Regulatory Actions against David W. Laudon, D.C.
Stephen Barrett, M.D.
In September 2015, as shown below, David Laudon, D.C. and the Minnesota Board of Chiropractic Examiners entered into a stipulated consent order under which his license was suspended for a year, the suspension was stayed, and he was ordered to take several continuing education courses and pass a special examination. The order notes that, based on a sampling of six charts, the board concluded that his recordkeeping was inadequate in that his records were "canned," lacked detail, failed to justify the course of care, and were "repetitive, nonsensical, and sometimes false." For example:
- Objective findings, assessment, and treatment parameters remain almost exactly the same for all patients, including 75 visits over 19 months for patient #3; 79 visits over nearly two years for patient #4; and 85 visits over eight months for patient #5.
- For patient #4, Lauden's daily "Subjective" note was exactly the same for the first 10 visits. He then modified the note which remained unchanged for the next 19 visits. His "Assessment" language remained unchanged for 20 visits. Later he recorded a "new condition" in the "Subjective" note, resulting from a slip and fall on New Year's Day, which remained a "New Condition" for 30 visits. Patient #4's records also contained an inexplicable statement "X-ray not taken no broken bones" on each daily note for nearly 70 visits.
- Records for patient #5 include a statement addressing a bicycle injury as happening "today" over a period of three visits, the bicycle injury then continues as the daily "subjective finding" for 33 visits and, in spite of the new bicycle injury, the diagnosis, treatment plan, and treatment remained unchanged. Pre- and post-injury notes are exactly the same.
In September 2015, the United States Tax Court upheld the findings of IRS auditors who concluded that Laudon had under-reported his income and taken improper deductions for practice expenses in his tax filings for 2007 through 2009. The discrepancies involved (a) depositing $80,000 more than he recorded as gross income in his office, (b) claiming business expense for driving 40,000 to 60,000 miles per year for "house calls" and other odd purposes, (c) deducting home office expenses that included expensive entertainment equipment, and taking "miscellaneous" deductions that he could not substantiate.
MINNESOTA BOARD OF CHIROPRACTIC EXAMINERS
|In the Matter of
David William Laudon, D.C.
License No. 4587
David W. Laudon, D.C., ("Respondent") and the Minnesota Board of Chiropractic Examiners Complaint Panel ("Panel") agree the above-referenced matter may be resolved without trial of any issue or fact as follows:
A. The Minnesota Board of Chiropractic Examiners ("Board") is authorized pursuant to Minnesota Statutes sections 148.01 to 148.108 to license and regulate chiropractors and to take disciplinary action as appropriate.
B. Respondent holds a license from the Board to practice chiropractic and is subject to the jurisdiction of the Board with respect to the matters referred to in this Stipulation and Order.
A. On August 13, 2015, Respondent appeared before the Panel, composed of Robert P. Daschner, DC, Board member, and Teresa L. Marshall, DC, Board Member, to discuss allegations contained in a Notice of Conference dated June 10, 2015. Lucas Clayton, Assistant Attorney General, represented the Panel at the conference.
B. Respondent was advised by the Board's representatives that he may choose to be represented by legal counsel in this matter. Respondent knowingly waived legal representation.
The parties agree this Stipulation and Order is based upon the following facts as derived from a detailed review of a sampling of six of Respondent's patient records and discussion with Respondent at the conference:
A. Respondent improperly managed health records by failing to maintain adequate health records, failing to keep records justifying the course of care, failing to comply with the statutory record-keeping requirements, and by keeping notes that lack detail, are repetitive, nonsensical, and sometimes false.
1. Respondent's treatment notes for all patients are canned and do not change pre- and post-injury, over long periods, or even after long gaps in care. Examples include:
a. Objective findings, assessment, and treatment parameters remain almost exactly the same for all patients, including 75 visits over 19 months for patient #3; 79 visits over nearly two years for patient #4; and 85 visits over eight months for patient #5.
b. Respondent's daily "Subjective" note for patient #4 is exactly the same for the first ten visits. Respondent then modified the note which remained unchanged for the next 19 visits. Respondent's "Assessment" language remained unchanged for 20 visits. Later Respondent recorded a "new condition" in the "Subjective" note for patient #4, resulting from a slip and fall on New Year's Day, which remained a "New Condition" for 30 visits.
c. Patient #4's records contain an inexplicable statement "X-ray not taken no broken bones" on each daily note for nearly 70 visits.
d. Records for patient #5 include a statement addressing a bicycle injury as happening "today" over a period of three visits, the bicycle injury then continues as the daily "subjective finding" for 33 visits and, in spite of the new bicycle injury, the diagnosis, treatment plan, and treatment remained unchanged. Pre- and post-injury notes are exactly the same.
2. Respondent's daily SOAP notes are false as demonstrated below:
a. Respondent recorded "NEG" for new event such as "trauma" or "medications" for patient #2, however this same form references trauma from a bar fight which resulted in spinal fractures and the use of medications.
b. Respondent recorded "NEG" for a new event such as "trauma" for patient #4, however this same form references trauma when patient #4 fell while stepping out of a public transportation bus.
c. Respondent recorded patient #5 as returning after two years with no treatment and no interim injury and "NEG" for new event such as "trauma". That same record indicates there has been a bike injury.
d. Respondent refers to patient #4, who is a male, as a female in his notes for ten consecutive visits. and patient #6, who is a male, as a female on three separate occasions in the context of a narrative report.
3. Respondent's records are inadequate as follows:
a. Records for patient #3 contain an examination indicating there is a new injury. However, there are no progress notes contained in the record for the next 10 months in spite of a billing statement reflecting 13 patient visits charged for during the period.
b. Respondent changed patient #2's treatment frequency from 6 visits/month to 8 visits/month with no explanation. This change is contraindicated by Respondent's daily notes characterizing the patient's condition as improving.
c. Respondent's notes for patient #4 contain the statement "X-ray not taken no broken bones." It is unclear how Respondent could conclude there were no broken bones in the absence of x-rays.
d. Respondent recorded suddenly and inexplicably that patient #4 "is not suicidal nor has he had any suicidal ideations of hurting himself." This statement continues on for 39 patient visits. There are no notations to indicate what would provoke such an entry into the record. During the conference Respondent reported that patient #4 threatened him with a gun during a patient visit, but failed to include that in the patient record or file a police report.
e. Respondent's records for patient #6 show 35 treatments comprised of aggressive treatment periods punctuated by long periods of non-treatment. There are no changes in objective findings in spite of multiple injury/exacerbation events.
B. Respondent failed to practice chiropractic at a level of care, skill, and treatment considered to be acceptable. Examples include the following:
1. Respondent's care protocols did not change for patient #2 following a significant injury which included fractures of two lumbar transverse processes. The records indicate Respondent continued to treat this patient exactly the same pre- and post-injury, in spite of the multiple lumbar fractures.
2. Respondent continued to treat patient #3 exactly the same pre- and post- injury in spite of several reported injuries and/or re-injuries.
3. All patients received the exact same diagnosis codes, which are vague, always non-allopathic, and did not change when the patients' condition warranted such changes. For example, patient #2's diagnosis codes were never upgraded to reflect the allopathic lesions (fractures) of the lumbar spine.
4. Respondent's records for patient #4 include only one examination for the entirety of calendar year 2012, despite the fact that there are a total of 56 visits and an inexplicable four-and-a-half month gap in care over that time period.
5. Following a four-and-a-half month gap in care, Respondent's notes for patient #4 starting care again are exactly the same as the notes preceding the gap in care, with the noted exception of an inexplicable reference to the patient's denial of suicidal ideations.
6. Respondent's objective findings and treatments for all patients remain nearly the same for extended treatment periods.
C. Respondent engaged in unprofessional conduct and gross ignorance of, or incompetence in the practice of chiropractic. Examples include the following:
1. Respondent's care protocols for patient #2 did not change following a significant injury which included fractures of two lumbar transverse processes. The patient records indicate Respondent continued to treat this patient exactly the same pre- and post-injury, in spite of multiple lumbar fractures.
2. Respondent's diagnosis codes for patient #2 were never upgraded from "non-allopathic" to reflect the allopathic lesions (fractures) of the lumbar spine.
3. In spite of a period of care spanning 23 months and 123 patient visits, Respondent never changed the diagnosis codes for patient #4.
4. Respondent's notes for patient #4 contain an incongruous and inexplicable statement which says: "X-ray not taken no broken bones." It is unclear how Respondent could conclude there were no broken bones in the absence of x-rays, nor why such a statement would be recorded.
The Panel concludes that the conduct described in section III. above constitutes a violation of Minnesota Statutes section 148.10 for purposes of this Stipulation and Order only and justifies the action described in section V. below. Respondent agrees that the conduct described in section III. above constitutes a violation of Minnesota Statutes section 148.10 if proven by the Panel but agrees to enter into this Stipulation and Order for purposes of settlement.
NOW, THEREFORE, IT IS FURTHER STIPULATED AND AGREED that upon this Stipulation, and without further notice or additional proceedings, the Board may, in its discretion, adopt and implement the following Order:
A. The Board hereby SUSPENDS Respondent's license to practice chiropractic for 12 months from the date of this order. The suspension is STAYED in its entirety contingent upon Respondent's compliance with the terms and conditions in paragraphs B as follows:
B. Respondent shall satisfactorily comply with the following CONDITIONS:
1. Respondent shall complete not less than 20 hours of one-on-one continuing education (CE) in healthcare documentation within 120 days of the effective date of this Order. These hours shall be provided by an instructor pre-approved by the Board. If the approved instructor is also a Board approved continuing education sponsor, only then shall these hours apply toward the annual license renewal requirements. Respondent shall cause the CE provider to submit a written report to the Board within two weeks of completion of this education affirming he/she has read this Order prior to providing the CE hours, and verifying Respondent's compliance with this requirement, understanding of documentation requirements, and citing any continuing recommendations for Respondent.
2. Respondent shall enroll in and successfully complete the National Board of Chiropractic Examiners (NBCE) Special Purposes Examination in Chiropractic (SPEC) within 120 days of the effective date of this order. The program information may be found online at http://mynbce.org. Failure to obtain a passing score in all five sections will be considered a violation of this order.
3. Respondent shall enroll in and successfully complete the National Board of Chiropractic Examiners (NBCE) Post Licensure Examination in Ethics and Boundaries within 120 days of the effective date of this order. The program information may be found online at http/www.ebas.org. Failure to obtain a passing score in all five sections will be considered a violation of this order.
4. Two to three months following completion of the CE requirement above, the Board will request a sampling of new patient records for review and verification of changes and compliance. The Board will specify the criteria for record selection which may include onsite selection. Failure to generate patient records that meet community standards following completion of the above CE conditions may necessitate further action.
5. Respondent shall arrange for participation in and completion of the above requirements and shall assume responsibility for all associated costs.
C. Respondent may petition for removal of the suspended status following 12 months from the effective date of this Order. The burden of proof shall be upon Respondent to demonstrate by a preponderance of the evidence that he has satisfied all the conditions of this Order and is capable of practicing chiropractic in a fit and competent manner. At the time of Respondent's petition, Respondent may be required to meet with a Complaint Panel toreview and evaluate his compliance and current practice procedures.
D. The Board may, at any regularly scheduled meeting following Respondent's petition for removal of the stayed suspension take any of the following actions:
1. Issue an Order granting Respondent an unrestricted chiropractic license;
2. Issue an Order granting Respondent a chiropractic license with limitations upon the scope of Respondent's practice and/or with conditions for Respondent's practice; or
3. Continue the stayed suspension of Respondent's chiropractic license upon his failure to meet the burden of proof.
CONSEQUENCES FOR NONCOMPLIANCE OR ADDITIONAL VIOLATIONS
A. It is Respondent's responsibility to ensure all payments, reports, evaluations, and doeumentation required to be filed with the Board pursuant to this Stipulation and Order are timely filed by those making the payment or preparing the report, evaluation, or documentation. Failure to make payments or file reports on or before their due date is a violation of this Stipulation and Order. The information contained in the reports, evaluations, and documentation is confidential and shall be submitted to the Board by United States mail, courier, [secure] email, or personal delivery only.
B. If the Panel has probable cause to believe Respondent has failed to comply with or has violated any of the requirements for staying the suspension as outlined in paragraphs B above, the Panel may remove the stayed suspension pursuant to the procedures outlined below, with the following additions and exceptions:
1. The removal of the stayed suspension shall take effect upon service of an Order of Removal of Stayed Suspension ("Order of Removal"). Respondent agrees that the Panel is authorized to issue an Order of Removal, which shall remain in effect and shall have the full force and effect of an order of the Board until the Board makes a final determination pursuant to the procedures outlined in paragraph VI.C below. The Order of Removal shall confirm the Panel has probable cause to believe Respondent has failed to comply with or has violated one or more of the requirements for staying the suspension of Respondent's license. Respondent further agrees an Order of Removal issued pursuant to this paragraph shall be . deemed a public document under the Minnesota Government Data Practices Act. Respondent waives any right to a conference or hearing before removal of the stayed suspension.
2. The Panel shall schedule the hearing pursuant to paragraph VI.C below to be held within 60 days of the notice.
C. If Respondent fails to comply with or violates this Stipulation and Order or it is determined Respondent has further violated Minnesota Statutes sections 148.01 to 148.108 or Minnesota Rules chapters 2500.0100 to 2500.7090, the Panel may, in its discretion, seek additional discipline either by initiating a contested case proceeding pursuant to Minnesota Statutes chapter 14 or by bringing the matter directly to the Board pursuant to the following procedure:
1. The Panel shall schedule a hearing before the Board. At least 20 days before the hearing, the Panel shall mail Respondent a notice of the violation(s) alleged by the Panel. In addition, the notice shall designate the time and place of the hearing. Within ten days after the notice is mailed, Respondent shall submit a written response to the allegations. If Respondent does not submit a timely response to the Board, the allegations may be deemed admitted.
2. The Panel, in its discretion, may schedule a conference with Respondent prior to the hearing before the Board to discuss the allegations and to attempt to resolve the allegations through agreement.
3. Prior to the hearing before the Board, the Panel and Respondent may submit affidavits and written argument in support of their positions. At the hearing, the Panel and Respondent may present oral argument. Argument shall not refer to matters outside the record. The evidentiary record shall be limited to the affidavits submitted prior to the hearing and this Stipulation and Order. The Panel shall have the burden of proving by a preponderance of the evidence-that a violation has occurred. If Respondent has failed to submit a timely response to the allegations, Respondent may not contest the allegations, but may present argument concerning the appropriateness of additional discipline. Respondent waives a hearing before an administrative law judge, discovery, cross-examination of adverse witnesses, and other procedures governing hearings pursuant to Minnesota Statutes chapter 14.
4. Respondent's correction of a violation before the conference, hearing, or meeting of the Board may be taken into account by the Board but shall not limit the Board's authority to impose discipline for the violation. A decision by the Panel not to seek discipline when it first learns of a violation shall not waive the Panel's right to later seek discipline for that violation, either alone or in combination with other violations, at any time while Respondent's license is in a Stayed Suspension status.
5. Following the hearing, the Board will deliberate confidentially. If the allegations are not proved, the Board shall dismiss the allegations. If a violation is proved, the Board may impose additional discipline, including lifting of the stay on the suspension, additional conditions or limitations on Respondent's practice, an additional period of suspension, additional conditions of reinstatement, or revocation of Respondent's license.
6. Nothing herein shall limit the Review Panel's or the Board's right to temporarily suspend Respondent's license pursuant to Minnesota Statutes section 148.10, subdivision 4, based on a violation of this Stipulation and Order or based on conduct of Respondent not specifically referred to herein.
A. In the event Respondent should leave Minnesota to reside or to practice outside of the state, Respondent shall give the Board written notification of the new location, as well as dates. of departure and return. Periods of residency and practice outside of Minnesota will not apply to the reduction of any period of Respondent's Stayed Suspension status in Minnesota unless Respondent demonstrates that the practice in another state conforms completely with this Stipulation and Order. If Respondent leaves the state, the terms of this Order continue to apply unless waived in writing.
B. Respondent waives the contested case hearing and all other procedures before the Board to which Respondent may be entitled under the Minnesota and United States constitutions, statutes, or rules.
C. Respondent waives any claims against the Board, the Minnesota Attorney General, the State of Minnesota, and their agents, employees, and representatives related to the investigation .of the conduct herein, or the negotiation or execution of this Stipulation and Order, which may otherwise be available to Respondent.
D. This Stipulation and Order, the files, records, and proceedings associated with this matter shall constitute the entire record and may be reviewed by the Board in its consideration of this matter.
E. Either party may seek enforcement of this Stipulation and Order in any appropriate civil court.
F. Respondent has read, understands, and agrees to this Stipulation and Order and has voluntarily signed the Stipulation and Order. Respondent is aware this Stipulation and Order must be approved by the Board before it goes into effect. The Board may approve the Stipulation and Order as proposed, approve it subject to specified change, or reject it. If the changes are acceptable to Respondent, the Stipulation and Order will take effect and the order as modified will be issued. If the changes are unacceptable to Respondent or the Board rejects the Stipulation and Order, it will be of no effect except as specified in the following paragraph.
G. Respondent agrees that if the Board rejects this Stipulation and Order or a lesser remedy than indicated in this settlement, and this case comes again before the Board, Respondent will assert no claim that the Board was prejudiced by its review and discussion of this Stipulation and Order or of any records relating to it.
H. This Stipulation and Order shall not limit the Board's authority to proceed against Respondent by initiating a contested case hearing or by other appropriate means on the basis of any act, conduct, or admission of Respondent which constitutes grounds for disciplinary action and which is not directly related to the specific facts and circumstances set forth in this document.
DATA PRACTICES NOTICES
A. This Stipulation and Order constitutes disciplinary action by the Board and is classified as public data pursuant to Minnesota Statutes section 13.41, subdivision 5. Data regarding this action will be provided to data banks as required by Federal law or consistent with Board policy. While this Stipulation and Order is in effect, information obtained by the Board pursuant to this Order is considered active investigative data on a licensed health professional, and as such, is classified as confidential data pursuant to Minnesota Statutes section 13.41, subdivision 4.
B. This Stipulation contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies this Stipulation.
|CONSENT:||BOARD OF CHIROPRACTIC EXAMINERS
Dated: Sept 10, 2015
Upon consideration of the Stipulation, the Board places Respondent's license in a Stayed Suspension status and adopts all of the terms and Conditions described above effective as of this 10th day of September, 2015.
OF CHIROPRACTIC EXAMINERS
This page was posted on November 19, 2015.