BEFORE THE STATE OF ARIZONA BOARD OF CHIROPRACTIC EXAMINERS CONSENT AGREEMENT RECITALS

Transcription

1 BEFORE THE STATE OF ARIZONA BOARD OF CHIROPRACTIC EXAMINERS In the Matter of: Zackery A. Conklin D.C. Holder of License No. For the Practice of Chiropractic In the State of Arizona l Case No.: & 0-01 CONSENT AGREEMENT AND FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER FOR VOLUNTARY SURRENDER 1 CONSENT AGREEMENT RECITALS In the interest of a prompt and judicious settlement of the above-captioned matter before the Arizona Board of Chiropractic Examiners ("Board") and consistent with the public interest, statutory requirements and responsibilities of the Board and pursuant to A.R.S (F)() and A.R.S. - et seq., Zackery A. Conklin, D.C. ("Respondent"), to practice chiropractic in the State of Arizona, and the Board enter into the following Recitals, Findings of Fact, Conclusions of Law and Order (Consent 1 Agreement) as the final disposition of this matter Respondent has read and understands this Consent Agreement as set forth 0 herein, and has had the opportunity to discuss this Consent Agreement with an attorney or has waived the opportunity. Respondent voluntarily enters into this Consent Agreement for the purpose of avoiding the expense and uncertainty of an administrative hearing.. Respondent understands that he has a right to a public administrative hearing concerning each and every allegation set forth in the above-captioned matter, at which administrative hearing he could present evidence and cross-examine witnesses. By entering into this Consent Agreement, Respondent freely and voluntarily relinquishes all rights to such an administrative hearing, as well as all rights of rehearing, review, reconsideration, appeal, judicial review or any other administrative and/or judicial action, 1

2 concerning the matters set forth herein. Respondent affirmatively agrees that this Consent Agreement shall be irrevocable-.. Respondent agrees that the Board may adopt this Consent Agreement or any part of this agreement, under A.R.S. -. Respondent understands that the Board may consider this Consent Agreement or any part of it in any future disciplinary action against him.. Respondent understands that this Consent Agreement does not constitute a dismissal or resolution of other matters currently pending before the Board, if any, and does not constitute any waiver, express or implied, of the Board's statutory authority or jurisdiction regarding any other pending or future investigation, action or proceeding. Respondent also understands that acceptance of the Consent Agreement does not preclude any other agency, subdivision or officer of this state from instituting other civil or criminal proceedings with respect to the conduct that is the subject of this Consent Agreement.. All admissions Respondent makes in this Consent Agreement are made solely for he final disposition of this matter, and any related administrative proceedings or civil itigation involving the Board and respondent.. By agreeing to allow the Board to impose the discipline ordered herein. Respondent acknowledges that the Board has evidence from which it could impose discipline under A.R.S. - (G).. Respondent acknowledges and agrees that, upon signing this Consent Agreement and returning this document to the Board, Respondent may not revoke his acceptance of the Consent Agreement or make any modifications to the document. Any modification to this original document is ineffective and void unless mutually approved by he parties in writing.

3 1. Respondent understands that the foregoing Consent Agreement shall not become effective unless and until the Board adopts it and the Chairperson signs it.. Respondent understands and agrees that if the Board does not adopt this Consent Agreement, he will not assert as a defense that the Board's consideration of it constitutes bias, prejudice, prejudgment or other similar defense in any future disciplinary action.. Respondent understands that this Consent Agreement is a public record that may be publicly disseminated as a formal disciplinary action of the Board, and shall be reported as required by law to the National Practitioner Data Bank.. Respondent understands that any violation of this Consent Agreement constitutes unprofessional conduct pursuant to A.R.S. - (A) (), "Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any of the provisions of this chapter or any Board order," and may result in disciplinary action pursuant to A.R.S IL D^TED^ ^Zackery A. Conklin, D.C. Respondent FINDINGS OF FACT 1. On or about June, 0, the Board received documents from the City of Phoenix Office of the City Prosecutor that Respondent had been convicted of violating A.R.S. - (A)(1), driving under the influence, a misdemeanor.. On or about October, 0, Respondent was charged with violating A.R.S. 1-10, shoplifting, a misdemeanor. RECEIVED JAN Z0 AZ BOARD OF CHIROPRACTIC EXAMINERS

4 Respondent failed to disclose the above misdemeanor charges within ten working days after the criminal charges were filed pursuant to A.R.S Respondent provided a written response and court documents relating to his misdemeanor arrests. In his written response to the Board, Respondent stated he was "dependent on the meds in order to operate as normal.". On or about May, 0, Respondent was convicted, following his guilty plea, of driving under the influence to the slightest degree, a Class 1 misdemeanor, in Phoenix City Court. Respondent was sentenced to probation with terms that included; a substance abuse screening and follow up treatment; months use of an interlock device; participation in a DUI impact panel; and fines/fees.. On July, 0, the Board reviewed the documents provided and issued Respondent an Interim Board Order requiring that he obtain a substance abuse/addiction evaluation from a Board approved addictionologist pursuant to A.R.S. - (C). Respondent failed to comply with the Interim Board Order by failing to obtain the substance abuse/addition evaluation.. On or about November, 0, Respondent was charged by criminal complaint with possession/use of drug paraphernalia, a misdemeanor, in violation of A.R.S. 1-(A), in Mesa Municipal Court. Respondent disclosed this misdemeanor offense to the Board on November, 0.. On or about November 1, 0, the Board reviewed the Respondent's noncompliance with the Interim Board Order requiring a substance abuse/addiction evaluation rom a Board approved addictionologist and voted to open a new complaint.. On or about November, 0, Respondent advised Board staff that he wishes to voluntarily surrender his license to practice chiropractic in Arizona at this time. Respondent advised Board staff that he is currently undergoing residential inpatient and detox for substance abuse issues in the state of New York.

5 CONCLUSIONS OF LAW 1. The conduct and circumstances described above in paragraphs 1- of the Factual Allegations constitute a violation of A.R.S. -(A) (), Unprofessional or dishonorable conduct of a character likely to deceive or defraud the public or tending to discredit the profession. ^. The conduct and circumstances described above in paragraph and of the Factual Allegations constitute a violation of A.R.S. - (A) (), Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any of the provisions of this chapter or any board order.. The conduct and circumstances described above in paragraphs 1- of the Factual Allegations constitute a violation of A.R.S. -0 (A), by failing to notify the Board in writing within ten working days after being charged with a misdemeanor involving conduct that may affect patient safety. ORDER Based upon the above Findings of Fact and Conclusions of Law, IT IS HEREBY ORDERED: 1. Chiropractic License No., issued to Respondent to practice chiropractic in the State of Arizona, shall be deemed VOLUNTARILY SURRENDERED upon adoption of this Consent Agreement by the Board, and Respondent shall immediately return license to the Board. A.R.S. -(0) ().. Physical Medicine Modalities and Therapeutic Procedures Certificate No. 0, issued to Respondent to practice chiropractic in the State of Arizona, shall be deemed VOLUNTARILY SURRENDERED upon adoption of this Consent Agreement by he Board, and Respondent shall immediately return certificate 0 to the Board.

6 DATED AND EFFECTIVE this! ' of,'j q!, 0^ -'K ^ STATE OF ARIZONA BOARD OF CHIROPRACTIC EXAMINERS By James Badge, D.C., Chair State of Arizona Board of Chiropractic Examiners Original of the foregoing filed this rd day of November. 0 with: State of Arizona Board of Chiropractic Examiners 1 West Camelback Road, Suite 0 Phoenix, AZ 0 Executed Copy of the foregoing mailed by Regular and U.S. Certified mail (Return receipt requested) This day of iebfuafu.-0t.^ /' A Certificate No. t>/ l(c>^g coq'^d.oi Zackery A. Conklin, D.C. State Rte. 1A Castile, NY Respondent Executed Copy of the foregoing electronically transmitted This c'~^' davof Tcbi ucir*^/,0 to Mona Baskin, Assistant Attorney General West Washington Phoenix, Arizona 00: to: Board Operations 0