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CONSENT AGREEMENT BETWEEN

CAROL G. RYAN, M.D., AND

THE STATE MEDICAL BOARD OF OHIO

This Consent Agreement is entered into by and between Carol G. Ryan, M.D., [Dr. Ryan], and the State Medical Board of Ohio [Board], a state agency charged with enforcing Chapter 4731., Ohio Revised Code.

Dr. Ryan enters into this Consent Agreement baing fully informed of her rights under Chapta 119., Ohio Revised Code, including the right to representation by counsel and the right to a formal adjudicative hearing on the issues considered herein.

BASIS FOR ACTION

This Consent Ageement is entered into on the basis of the following stipulations, admissions and understandings:

A. The Board is empowered by Section 473 1.22(B), Ohio Revised Code, to limit, revoke, suspend a certificate, refuse to register or reinstate an applicant, or reprimand or place on probation the holder of a certificate for aviolation of Section 473 1,22(B)(2), Ohio Revised Code, for "[flailure to maintain minimal standal-ds applicable to the selection or administration of drugs, or failure to employ acceptable scientific methods in the selection of dmgs or other modalities for treatment of disease;" and Section 4731.22(8)(6), Ohio Revised Code, for "departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether oi,not actual injury to a patient is established."

B. The Board enters into this Consent Agraement in lieu of formal proceedings based upon the violation of Sections 473 1.22(B)(2) and (B)(6), Ohio Revised Code, as set forth in the post-cite Consent Agreement Between Carol G. Ryan, M.D. and the State Medical Board of Ohio [February 2014 Consent Agreement], effective on or about March 14,2014, and as set forth in Paragraph E, below, and expressly reselves the right to institute formal proceedings based upon any other violabons of Chapter 473 1. of the Revised Code, whethe1 occurring before or after the effective date of this Consent Agreement.

C. Dr. Ryan is seeking reinstatement of her certificate to practice medicine and surgery, license number 35.038029, which was indefinitely suspended, but not less than 180 days, pursuant to the posr-cite Februaly 2014 Step I Consent Agreement.

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CONSENT AGrnEMENT CAROL G. RYAN, M.D. PAOE 2

D. Dr. Ryan states that she is not licensed to practice in any other state or jurisdiction,

E. Dr. Ryan admits that, subsequent to her post-cite February 20 14 Consent Agreement, she stopped practicing medicine and surgery and served her suspension. Dr. Ryan also admits, and the Board aclmowledges receipt of inforrnat~on to support, that on or about June 6 and 7,2013, she attended an Intensive Course inMedical Record Keeping with Individual Preceptorships, which was accepted and approved by the Board's Secretary and Supetv~sing Member. Dr. Ryan admits that she subsequently submitted a report outlining the course, what she learned and how she would apply what she learned to her practice of medicine and surgery. Dr. Ryan further admits, and the Board acknowledges receipt of information to suppon, that on or about December 3 through 6,2013, she atteuded the Intensive Course in Controlled Substance Prescribing, which was accepted and approved by the Board's Secretary and Supervising Member. Dr. Ryan admits she subsequently submitted a report outlining the course, what she learned and how she would apply what she learned to her practice of medicine and surgery

Dr. Ryan states, and the Board aclcnowledges receipt of information to slipport, that she has complied with the terms of reinstatement set forthin her post-cite February 2014 Consent Agreement.

AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, the certificate of Dr. Ryan to practice medicine and surgery in the State of Ohio shall be REINSTATED effective on September 12,2014, or upon the effective date of this agreement, whichever is later. Further, Dr. Ryan lcnowingly and voluntarily agrees with the Board to the following PROBATIONARY terms, conditions and limitations:

1. Dr. Ryan shall obey all federal, state, and local laws, and all rules governing the practice of medicine in Ohio.

2. Dr. Ryan shall submit quarterly declarations under penalty of Board disciplinary action andtor criminal prosecution, stating whether there has been compliance with all the conditions of this Consent A~greement. The first quarterly declaration must be received in the Board's ofices on the date her quarterly declaration would have been due pursuant to her post-cite February 2014 Consent Agreement with the Board, or as otherwise requested by the Board. Subsequent quarterly declarations must be received in the Board's ofices on or before the first day of evely third month

3. Dr. Ryan shall appear in person for aninterview before the full Board or its designated representative. The first such appearance shall take place on the date her appearance would have been scheduled pursuant to her post-cite February 2014 Step I

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CONSENT AGREEMENT CAROL 0. RYAN3 M.D. PAGE 3

Consent Agreement with the Board. Subsequent personal appearances mTdst occur every three months thereafter, andlor as otherwise requested by the Board. If an appearance is missed or is rescheduled for any reason, ensuing appearances shall be scheduled based on the appearance date as originaliy scheduled.

4. In the event Dr. Ryan is found by the Secretary of the Board to have failed to comply with any provision of this Consent Agreement, and is so notified of that deficiency in writing, suchperiod(s) of noncompli& will hot apply to the reduction of the probationary period under this Consent Agreement.

Practice Plan and Monitoring Physician

5. Before engaging in any medical practice, Dr. Ryan shall submit to the Board and receive its approval for a plan of practice in Ohio. The practice plan, unless othenvise determined by the Boad, shall he limited to a supervised structured environment in which Dr. Ryan's activities will be supervised and overseen by a monitoring physician approved by the Board. Dr. Ryan shall obtain the Board's prior approval for any alteration to the practice plan approved pursuant to this Order.

6 . Before engaging in any medical practice, Dr. Ryan shall submit to the Board in writing the name and curriculum vitae of a monitoring physician for prior written zpproval by the secretby or Supervising Member of the Board. In approving an individual to serve in this capacity, the Secretary and Supervising Member will give preference to a physician who practices in the same locale as Dr. Ryan and who is engaged in the same or similar practice specialty.

The monitoring physician shall monitor Dr. Ryan and her medical practice, and shall review Dr. Ryan's patient charts. The chart review may be done on a random basis, with the frequency and number of charts reviewed to be determined by the Board.

Further, the monitoring physician shall provide the Board with reporh on the monitoring of Dr. Ryan and her medical practice, and on the review of Dr. Ryan's patient charts. Dr. Ryan shall ensure that the reports are forwarded to the Boa-d on a quarterly basis and are received in the Boa-fs offices no later than the due date for Dr. Ryan's quarterly declaration.

In the event that the designated monitoring physician becomes unable or unwilling to serve in this capacity, Dr. Ryan must immediately so notify the Board in writing. In addition, Dr. Ryan shall make arrangements acceptable to the Board for another monitoring physician within thirty days after the previously designated monitoring physician becomes unable or unwilling to serve, unless otherwise determined by the Board. Furthermore, Dr. Ryan shall ensure that the previously designated moniloring physician also notifies the Board directly of his or her inability to continue to sewe and the reasons therefore.

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The Board expressly reserves the right to disapprove any person proposed to serve as Dr. Ryan's designated monitoring physician, or to withdraw approval of any person previously approved to serve-as Dr. Ryan's designated monitoring physician, in the event that the Secretary and Supervising Member of the Board determine that any such monitoring has demonstrated a lack of cooperation in providing information to the Board or for any other reason,

Required Reporting by Licensee

7. Within thirty days of the effective date of this Consent Agreement, Dr. Ryan shall provide a copy of this Consent Agreement to all employers or entities with which she is under contract to provide health care services (including but not limited to third p a payors) or is receiving Wining, and the Chief of Staff at each hospital where she has privileges or appointments. Further, Dr. Ryan shall promptly provide a copy of this Consent Agreement to aU employers or entities with which she contracts to provide health care services, or applies for or receives training, and the Chief of Staff at each hospital where she applies for or obtains privileges or appointments. In the event that Dr. Ryan provides any health care services or health care direction or medical oversight to any emergency medical services organization or emergency medical services provider, within thirty days of the effective date of this Consent Agreement Dr. Ryan shall provide a copy of this Consent Agreement to the Ohio Department of Public Safety, Division of Emergency Medical S e ~ c e s . Further, Dr. Ryan shall provide the Boad with one of the following dacuments as proof of each required notification within thirty days of the date of each such notification: (1) the return receipt of certified mail within thirty days of receivuig that return receipt, (2) an acknowledgement of delivery bearing the origmal ink signature of the person to whom a copy of the Consent Agreement was hand delivered, (3) the original facsimile-generated report confirming successful lxansmission of a copy of the Consent Agreement to the person or entity to whom a copy of the Consent Agreement was faxed, or (4) an original computer-generated printout of electronic mail communication documenting the email transmission of a copy of the Consent Agreement to the person or entity to whom a copy of the Consent Agreement was emailed.

8 . Within thirty days ofthe effective date of this Consent Agreement, Dr. Ryan shall provide a copy of this Consent Agreement to the proper licensing authority of any state or jurisdiction in which she'currently holds any professional license, as well as any federal agency or entity, including but not limited to the Drug Enforcement Agency, through which she currently holds any license or certificate. Dr. Ryan further agrees to provide a copy of this Consent Agreement at time of application to the proper licensing authority of any state in which she applies for any professional license or for reinstatement of any professional license. Further, Dr. Ryan shall provide the Board with one of the following documents as proof of each required notification within thirty days of the dateof each such notification: (1 ) the return

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CONSENT AGREEMENT CAROL G. RYAN, M.D. PAGE 5

receipt of certified mail within thirty days of receiving that return receipt, (2) an acknowledgement of delivery bearing the original ink signature of the person to whom a copy of the Consent Agreement was hand delivered, (3) the original facsimile-generated report confirming successful transmission of a copy of the Consent Agreement to the person or ennty to whom a copy of the Consent Agreement was faxed, or (4) an original computer-generated plintout of electronic mail communication documenting the email transmission of a copy of the Consent Agreement to the peison or entity to whom a copy of the Consent Agreement was emailed.

9. Dr. Ryan shall notify the Board in writing of any change of principal practice address or residence address within thirty days of such change.

FAILURF, TO COMPLY

If, in the discretion of the Secretary and Supervising Member of the Board, Dr. Ryan appears to have violated or breached any term or condition of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohro occumng before the effective date of this Consent Agreement.

If the Secretary and Supervising Member of the Board determine that there is clear and convincing evidence that Dr. Ryan has violated any term, condition or limitation of this Consent Agreement, Dr. Ryan agrees that the violation, as alleged, also constitutes clear and convincing evidence that her continued practice presents a danger of immediate and serious harm to the public for purposes of initiating a summary suspension pursuant to Section 473 1.22(G), O h o Revised Code,

DURATIONMODZFICATION OF TERMS

Dr. Ryan shall not request termination of this Consent Agreement for a minimum of three years. In addition, Dr. Ryan shall not request modification to the probationary terms, limitations, and conditions contained herein for at least one yeai, except that Dr. Ryan may make such request with the mutual approval and joint recommendation of the Secretaiy and Supervising Member. Otherwise, the above-described terms, limitations and conditions may be amended or terminated in writing at any time upon the agreement of both parties.

In the event that the Board initiates future formal proceedings against Dr. Ryan, including hut not limited to issuance of a Notice of Opportunity for Hearing, this Consent Agreement shall continue in full force and effect until such time that it is superseded by ratification by the Board of a subsequent Consent Agreement or issuance hy the Boad of a final Board Order.

In the event that any tam, limitation, or condition contained in this Consent Agreement is determined to be invalid by a murt of competent jurisdiction, Dr. Ryan and the Board agree that

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CONSENT AGREEMENT CAROL G. RYAN, M.D. PAGE 6

all other terms, limitations, and conditions contained in this Consent Agreement shall be unaffected.

Dr. Ryan acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions aslced have been answexed in a satisfactory manner.

Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedure Act, Chapter 119., Ohio Revised Code.

Dr. Ryan hereby releases the Board, its members, employees, agents, officers and representatives jointly and severally from any and all liability arising from the withn matter.

This Consent Agreement shall be considered a public record as that term is used in Section 149.43, Ohio Revised Code. Further, this information may be reported to appropriate organizations, data banks and governmental bodies. Dr. Ryan aclcnowledges that her social security number will be used if this information is so reported and agrees to provide her social security number to the Board for such purposes.

EFFECTIVE DATE

It is expressly understood that this Consent Agreement is subject to ratification by the Board prior to siguature by the Secretary and Supervising Member and shall become effective upon the last date of signature below.

gdd 4. &&,G* MARK A. BECHTEL, M.D.

U Secretary

DATE DATE

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CONSENT AGREEMENT CAROL G. RYAN, M.D. PAGE 7

P % Y ~ Q js"~? PHYLLI . BROWN W,B. M ~ C O V I T S Attorney for Dr. Ryan

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g,/,* ?//+ RUCE R. SAFER . P.M.

Supervising Member

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CHEIZYL~. POKORNY Enforcement Attorney