A meeting of the New Jersey State Board of Medical Examiners was held on Wednesday, January 14, 2009 at the Richard J. Hughes Justice Complex, 25 Market Street, 4th Floor Conference Center, Trenton, New Jersey for Disciplinary Matters Pending Conclusion, open to the public. The meeting was called to order by Ms. Karen Criss, Chairperson for Open Disciplinary Matters.

PRESENT

Board Members Criss, Mendelowitz, Lambert, Walsh, Haddad, Lomazow, Criscito, Ciechanowski, DeGregorio, Nussbaum, Wheeler, Stanley, Paul, Cheema and Scott.

EXCUSED

Board Members Salas-Lopez, Jordan and Strand.

ALSO PRESENT

Deputy Attorneys General Levine, Warhaftig, Dick, Flanzman, Cordoma, Puteska, Ehrenkrantz, Gelber, Executive Director Roeder and Mary Lou Mottola, Executive Director of the Medical Practitioner Review Panel.

RATIFICATION OF MINUTES

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO APPROVE THE MINUTES FROM THE DECEMBER 3, 2008 BOARD MEETING.

HEARINGS, PLEAS, AND APPEARANCES

1. RAGI, Gangaram MD 25MA05675000
Kim D. Ringler, DAG
Benjamin Clarke, Esq. For the Respondent

A Motion For Summary Decision was filed by the Board on December 30 , 2008. Counsel for Dr. Raji objected to the Motion for Summary Decision and challenged that the Board had not determined whether it was contested and requested that the matter be transferred to the Office of Administrative Law.

Dr. Mendelowitz recused from discussion and vote in this matter and left the room.

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO MOVE INTO CLOSED SESSION FOR DISCUSSION AND ADVICE OF COUNSEL.

All parties, except counseling and administrative staff, left the room.

Returning to open session, the Board announced the following:

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED AND DETERMINED THAT THIS IS A CONTESTED CASE AND THAT IT WILL RETAIN JURISDICTION OF THIS MATTER FOR THE PURPOSES OF HEARING THE SUMMARY DECISION MOTION FILED BY THE ATTORNEY GENERAL. IT WILL HEAR THAT MOTION AT ITS FEBRUARY MEETING. AT THE CONCLUSION OF THE PROCEEDING, THE BOARD, IF NECESSARY, WILL MAKE THE DETERMINATION OF WHETHER THE MATTER WILL BE REFERRED TO THE OFFICE OF ADMINISTRATIVE LAW.

2. AZAM, Chowdhury M. M.D.25MA06382200
Steven I Kern, Esq. for the Respondent
David Puteska, DAG

The Attorney General was seeking the temporary suspension of Dr. Azam’s license to practice medicine and surgery and for other such relief deemed appropriate. This matter was opened to the Board by Verified Administrative Complaint filed on December 19, 2008. The matter was heard by the Board on January 14, 2009 at 10 a.m.

Drs. Criscito and Ciechanowski recused from discussion and vote in this matter and left the room.

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO MOVE INTO CLOSED SESSION FOR DISCUSSION AND ADVICE OF COUNSEL.

All parties, except counseling and administrative staff, left the room.

Returning to open session, Ms. Criss convened the hearing.

DAG Puteska and Mr. Kern placed their appearances on the record.

DAG Puteska noted that the court reporter had been asked to redact any names or cell phone numbers that may inadvertently be used during the hearing.

DAG Puteska, briefly in his opening, thanked the Board for its time in hearing the temporary suspension which is based on multiple allegations of inappropriate behavior with patient EY. Dr. Azam’s medical judgment, according to the Attorney General, had been demonstrated as appalling and thus, required the temporary suspension of his license to practice medicine.

Mr. Kern opened by stating that Dr. Azam had been practicing medicine in New Jersey for 12 years with a flawless career. He noted that since the allegations were made, no new complaints were made and no other patients came forward. Mr. Kern advised that the question before the Board was not whether Dr. Azam did something wrong on October 16, but based on all that is presented to the Board, whether his practice poses an imminent danger to the safety and welfare of his patients. Mr. Kern posited that the State will make presentations of what the doctor did, but nothing presented as part of the State’s case demonstrated that there was an immediate or impending danger to the public health, safety and welfare. He continued that the Board, as it considered this case, was not asked to determine the doctor’s guilt or innocence, but rather, did his continued practice present an imminent danger. The Respondent presented two opinions from qualified experts indicating that Dr. Azam was not a danger. According to Mr. Kern, the State had not rebutted the evidence.

Turning to his case in chief, DAG Puteska provided a notebook that had been pre-marked which exhibits that he requested be accepted into evidence.

Mr. Kern objected to the entry of P-1 as it lacked probative value and simply represented one officer's account of a third party. The Chair ruled to move it into evidence and noted that it would be given appropriate weight in the deliberation process.

DAG Puteska then entered the audio tapes and the accompanying transcript, P-2 and P-3. Mr. Kern objected because the transcript was unverified and had no relevance in this matter to determine whether Dr. Azam posed an imminent danger. He also noted that there were inaccuracies in the transcript, and there was no foundation made by the Attorney General. DAG Puteska responded that the audio tape was a sworn statement of the witness and is permissible under the Rules of Evidence. It was the victim's statement which was made within twenty four hours of the alleged incident. Mr. Kern continued his objection as there was no validation that this is the voice of EY or any other identification of the voices. He said it was an unverified recording. The Chair overruled the objections and entered the audio tapes into evidence.

DAG Puteska played the October audio tape recording. It contained the statement of EY, the alleged victim in this case. She was sworn in. EY told the officers that the day before she saw Dr. Azam because she needed a refill on one of her medications, Suboxone. According to the witness, she had been seeing the doctor for the past ten months. She was the last patient of the day. During her appointment, Dr. Azam asked about her breasts, as she had undergone surgery on her breasts in the recent past. In the past, he had asked about the surgery and the scar, but this was the first time he ever touched the scar. Although he asked to see her breast, she did not show it to him. After this, he continued to ask her a few questions, e.g., about her husband and how her marriage was going. Thinking that the appointment was over, she tried to leave, but Dr. Azam asked her to sit back down. He came over to her and massaged her back, and then slid his hand under her blouse and grabbed her right breast. With the breast in his hand, he asked if she had any pain. The witness claimed that she responded "no" and then got up and left the room. EY’s description of his action was that "he just put his hand over her breast." She denied that he grabbed it or fondled her breast when he put his hand into her blouse. When she left, she called a friend and told her about what had happened. Upon returning home, she told her husband and her mother-in-law. EY also discussed it with her friend, Maya, who advised her to telephone the doctor. She called Dr. Azam and put him on speaker phone. The witness got very upset and told Dr. Azam to never do it again. During their conversation, according to EY, Dr. Azam apologized and told her he shouldn't have touched her. Following that telephone call, EY spoke with the Edison police. While she was on the way to the police station, Dr. Azam telephoned her on her cell phone. During that conversation, he again apologized for what he did, asked her forgiveness, and wanted to regain her trust and friendship. In the past, she denied any physical contact between the two of them. EY again stated that he touched her entire chest as he moved his left hand over her entire chest before touching the right breast. His whole hand was over her breast, but she could not say that he cupped it. She was confused as to why he went into her bra at first, and before she realized it, he was touching her breast.

Moving to P-4, DAG Puteska explained that it represented an audio tape of a conversation between EY and Dr. Azam, which was recorded by the Edison Police. Mr. Kern renewed his objection made as for P-2 and P-3. The Chair overruled the objection for the same reasons stated earlier.

The Board listened to P-4 while reviewing the transcript marked P-5. During this tape, EY spoke with Dr. Azam. During this conversation, she explained that she felt violated and couldn't understand why he touched her breasts. Dr. Azam apologized to her and noted that he was very attracted to her. He assured her that nothing like that would ever happen again. He regretted his behavior and asked for a second chance to regain her trust. They also discussed the fact that there were other people in the office, but EY kept stressing that no one was in the office with her. He repeatedly apologized to her and admitted that he had a moment of weakness. He thanked her for the card, but she reminded him that it was to simply say thank you to him and that it was not meant as an invitation or come-on.

The Board then listened to the portion of tape of Dr. Azam during his interview with the police. At that time, Dr. Azam was advised of his rights and the charges being brought against him. Dr. Azam stated that when EY came to his office it was because she was having some problems with her husband and that because of her stress, she was experiencing a tightness in her shoulders and neck. He also stated without solicitation that he never touched her breasts and there were people in the examining rooms on either side of him. He recalled that she gave him a card which stated her appreciation for all his help. She didn't say anything to him or push him away. While he was home later that evening, he received a telephone call from him asking why he touched her breasts. During the call, he told her that he shouldn't have touched her at all, meaning when he was checking her neck and shoulder area where she had pain. EY continued to ask him over and over again, why he touched her breasts? He did admit touching her shoulder but denied touching her breasts. Dr. Azam asked EY the reason she thought he would do something like that considering that he is happily married with children. According to Dr. Azam, the patient had been seeing him for a number of months and has been treated for her addiction problems. Dr. Azam also addressed the fact that he telephoned her to apologize that he had upset her. He stressed that anytime he said, "I am sorry for touching you", he was referring to her shoulder/neck area when he touched her during the exam. The police explained to Dr. Azam that EY’s story was different from his, but Dr. Azam could not explain the reason she would lie. He admitted that in the past, he asked to see her scar from her breast surgery. He also admitted that he "massaged" her when she complained about the tightness and stress in her shoulder/neck area and now is very sorry. It was explained to him that EY claimed that he touched her chest and breasts, which Dr. Azam again denied. Even when questioned whether it may have been an accident, he stated that it was possible his hand could have accidently touched her breast. The police asked him to give the victim the common courtesy to admit his mistake and to admit that he touched her breasts. He denied touching any other part of her body and further denied that he asked her to touch any part of him. Dr. Azam also admitted that he was attracted to her, but continued to maintain that it was an accident -- a mistake. He finally admitted that he did put his hand down her blouse and touched her breast.

Dr. Azam explained that the patient is on Suboxone. The drug assists individuals who have addiction problems to maintain sobriety. This patient was returning to obtain a refill for her prescription. He indicted that generally speaking, the patient was doing well, although, there was some issue about her compliance with the medication regimen.

Mr. Kern reminded the Board that it was provided with two treating psychiatrists’ reports. Both evaluations concluded that Dr. Azam is not a risk, and the Attorney General did not provide any rebuttal evidence to counter those conclusions. He moved both of the reports into evidence, and DAG Puteska did not object. The Answer, with the accompanying exhibits, were admitted into evidence as R-1. R-2 was a letter from Dr. Nover, dated January 12, 2009. Also, from Dr. Louis Baxter, a letter dated January 13, 2009, was admitted as R-3. Mr. Kern argued that all three letters support the position that Dr. Azam is not a danger. Even if one were to assume that everything happened as EY alleged, according to the Attorney General's test to determine the level of criminal tiering, he had been found to be a low risk. The Attorney General had not submitted any testimony or evidence to the contrary. He also noted that at the suggestion of Dr. Baxter, Dr. Azam is being scheduled to undergo an evaluation at Peter's Institute.

Mr. Kern advised that, because of the pendency of the criminal matter, Dr. Azam had chosen not to testify. If he did testify, he would deny all the allegations. Also, if he could, he would explain that based on his culture and upbringing, when confronted with something like this, he would "automatically" back off and apologize. If he could testify, he would confirm this fact and explain that he only meant that he was sorry he touched her shoulders. He was also willing to assure that when he saw patients, other psychiatrists would be present. The practice manager, Mr. Parana, had hired him and if needed, could even limit the population to male patients until further assessments.

Mr. Kern called Mr. Parana as his first witness. Mr. Parana is the administrator of a private psychiatry office, Insight Behavior Health, in Point Pleasant, New Jersey. The office provides services from four psychiatrists. Exhibit E from the Answer is a certification from Dr. Drewey, Medical Director of the Practice, who oversees all operations of the practice. Mr. Parana noted that Dr. Azam had worked on a part-time basis with Insight Behavioral Health in the past. Based on his personal knowledge of Dr. Azam, he offered him employment prior to this incident. Following the incident, the members of the practice met and reaffirmed its decision to hire him. Dr. Azam would be supervised by the Medical Director who would review Dr. Azam's practice and report to the Board. It could also be facilitated within the office to have him further monitored if the Board believed it necessary. On cross examination, he admitted that he was the administrator of the practice and did not have authority to hire or fire.

Mr. Kern’s concluded by noting that over the course of 12 years, there was only a single complaint of Dr. Azam’s inappropriate touching. EY admitted that, in fact, he did not fondle her breast. While there was an allegation that Dr. Azam was providing this service in the course of psychotherapy, there is no documentation in the patient record. Dr. Azam was treating her for her addiction to Percodan. During the last exam, she was complaining about the pain emanating from her breast surgery. It was well within his purview to inquire as to the pain she was experiencing, in light of her addiction to pain killers. Mr. Kern argued that the allegations in the complaint were overstated and at best it is a complaint about a purported touching – at worst a fourth degree crime. He also noted that within a day or so after filing this complaint, EY hired a lawyer. Her history, according to Mr. Kern, makes her a rather suspect witness.

He continued by arguing that the Board’s purpose at this hearing is to decide whether Dr. Azam is an imminent danger to the health, safety and welfare of his patients. The Attorney General has not produced one scintilla of evidence to suggest this is the case. In spite of this, Dr. Azam voluntarily offered to work in a monitored setting until he can be further evaluated by the Peters Institute. Mr. Kern stated that he is convinced that it will be the same as the other evaluations which concluded that he does not present a danger to his patients. Even assuming that he did perform the alleged acts, even on the Attorney General's scale of sex offenders, he is at the low tier. He asked that the Board conclude that the Attorney General has not demonstrated palpably that Dr. Azam is an imminent danger to the health, safety and welfare of his patients.

DAG Puteska reminded the Board that based on its experience, sexual misconduct is one of the more egregious betrayals of patient trust in a doctor. His lack of candor with the police, with his psychiatrist, and with this Board, points to such a flawed judgment that he represented an imminent danger.

DAG Puteska continued, stating that Patient EY sought out assistance from Dr. Azam and, in fact, he was helping her. She even gave him a card thanking him. Unfortunately, he saw the gratitude as an opportunity to molest her. In this case, there is a mountain of admissions from the doctor to both the patient and to the police. It is clear, based on the evidence presented, that Dr. Azam committed four incidents of sexual misconduct: He asked her to lift her top to see her "scar"; he massaged her shoulders/neck; he puts his hand under her blouse and under her bra, and he fondled her breasts.

After the incident in question, DAG Puteska noted that there were multiple phone calls between EY and Dr. Azam, two of which he initiated. In each of these, there were a number of statements admitting that he was attracted to her and that he had a moment of weakness. His defense, he continued, was inconsistent with his prior statements. His defense was that he simply touched her shoulders/neck. But even this admission was a violation of the Board's laws. Such a "massage" was unsolicited and inappropriate for a medical professional in any event. DAG Puteska also addressed his defense that the apology was part of his upbringing and culture. There is no evidence to support this statement. Quite frankly, DAG Puteska posited that based on the Board's own expertise, such a defense was absurd.

Mr. Kern stated that the question is whether Dr. Azam’s medical judgment impairs him or is it so flawed that it presents an imminent danger? He advised that nothing in the record supported such a premise. Dr. Azam practiced for 12 years with an unblemished record. Mr. Kern noted that the Board must look at the evidence, and opned that DAG Puteska repeatedly mis-stated the facts. The witness never stated that her breasts were fondled and he pointed this out in the pages of the transcripts. In fact, according to Mr. Kern, the witness even stated that after he touched her breasts, Dr. Azam asked EY whether there was any pain. While the Attorney General argued that the evaluations were flawed, it mis-characterized what the report stated. Even so, the Attorney General failed to note that it has not produced anything in rebuttal to the reports submitted by the Respondent which unanimously stated that he did not present a danger to public. He also noted that even when the report assumed that everything that the witness stated was true, the evaluators still concluded that he posed no risk.

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO MOVE INTO CLOSED SESSION FOR DELIBERATIONS AND ADVICE OF COUNSEL.

All parties, except administrative and counseling staff, left the room.

Returning to Open session, the Board announced the following.

Mr. Wheeler left and was not present for this portion of the meeting.

UPON REVIEW OF THE APPLICATION MADE BY THE ATTORNEY GENERAL, THE BOARD DOES NOT FIND THAT A PALPABLE DEMONSTRATION TO SUPPORT A TEMPORARY SUSPENSION HAS BEEN MADE; THE BOARD DOES FIND, HOWEVER, THAT THE ATTORNEY GENERAL HAS MADE A DEMONSTRATION THAT THE CONTINUED UNRESTRICTED PRACTICE PENDING PLENARY HEARING, MAY POSE A RISK TO THE HEALTH, SAFETY AND WELFARE OF DR. AZAM’S PATIENTS. BASED ON THAT DEMONSTRATION, THE BOARD ORDERS (AND AS SUGGESTED BY RESPONDENT) THAT DR. AZAM MAY ONLY PRACTICE IN A SUPERVISED SETTING, WITH A PHYSICIAN PRACTICE MONITOR IN PLACE. THE BOARD APPROVES DR. AZAM’S PRACTICE AT INSIGHTS WITH DR. JAMES DRURY AS MONITOR. DR. AZAM MAY ONLY PRACTICE AT SUCH TIMES THAT AT LEAST ONE OTHER PHYSICIAN AND TWO STAFF MEMBERS ARE WORKING AT THE SAME TIME; THE PRACTICE MONITOR WILL SUBMIT MONTHLY REPORTS AND WILL IMMEDIATELY REPORT ANY SOURCE OF ENGAGING IN INAPPROPRIATE CONDUCT, INCLUDING BUT NOT LIMITED TO COMPLAINTS FROM PATIENTS. DR. AZAM’S PRACTICE WILL BE LIMITED TO MALE PATIENTS ONLY, BASED ON HIS OFFER TO LIMIT HIS PRACTICE TO MALE PATIENTS ONLY. THE BOARD FURTHER ORDERS A COMPLETE PSYCHOTHERAPY EVALUATION AT THE PETERS INSTITUTE. A REPORT OF THE EVALUATION IS TO BE PROVIDED TO THE BOARD WITHIN 60 DAYS. COPIES OF ALL TRANSCRIPTS AND EVIDENCE ADMITTED FOR THE HEARING ARE TO BE PROVIDED TO THE INSTITUTE PRIOR TO DR. AZAM’S EVALUATION. THE BOARD RETAINS THE RIGHT TO RESTRICT OR AMEND ITS ORDER AT THE CONCLUSION OF THE EVALUATION .

Mr. Kern requested that the Board consider a delay in implementing the terms of the Order for two weeks to permit the transfer of Dr. Azam’s current patients.

The Attorney General opposed the request and determined that a delay posed a threat.

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO GRANT THE RESPONENT TEN DAYS TO TRANSFER EXISTING PATIENTS. IF DURING THIS TIME HE SEES FEMALE PATIENTS, A CHAPERONE MUST BE PRESENT.

OFF AGENDA ITEM:

DENDRINOS, George M.D. 25MA06789900
Jeri Warhaftig, DAG

Dr. Ciechanowski was recused from discussion and vote in this matter and left the room.

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO MOVE INTO CLOSED SESSION FOR DELIBERATIONS AND ADVICE OF COUNSEL.

All parties, except administrative and counseling staff, left the room.

Returning to Open session, the Board announced the following.

THE BOARD, UPON MOTION MADE AND SECONDED, VOTED TO PERMIT THE RESPONDENT'S SUBMISSION. ON FURTHER REVIEW, HOWEVER, IT REAFFIRMED ITS PRIOR POSITION AND RATIONALE.

Respectfully submitted,

Karen Criss, R.N., C.N.M., Chairperson
For Open Disciplinary Minutes