Decline To Sign

LICENSE NO. F-7054 In The Matter of The LICENSE OF

Before the

Shirley Persons Pigott, M.D.

Texas Medical Board

AGREED ORDER On the _______ day of ____________________, 2007, came on to be heard before the Texas Medical Board (the "Board"), duly in session, the matter of the license of Shirley Persons Pigott, M.D. ("Respondent"). On September 14, 2006, Respondent appeared in person, without counsel , at an Informal Show Compliance Proceeding and Settlement Conference in response to a letter of invitation from the staff of the Board. Katie Johnsonius represented Board staff. The Board's representatives were Keith E. Miller, M.D., a member of the Board, and Larry Buehler, a member of the District Review Committee. Upon the recommendation of the Board's representatives and with the consent of Respondent, the Board makes the following Findings of Fact and Conclusions of Law and enters this Agreed Order. FINDINGS OF FACT

The Board finds that: 1. Respondent received all notice required by law. All jurisdictional requirements have been satisfied. Respondent waives any defect in notice and any further right to notice or hearing under the Medical Practice Act, Title 3, Subtitle B, Texas Occupations Code (the "Act") or the Rules of the Board. 2. Respondent currently holds Texas Medical License No. F-7054 . Respondent was originally issued this license to practice medicine in Texas on August 24, 1980. Respondent is not licensed to practice in any other state. 3. Respondent is primarily engaged in the practice of family medicine . Respondent is not board certified. (I AM BOARD CERTIFIED!!) 4. Respondent is 58 years of age. 5. Respondent has not previously been the subject of disciplinary action by the Board. 6. On March 7, 2006, Respondent had an initial appointment with patient CH, and ordered several tests, some of which were particularly requested by CH. On March 22, 2006, CH first requested copies of her lab reports. On March 23, 2006, a member of Respondent's staff reported to CH that the lab results were all in, but that she would have to make an appointment with the Respondent to receive them. CH made several written requests for the records, including a letter quoting the Board's rule regarding a physician's duty relating to release of records. 7. Respondent did not provide CH with her lab results, or offer her a written statement regarding why Respondent would not produce them. Respondent has offered the complainant and the Board several conflicting explanations as to why she could or would not provide them. The physician provided CH with the lab report after action was taken to insure that she was no longer a patient. Had CH wanted uninterpreted lab results, she could have contacted the lab, which is under no obligation to practice medicine. 8. After Respondent learned that CH had filed a complaint with the Board regarding the records, Respondent's office sent CH a bill for $20, with a notice on it that it was overdue. When CH called the office in an attempt to learn what the bill was for, Respondent came onto the line, accused CH of being overly-demanding and rude, and hung up the phone. CH's account was actually paid in full. The board assumed the complainant's allegations were correct and did not question the physician. The board neglected to consider that the patient called at a time the physician was in with another patient; no staff were in the office; the physician had to leave a patient with an

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appointment to take the phone call. The patient refused the offer to take up the matter with staff, at a time when staff were available. After that call, Respondent had CH served with a Criminal Trespass Warning by the Victoria Police Department. Respondent stated that she had become concerned for her own safety where CH was concerned. There is no evidence that CH made or posed any sort of threat whatsoever, except by the filing of the complaint with this Board The board failed to interview doctor's staff. In responding to the Board's inquiry into reasons for the delay in producing CH's medical records, the Respondent indicated that it is her practice to hold all test results until complete results have been obtained, and then to require her patients to come into the office to receive test results in person. She indicated in her May 10, 2006, written response to the Board's investigation that she does not believe that it is the best interest of her patients to deviate from this policy. (Deviating from policy increases the risk of medical errors. The board has little interest in controlling medical errors.) Respondent explained that her policy regarding holding test results until all results have been received and the patient has come in for a follow-up appointment is not written, but that it is nonetheless known by all her staff and communicated to all patients. However, there is no credible evidence that the complainant was notified of this office policy. (The board failed to interview staff.) Respondent has cooperated in the investigation of the allegations related to this Agreed Order. Respondent's cooperation, through consent to this Agreed Order, pursuant to the provisions of Section 164.002 the Act, will save money and resources for the State of Texas. To avoid further investigation, hearings, and the expense and inconvenience of litigation, Respondent agrees to the entry of this Agreed Order and to comply with its terms and conditions. CONCLUSIONS OF LAW

Based on the above Findings of Fact, the Board concludes that: 1. The Board has jurisdiction over the subject matter and Respondent pursuant to the Act. 2. Section164.052(a)(5) of the Act authorizes the Board to take disciplinary action against Respondent based upon Respondent's unprofessional or dishonorable conduct that is likely to injure the public, in particular, the disruptive behaviors that could reasonably be expected to impact the quality of her patients' care, as described in Board Rule 190.8(2)(Q). 3. [c04-Vio Rule 165 – Med Recds]Section 164.051 (a)(3) of the Act authorizes the Board to take disciplinary action against Respondent based on Respondent's violation of Board Rule 165.2 relating to the release of medical records pursuant to written request. 4. Section 164.001 of the Act authorizes the Board to impose a range of disciplinary actions against a person for violation of the Act or a Board rule. Such sanctions include: revocation, suspension, probation, public reprimand, limitation or restriction on practice, counseling or treatment, required educational or counseling programs, monitored practice, public service, and an administrative penalty. 5. Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition of this matter through an Agreed Order. 6. Section 164.002(d) of the Act provides that this Agreed Order is a settlement agreement under the Texas Rules of Evidence for purposes of civil litigation. ORDER Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that: [g01-Chart Monitoring] 1. For a period of one year from the date of the Board's entry of this Order, Respondent's practice shall be monitored by a physician ("monitor"), in accordance with §164.001(b)(7) of the Act. a. The Compliance Division of the Board shall designate the monitor and may change the monitor at any time for any reason. The monitor shall have expertise in a similar specialty area as Respondent. The Compliance Division shall provide a copy of this Order to the monitor, together with other information necessary to assist the monitor.

b. As requested by the Compliance Division, Respondent shall prepare and provide complete legible copies of selected patient medical and billing records ("selected records"). The Compliance Division shall select records for at least 30 patients seen by Respondent during each three-month period following the last day of the month of entry of this Order ("reporting period"). The Compliance Division may select records for more than 30 patients, up to ten percent of the patients seen during a reporting period. If Respondent fails to see at least 30 patients during any three-month period, the term of this Order shall be extended until Respondent can submit a sufficient number of records for a monitor to review. 2.The monitor shall perform the following duties: a. Personally review the selected records b. Prepare written reports documenting any perceived deficiencies and any recommendations to improve Respondent's practice of medicine or assist in the ongoing monitoring process. Reports shall be submitted as requested by the Compliance Division; and 3. Perform any other duty that the Compliance Division determines will assist the effective monitoring of Respondent's practice. 4. The Compliance Division shall provide to Respondent a copy of any deficiencies or recommendations submitted by the monitor. Respondent shall implement the recommendations as directed by the Compliance Division. 5.The monitor shall be the agent of the Board, but shall be compensated by the Respondent through the Board. Such compensation and any costs incurred by the monitor shall be paid by Respondent to the Board and remitted by the Board to the monitor. Respondent shall not charge the compensation and costs paid to the monitor to any patients. 6. [i08-Specific Subject/Time to Complete]Within one year from the date on which the Board enters this Order, Respondent shall obtain ten hours of Continuing Medical Education (CME) in the area of medical recordkeeping, to be approved in advance by the Executive Director of the Board. Upon completion of the required CME, Respondent shall submit proof to the Board. A copy of attendance certificates or a detailed report that can be readily verified by the Board shall satisfy this requirement. 7. Within 90 days from the date on which the Board enters this Order, Respondent shall submit to the Board's Compliance Department written office policies relating to the office's practice and procedure for managing requests for medical records and lab reports. These written policies shall be consistent with Board Rule 165. 8. [j01-Admin Penalty] Respondent shall pay an administrative penalty in the amount of $500 within 90 days of the date of entry of this Order. The administrative penalty shall be paid in a single payment by cashier's check or money order payable to the Texas Medical Board and shall be submitted to the Director of Compliance for the Board for routing so as to be remitted to the Comptroller of Texas for deposit in the general revenue fund. Respondent's failure to pay the administrative penalty as ordered shall constitute grounds for further disciplinary action by the Board, and may result in a referral by the Executive Director of the Board for collection by the Office of the Attorney General.[i03-Specific Sub/Nos Hrs] 9. Respondent shall be permitted to supervise and delegate prescriptive authority to physician assistants and advanced practice nurses and to supervise surgical assistants. 10. The time period of this Order shall be extended for any period of time that (a) Respondent subsequently resides or practices outside the State of Texas, (b) Respondent's license is subsequently canceled for nonpayment of licensure fees, or (c) this Order is stayed or enjoined by Court Order. If Respondent leaves Texas to live or practice elsewhere, Respondent shall immediately notify the Board in writing of the dates of Respondent's departure from and subsequent return to Texas. When the period of extension ends, Respondent shall be required to comply with the terms of this Order for the period of time remaining on the extended Order. Respondent shall pay all fees for reinstatement or renewal of a license covering the period of extension. (standard paragraph- non-negotiable) 11. Respondent shall comply with all the provisions of the Act and other statutes regulating the Respondent's practice. (standard paragraph- non-negotiable)

12. Respondent shall fully cooperate with the Board and the Board staff, including Board attorneys, investigators, compliance officers, consultants, and other employees or agents of the Board in any way involved in investigation, review, or monitoring associated with Respondent's compliance with this Order. Failure to fully cooperate shall constitute a violation of this order and a basis for disciplinary action against Respondent pursuant to the Act. (standard paragraph- non-negotiable) 13.Respondent shall inform the Board in writing of any change of Respondent's mailing or practice address within ten days of the address change. This information shall be submitted to the Permits Department and the Director of Compliance for the Board. Failure to provide such information in a timely manner shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act. (standard paragraph- nonnegotiable) 14.Any violation of the terms, conditions, or requirements of this Order by Respondent shall constitute unprofessional conduct likely to deceive or defraud the public, and to injure the public, and shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act. Respondent agrees that ten days notice of a Probationer Show Compliance Proceeding to address any allegation of non-compliance of this Agreed Order is adequate and reasonable notice prior to the initiation of formal disciplinary action. Respondent waives the 30 day notice requirement provided by §164.003(b)(2) of the Medical Practice Act and agrees to 10 days notice, as provided in 22 Texas Administrative Code §187.44(4). (standard paragraph- non-negotiable) 15. The above referenced conditions shall continue in full force and effect without opportunity for amendment, except for clear error in drafting, for 12 months following entry of this Order. If, after the passage of the 12 month period, Respondent wishes to seek amendment or termination of these conditions, Respondent may petition the Board in writing. The Board may inquire into the request and may, in its sole discretion, grant or deny the petition without further appeal or review. Petitions for modifying or terminating may be filed only once a year thereafter. (standard paragraph- non-negotiable) RESPONDENT WAIVES ANY FURTHER HEARINGS OR APPEALS TO THE BOARD OR TO ANY COURT IN REGARD TO ALL TERMS AND CONDITIONS OF THIS AGREED ORDER. RESPONDENT AGREES THAT THIS IS A FINAL ORDER. (standard paragraph- non-negotiable) THIS ORDER IS A PUBLIC RECORD. (standard paragraph- non-negotiable) I, Shirley Persons Pigott, M.D. , HAVE READ AND UNDERSTAND THE FOREGOING AGREED ORDER. I UNDERSTAND THAT BY SIGNING, I WAIVE CERTAIN RIGHTS. I SIGN IT VOLUNTARILY. I UNDERSTAND THIS AGREED ORDER CONTAINS THE ENTIRE AGREEMENT AND THERE IS NO OTHER AGREEMENT OF ANY KIND, VERBAL, WRITTEN OR OTHERWISE. (standard paragraph- non-negotiable) DATED: _______________, 2007. ____________________________________ SHIRLEY PERSONS PIGOTT, M.D., Respondent STATE OF __________________ §

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SWORN TO AND ACKNOWLEDGED BEFORE ME, the undersigned Notary Public, on this _______ day of ____________________, 2007. (Notary Seal) ____________________________________ Signature of Notary Public SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this _______ day of ____________________, 2007. _______________________________________ Roberta M. Kalafut, D.O., President Texas Medical Board

Shirley Pigott MD 1412 E Red River Victoria, Texas 77901 March 29, 2007 Roberta Kalafut DO, President, Texas Medical Board PO Box 2018 Austin, Texas 78768-2018 Regarding Licensee F-7054: Shirley Pigott MD; formal response to a proposed public order. Dear Dr. Kalafut, I must decline to sign the proposed public Texas Medical Board Order delivered to my medical office at 1412 E Red River, Victoria, Texas, by certified mail on or about March 5, 2007. The complaint leading to the Board's recent order is an alleged failure to release uninterpreted lab results within 15 business days of written request by one patient (CH) who sought medical advice to assist her with health risk reduction. Determining someone's health risks requires a history, physical exam, and interpretation of medical tests, a process we explain to new patients. Ms H visited my office once, in March, 2006. After my evaluation, I ordered lab. Instead of returning for the interpretation as she had agreed to do, Ms H began calling our office. For one of her calls, I left another patient to talk with her. She demanded that I locate her financial records immediately to explain a $20 unpaid release of records charge. Literature on workplace safety reports an increased risk of violence in medical facilities. The Occupational Safety and Health Administration requires me to provide a safe working environment for my employees, myself, and my patients. Ms H's behavior alarmed me and I consulted the Victoria Police Department; the officer issued a criminal trespass warning. The Board findings of fact : "There is no evidence that CH made or posed any sort of threat whatsoever, except by the filing of the complaint with this Board". A physician directly involved in a clinical situation has an advantage over one who is not present. The Board's insensitivity to the vulnerability of a medical facility is disturbing. In several points the Order is inflammatory, exaggerated, or false. It is inconsistent with the missions of the Texas Medical Board and the Federation of State Medical Boards. Enforcement of the order would violate basic civil rights guaranteed me by the Texas and United States Constitutions. This incident is an egregious example of what is commonly termed sham peer review. Without conscience, certain members of the Board have defamed my character and have determined to cause me harm. A single question begs to be answered: What is a possible motive? The Board is aware of my family's advocacy for persons with bipolar disorder from its previous investigations of my family. The board knows my teen-age son and I have stable bipolar disorder and have been under expert care for years. My patients with psychiatric conditions are encouraged when I freely talk about how well we have coped. Although my son and I are not impaired, and although I have never been impaired, the Board continues to make regular intrusions into my personal affairs. The board has not acknowledged repeated inquiries by my own physicians and the board's appointed psychiatrist as to why their frequent reports are justified. When I questioned the TMB as to why it might be focusing its limited resources on such an inconsequential complaint as CH's, the Board's attorney remarked to no one in particular as to whether Ms H's complaint "might be related" to my bipolar disorder. Rather than speculating at my hearing, why were the two

psychiatrists the Board requires me to see several times a year not asked their expert opinions in advance? Their answers should have provided enough information to permit even an over-zealous regulatory agency to focus on matters of greater import. If something causes something else (A => B), one would expect to find at least one case where A => B. The Board has fallen short. Another option would be to trick someone into agreeing that under some theoretical circumstance "A causes B" might be a true statement. That is exactly what the Board has determined to do with regard to my bipolar disorder causing a delayed release of a single lab report, and I won't fall for it. Stating that 'not releasing a lab report to someone who could have just as easily called the lab' is 'an indication that a physician is a danger to the public' is a bit of a stretch. The Board would coerce me to waive unspecified civil rights and consent to intrusive monitoring of my patients' personal health and financial records indefinitely, at my own expense. It would deny me any right of future appeal and require me to concur with the Board's accusation that I am a danger to the health of Texans, and swear, incredibly, that I am signing it voluntarily! At my hearing, a member of the panel stated that I should "assist in paying for" the Board's investigation. Under the circumstances, the $500 'administrative penalty' the Board wishes to impose on me is extortion. I will cite two recent examples where perhaps I actually protected the good health of Texans. A personal friend, not a patient, will testify upon request as to my role in the diagnosis and successful treatment of his florid mania. I am privileged to have been present during his time of need. A young woman was recently brought to me by her worried mother after she had been in a serious motor vehicle accident. Although she was not physically hurt, she didn't remember what had happened. Two previous physicians had dismissed her concerns as 'hormones'. Fortunately I was present when she needed me. This young woman, her mother and father, and RN brother all are are satisfied with my diagnostic acumen and urgent referral to qualified care. I have included a copy of the mother's statement. The neurosurgeon at the University of Texas Health Science Center in Houston who successfully removed her temporal lobe bleeding arterio-venous malformation in a timely manner is reluctant to testify in my behalf because of his fear of retaliation by the Board. The Board's actions are so outrageous as to convince me there must be another agenda, hence my suspicions of sham peer review. Sincerely, Shirley Pigott MD