. However, in reviewing records, it was noted that Dr. Dao tends to have poor decision-making despite his overall level of ability. His choices have resulted in significant consequences over the years yet he continues to function in this manner. He is generally not forthright regarding details of evenis unless challenged and at times he will tell different versions of a story to different interviewers. For example, he initially stated that he volunteered in a hospital Vietnam. Yet, by the end of the week he stated that he worked there. According to the records (8-8-11), hhe informed Dr. Brady that he practiced medicine in Vietnam and was paid $1000 per month. Additionally, notes dated 5/12/09 reference inconsistencies between Dr. Gannon, Dr. Brady and myself regerding Dr. ‘Dao's control of his diabetes and his ability to return to work. Although one ‘might hypothesize that language may play a role in his ability to receive and integrate information, current testing and history do not support language as ‘a major contributor, especially, in ight of his previous success in the United States. In my opinion, Dr. Brady's notes are telling of some of the difficulties Dr. ‘Deo has had interpersonally. As far back as April, 2002, Dr. Brady notes “che would unilaterally chose to do his own thing”. This remains ‘concem to this day and without a high degree of structure and accountability ‘he is at risk for further boundary related practice issues.RECOMMENDATIONS 1. Given that Dr. Dao has not progressed in outpatient therapy to the level expected to practice medicine safely and with the necessary integrity the profession demands, i is our recommendation that he attend a residential program to address his character deficits. Options include, The Professional Enhancement Program at Pine Grove, Sante’ Center for Healing, or the Professional Renewal Center. 2. Dr. Dao will need to complete a polygraph without evidence of deception prior to re-instatement of his license, 3. Dr. Dao will need to complete professional boundacies course if ‘has not done so inthe pat three years, 4. Random urine and polygraph examinations are recommended, >. A highly structured practice plan with a restricted DEA license is necessary ifwhen he is able to return to medical practice. 18, From November 2011 through January 5, 2012, the licensee patcpated in the recommended Profesional Enhancement Program (CPEP") at Pine Grove, where he reevived additonal Axis 1 diagnoses of Occupational Problem (Profesional Srual Misconduct, boundary violations) and Complex PTSD. The Discharge Summary included the following Brit Summary of Overall Progress: Dr. Dao was admitted to the Professional Enhancement Program (PEP) on 11/072011. Dr. Dao’s treatment focused on his vocational sexual misconduct, personality traits, depression and anxiety, trauma, and relational issues with his spouse and family. While at PEP, Dr. Dao received feedback about his lack of awareness around his personality and relational issues and his dificulty taking responsibility for his boundary violations. He struggled with interpersonal relationships, particularly with recognizing how his personality traits inhibited his ability to function and be genuine in felationships with his peers and wife, During his time here he did gain an understanding of his role in unhealthy relationships and was able to take ‘more responsibility for his actions. He also gained and practiced valuable ‘new coping and relational skills. Overall, Dr. Dao gained an awareness of his maladaptive behaviors while in weatment and would benefit from continued work to maintain his progress, to continue to process his vocational sexual misconduct, and to further address his personality traits, Dr. Deo agreed to follow through with discharge plans to seek employment ‘outside of the medical field where he can practice health boundaries and continue to process treetment issues with an outpatient therapist. It was recommended that he return to PEP in,19. The licensee retumed to PEP on June 4 and was discharged on June 15, 2012. The Discharge Summary included the following Return to Work Recommendations ‘Pending the approval of the Kentucky Board of Medical Examiners and the Kentucky Physicians Health Foundation Dr. Dao may return to the practice ‘of medicine with appropriate continuous monitoring. Pending approval of the Kentucky Board of Medical Examiners to retum to practice, it is recommended that Dr. Dao sign & contract with the Kentucky Physicians Health Foundation aftercare monitoring and follow — all recommendations and guidelines ofthis contract. Return to the Professional Enhancement Program (PEP) in one year (June 2013) for a Slay reevaluation to assess for further workplace recommendations, It will be his responsibility to call PEP in order to set this up at least 2 weeks prior to entrance. Prior to acceptance of any position Dr. Dao should discuss ‘employment options with his therapist. Once employment in medicine is cobisined, it is recommended that Dr. Dao paticipate in PEP care ‘monitoring. It is Dr. Dao’s responsibility to contact PEP in order to begin this process, Participate in polygraph testing to be completed in one year at PEP upon his return for reevaluation. 20.tn or around October 2012, the Panel considered the above information and vod to defer action until the licensee succesfully completed an updated CPEP Clinical Skils Assessment and obtained an Education Plan, if recommended. 21. In or around February 2012, the licensee paticipeted in an updated CPEP Clinical Skis Assessment inthe specialty of pulmonology fom which CPEP found in pat During this Assessment, Dr. Dao demonstrated medical knowledge that was ‘marginally acceptable with gaps in some areas important to practice. His knowledge appeared stronger in topics pertinent to the outpatient setting. His clinical judgment and reasoning were lacking overall, Dr. Dao's communication skills were adequate, with room for improvement, with Simulated Patients (SPs); his communication skills with peers was professional. His documentation for the SP encounters was marginally adequate with the need for improvement, ‘The educational needs identified in this Assessment are listed in Section I. Assessment Findings. Review of a history and physical exam conducted in January 2013 did not reveal any conditions that should affect Dr. Dao's medical practice. Dr. Deo also submitted 9 discharge summary from Professional EnhancementProgram (PEP) pertaining to a June 2012 admission, Some of te diagnoses identified have the potential to impact medical practice andlor were related to previous licensure discipline (boundary violations). His cognitive function sereen results were below expectations. 22. n or around May 2013, the licensee completed a neuropsychological evaluation, which found no Axis I diagnoses, In the Summary and Discussion, the evalustor concluded, in part, ‘The results of the neuropsychological evaluation revealed that, a the time of the testing, Dr. Dao emotionally was free of debilitating anxiety, depression, or psychological turmoil to the extent that it would affect his ability to function in activities of daily living or manage the practice of medicine. [Neuropsychologically, the man is functioning in the Average Range with High Average skills in perceptual reasoning and working memory. His Average performances in processing speed and verbal comprehension still Were within anticipated parameters especially for someone who was born and raised in foreign country with English asa second language, Agxin, diagnostically the results of this evaluation give no evidence of cortical or subcortical dysfunction or cognitive impairment that would impede this gentleman’s ability to retum tothe practice of medicine 1t is recommended that as he retums to the practice of medicine that he follows the recommendations offered in his last visit to the Professional Enhancement Program in 2012. 23. In or around July 2013, CPEP developed an updated Educational Inervention Plan for the licensee in the specialty of pulmonology, which anticipated thatthe licensee would hhave 100% direct supervi 24. nor around August 2013, the Panel considered the above information and voted to defer action on the licensee's petition for reinstatement until he presented an appropriate practice plan. 25. On or about March 14, 2014, the licensee submitted for the Panel's consideration a plan to practice intemal medicine in Elizabethtown, Kentucky, with Dr. liam Godfrey. 10However, because the licensee had presented himself as a pulmonologist and submitted ‘to clinical skills assessments only in the specialty of pulmonology in 2007 and 2013, (CPEP could not comment or approve of his plan to practice internal medicine. 26. 1n ot around April 2014, the Panel chose to defer action on the licensee's request to reinstate his medical license until he retumed to CPEP and completed an assessment in Internal Medicine and obtained an education plan, ifrecommended, 27. In or around August 2014, the licensee returned to CPEP and completed an assessment in ‘outpatient intemal medicine. CPEP noted thatthe licensee had net practiced medicine in ‘the United States since 2005 and that he hed not practiced in a primary care or intemal ‘medicine setting outside of residency training. Although the liceasee had participated in ‘two different intemal medicine review CMEs in the prior 36 months, he still demonstrated significant deficiencies which may be difficult to remediate. Overall, (CPEP found that the licensee “demonstrated a very limited fund of knowledge in ‘outpatient and inpatient internal medicine with broad-based end significant deficiencies in the majority of areas covered.” It was noted that he demonstrated “significant and ‘broad deficiencies in areas common to primary care,” his knowledge of health ‘maintenance was “globally inadequate,” and he demonstrated unasceptable knowledge of basic physical examinations and medications. The licensee demonstrated inadequate clinical judgment and reasoning, his thought processes were slow and disorganized. In ‘one case he omitted a pulmonary condition fom a differential diagnosis ~ this was noted to be especially conceming because the licensee isa pulmonologi 28. In or around November 2014, CPEP developed an Educational Intervention Plan for the licensee in the practice of outpatient internal medicine, The Educational InterventionPlan requires that the licensee have 100% direct supervision fom his Preceptor, Dr Wiliam Godttey, during all outpatient intemal medicine paint encounters for an indeterminate period of time, CPEP does not recommend tha th licensee be allowed to practice in higher acuity inpatient setng without first completing a residency program, ven his demonstrated deficiencies in managing emergent scenarios and in treatment planning, 29.0n or about Apel 16,2015, the Pane agreed to allow the licensee to resume the practice of medicine pursuant othe terms and condition st forth n an Agreed Order, 30.In December 2015, CPEP issued Progress Report [in egard to the licensee's education plan and sted Dr, Dao demonstrated compliance with and dedication to his Plan during this reporting period. To progres with his Pan ths report is being provided to the KBML for their consideration in determine ‘fr, Dao may procecd to End of Day Review, which isthe next stepin the Point of Care Experience Dr. Dao’s preceptor, Dr. Godfey, has submited a write report detailing his 100% supervision of Dr Dao one day each week for a period of 3-4 months and stating that he believes that De. Dao is ready to proceed tothe next phase of his esucation plan requiring end of day review, 31. The licensee's Agreed Order required, in part, that “upon competion ofeach phase ofthe Educational Inerventon Plan, the licensee SHALL obain the Panel's writen approval Prior to proceeding with subsequent portion ofthe Educational Intervention Plan” 32, On February 18,2016 the licenses appeared before the Panel and acknowiedged that he had violated the Agreed Onder because he and his preceptor, Dr. Godley, had proceeded to the next phase of is Educational Intervention Plan without the Panels approval. RIPULATED CONCLI LAW ‘The pares stipulate the following Conclusions of Law, which serve asthe legal bases for this Amended Agreed Order 1. The Hoensee's Kentucky medical lisense is subject to regulation and diseptne by the Board 2. Based upon the Stipulations of Fac, the license bas engaged in conduct which violates ‘the provisions of KRS 311.595(4, (8), (9) ~a illustrated by KRS 311.597(1)~ (13) and (21), Accordingly, there are legl grounds for te paties to enter into this Amended Agreed Order 3, Pursuant to KRS 311.591(6) and 201 KAR 9:08, the parties may allow the licensee to resume the practic of medicine pursuant to ths Amended Agreed Order. AMENDED AGREED ORDER Based upon the foregoing Stpulatons of Fct and Stiplsted Conclsions of Law, and, based upon their mutual desire to allow the licensee to resume the practice of medicine, the ities hereby ENTER INTO the following AMENDED AGREED ORDER: 1. The license to practice medicine in the Commonwealth of Kentucky held by David A. Deo, MD., is RESTRICTEDILIMITED FOR AN INDEFINITE PERIOD OF TIME, effective immediatly ypon the fling ofthis Amended Agreed Onder, 2 During the effective period of this Amended Agreed Order the licensee's Kentucky medicel Heese SHALL BE SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS until further order ofthe Pant 4 The licensee's practice of medicine is EXPRESSLY RESTRICTED/LIMITED to the practice of internal medicine in an outpatient office-based environment, and he SHALL NEITHER practice in an inpatient setting (including but notlimited to nursing homes) NOR provide any treatment for conditions outside of the specialty of internal medicine, unless and until approved to do so by the Panel; ». The licensee SHALL NOT perform any act which would constitute the “practice ‘of medicine,” as that term is defined in KRS 311.550(10), unless and until the Panel or its Chair has approved, in writing, the specific practice location at which hae will practice medicine. ‘The decision whether to approve a particular practice location lies in the sole discretion of the Panel or its Chair. In determining ‘whether to approve a particular practice location, the Panel or its Chair will particularly consider whether there will be appropriate supervision of the licensee, ‘and may also consider the nature ofthe practice, including the licensee's proposed ‘duties and hours to be worked, In approving such practice location, the Panel or its Chair may include specific conditions/testritions to ensure patient safety and ‘may require additional conditions end/or restrictions as a condition of it granting approval fora new practice location. The parties agree thatthe Panel or its Chair ‘must approve any change in practice location forthe licensee in writing and prior to the licensee commencing the practice of medicine at any location(s); i. ‘The licensee is hereby approved to and SHALL ONLY practice internal ‘medicine one (1) day each week atthe office-based outpatient practice of| William J. Godfiey, MD., 914 West Dixie Avenue, Elizabethtown, Kentucky 42701; . The licensee SHALL comply with and shall successfully complete all requicements of his CPEP Educational Intervention Plan, at his expense and as. directed by CPEP, a copy of which is attached; |. The licensee SHALL TAKE ALL NECESSARY STEPS, including the execution ‘of waivers and/or releases to ensure that CPEP provides timely written reports to the Panel outlining his compliance with the Educational Intervention Plan. The licensee SHALL further ensure that CPEP shall notify the Board immediately if the licensee should fail to comply with the Educational Intervention Plan or practices medicine in a manner that creates a danger or tsk of danger to the health or safety of patients or the public; ‘Upon completion of each phase ofthe Educational Intervention Plan, the licensee SHALL oblain the Panel or Panel Chair's written approval prior to proceeding ‘with subsequest portions of the Educational Intervention Plan. The licensee SHALL ensure that the Panel or Panel Chair is provided with all written evaluation reperts by CPEP and a written (or in person) report from William J. Godftey, M.D, in order to make a fully informed decision at each interval; If deemed necessary and appropriate by CPEP, the licensee SHALL SUCCESSFULLY COMPLETE the Post-Education Assessment, at his expense ‘and as directed by CPEP; and “4{The licensee SHALL NOT violate any provision of KRS 311.595 and/3r 311.597. 3. The licensee expressly agrees that if he should violate any term or condition of this ‘Amended Agreed Order, the licensee's practice will constitute an immediate danger to the public health, safety, or welfare, as provided in KRS 311.592 and 13B.125. The partes further agree that ifthe Board should receive information thet he has violated any ‘erm or condition ofthis Amended Agreed Order, the Panel Chair is authorized by law to enter an Emergency Order of Suspension or Restriction immediately upon s finding of probable cause that a violation has occurred, after an ex parte presentation of the relevant facts by the Board's General Counsel or Assistant General Counsel. Ifthe Panel Chair should issue such an Emergency Order, the parties agree and stipulate that a violation of any term or condition ofthis Amended Agreed Order would render the licensee's practice ‘an immediate danger to the health, welfare and safety of patients and the geveral public, pursuant to KRS 311.592 and 13B.125; accordingly, the only relevant quesion for any ‘emergency hearing conducted pursuant to KRS 138.125 would be whether the licensee violated a term or condition ofthis Amended Agreed Order. 4, The licensee understands and agrees that any violation of the terms of this Amended Agreed Order would provide a legel basis for additional disciplinary action, including: revocation, pursuant to KRS 311.595(13), ain may provide « lepal bus prosecution. SO AGREED on this 24 day Oh Fabs FOR THE LICENSEE: 1sFORTHE BOARD: CWILLIAM BRISCOE, MD. CHAIR, HEARING PANEL A TEANNE K DIAKOV General Counsel Kentucky Board of Medical Licensure 310 Whitington Pareway, Suite IB Louisville, Kentucky 40222 “al. (502) 829-7150, 16CP. EPS P Ss EDUCATIONAL INTERVENTION PROGRAM. EDUCATION PLAN, Developed November 2014 for David A. Dao, M.D. [NATIONALLY RECOGNIZED * PROVEN LEADER * TRUSTED RESOURCE ‘720 8, Colorado Boulevard, Suite 1100-N Deaver, Colorado 80246 ‘Phone: 303-577-3232 Far: 303-577.3241 ‘wrw.cpepdoc.org “Ts doamonl ood onlrs ee eonlonss end iced fr be ecava use ef CPE, Paraben, and aiomed rofl ovewcrpanlzan).s pvepd unc plea rv, aareiin vak pro yde wee ‘3 prvi byl, Use dca wou wien euhzten ten CPEP ey rit, you ta eed ‘is eounont mom, plone conta CPEP immedi.Edveation Plan Davd A. Dao, MD. Appendix A Appendix B Appendix C & Page 20f 19 EDUCATION PLAN OVERVIEW Itroduction and Plan Desiga Individesl Leeraing Goals ‘© Specific areas of educational need Pesformance Objectives (Modules A and B) © Self-study, CME, Preceptor Meetings Initiation ofthe Plan and Preceptor Approval ‘© Determining the start of activities Education Notebook ‘+ Preceptor Approval Process Paticipation and Monitoring * Participation Expectations ‘Evaluation Process Deration APPENDICES: Practice Profile Federal Regulations of Privacy of Individually identifiable Health Information Glossary and Educational Terms‘Béucation Plan David A.Dao, MD. Page 3 of 19 |. INTRODUCTION Dr. Dao has not practiced inthe United States since 2005. His previous practice experience was in pulmonology. ‘Dr. Dao hes not precticed in a primary cre or interoal medicine seting outside ‘of residency tsining. Due to the dificulie in ideaifying a preceptorhip in pulmonology, Dr. Dao presested to CPEP for a clinical skills Addendum in intemal medicine in Angust 2014, ‘which identified areas of educational need. The development of this Education Plan (Plan) was based on those needs. The Plan was also based on dats gathered by CPEP and information obisined from Dr. Dao. The purpose ofthis Plan is to provide a framework in which Dr. Dao ‘an address his educational neods in outpatient intemal medicine. For a complete history of Dr. Dao"s CPEP activites, see his August 2014 Assessment Report (oleae dato November 7, 2014), Important to Note: ‘During his Assessment, Dr. Dao demonstrated a significant numberof educational needs related to outpatient internal medicine. It is CPEP’s opinion that an attempt at supervised remedial ‘education in th area of outpatient internal medicine may be appropriate for Dr. Dao. However, ‘based on the information that Dr. Duo provided to CPEP, it appeared that he participated in two different internal medicine review Continuing Medical Education (CME) activities in the past 36 ‘months and sll had mumerous knowledge deficiencies recognized during the Addeodum, which suggests that he may have difficulty remediating ‘Educational programs developed by CPEP cannot provide the same rigor or level of supervision 5 a residency program, and CPEP cannot guarantee that Dr. Dao will be able to access the ‘educational resources needed for him to successfully address his educational needs ouside of a residency setting. Areas such os Dr. Dao's clinical judgment and reasoning can be challenging to remediate and may requir time to ensure success. In light of the extent of the deficiencies identified, any remediation would requize interest by the Boacd, extensive resources, and fll commitment by Dr. Deo. CPEP recognizes that decisions about licensing or privileging are ‘made a the local level and based on many factors other than the Assessment. A glossary of Educational Intervention terms is enclosed. FOCUS OF PLAN ‘Outpatient [nteral Medicine: This Plan adresses Dr. Dao's practice of outpatient intemal medicine. If areas of educational need other than those addressed in this Plan are identified while Dr. Dao is participating in the Plan, CPEP will notify the referring organization and Dr, Dao and determine ifthe educstional needs can be addressed within the context ofthis Plan. Inpatient Intemal Medicine: Based on Dr, Dao's performance during the Addendum, in particular his deficiencies in managing emergent hypothetical scenarios and in treatment planning, Dr. Dao did not demonstrate ability to safely practice in a higher-acuty inpatient setting. ‘Tie Gouret end colons ev cunflonl md lio fr be excuse oo a CPEF, Patcoan a wind rofesonlvon cmineabn), 2a pega ude peal ev, ey ver redo belo os Fermi by lon. Ue x dacoque wiht witenaxboraion fen CPEP sei prised you hae rch is ‘ocala coi PEP ned,David A.Dao, MD. ‘Education Plan Page 4 of 19 LimmraTions CCPEP cannot guarantee that « Preceptor andlor an appropiate setting canbe identified t address this Plan ‘+ A CREP Associate Medical Direcior spoke with Dr. William Gosifrey on May 20, 2014, ‘regarding serving as Dr. Dao'seducetional Preceptor should Dr. Dao participate in CPEP ‘Assessment activities persining tothe practice of outpatient intemal medicine and areas in need of improvement eo ideaiSed. ‘The AMD concluded that Dr. Godley would be ‘ap acceptable Proceptor candidate and emphasized that, given the past collegial relationship beween Dr. Dao and Dr. Godifey, it is important fo understand that as the receptor, Dr. Gdirey would be inthe role ofa educator and evaluator. HEALTH CONSIDERATIONS Review of public Keamcky Board of Medical Licensure (Board) documeats indicate that Dr. Dao may have a health condition that could interfere with his ability to return to medical practice. Dr. Dao provided CPEP witha copy of «history and physical dated July 2014, but it id not include information sbout the preseat status of the health condition known tothe Board, De. Dao also provided CPEP with a copy of a neuropsychological examinetion conducted May 2013, which didnot reveal any cognitive concerns. ‘+ Ifhe has not already done so, Dr. Dao should undergo an evaluation by a sate physician ‘beats program to be sure that any health condition(s) that might affect his ability to ‘return to active clinical practice aze well controlled. CCPEP does not monitor participants’ health issues. CPEP will contact Dr. Dao andlor the referring organization if concerns arise indicating that health issues may be impacting Dr. Dao's ability to complete the Plan activities. LICENSING ‘Because CPEP Education plans are practice-based, physician-participants must have a medical license in order to complete a Plan. Some activities, such as self-study, may be completed Without a medical license, It i he parcicipants responsibility to ensure that he prectices within the parameters of hs licensure status. DESIGN ‘The individual Learning Goals described below in Section IT were derived from the findings of the Assessment. ‘This Plan was designed to address those Learning Goels through Medical Knowiedge Enhancement and Patient Care Enhancement educational activities described in Section IIT 05 Modules A and B. Evalustion of Dr. Dao's progress and oversight of his participation will be provided by the CPEP Associate Medical Director. The Plan is designed sround continuous and timely participation so that maximum educational benefit is received and ongoing progress is made. Following is more detailed information about the Modules and the ‘Associate Medical Director oversight. zcmect end fs cents wo corer eo Wed rhe enteuse of OPE, Pala ed sshotsd Flan vou cranial ridged dor ptssiond eon, eonayn, wk eo ted ares Ferted by lex. Ue or desu vot witen eaberaaion Fon CPE? is ty pcted yeu haw recbadis ‘earert nore, lose cain OPEP medleyEducation Plan ‘David A. Dao, MD. ge 5019 Nore: ‘The requcements of this Plan are not tended to supersede or exclude any requirements specific to his employer, credentialing, or licensure regulations. However, some activities may ‘be applicable to both the Pan and such requirements ‘A. Medical Knowledge Enhancement (Module A) ‘The Medical Knowledge Enhancement Leaming Goals ere sddessed independently by the participant ac well as through discussions with the Preceptor. The scivtes are designed to Improve the participant's medical knowledge specific to the Learning Goals. Other improvements are generally relized as a reslt ofthe ecivities. A Preceptor is not needed to ‘opin the activites deseribed in Module A. CPEP encourages Dr. Dao to begin the activites as 000 as be hes initiated the Plan, The recommended activities include: ' Independentmnsupervsed self-study; ‘+ Bvidence-based research; ‘+ Continuing medical education activities and/or courses. B. Patient Care Enhancement (Module B) Dr. Dao will work with « Precepior Wino has a practice similar to his. He will participate in Point of Care (PoC) activities as described below. Subsequently, Dr. Dao will participate in a Jongitudinalleaming experience tht is reliant on regularly scheduled Preceptor Meetings. The PoC Experience will be completed prior to Dr. Dao seeing patients independent!yhunsupervised 1s deseribed in Module B. During these experiences Dr. Dao will: ‘© Address his more immediate educational needs by initially seeing patients with direct supervision, He will then progress through decreasing levels of supervision and ultimately se patents independentlynsupervsed; ‘+ Retospectvely review charts with the Preceptor of patents for whom De. Dao provided independent/unsupervsed care; © Receive one-on-one cosching and constructive feedback with regard to medical Iknowledge, clinical judgment end documentation, particulary with regard to those areas identified in the Plan Learning Goals (ee Section 1) ‘+ Discuss and reinforce new information and skills gained for full integration into daily patient care; * Appeecite the value of lifelong lesming, peer relationships, and self-assessment tothe ‘quality of patient care. ©. Oversight ‘The Associate Medical Director oversight includes Preceptor training, consideration of the feedback provided by the Preceptor and review of educational materials submitted by Dr. Dao (Gee Section ¥). The Associate Medical Director will regularly communicate with and provide ‘ongoing feedback and cosching to Dr. Dao andthe Preceptor with regard to Dr. Dao's progress. ‘Wie coramert aod fa cats av ooenll an flood r fe erouave in of CPEP,Periopntand waist rolessenal aw ejnzs(s). pried under passion row, teen wok por ade act et arid by lat. Use or disire wit witen achoraston fm CPEP atic orchid. fou have edie it (eunsitin ay sew coca CPEP edly.® e ‘Education Plan Page 6 0f19 David A. Dao, MD. . LEARNING GOALS A. Medical Knowledge Although Dr. Dao will be practicing in an outpatient setting, it will be sppropriate for him to participate in self-study to addcess the Medical Knowledge educational needs peraizing to inpatient care so that he i adequately knowledgeable about these topics and wien to refer ® patient for treatment of such conditions. ‘To improve evidenced based medical knowledge including, but not limited to, the following 1. Comprehensive and intensive review of internal medicine;* 2. Cardiology:** 8 Comprehensive review of ECG interpretation including but not limited to, common shythm abaormalities such as atrial fbrllation, conduction system disorders, Q ‘waves, ST segments, and T way '. Office and emergency room treatment of acute coronary syndrome, including dosing and adainistation of aspirin and use of morphine; \Nitroglyeesin: indications for sublingual versus intravenous use; ™ Management recommendations in patonts with knowa coronary atary disease; Medication management of congestive heart falure, including systolic and diastolic hear failure Atrial fibrillation: management recommendations and selection of ant-coagulation, including newer medications such as Karelto;* ‘Warfarin management, inchuding international normalized ratio gols; * ‘Antihypertensive medications, including but not limited to: 1) Beta blockers: options, side effects, contraindicatons; ”* 2) Angiotensin-convertng enzyme inhibitors: options, indications, containdications, side effect, (Causes and evaluation of secondary hypertension; J. Diagnosis of hypertensive urgency versus hypestensive emergency; K Evaluation (including assessment of renal functoc) and treatment of hypertensive emergency in the inpatient setting, including medication options snd recommendations regarding rate for lowering the blood pressure; 3. Pulmonary: Treatment of pulmonary embolus, including but not limited to, indications for thrombolytic medications; », Lowrmolecular-weight heparin: indications and use; ™ © Causes of respirstory distress in a hospitalized patient admitted with diagnosis of ‘pneumonia; 4, Infectious disease: 1. Sepsis: pathophysiology, carly goal-directed therapy guidelines, use of Vancomycin; '. Management of cellulitis in the inpatient setting; ©. Diagnosis of ehlamydie; 4. Diagnosis of urinary tract infection, urinalysis interpretation; emp re = “Wis ocunet ond ts cicions wre cotrd lfleded bx Do archove iso of OFEP,Perldpon, on eiboruat plese iw ogc) t's ped under profesional oo, stoner, wa okt o Ue para st armies by ew. Use er dace wit writen auborznton fon CPEs sity pron. you hae rsa ‘oar in err, plas cota PEP nme)‘veation Plan Page 7 of 18 David A-Dao, MD. ©. Healthcare-astociated pneumonie: diagnosis and troatment; 5. Endoinley 1a Diabetes melius: 1) Current recommendations regarding blood sugar, lipids, and blood pressure control, 2) Medications available, including but not limited to, DPP-4 inhibitors, GLPL receptor agonists; . Dosing of thyroid replacement in elderly patients when initiating treatment of hhypottyroidism and timing for checking the thyroid-stimulating hoamone level ater ose adjustments; ‘Treatment of osteqporasic, madieatinn options: machanism of retion, sida effete? 6, Gestoeteobog: ‘2 Indications for endoscopy; '. Causes and evaluation of chronic dare; €. Diagnosis of pancreatitis; 4. Cimbosis: screening recommendations for hepatocellular carcinoma; 7. Nephrology:** ‘8, Common medications that affect renal function;*™ '. Classification of renal insufficiency with glomerular filtration rte, and recommendations by class; Evaluation of ead insuficiency; 8, Hematology:** ‘8 Evaluation of iron-deficiency anemia, '. Evaluation and treatment of macrosytic anemia ¢. Treatment of idiopathic thrombocytopenic purpur; 9. Musculoskeletal disorders: 18. Back pain: 1) Causes; 2) Physical examination; '3) Management options other than nonsteroidl ant-inflamamatory drugs; , Knee complaints 1) Causes; 2) Physical examination of knee, inchuding common provocative testing; 3) Indications for imaging: 10, Healy maintenance, including but not limited to:** Screening for substance abuse (tobacco, alcohol illicit substances) in both females and males; , including indications for BRCA testing: Screening recommendations for chlamydia in females; Colon cancer screening recommendations: initiation, frequency, cessation; ‘Prostate cancer screening controversy; Osteoporosis sereening recommendations: initiation, frequency; Lack of indications for routine cardiac stress testing; Adult immunizations: = ‘hs doomert end scons we cnr ond Flndcd ro exavove ts of OPE, Patehant wet avtod Femene olesna even rezone piged user reson vw, nyse wak rai, o ae ao Period by an, Use or dacosre wit wlan eubofzien fon CPEP asi pohibed. you have recede cues tan, eee cori CPEP ined.‘Bducition Plan Page 8 of 9 David A. Dao, MD. 1) Gardasil: indications; 2) Paeumovex: indications; 3) Thfluenza vaccine: indications; 4) Zostavax: indications; 11, Mental nal a. Diagnosis of depression; 'b, Medication options for treatment of depression: indications, mechanism of action, ide effects; ™ ©. Diagnosis of eaxiety; 44. Medication options for treatment of anxiety: indication, mechenim of ation, side effects, Medications to teat insomnia; 12, Women's heath 8 Causes and evaluation of east mass; '. Causes and evaluation of vaginal discharge; &. Management of menopausal symptoms. P*These needs are relevant to pharmacology but are grouped under disease catgores for simplicity ‘Topic summary not required. **Subtopics may be combined into one summary; tv references required (See IILC below for description of topic summaries) B. Clinical Judgment ‘To consistently demonstrate appropriate clinical judgment in the areas that include, but are not limited to, the following: Alilty to guther information in an organized aad complete fashion; ‘Demonstration of consisteatly logical thought processes, Structured formulation of differential diagnoses; Consistent ability to correctly assess acuity of illness; Adequate ability to respond to emergent situation Satisfactory patent care, including ability to develop treatment plans from beginaing to end Appropriate use of consultants; ustifleation for testing, ©. Documentation The following are based on the recommendations generated from the simulated patent docuimentation exercise conducted in Dr. Dao’s 2013 Assessment: ‘The participant will leam principles of documentation that are based on recommendations and requirements of nationally recognized organizations such a the Joint Commission and Cages {for Medicare aad Medicaid Services (CMS) end recommendations of national specialty societies and will consistently demonstrate appropriate patient care documectation tha includes, but isnot limited to, the following: ‘Tie decom ot Ivonne ow oman ond Wnaed rb ole tw @ OPEN, Palopat od oboe (essa mi asics). ls prifeged unde prone ven, eoreyln, vo pod, o ade ea armidby law. Use rdsu wit wean auotason fom OPEP soy robe yo he raed is cme er, pleas crt CPE ies,Education Plan Page 9019 David A. Dao, MD. 1. Coaching from a Preceptor ox experienced colleague 2 Consideration of attending @ medical recordkeepizg course thst includes a follow-up component, depending on progress with eosching. Guide ‘Adequate documentation requires inclusion of sufficient detail in visit notes such that the notes “standalone” and determination ofthe level ofeare provided does not require verbal input from the documenting physician tobe fully understood. Ultimately, adequate documentation includes chart organization and systems tools that allow another physician to easily assume care of a patient. D. Practice-based Learning 1 Expanded variety of medical resources, E. Physician-Pationt Communication Skills The following are based on the recommendations generated from the simulated patient ‘cominunication exercise conducted ix Dr. Dao's 2013 Assessment: To consistently demonstrate sppropriste communication sills in the ereas that include, but are not limited t, the following 1. Consideration of accent modification taining if his patients and colleagues are largely English speaking; 2, Incorporstion of a routin of assessing patient comprehension rather than presuming that ‘the patient understands what is being ssi. lll, PERFORMANCE OBJECTIVES Performance Objectives are specific educational activities that provide focused leaning experiences designed to assist the participant with achievement ofthe Learning Goals (Section 1D, Tre participant will integrate newly learmed information into his daily practice and demonstrat long-term improved patient care during Module B Activites. MODULE A MEDICAL KNOWLEDGE ENHANCEMENT. Module A activities do not require approval of a Preceptorto initiate, Dr. Dao will: Document all activities, including ongoing casebased activities, continuing medical education activities (CME) and self-study on an Education Log provided by CPEP; Participate in self-study activities during participation in the Plan that demonstrate lifelong learning skills; ‘+ Submit cartficats of completion for aay courses if applicable, Sn oanent ard Ts cats we caer and hnded ft exes ts o CPE, Pusher, an atod ‘ional review aprizafon). Bis dpe unde cess evn, eye wk pr, or dese es amid rv Use or disore vost etn ashaaon Ken CPP la oy pood Wyo hove cad te ureter, lose tact OPEP realy.@ @ David A.Dso, MD. ‘Education Plan Page 10 of 19 Timelines. The timelines below are recommended to maximize participation inthe Plan. ‘+ Independentansupervised activities, such as self-study, should be initiated immediately cnce the Plan has beea signed. + Topic/subtopic summaries should be complete by the sixth month of Plan activities. ‘Courses mde CME activities should be completed nn Intar than the fourth month of ‘puticipation. uideine The list of Medical Knowledge topics is extensive; therefore, it willbe essetial that Dr. Dao develop a strategy that ensures he submits all topic/subtopic summaries within six months of intiting the Plan so that e has ample time to demonstrate his application of new kmowledge to his actual patient care during the Precepted Education component. Associate Medical Director Approval of Resources Dr. Dao may ideotfy resources other than those mentioned below; however, the Associate Medical Director must approve those resources in order for the activites to be applicable to the Plan. IfDr. Dao identifies a course(s) other than those recommended below, he must submit a brochure atleast 60 days prior tothe course date ifthe course is date specific. He should receive approval of resources prior to incorporating those resources into his Pan activites. ‘A. Courses De. Dao wil: |. Within the first four months of participation in the Plan, complete comprehensive internal medicine review course, which should inchide a component pertinent to ‘Pharmacology, such as the Medical Knowledge Self-Assessment Program (MKSAP) offered by the American College of Physicians. Information can be found a Itspzlorw seponline.org; If Dr. Dao previously completed the MKSAP, be will research and discuss other review courses with the Associate Medical Dizector; 2. The Associate Medical Director will monitor Dr. Dao's documentation skills to determine if he would benefit from participating in a documentation course. If such a ‘recommendation is made more information Would be provided to Dr. Dao a that time, It-will be important for Dr. Dao to attend a comprehensive review early in his participation inthe Plan rather than later so that he has time to integrate newly learned skis and sufficiently demonstrate his maintenance improvements in charts reviewed, B. Electrocardiogram Interpretation Activities Important to note ‘© Dr. Dao should not be responsible for ECG interpretation (without overreading) prior to demonstrating competence to his Precepior. “Tis osunent oo conta ae confvtaend honed fr De orto use o OPE, Patopar wd ator professional ee crniza() spleped unde poossonal ee, aloe, work pid, ote ace et bore by an Use or dasosr thou ten ara fom CPEP I ay ped ou have ee i oem eps coral CPEP eed,@ % ‘Education Pian Page 11 of 19 David A. Deo, MD. Dr. Dao will: 1. Read dhe textbook and practice guide Kapid interpretation of EKGs by Dubin or Clinical Eleckrocardiogmoh: A Simplified Anooach by Ary L. Goldberger, and review with the receptor; 2. Review a least 25 to 30 ECGs using resources such as: “Alin E, Lindsay ECG Learning Center" on the Univesity of Uh School of “Modicine website located at to-/esg.uth.edinreduetion ', hipu/vrrw.2c9-intepretaton blogspoLcomy 3. Document independeninsupervised ECG reading and review aswell as ECGs reviewed vith the Preceptor on Edueation Logs. C. Evidence-Based Self-Study The purpose of this module is to demonstrate self-directed leaning and to creste educational resources for refecence. Dr, Dao will 1. Submit a brief paragraph, case based discussion, outline, or algorithm to summarize the ‘aor poisleemed: ‘In preparing the submission, Dr. Dao will use atleast wo resources for each ofthe topics and subtopics listed in the Medical Knowledge Exhancement Learning Goals (except for those indicated with asterisks). The submission should explsin the applicability of knowledge to his practice, including how he will ullize the leamed information in his practice. If the information is not applicable to his practice, he should explain his rationale; 1) Appropriate resources’ are current, peer-reviewed, evidence-based medical references. Noles ffom a pertinent conference may be utilized with prior ‘Associate Medical Director epproval; 2, Identify and become familiar withthe resources for current guidelines relevant fo the Medical Knowledge Learning Goals ‘2. Document and submit appropriate clinical guideline resources on an Rducstion Log; 3. Subscribe to The Medical Leter or Prescriber’s Letter for current pharmacology review; 44. Procedures for Primary Care, by John L. Pfenninger, MID., FAAFP, Michael Tugey, MD, Grant C.Fowier, MD, and Jorge Garcia, MD. ‘5. Participate in self-study relevant to his practice forthe duration of the Pan, D. Case-Based Activities Dr, Dao will: 1. Participate in case-based self-study activities such as those offered online by the CCeveland Clinic Center for Continuing Education: Intp/waw clevelendelinicmeded.com! E. Practice-based Learning Dr. Dao will: 1. Review current peer-reviewed, evidence-based medical literature pertinent to intemal ‘medicine throughout the duration of the Plan: 2, Utilize appropriate Intemet websites and other medical resources. “is deamnent and te cae er contd ed wloied fr Beets use of OFEP,Peiopat end eohorcad esha reve cparzan() kis pevogd under poleesnal oe, mein, wa produc, ota val arta by ow. Use er dou wit win auboreton tm CPE ley one ‘oor ier, pls cain PEP ined,Education Plan Page 12 0f19 David A.Dao, MD. F. Computer-Based Medical Information Resources Dr. Dao will: 1. Ihe does not already do so, utilize electronic resources at th point of car, such as ¢ hhindheld device andlor computer with access to the Intemet. Sofware or web sites should assist with immediate access to up-o-dste medical infomnetion relevant 10 medication prescribing and. drug interactions, and patient care decisions, including formulating an sdequate diferentil diagnosis, interpreting txt results and evaluating ‘aeatment options. ©. Communication i. Day wile 1. Receive Preceptor coaching and feedback as a result ofthe patient encounters observed by the Preceptor; 2, Incorporate a routine of assessing patent comprehension rather than presume that the patient understands what is being said; 3, Consider accent modification training; 44 Participate in more structured communication educational experience if, based on Preceptor feedback, the Associate Medical Director determines that Dr. Dio would ‘benefit from such’ aa experience. More information would be provided if such & recommendation is made, MODULE B PATIENT CARE ENHANCEMENT During the activites described in this Module the Preceptor will provide feedback to Dr. Dao with regard to improvements in all areas of the Learning Goals. The Precept will coach Dr. Dao to integrate improved knowledge, decision-making and documentation into daily patient care, All meetings and activities willbe documented on an Education Log provided by CPEP, Timeline ‘+ See Section IV for complete time frames forthe Precept appraval process and initiation int of Care Experience and Preceptor Meetings. ated, receptor Meetings and chart reviews Will cntiaue forthe duration ofthe ‘A. Point of Gare Experience ~ Outpatient Setting ‘Dating this experience Dr. Dao wl: 1. Shadow: ‘8 Shadow his Preceptor for approximately one day in the outpatient setting; bi, Discuss each case including diagnosis, management options snd expected outcomes; © Document the cases specifying conition/diagnosis on the PoC Case Log provided by CREP a “Tis covet and scorers av colon wa Wane br bs axauave wo o OPED, Paopent ond sibomad profes oew raza). priveped unde presen, maya, ek rio ado ee pesmi by len Use order tout wien suzaion Fon CPEP ls iy poe. you hae rehad is eure ine, les cenit CPEP keiEducation Plan Page 13 of 19 David A-Dao, MD. 2. Supervision: ‘8 Foc a period of time to be determined by the Preceptor end Associate Medical Director, manage patients with 100% direct suservision atthe PoC by the Precepto 1) Direct supervision is defined as side-by-side observation ofthe patient encounter by the Preceptr; b, Discuss each ease including management options and expected outcomes; : Document the cases specifying the condition/disgnosis and procedure and/or {reatment plan for each patient on the PoC Case Log provided by CPEP;, 3. Concunent Cese Review: 8. For a period of time to-be determined by the Preceptor and. Associate Medical Director, review each case with tho Precentor prior to releasing the patient to determine if the exam and evaluation have been adequsic and if the plan is appropriate; '. Have each note for the above patient encosnters reviewed for completeness and ‘overall quality by the Preceptor when the note is completed ot when the dictatons are lable, and receive feedback on management and documentation of the patent ©. Document the cases specifying the condition/diagnosis and procedure andlor ‘weetmeat plan for each patient onthe PoC Case Log provided by CPEP; 4, End of Day Review: 8. For a petiod of time to be determined by the Preceptor and Astocate Medical Director, review each case wit the Precept at the end of each day to determine if ‘the exam and evaluation have been adequate mad ifthe pan is appropriate; ', Have each ote for the above patient encounters reviewed for completeness and Coversll quality by the receptor when the not is completed or when the dicttions are available, and receive feedback on management and documentation of the patient visit; © Document the cases specifying the condtion/diggnesis and procedure and/or ‘zeatment plan foreach patient on the PoC Case Log provided by CPEP 5. Onsite Consultation: ‘8 Manage patients with immediate onsite physsian consultation available if needed for approximately one month;* 4) The onsite physician may be someone cther than the Preceptor, but should be someone who undersiands the expectation of their role and ‘who bas been approved by the Associate Medical Director; ', Implement weekly PoC meetings. During these meetings: 1) Retrospectively review each case and outcome withthe Preceptor;** 2) Have each note for the above patient encounters reviewed for completeness and coverall quality by the Preceptor and receive feedback on management and documentation ofthe patent visit: ©. Affer seeing patients for three weeks, submit six chars to the Associate Medical Director for review to evaluate Dr. Dao's readiness to progress to the Precepted ‘Education Experience addressing outpatient care; ——— “is document ard Te comets wo cola ad ded hr be mus wee OPEP, Peipan an edborind owen eve arenizan) Ii pvsged under poledonl au, aonoyiden, wrk pdt Ue wcel st miod by aw. Use or duces wo wits eubotzaon fom CPP ew pced I you Nae racsnd tht ooumet epee conn CPE nadeFaeation Plan Page 14 of 19 David A. Dap, MD. 4 Document every case specifying the condition/diagnosis and procedure and/or treatment plan for each patient on the PoC Case Log provided by CPEP and submit the Case Log along with te charts mentioned immediately above, 6. Conclusion ‘8 Atthe completion of te above activites, the participant will: 1) Ensure thatthe Preceptor speaks withthe Associate Medical Director and submits 1 waitin report documenting Dr. Dao's readiness to proceed to independent! ‘unsupervised patient care in the outpatient seting; 2) Receive notification from the Associate Medical Director that the PoC Experience has been completed. “One month is an estimated timeframe and may be lengthened if itis determined thet Dr. Deo ‘would receive educational benefit from extending the experience **IFDe. Dao's patient volume is too large to allow review ofeach case, he and the Preeeptor should review no fewer than six eases per weeldy meeting that are relevant to his Plan Learning Goals as much as possible. B, PRECEPTED EDUCATION [twill be important thatthe Preceptor Meetings and activities are thorough and tha the Preceptor provides objective feedback suficieat to support Dr. Dao's improvement with regard to the specific Plan Learning Goals. All mestings and activities will be documented on an Education Log provided by CPEP. Guiding Having knowledge is distinct ftom applying knowledge. It is essential that, when reviewing charts, the Preceptor determine whether or not the participant applied his knowledge to actual patient cre PRECEFTOR MEETINGS. ‘After completion of the PoC Experience, Dr. Dao will: 1 Meet with the receptor twice monthly forthe duration of the Plan. To provide a quality learning experience, CPEP recommends that each meting be a minimum of two bouts; 2. ‘With the Preceptor and in conjunction withthe activities described below in Preceptor Meeting Activities, tlie the fllowing to adress the Learaing Goals: Cart review and case-based discussions; Hypothetical case discussions; ‘Topic discussions; (Current medical literature reviews; Utilization of epproprate Internet websites and other medical resources. peree Cuidetine Although imprompt collegial discussions may occur outside of Preceptor Meetings, such discussions are separate from the Preceptor Meeting requirement. "fis coment ards omnis we conontd essed fx Bo eicab tse of OPED, Putoget, end ehaaed pasa vw apenas). Ns pviaped und professor, amen, ork oi, or Rad sae eb mid by ew Use of dscisue witout itn auhotzaon fun EP esti roid. osha aie is ‘reuters cote CPEP medEducation Plan ‘David A. Dao, MD. Page 15 of 19 Precepror MeeTiNa AcrIViTiEs Chart Review Objectives, Charts re the primary method of evaluating the participant's application of knowledge and clinical judgment and reasoning. Therefore, charts Submited to the Preceptor and the Associate Medical Director as described below should demonstrate the participant's integration of feedback and information learned es a result of completing Module A activities. Submitted charts should reflect consistent improvements in overall patient care, Charis reviewed during Preceptor Meetings will be thse of patients for whom Dr. Dao provided ‘ndependentunsypecvised care, Charts as described below should address the Plan Learning Goals as much as possible. using he Pca Beton, Dr. Dao wil ‘Retrospestive Chart Reviews: {Submit tothe Preceptor for review no fewer than 24 redacted* chats pec month (12 ‘charts per twice-monthly sesions); 1) TheProceptor may also specify cases tobe reviewed; 2) Redacted* copies of chars should be submitted to the Precepior in time foe the receptor to review them before the meeting; ', Submit to CPEP by the fith of every other month (month to be determined), six of ‘the 24 rodacted® charts used inthe Preceptor Meetings; 1) The Associate Medical Director may also specify charts to be submitted; Cases shouldbe specifically relevant tothe Plan as well as representative ofthe scope ‘of Dr. Dao's practice as much as possible. puree Clinical Judgment: 1) With the Preceptor, discuss the Clinical Judgment Leaming Goals and application ‘of knowledge to petient care; 2) Develop and discuss withthe Preceptor systems (protocols, algorithms, and/or ‘chart templates) or other strategies for organizing the clinical evaluation to ensure that the Clinical Judgment Learning Goals are addressed and that improvements ace intgrated into his daily patient care; 3) To assist with completing the above objective, review and discuss with the receptor the University of California San Diego (UCSD) website, A Practical Guide t Clinical Medicine, at hip: /meded weed educlinicalmed/hinking bin. . Documentation: 1) Receive coaching from the Preceptor that addresses general documentation principles as well as the specific areas of need described in Leaming Goal C, Documentation, including strategies endlor use of chart templates for improved documentation; ©. Medical Knowledge: 1) Discuss with the Preceptor each topic and subtopic identifed in Module A, including eppicable end curent evidence-based guidelines as available. Dr. Dao should also discuss his topic/subtopic summaries wth the Preceptor; “is docuver ad We cans ar cone und toned fx Be eich use of OPEP, Pepa, ao evbrxt ‘oes eeu cxpsrizal) spond under potssoral ree, atone wo poe, eee eels ried by ak Use er doco wits vein euhotaatin ron CPEs sty pci you haa rene is oeentin ay, ples conic CPEP ined‘Education Plan age 16 of 19 David A. Dao, MD. 4. Communication: 1) Receive coaching and review reference materials described inthe Plan related te communication skills; 3 i ‘8 Develop lifelong learning kis: 1) Diseuss and develop a plan withthe Preceptor for maintaining curent standards in intemal medicine alee conclusion of the Educational Intervention. Dios the plan with the Associate Medical Director and demonstrate ongoing leaming throughout the duration ofthe Plan. The plan should 1) Incorporate computer-based resources, 'b) Integrate evidence-based medicine resources; ©) Promote lifelong earning: 4) Include activities that address clinical decision-making, such as ease studies snd grand rounds 1b. CPEP encourages Dr. Dao to: 1) Review and reflect onthe status of his leaning ond improvements on n ongoing basis; 2) Keep a learning journal on his reflections, including which activities were beneficial, or not beneficial, and why. * Refer to Appendix: B, Privacy of IndviduallyIdentffable Health Information Guides ‘+ During the Preceptor Mestings, the Preceptor should provide coaching and ‘recommendations tothe participant to ensure thet improvements in all Leering Goals ‘dentifed in the Pn ae collectively and consstetly eppied to Dr. Dao's actual patient + The participant's progress will be determined based on the achievement of the Learning Goals and in considerstion with generally accepted standards of care. ‘The coxsrants of 1 physician's prectice circumstances, suchas te availability of local medical resources, ‘are take into consideration when reviewing a physician's actual practices. IV. INITIATING THE PLAN A. Determining the Start Date and Beginning Educational Activities 1. Dr, Dao wil sign and retum the Plan to CPEP within two weeks of receiving rotification of licensure, He will then: ‘Initiate the Plan the first day of the month following CPEP's rece ofthe signed ‘an Education Notebook from CPEP with directions, Edveston Logs, ‘resources, and other information to complete the educational activities; . Initiate and document self-study activities and course participation; ——— “Tie coamert and Ws coisa conrad wed hunded fr be eicehe tse CPEP, Papa, we abate! ceena revi rei) ts phlgad under psa re, tye, werk pou or ac ares iid by en Use rdsu wat wrisn autoreton fam CPEP a ey riod Hou bam eid ie beurre, lane cnt CPEP meet.Balucation Plan Poge 17 of 19 David A. Dao, MD. 4d. Afr reviewing the Preceptor qualifications described in the Precaptor Job ‘Deseription (attached) identify u Precept candidate if Dr. Dao has not already done 0, 1) The Preceptor must be board certified in the same specialty and have a prectice similar to Dr. Dao’s; 2. Provide a copy of the Plan, the attached Preceptor Job Description and Confidentiality Statemeat, and a copy of the Assessment Report to the proposed Preceptor so that the "approval process as described below, can progress accordingly. B. Preceptor Approval De, William Godfrey was approved to serve as Dr. Dao's Preceptor on May 20, 2014, in soticipation of the possibilty tht Dr, Dao would be graated licensure fo participate in 8 CPEP Education Plan pertaining tothe practice of outpatient intemal medicine. uidaine For the participant's educational benefit, the Preceptor must mest the qualifications as described in the Precepior Job Description. Additionally, CPEP must approve the Preceptar in ordee for any precepted activities tobe applicable to the Plan. V. PARTICIPATION AND MONITORING Consistent participation in educational activities, including regular and timely submission of ‘muterials and partcipetion in scheduled CPEP conference calls, enhances the educational experience. Such participation may also impact the duration of the Plan. Because the Associate Medical Director must be abe to evaluate the participant's ongoing progress and provide timely snd pertinent feedback, Dr. Dao will: 1, Maintain Education and PoC Case Logs: Education Logs should document all educational sctivities including Preceptor ‘Meetings andthe content ofthe Meetings, and those activites that are outside of the scope ofthe Plan but relevant to his practice; '. PoC Case Logs should document PoC sctivities as previously described in Module B; 2. Submit matesils: 1. By te ith of every month submit: 1) Education Logs; 2) Preceptor Report forms completed by the Preceptor, 3) Other materials relevant to the Plan or as requested by the Associate Medical Director; ». By the fifth of every month and until the following has been completed, submit: 1) Case Logs forthe PoC activities; 2) Topielsubtopic summaries; 3) CME certificates and/or other documentation of completed activities specified in the Pln (if applicable); “is dovumort an ts Oolons wre coen ard ded fx Ge ee tne of OPEP, Patopan end soborzd ies! row eqs) speed und profession roe, alc, work ad, tad aes aid byl. Uso or dado wit wtanaubotaaton fn CPEP i ay prod. you fave ashe ls ‘ecumenn plow lc PEP ned,Education Plan Page 18 of 19 David A. Dio, MD. 3. Submit Charts: ‘2 Either monthly or every other month, as ditectod by CPEP, submit charts,"* a= Aeserbed in Module B. Charis must be complete and if possible, inciude one your of patieateare. More information will be provided when the Plan is initinted: 1b. At the request of the Associate Medical Director, submit randomly selected charts for review from Dr. Dao appointment sched 4, Communication: ‘8 Participate in calls with CPEP as requested; 1, Recpond to emails or letters ftom CPEP ia a timely fashions 5, Be responsible for his and hie Preceptor's participation in the Plan acivities and bis ‘educational progress; 6, Demonstrate maintenance of improvements for all Leaming Goals prior to conclusion of the Patient Care Enhancement activities. ‘**See Module B, Retrospective Chart Review to deteraine if charts shouldbe submitted moxthly for every other moath FORMATIVE EVALUATION Evaluation of Educational Progress Ongoing progres is measured using formative evaluation tools such as regular chart reviews, review of topic/subtopie summaries, participant and Preceptor discussions with the Associats ‘Medical Director, and written Preceptor Reports Approximately every four months, Progress Reports will be genecated end provided to Dr. Dao and to other entities for which Dr. Dao has provided authorization. ‘The Progress Reports will ‘capture Dr. Dao's progress as demonstrated during Formative Evaluations conducted during that reporting period. ‘SUMMATIVE EVALUATION Post-Education Evaluation Following the completion of the Plan activities, De. Dao will participate in a Post-Eéusation ‘Evaluation (Evaluation) to demonstrate that he achieved the Learning Goals and succesfully, completed the Educational Intervention, The Evaluation willbe focused on the areas idetified 1s Learning Goals in the Plan and will conse Dr. Daa's scope of practice. See Section 5.1(@) of the CPEP Educational Intervention Participation Agreement foe more information ) ‘+ Dr. Dao will schedule the Evaluation no sooner than two months, and no later tha four ‘months, following notification from CPEP that he has completed the Pan activities. “Tord! wl ror sm oman pt Fed fb cb tao COFP Pr, oe ard Fresina revi xian). ts pieged unde peso ei, aomayce, wok pod ree aces Fermi by av. Uso or dedouravitt wien aubofaion fon CPEP is sity cid. fo have evade beatin pln corset CPEP inne.Edeation Plan Page 19 of 19 David A.Dao, MD. VI. ESTIMATED DURATION Plan Learning Goals and Performance Objectives Most participants complete an Education Plan in approximately 12-18 months. ‘The actual duration varies depending on many factors including the seope of educaticnal needs ideatfied. conorions ‘+ Modifjing an approach to overall patient care, specifically aplication of knowledge, Clnial jugmeat and docuneatation may be callenging. Addionally, extn wspecs ofthe Plan canot be predicted, such as spectrum of patients and cases presented swell & the participant's dedication tothe educational ectvites. Therefore, te duration ofthe Plan can ony be estimated. + CPEP reserves the ight to change the content andlor dustin of te Education Plan + CPEP isnot responsible for easuring that the parcipentabains any required privileges ot exedenals hile pareipating ia the Education Plan; this is he sosponsibiy of the ptcpant. ; + Once the parcpant hs completed the Eestion Plan andor has heen authorized to ‘complete the PostEdvcation Evaluation, CPEP is no longs reviewing cheris or ‘providing educational services othe pariipant. + IFDr. Deo does not eogags in this Plan by January 21, 2016, CPEP may require complesion of additional Assesment acivites to ensue thal Dr, Dao's curent educational needs ae addressed SIGNATURE! i YS )L0/5 David A Dio, DS Dae Date Associate Medical Diector ‘Retum the signed original Education Plan to CPEP. Keep copies of the Plen for "your reference and to forward to Preceptor candidates. eo “coven! ond bs covets we colonel eo Mando br Ue ecune woof CPEP, Patch wd alti! fesna vow parzlns. t's piloed under reo vn, atoyldon wa pot rede wre as Feed by aw Use ose vot wen austen fam CPEP a wily polled. Mf you Reve recede fecument nee, plese cant CPEP inde,FILED OF RECORD pve 14 2085 COMMONWEALTH OF KENTUCKY ae BOARD OF MEDICAL LICENSURE ~ ‘CASENO. 917 INRE:THE LICENSE TO PRACTICE MEDICINE IN THE COMMONWEALTH OF KENTUCKY HELD BY DAVID A. DAO, MD., LICENSE NO. 22439, 4657 ‘SHEPHERDSVILLE ROAD, ELIZABETHTOWN, KENTUCKY 42701 AGREED ORDER ‘Come now the Kentucky Board of Medical Licensure (‘the Board”), acting by and ‘trough its Hearing Panel A, end David A. Dao, M.D. (the lenses", and, based pon their ‘mutual desire to allow the licensee to resume the practice of medicine, hereby ENTER INTO the ‘bllowing AGREED ORDER: TPULATIO} ‘The parties stipulate the following facts, which serve a the fctual bases for th Agreed Order: |. At all relevant times, David A. Dao, M.D., was licensed by the Board to practice ‘medicine within the Commonwealth of Kentucky. 2. ‘The livensee's medical specialty is Pulmonary Disease, 3. Onorsbout July 30, 2003, Sergeant Bill Stivers contacted the Board and advised tht the licenses ad been arrested for drug-related offenses after an undercover investigton. 4. In October 2003, the licensee was indicted by the Jefferson County Grand Jury for criminal acts of Trafficking in a Controlled Substance, Obaining Drugs by Faud and Deceit, and Unauthorized Prescribing, Dispensing or Administering of Cyatolled Substances, ‘5. On or about October 16, 2003, the Board fled a Complaint and Emergency Onder of Suspension against the licensee's Kentucky medical license.& nor sound March 2006, the lcensee vas indicted in Neen County, Keatcky wih Sight (felony counts of Obtaining Controle Substances by aul and Deceit nd eight (© counts of Complisty to Obiin Controlled Substances by Feaud and Deceit. At or sound the sare dine, the cence was e-indicted in Jefferson County, Kentucky with ‘weny-ne 21) felony coun of Tracking ina Cond Substance, Oasing Drags 4 Fraud and Decl, and Protibited Activites Relating to Controlled Substances, 7. On or about May 11, 2004 the Board issued an Amended Complaint and Amended Emergency Order of Suspension. 4% Durng the Boar's investigation int the criminal charges aginst the lense, he Board etre thatthe licensor Ind become sexually interested in a patie who had been ‘efoed to his practice, Patent A; during the intl evluton the lcense prfomed complete physical examination, including e genital examination, for Patient A who had been refered for collapsed lungs and chet pin; holy ater hs fst appointment, he Hoensee made Patieot A his office manager; socorting to Patent A, he quit tht job because of insppropit remarks made by the const; after he gut, he icensee pred ‘im ogeresively, finally aanging to provide controlled substance prescription to him inexchange for sexual acts; this continved fr sometime, with Patent A and the licensee ‘esing at hotel rooms and some of these maecings were recorded; at sme point the Uoensee began spliting some of the prescsipons with Paint A and gave Paint A ‘money to Sl the prescriptions the licensee aio assisted Patent A to Gl the cooled substanes preseiptions in a variety of names of oer persons; police were able to ‘deatfy approximately 33 taudueat presrptions as part oftheir investigation wih Patent A’s assistance, the police were able to put together a suficent case to anette10. ’ 2 13, Hcensee and bring chages agnnst him in two counties; round the same time, the Ueensee was placed on 8 comostive action plan by Hardin Memorial Hospital due to Gisrpive conduct and refered to the Kentusky Physicians Health Foundation Ce Foundation’) for evalusion wad anger management; after bis est, the licensee wes ‘ested by the hospital and tested postive for Utramy Tramadol nd as esl ofthe drug ‘es reuls and th ciminal charges, th eeuse's hospital privileges became suspended on Seplember 13, 2003, On a shout November 3, 2004, afer a jury tial in Jefferson County, the cease was convicted on si (8 felony counts of Obtaining Drugs by Freud and Deceit, The jury ‘recommended a sentence of two (2) years and eight (8) months on each feloay count. ‘On or about January 6, 2005 the licensee was sentenced in Jefferson Circuit Couto two (@) years and eight (8) months on each felony conviction, The Court granted the licensee's request for probation and placed the licensee on five (5) years supervised probation. (On or about February 17, 2005, the licensee surendered his licnse to practice medicine inshe Commonwealth of Kentucky by entering into an Agreed Order of Surrender, ‘At the time the licensee surrendered his Kentucky medical licens, he was awaiting trial on the indictments in Nelson County. In April 2005, the Nelson County charges were ls ty proieIyouhee ected it ‘oeumerin ere, pls otc CPEP mayEducation Plan Page 14 of 19 David A. Dao, MD. 4. Document every case specifying the condition/diagnosis and procedure and/or ‘ueatment plan for each patient on the PoC Case Log provided by CPEP and submit the Case Log along with the charts mentioned immediately above: 6. Conclusion: 1 Atthe completion cf the above activities, the participant wil 1) Ensure that the receptor speaks with the Associate Medical Director and submits 4 writen repo documenting Dr. Dao's readiness to proceed to independent! unsupervised patient care in the outpatient 2) Receive notification from the Associate Medi thas been competed. One month is an estimated timeframe and may be lengthened if tis determined that Dr. Dao ‘would receive educational benefit from extending the experience **IE Dr. Dao’s patient volume is 100 large to allow review of each case, he and the Preceptor should review no fewer than six cases per weekly meeting that ae relevant to his Plan Leaming Goals as much as possible. B. PRECEPTED EDUCATION twill be important thatthe Preceptor Meetings and sctvities are thorough and thatthe Preceptor provides objective feedback sufficient to support Dr. Dao's improvement with regard to the specifi Plan Learning Goals. All meetings and activites will be documented on an Education Log provided by CPEP. Guideline Having knowledge is distinct from applying knowledge, It is essential that, when reviewing charts, the Preceptor determine whether or not the participant applied his knowledge to actual patient care. RECEPTOR MEETINGS ‘After completion of the PoC Experience, Dr. Dao will: 1. -Meet with the Peceptce twice monthly forthe duration of the Plan. To provide a quality learning experience, CPEP recommends that each mesting be a minimum of two hours; the Preceptor and in conjunction with the activities described below in Preceptor ‘Meeting Activities, uilize te following to address the Learning Goals: CChart review and case-based discussions; Hypothetical case discussions; Topic discussions; Current medical literature reviews; lization of apprepriate Internet web sites and other medical resources. 2 ‘impromptu collegial discussions may occur outside of Preceptor Meetings, such discussions are separate from the Preceptor Meeting requirement. “Tis ocamen arcs stats uv ont ong iwlee br Bo eraiove wo of OPEP,Paopen end aries flea vi cena). 1 rege undo pfesond ove, atzoycie wa pe, Toe sacs 0s ered ew Use or doen wht wien abalone CPEP ey prod ou Rae ecaed be out ere lo ciel CPP ody,Elucation Plan Page 15 of 19 David A. Dao, MD. RECEPTOR MEETING ACTIVITIES Chart Review Objectives CCharts are the primary method of evaluating the participant's application of knowledge and clinical judgment and reasoning. Therefore, chars submitted tothe Preceptor and the Associate Nedical Direcior as described below should demonstrate the participant's integration of feedback snd information learned as a result of completing Module A activities. Submitted chars should reflect consistent improvements in overal patient are Charts reviewed ducing Preceptor Meetings wil be those of patients for whom Dr. Dao provided lependentunsupervised care. Charts as deseribed below should address the Plan Leeming “Goals as much es possible Dasing the Precpad Euan Dr. Deo wil 1. Retospective Chart Reviews: ‘8 Submit to the Preceptor for review no fewer than 24 redacted® chasts pee month (12 chart per twice-monthly sessions); 1) The receptor may also specify cases tobe reviewed; 2) Redacted* copies of chars should be submited tothe Preceptor in time for the Preceptor to review them before the meetings; '. Submit to CPEP by the fith of every other month (month to be determined), sic of the 24 redacted® charts usd inthe Preceptor Met 1) The Associate Medical Director may also specify charts to be submited; Cases shouldbe specifically relevant tothe Plan as well as representative ofthe scope ‘of Dr. Dao's practice as much as possible 2, Didactic Dis Clinical Judgment: 1) With the Preceptr, discuss the of knowledge to patient care; 2) Develop and discuss with the Preceptor systems (protocols, algorithms, and/or chart templates) or other strategies for organizing the clinical evaluation to ensure ‘hat the Clinical Judgment Learning Goals are addressed and that improvements are integrated into his daily patient care; 3) To assist with completing, the above objective, review and discuss with the receptor the University of California San Diego (UCSD) web site, A Practical Guide 10 Clinical Medicine, at btp:/imeded uesd edu linicalmed/thinking hin. ’. Documentation: 1) Receive coaching from the Preceptor that addresses general documentation principles as well as the specific areas of need described in Learning Gosl C, ‘Documentation, including strategies andlor use of chart templates for improved ‘documentation; Medical Knowledge: 1) Discuss with the Preceptor each topic and subtopic identified in Module A, including applicable and current evidence-based guidelines as available. Dr. Dao should also discuss his topi/subtopic summaries withthe Preceptr, nical Judgment Learning Goals and application "Wie amet rd te nas eo ontirba and vied hr be erooive tee ch CPEP, Puropen ane auhuraed pioeson rev rpaniztn). it prilgad under reson ew, tomeycie, werk prec ta soca ot amie bylaw. Use or dedcaue who wien aubafzon fur CPEP is shy roid. you have eid ts acumen r,s ict CPEP inode.Education Plan Page 16 of 19 David A. Dao, MD. 4. Communication: 1) Receive coaching and review reference materials describe! in the Plan related to communication skills 3. Lifelong Leaming: Develop lifelong lesning skills: 1) Discuss and develop a plan with the Preceptor for maintaining curent standards in internal medicine after conclusion of the Educational Intervention. Discuss the plan with the Associate Medical Director and demonstate ongoing leaming throughout the duration of the Plan. The plan should 1) Incorporate computer-based resources, b) Integrate evidence-based medicine resources; ¢) Promote lifelong learning; 4) Include activities that address clinical decision-making, such as ease studies and grand rounds. b. CPEP encourages Dr. Dao to 1) Review and reflect on the status of his learning and imerovemeats on an ongoing basis 2) Koop 2 leering joumal on his reflections, inclufing which activites were beneficial, or not beneficial, and why. * Refer to Appendix B, Privacy of Individually Identifiable Health Information Guideines During the Preceptor Meetings, the Preceptor should provide coaching and recommendations to the participant to ensure that improvements in all Leeming, Goals identified inthe Pian ae collectively and consistently applied to Dr. Dao's actual patient ‘+The participant's progress will be determined based on the achievement ofthe Learing Goals and in consideration with generally accepted standards of care. The constraints of «2 physician's practice circumstances, such asthe availablity of local medical resources, are taken into consideration when reviewing a physicians actual practices, IV. INITIATING THE PLAN A. Determining the Start Date and Beginning Educational Activi 1. Dr, Dao will sign and return the lan to CPEP within two weeks of receiving notification of licensure. He wil ten: ‘8 Initiate the Plan the frst day of the month following CPEP's receipt of the signed Plan; 1. Receive an Educstion Notebook from CPEP with directions, Education Logs, resources, and othe information to complete the educational activities; Initiate and document self-study activities and course participation; ‘Tie conan end fo conus a onion ons Wied tr Pe clove ton o COEF Patent an eoberie letsina ov aarzatn() it pivaped nde plosnd ew, tomeycla eck proie tee Seow 98 Ferrite by low Use or Sau wibout wan etrcaton ton CPEP est pcisied. I you hav Teoved ths focamest ere, plss conic CPEPinmedaay.Eavcation Plan Page 7 of 19 David A. Dao, MD. 4. After reviewing the Procepior qualifications described in the Precepior Job Deseription (attached) identify a Preceptor candidate if Dr. Dao bas not already done 1) The Preceptor must be board certified in the same specialty and have a practice similar to Dr. Dao's, 2. Provide 1 copy of the Plan, the attached Preceptor Job Description and Confidentiality Statemect, and a copy of the Assessment Report to the proposed Preceptor so that the approval process as described below, can progress accordingly. B. Preceptor Approval Di. William Godfrey was approved to serve as Dr. Dao's Preceptor on May 20, 2014, in anticipation ofthe possibilty that Dr. Dao would be granted licensure to participate in a CPEP Edlucation Plan pertaining tothe practice of outpatient intemal medicine Guiting Fer the participant's educational benefit the Preceptor must met the qualifications as described in the Preceptor Job Description. Additionally, CPEP must approve the Precesfor in order for ‘any precepted acivities to be appliceble tothe Plan. V. PARTICIPATION AND MONITORING ‘experienes. Such participation may also impact the duration ofthe Plan. Because the Associate ‘Medical Directo: must be able to evaluate the participant's ongoing progress and provide timely and pectnent feedback, Dr. Deo wil TL Maintain Education and PoC Case Logs: ‘a. Educstion Logs should document all educational activites including Preceptor Meetings and the content ofthe Meetings, and those activities that are outside ofthe scope ofthe Plan but relevant to his practice; '. PoC Case Logs should document PoC activities as previously decribed in Module B; 2. Submit materials a. By te fith of every month, submit: 1) Education Lops: 2) Preceptor Report forms completed by the Preceptor; 3) Gther materials relevant to the Plan or as requested by the Associate Medical Director, 'b. By the fith of every month and until the following has been competed, submit: 1) Case Logs forthe PoC activites; 2) Topic/subtopic suramaries; 3) OME certificates and/or other documentation of completed activities specified in tte Plan (if applicable); ‘Tis Geren ond cars a omrta end Piened br ercumwe te of CP, Patopan end eahurisd esa review optical). 1s phged under press rove, etinaylenh, work pea ore sores os amis by ow Use decoy went wien naeraton fam CEP seisy prod you hav eed ecumetin an plas cviet CPEP inet,-Edueation Plan Page 18 0f 19 David A. Dao, MD. 3. Submit Chart: 8. Either momthly or every other month, as directed by CPEP, submit charts,** as described in Module B. Charts must be complete and if possible, include one year of, patient care, More information will be provided when the Plan is initiated; b. At the request ofthe Associate Medical Director, submit randomly selected charts for review from Dr. Dao appointment schedule; 4. Communication: ‘a. Participate in calls with CPEP as requested; 'b, Respond to emails or ltters from CPEP ina timely fashion; 5, Be responsible for his and his Preceptor’s participation in the Plan activities and his ‘educational progres; 6. Demonstrate maintenance of improvements fr all Learning Goals prior to conclusion of ‘tho Patient Care Enhancement activities. ‘See Module B, Retrospective Chart Review to determine if chars shouldbe submited monthly cocevery other month FORMATIVE EVALUATION Evaluation of Educational Progress ‘Ongoing progress is measured using formative evaluation tools such as regular chart reviews, review of topiclsublopie summaries, participant and Preceptor discussions with the Associate ‘Medical Director, and written Preceptor Reports. ‘Approximately every four months, Progress Reports will be generated and provided to Dr. Dao sed to other entities for which Dr. Dao has provided authorization. ‘The Progress Reports will capture Dr, Dao’s progress as demonsrated during Formative Evaluations conducted during that porting period. ‘SUMMATIVE EVALUATION Post-Education Evaluation Following the completion of the Plan activities, Dr, Dao will participate in a Post-Education Evaluation (Evaluation) to demonstrate that he achieved the Leeming Goals and successfully ‘completed the Educstional Intervention. ‘The Evaluation will be focused on the areas identified. 1 Learning Goals in the Plan and will consider Dr. Dao's scope of practice. (See Section 5.1(e) ‘fhe CPEP Educational Intervention Participation Agreement for more information.) + Dr. Dao will schedule the Evaluation no sooner than two months, and no later than four ‘months, fllowing notification from CPEP that he has completed the Plan activities. “Tm deamon and corer ae oma ong nicer be echo wee ef CPEP, Parga end exhorted podkasend review ogni). kis phioged unr ptssonl oo, aomeysn, wk pi, ode sels Pec by av. Use or dadosue wiht wetnauborzaon fo CPEP is ty pried. yeu haw cid his ‘mont er, Hess crac! OPEP ennaEaveation Plan Page 19 of 19 David A. Dao, MD. Vi. ESTIMATED DURATION Plan Learning Goals and Performance Objectives ‘Most participants complete an Education Plan in approximetely 12-18 months. The actual

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