STEPII

CONSENTAGREEMENT
BETWEEN
ZEVR. MAYCONM.D.,
AND
THESTATEMEDICALBOARDOFOHIO
This ConsentAgreementisenteredinto byand betweenZev R.MayconM.D., [Dr.Maycon],
andthe State MedicalBoardofOhio [Board], astate agency chargedwith enforcingChapter
4731., Ohio RevisedCode.
Dr.Mayconentersinto this ConsentAgreementbeing fullyinformedofhisrightsunder Chapter
119.,Ohio RevisedCode, includingthe righttorepresentationbycounselandthe right toa
formal adjudicativehearingonthe issues consideredherein.
BASISFORACTION
This ConsentAgreementisenteredinto onthe basis ofthe following stipulations,admissions
andunderstandings:
A. The BoardisempoweredbySection4731.22(B),Ohio RevisedCode, to limit,
revoke, suspendacertificate,refuse toregisterorreinstateanapplicant,orreprimand
orplace on probationthe holderofacertificateforviolationofSection
4731.22(B)(6), Ohio RevisedCode"[a] departurefrom, orthe failure toconformto,
minimalstandardsofcare ofsimilarpractitionersunderthe same orsimilar
circumstances,whetherornot actual injurytoapatientisestablished;"Section
4731.22(B)(9), Ohio RevisedCode, "[a] plea ofguilty to, ajudicialfindingofguiltof,
orajudicialfindingofeligibilityforinterventioninlieu ofconvictionfor,afelony;"
Section4731.22(B)(18),Ohio RevisedCode "[v]iolationofanyprovisionofacode
ofethicsof the Americanmedicalassociation,the Americanosteopathicassociation,
the Americanpodiatricmedicalassociation, oranyothernationalprofessional
organizationsthatthe boardspecifiesbyrule;" and/orSection4731.22(B)(26),Ohio
RevisedCode,for"impairmentof abilitytopracticeaccordingtoacceptableand
prevailingstandardsof care becauseofhabitualorexcessiveuse orabuse ofdrugs,
alcohol, orothersubstancesthat impairability to practice."
B. The Boardentersinto this ConsentAgreementinlieuofformal proceedingsbased
upon the violationsofSection4731.22(B)(6),Ohio RevisedCode; Section
4731.22(B)(9),Ohio RevisedCode; Section4731.22(B)(26),Ohio RevisedCode; and
Section4731.22(B)(18),Ohio RevisedCode, to wit: PrinciplesI,IIand IVofthe
AmericanMedicalAssociation'sPrinciplesofMedicalEthics,assetforth in
ParagraphsEthroughH,belowandtherelatedviolationsas setforth inthe StepI
STEP IICONSENTAGREEMENT
ZEVR:MAYCON, M.D.
PAGE 2
Consent AgreementBetweenZevR. Maycon,M.D.,andthe StateMedicalBoardof
Ohio,effectiveMay 14,2008[May2008StepIConsent Agreement] ,acopyof
which isattachedheretoandincorporatedherein. TheBoardexpressly reservesthe
righttoinstitute formalproceedingsbaseduponanyotherviolationsofChapter4731.
oftheRevised Code,whether occurringbeforeoraftertheeffective dateofthis
Agreement.
C. Dr.Maycon isseeking reinstatementofhiscertificate topractice medicine and
surgery,license number35.072264, whichwasindefinitely suspended, butnotless
than 18months, pursuanttothe May2008 StepIConsent Agreement.
D. Dr.Maycon statesthatheisnotlicensedtopractice inanyother stateorjurisdiction.
E. Dr.Maycon admits thatonoraboutJune30,2008,heentered inpatienttreatmentfor
chemical dependenceattheAlcoholandDrugRecoveryCenter attheCleveland
Clinic Foundation[ClevelandClinic], aBoardapproved treatmentproviderin
Cleveland,Ohio,andthathewasdischargedtreatmentcompleteonoraboutJuly28,
2008. Dr.MayconstatesandtheBoardacknowledges receipt ofinformationto
supportthathehasremainedcompliantwiththeterms ofhisaftercarecontractwith
theClevelandClinic, whichiseffectivefromonoraboutJuly23,2008,toJuly23,
2010.
F. Dr.Mayconadmits afterenteringintotheMay2008StepIConsentAgreement,onor
aboutJanuary 22,2009,intheCourtofCommonPleas, StarkCounty,Ohio,he
applied forandwasgrantedbytheCourtinterventioninlieuofconvictionafter
previouslyhaving pleadedguiltytothefelonycounts ofAggravated Traffickingin
Drugs,inviolationofSection 2925.03(A)(1)and(C)(l)(c),OhioRevised Code,and
DeceptiontoObtainDangerousDrugs,inviolationofSection 2925.22(A), Ohio
Revised Code.
G. Dr.Mayconstates andtheBoardacknowledgesthat David W.Streem,M.D.,ofthe
Cleveland Clinic, aBoard-approvedtreatmentprovider, andThomas Robb,D.O.,a
physicianwhohasbeen approvedbytheBoardforthepurposeofperforming
reinstatementassessmentsrelatedtochemical dependency, have eachprovided
writtenreports indicating thatDr.Maycon'sabilitytopractice hasbeenassessedand
thathehasbeenfound capableofpracticing accordingtoacceptable andprevailing
standards ofcare,aslongascertaintreatment andmonitoringrequirementsarein
place. Dr.Mayconstates andtheBoardacknowledgesthat onoraboutFebruary 11,
2009,the BoardreceivedareportfromDARHIL,inCleveland,Ohio,thathe
successfully completedtwelve hoursofmedicalethicscontinuingeducation, andthat
Dr.Maycon subsequentlyprovided totheBoardawritten reportdescribing whathe
learnedinthecourse andhowhewillapplyittohispractice ofmedicine.
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STEP IICONSENTAGREEMENT
. ZEVR:MAYCON, M.D.
PAGE3
H. Dr.Mayconstates andtheBoard acknowledgesreceipt ofinformationtosupportthat
Dr.Mayconhas fulfilledtheconditions forreinstatementofhiscertificatetopractice
medicine andsurgeryinthe StateofOhio,asestablishedintheabove-mentionedMay
2008 StepIConsentAgreement betweenDr.Maycon andtheBoard.
AGREED CONDITIONS
Wherefore, inconsiderationoftheforegoing andmutualpromises hereinaftersetforth,andin
lieuofanyformal proceedingsatthistime,thecertificate ofDr.Maycontopractice medicine
andsurgeryinthe StateofOhioshallbeREINSTATED, andDr.Mayconknowingly and
voluntarilyagreeswiththe BoardtothefollowingPROBATIONARYterms, conditions and
limitations:
1. Dr.Maycon shallobeyallfederal, state,andlocallaws,andallrules governingthe
practice ofmedicineinOhio,andalltermsimposed bytheCourtofCommonPleas
forStarkCounty, Ohio, incriminalcasenumber2008CR1521.
2. Dr.Maycon shall submit quarterlydeclarations underpenaltyofBoarddisciplinary
actionand/orcriminal prosecution,statingwhetherthere hasbeencompliance withall
theconditionsofthis ConsentAgreement. Thefirstquarterlydeclaration mustbe
received inthe Board'sofficesonthedatehisquarterlydeclaration would havebeen
duepursuanttohisMay2008 StepIConsent Agreement withtheBoard,oras
otherwiserequestedbytheBoard. Subsequentquarterly declarations mustbe
received intheBoard'sofficesonorbeforethefirstdayofeverythird month.
3. Dr.Maycon shallappearinperson foraninterviewbeforethefullBoardorits
designatedrepresentative. Thefirstsuchappearance shalltakeplace onthedatehis
appearancewould havebeenscheduledpursuant tohisMay2008 StepIConsent
AgreementwiththeBoard. Subsequentpersonal appearances mustoccureverythree
months thereafter,and/orasotherwiserequested bythe Board. Ifanappearanceis
missedorisrescheduledforanyreason,ensuingappearancesshallbescheduled
based ontheappearancedateasoriginallyscheduled.
4. Dr.Maycon shallobtain permissionfromtheBoardfordepartures orabsencesfrom
Ohio. Suchperiodsofabsence shallnotreducetheprobationaryterm, unless
otherwisedeterminedbymotionoftheBoardforabsencesofthree monthsorlonger,
orbythe Secretary ortheSupervising MemberoftheBoardforabsencesoflessthan
threemonths, ininstances wheretheBoardcanbeassuredthatprobationary
monitoring isotherwisebeingperformed. Further,the SecretaryandSupervising
Member ofthe Board shallhavethediscretiontograntawaiver ofpartorallofthe
probationaryterms setforthinthisConsentAgreement foroccasional periodsof
absence offourteen daysorless. IntheeventthatDr.Mayconresides and/oris
employed atalocation that iswithinfiftymilesofthegeographic borderofOhioand
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STEP IICONSENTAGREEMENT
. ZEV R:MAYCON, M.D.
PAGE 4
anyofitscontiguousstates, Dr.Mayconmaytravel betweenOhio andthatcontiguous
state withoutseekingprior approval ofthe SecretaryorSupervisingMemberprovided
that Dr.Mayconisabletootherwisemaintainfullcompliancewith allotherterms,
conditionsand limitationssetforth inthis ConsentAgreement.
5. Inthe eventDr.Mayconisfound bythe Secretary of the Boardtohavefailed to
complywith anyprovisionofthis ConsentAgreement,andissonotifiedofthat
deficiencyinwriting, suchperiod(s)ofnoncompliancewill not applytothereduction
ofthe probationaryperiodunderthis ConsentAgreement.
MONITORING OF REHABILITATION AND TREATMENT
Drug Associated Restrictions
6. Dr.Mayconshallkeep alogofallcontrolledsubstancesprescribed. Such logshallbe
submitted,inthe format approvedbythe Board, onthe date upon which
Dr.Maycon'squarterlydeclarationisdue,orasotherwisedirectedbythe Board.
Further, Dr.Mayconshallmake hispatientrecords withregard to suchprescribing
availableforreviewbyanagent of the Board immediatelyuponrequest.
7. Dr.Mayconshall not, withoutprior Board approval, administer,personallyfurnish, or
possess(exceptasallowedunderParagraph8below) anycontrolledsubstancesas
definedbystate or federal law. Intheevent thatthe Boardagrees atafuturedateto
modifythis ConsentAgreementtoallow Dr.Maycon toadministerorpersonally
furnish controlledsubstances,Dr.Mayconshallkeep alogofallcontrolled
substancesprescribed,administeredorpersonallyfurnished. Such logshall be
submittedinthe format approvedbytheBoard andshall besubmittedtotheBoard no
laterthanthe date uponwhichDr.Maycon'squarterly declarationisdue,oras
otherwisedirectedbytheBoard. Further, Dr.Maycon shallmake his patientrecords
withregard to such prescribing,administering,orpersonallyfurnishingavailable for
reviewbyanagent oftheBoard immediatelyuponrequest.
Sobriety
8. Dr.Mayconshall abstaincompletelyfromthe personal useorpersonalpossessionof
drugs, exceptthoseprescribed,dispensedoradministeredtohim byanotherso
authorizedbylawwho has fullknowledgeofDr.Maycon'shistory ofchemical
dependency. Further,inthe event that Dr.Maycon issoprescribed,dispensedor
administeredanycontrolledsubstance, carisoprodol,ortramadol,Dr.Maycon shall
notify the Boardinwritingwithinsevendays,providingthe Board withtheidentity of
theprescriber;the name ofthedrug Dr.Maycon received;themedicalpurposefor
whichhereceivedsaid drug;the date suchdrug was initiallyreceived; andthe dosage,
amount,numberofrefills, anddirectionsforuse. Further, withinthirty daysofthe
date said drug issoprescribed,dispensed,oradministeredtohim, Dr.Maycon shall
STEPIICONSENTAGREEMENT
. ZEVR. MAYCON, M.D.
PAGE 5
providethe Boardwith eitheracopyofthe written prescriptionorother written
verificationfrom the prescriber,including the dosage, amount,numberofrefills, and
directionsforuse.
9. Dr.Mayconshall abstaincompletelyfromtheuseofalcohol.
Drug and Alcohol Screens/DrugTesting Facility and Collection Site
10. Dr.Mayconshall submittorandom urine screeningsfordrugs and alcohol atleast
two times per month, orasotherwisedirected bythe Board. Dr.Maycon shallensure
that allscreeningreportsareforwardeddirectlytothe Boardonaquarterly basis. The
drugtestingpanelutilizedmust beacceptabletothe Secretaryofthe Board, andshall
includeDr.Maycon'sdrug(s) ofchoice. Further, Dr.Mayconshall ensurethat
additionaltestingofurine specimensforFentanyl isdone onarandombasisto
include atleast one specimeneachmonth.
Dr.Mayconshall abstainfromthe useofanysubstanceandthe consumptionofpoppy
seeds oranyotherfood orliquid that mayproducealow level positiveresult ina
toxicologyscreen. Dr.Maycon acknowledgesthat heunderstandsthat the
consumptionoruseofsuch substances,including butnot limitedto substancessuch
asmouthwashorhand cleaninggel,maycause apositivedrug screenthat maynotbe
ableto bedifferentiatedfrom intentionalingestion, andthereforesuchconsumptionor
useisprohibitedunderthis ConsentAgreement.
Allsuch urine screeningsfordrugs andalcohol shall beconductedthroughaBoard-
approveddrug testingfacility andcollectionsitepursuanttothe global contract
betweensaidfacility andthe Board,thatprovidesforthe Boardtomaintainultimate
controlover the urine screeningprocess andtopreservethe confidentialityofall
positivescreeningresults inaccordancewith Section4731.22(F)(5),OhioRevised
Code, andthe screeningprocess shallrequire adailycall-inprocedure. Further, inthe
eventthat the Boardexercisesitsdiscretion,asprovidedinParagraph 11below, to
approveurine screeningstobeconductedatanalternativedrugtesting facilityand/or
collectionsiteorasupervisingphysician, suchapprovalshall beexpresslycontingent
upon the Boardretainingultimatecontrol over theurine screeningprocess ina
mannerthat preservesthe aforementionedconfidentialityofallpositivescreening
results.
Dr.Mayconshall submit,athisexpense andonthedayselected,urine specimensfor
drugand/oralcoholanalysis. All specimenssubmittedbyDr.Mayconshallbe
negative,exceptforthose substancesprescribed,administered,ordispensedtohim in
conformancewith theterms,conditionsandlimitationssetforth inthis Consent
Agreement. Refusalto submitsuch specimen,orfailure to submitsuchspecimenon
the dayheisselectedorinsuch manner asthe Board mayrequest, shallconstitutea
violationofthis ConsentAgreement.
STEP II CONSENT AGREEMENT
. ZEV R. MAYCON, M.D.
PAGE 6
Further, within thirty days of the effective date of this Consent Agreement, Dr.
Maycon shall enter into the necessary financial and/or contractual arrangements with
the Board-approved drug testing facility and/or collection site in order to facilitate the
urine screening process in the manner required by this Consent Agreement. Further,
Dr. Maycon shall promptly provide to the Board written documentation of completion
of such arrangements, including a copy of any contract entered into between Dr.
Maycon and the Board-approved drug testing facility and/or collection site. Dr.
Maycon's failure to timely complete such arrangements, or failure to timely provide
written documentation to the Board of completion of such arrangements, shall
constitute a violation of this Consent Agreement. However, Dr. Maycon and the
Board further agree that in the event Dr. Maycon previously entered into the
aforementioned financial and contractual agreements pursuant to the requirements of
a prior consent agreement with the Board under which Dr. Maycon is currently
participating in an ongoing urine screening process, then this requirement shall be
waived under the instant consent agreement.
Dr. Maycon shall ensure that the urine screening process performed through the
Board-approved drug testing facility and/or collection site requires a daily call-in
procedure; that the urine specimens are obtained on a random basis; and that the
giving of the specimen is witnessed by a reliable person. In addition, Dr. Maycon and
the Board-approved drug testing facility and collection site shall assure that
appropriate control over the specimen is maintained and shall immediately inform the
Board of any positive screening results.
Dr. Maycon shall ensure that the Board-approved drug testing facility and/or
collection site provides quarterly reports to the Board, in a format acceptable to the
Board, verifying whether all urine screens have been conducted in compliance with
this Consent Agreement, and whether all urine screens have been negative.
In the event that the Board-approved drug testing facility and/or collection site
becomes unable or unwilling to serve as required by this Consent Agreement, Dr.
Maycon must immediately notify the Board in writing, and make arrangements
acceptable to the Board pursuant to Paragraph 11 below, as soon as practicable. Dr.
Maycon shall further ensure that the Board-approved drug testing facility and/or
collection site also notifies the Board directly of its inability to continue to serve and
the reasons therefore.
Dr. Maycon acknowledges that the Board expressly reserves the right to withdraw its
approval of any drug testing facility and/or collection site in the event that the
Secretary and Supervising Member of the Board determine that the drug testing
facility and/or collection site has demonstrated a lack of cooperation in providing
information to the Board or for any other reason.
STEP IICONSENTAGREEMENT
ZEVR.MAYCON, M.D.
PAGE?
11. Dr.Mayconandthe Board agreethatit istheintent ofthis ConsentAgreementthat
Dr.Mayconshall submithisurine specimens totheBoard-approveddrugtesting
facility and collectionsite chosen bytheBoard. However,intheevent thatutilizing
saidBoard-approveddrugtestingfacility and/or collectionsitecreates an
extraordinaryhardshipupon Dr.Maycon, asdeterminedinthe solediscretionofthe
Board, then subjecttothefollowing requirements,the Board mayapprove analternate
drugtestingfacility and/orcollectionsite,orasupervisingphysician,tofacilitate the
urine screeningprocessforDr.Maycon:
a. Withinthirty daysofthedate uponwhichDr.MayconisnotifiedoftheBoard's
determinationthat utilizingtheBoard-approveddrugtestingfacility and/or
collectionsite constitutesanextraordinaryhardshipupon Dr.Maycon, heshall
submittothe Board inwriting foritspriorapprovalthe identityofeither an
alternatedrug testingfacilityandcollectionsite,orthename ofaproposed
supervisingphysician,towhom Dr.Mayconshallsubmittherequiredurine
specimens. Inapprovingafacility, entity, oranindividualto serveinthis
capacity, the Board will givepreferencetoafacility locatednearDr.Maycon's
residenceoremploymentlocation, ortoaphysicianwhopracticesinthesame
locale asDr.Maycon. Dr.Mayconshallensure thatthe urine screeningprocess
performedthroughthe alternate drugtesting facility and/orcollectionsite,or
throughthe supervisingphysician, requires adailycall-inprocedure;thatthe
urine specimensareobtainedonarandombasis; andthat thegiving ofthe
specimeniswitnessedbyareliable person. Inaddition,Dr.Maycon
acknowledgesthatthealternate drugtesting facility andcollectionsite,orthe
supervisingphysician,shallassurethat appropriatecontroloverthe specimenis
maintainedand shall immediatelyinformtheBoard ofanypositivescreening
results.
b. Dr.Mayconshall ensure thatthealternate drug testingfacility and/or collection
site, orthe supervisingphysician,providesquarterlyreports totheBoard, ina
format acceptabletotheBoard, verifying whetherallurine screens havebeen
conductedincompliancewiththis ConsentAgreement,andwhetherallurine
screens have beennegative.
c. Intheeventthat thedesignatedalternate drugtestingfacility and/or collection
site, orthe supervisingphysician, becomesunable orunwillingto soserve,Dr.
Mayconmustimmediatelynotifythe Board inwriting. Dr.Mayconshallfurther
ensure that the previouslydesignatedalternate drugtestingfacility and
collectionsite, orthesupervisingphysician, alsonotifiestheBoard directlyof
the inabilitytocontinuetoserveandthereasons therefore. Further, inorderto
ensurethat there will benointerruptioninhisurine screeningprocess, uponthe
previouslyapprovedalternate drugtesting facility, collectionsite,orsupervising
physicianbecomingunabletoserve,Dr.Mayconshall immediatelycommence
urine screeningattheBoard-approveddrugtestingfacility andcollectionsite
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STEP IICONSENTAGREEMENT
, ZEV R.MAYCON, M.D.
PAGE 8
chosenbythe Board, until suchtime, ifany,that the Board approvesa
subsequentalternatedrugtesting facility, collectionsite, orsupervising
physician,ifrequestedbyDr.Maycon.
d. TheBoardexpresslyreserves theright todisapproveanyentity orfacility
proposedto serve asDr.Maycon'sdesignatedalternatedrug testing facility
and/orcollectionsite,oranyperson proposedto serve ashis supervising
physician,ortowithdrawapproval ofanyentity, facility orpersonpreviously
approvedto soserve inthe eventthatthe Secretaryand SupervisingMember of
the Boarddeterminethatanysuchentity,facility orpersonhasdemonstrateda
lackofcooperationinprovidinginformationtotheBoardorforanyother
reason.
e. Inthe event that the Board approvedanalternatedrugtesting facility and/or
collectionsite, orasupervisingphysician, pursuanttotheMay2008 StepI
ConsentAgreementbetweenDr.Maycon andthe Board, Dr.Maycon andthe
Board agree that theentity, facility orpersonpreviouslyapprovedbythe Board
tososerve pursuanttotheMay2008 StepIConsentAgreementishereby
approvedto continueasDr.Maycon'sdesignatedalternatedrug testing facility
andcollectionsiteorashis supervisingphysicianunderthis Consent
Agreement.
12. All screeningreportsrequiredunderthis ConsentAgreementfromtheBoard-
approveddrug testingfacility and/orcollectionsite,orfrom thealternatedrugtesting
facility and/orcollectionsiteorsupervisingphysician,must bereceivedinthe
Board'sofficesnolater than theduedate forDr.Maycon'squarterlydeclaration. It is
Dr. Maycon'sresponsibilitytoensurethat reports aretimely submitted.
13. The Board retainstheright torequire, andDr. Maycon agrees tosubmit, blood, urine,
breath, salivaand/orhair specimensforscreening fordrugs andalcohol, foranalysis
oftherapeuticlevels ofmedicationsthatmaybeprescribedforDr.Maycon, orforany
otherpurpose,atDr. Maycon'sexpense uponthe Board'srequestandwithoutprior
notice. Dr.Maycon'srefusal to submit aspecimenuponrequestofthe Boardshall
result inaminimumofoneyearofactual license suspension. Further, thecollection
ofsuch specimensshall bewitnessedbyarepresentativeofthe Board, oranother
personacceptabletotheSecretaryorSupervisingMemberoftheBoard.
Monitoring Physician
14. Before engaginginanymedicalpractice, Dr.Maycon shall submittothe Board in
writingthename andcurriculumvitae ofamonitoringphysicianforprior written
approvalbythe SecretaryorSupervisingMemberofthe Board. Inapprovingan
individualto serve inthis capacity, the Secretaryand SupervisingMemberwill give
preferencetoaphysicianwho practicesinthe samelocale asDr. Maycon andwho is
STEP IICONSENTAGREEMENT
, ZEV R:MAYCON, M.D.
PAGE 9
engagedinthe sameorsimilarpracticespecialty.
The monitoringphysicianshall monitorDr.Maycon and his medical practice, and
shallreviewDr.Maycon'spatientcharts. The chartreviewmaybedone onarandom
basis, with the frequencyandnumberofchartsreviewedtobedeterminedbythe
Board.
Further, the monitoringphysicianshallprovidethe Board with reports onthe
monitoringofDr.Mayconandhismedical practice,andonthereviewof
Dr. Maycon'spatientcharts. Dr.Maycon shall ensure thatthereportsareforwarded
tothe Boardonaquarterlybasis andarereceived inthe Board'soffices nolaterthan
the due date for Dr.Maycon'squarterly declaration.
Inthe eventthat the designatedmonitoringphysicianbecomesunable orunwillingto
serve inthis capacity, Dr.Maycon must immediatelysonotify the Board inwriting.
Inaddition, Dr. Mayconshallmake arrangementsacceptabletothe Boardforanother
monitoringphysicianwithinthirtydaysafterthe previouslydesignatedmonitoring
physicianbecomesunable orunwillingto serve, unless otherwisedeterminedbythe
Board. Furthermore,Dr.Maycon shallensure that thepreviouslydesignated
monitoringphysicianalso notifies theBoard directlyofhis orher inabilitytocontinue
to serveand the reasonstherefore.
The Boardexpresslyreservestherighttodisapproveanypersonproposedto
serve asDr.Maycon'sdesignatedmonitoringphysician,ortowithdraw
approval ofanypersonpreviouslyapprovedtoserve asDr.Maycon's
designatedmonitoringphysician, intheevent that the Secretaryand Supervising
Memberofthe Boarddeterminethatanysuchmonitoringphysicianhas
demonstratedalack ofcooperationinprovidinginformationtotheBoardorfor
anyother reason.
Rehabilitation Program
15. Dr.Mayconshall maintainparticipationinanalcohol anddrug rehabilitation
program, such asA.A., N.A., C.A., orCaduceus, no lessthan three times perweek.
Substitutionofanyother specificprogrammust receiveprior Board approval.
Dr.Mayconshall submitacceptabledocumentaryevidenceofcontinuingcompliance
withthis program,includingsubmissiontotheBoardofmeetingattendancelogs,
whichmustbereceivedinthe Board'soffices nolaterthanthe duedatefor
Dr.Maycon'squarterlydeclarations.
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STEP IICONSENTAGREEMENT
, ZEV R'. MAYCON,M.D.
PAGE 10
Aftercare
16. Dr. Mayconshall contactanappropriateimpairedphysicianscommittee,approvedby
the Board,to arrangefor assistance inrecoveryoraftercare.
17. Dr. Mayconshall maintaincontinuedcompliancewiththe termsofthe aftercare
contractenteredinto withaBoard-approvedtreatmentprovider,providedthat, where
termsofthe aftercarecontractconflictwithtermsof this ConsentAgreement,the
termsofthis ConsentAgreementshall control.
Releases
18. Dr. Mayconshall provideauthorization,throughappropriatewrittenconsentforms,
for disclosureofevaluativereports, summaries,and records, ofwhatevernature, by
any and allpartiesthatprovidetreatmentorevaluationfor Dr. Maycon'schemical
dependencyorrelatedconditions,orforpurposesofcomplyingwiththis Consent
Agreement,whethersuch treatmentorevaluationoccurredbeforeor after the
effectivedate ofthisConsentAgreement. Tothe extentpermittedbylaw,the above-
mentionedevaluativereports, summaries,andrecordsare consideredmedicalrecords
for purposesofSection 149.43 ofthe Ohio RevisedCodeand areconfidential
pursuantto statute. Dr. Mayconfurtheragrees toprovidethe Boardwrittenconsent
permittinganytreatmentproviderfrom whomheobtainstreatmenttonotify the
Boardinthe eventhe fails to agree to orcomplywithanytreatmentcontractor
aftercarecontract. Failureto providesuch consent,orrevocationofsuchconsent,
shall constituteaviolationof this ConsentAgreement.
RequiredReportingby Licensee
19. Withinthirtydays ofthe effectivedate of this ConsentAgreement,Dr.Mayconshall
provideacopy ofthisConsentAgreementtoall employersorentitieswith whichhe
is undercontractto providehealthcare services(includingbut not limitedtothird
partypayors)or isreceivingtraining,and the ChiefofStaffateachhospitalwherehe
has privilegesorappointments. Further,Dr. Mayconshall promptlyprovideacopy
ofthis ConsentAgreementto all employersorentitieswithwhichhecontractsto
providehealthcare services,or appliesfororreceivestraining,andthe ChiefofStaff
ateachhospitalwherehe appliesfororobtainsprivilegesor appointments. Inthe
eventthatDr. Mayconprovidesanyhealthcare servicesorhealthcare directionor
medicaloversightto any emergencymedicalservicesorganizationoremergency
medicalservicesprovider,withinthirty daysoftheeffectivedate ofthis Consent
AgreementDr. Mayconshall provideacopy ofthisConsentAgreementtothe Ohio
DepartmentofPublicSafety, DivisionofEmergencyMedicalServices. Further,Dr.
Mayconshall providethe Boardwithone ofthefollowingdocumentsasproofofeach
requirednotificationwithinthirtydaysofthe date ofeachsuchnotification: (l)the
returnreceiptofcertifiedmail withinthirty days ofreceivingthatreturnreceipt,(2)an
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STEP IICONSENTAGREEMENT
. ZEVR. MAYCON, M.D.
PAGE 11
acknowledgementofdeliverybearing theoriginal ink signatureofthepersonto
whomacopy ofthe ConsentAgreementwashand delivered, (3)theoriginal
facsimile-generatedreportconfirmingsuccessful transmissionofacopyofthe
ConsentAgreementtothe personorentitytowhom acopyof the ConsentAgreement
wasfaxed, or(4) anoriginal computer-generatedprintoutofelectronicmail
communicationdocumentingtheemailtransmissionofacopyofthe Consent
Agreementtothe personorentitytowhom acopyofthe ConsentAgreementwas
emailed.
20. Withinthirtydays ofthe effectivedateofthis ConsentAgreement,Dr.Maycon shall
provideacopy ofthis ConsentAgreementtothe proper licensingauthorityofany
stateorjurisdictioninwhichhecurrently holds anyprofessionallicense, aswellas
anyfederal agency orentity, includingbutnot limited tothe Drug Enforcement
Agency, throughwhichhecurrentlyholds anylicense orcertificate. Dr.Maycon
further agrees to provideacopyofthis ConsentAgreementattime ofapplicationto
the properlicensingauthorityofanystateinwhich heapplies foranyprofessional
license orforreinstatementofanyprofessionallicense. Further,Dr. Maycon shall
providethe Boardwith oneofthefollowing documentsasproofofeachrequired
notificationwithinthirty daysof thedateofeach suchnotification: (1)thereturn
receiptofcertifiedmail within thirtydaysofreceivingthat returnreceipt, (2)an
acknowledgementofdeliverybearing theoriginal ink signatureofthe personto
whom acopy ofthe ConsentAgreementwashanddelivered,(3)the original
facsimile-generatedreportconfirmingsuccessfultransmissionofacopyofthe
ConsentAgreementtothepersonorentitytowhomacopyofthe ConsentAgreement
wasfaxed, or(4) anoriginal computer-generatedprintoutofelectronicmail
communicationdocumentingtheemailtransmissionofacopyof the Consent
Agreementtothe personorentitytowhom acopyofthe ConsentAgreementwas
emailed.
21. Dr.Mayconshall promptlyprovide acopyofthis ConsentAgreementtoallpersons
andentitiesthat provideDr.Maycon chemical dependencytreatmentormonitoring.
Further,Dr.MayconshallprovidetheBoard withoneof the followingdocumentsas
proofofeach requirednotificationwithinthirty daysofthedate ofeach such
notification: (1)the returnreceipt ofcertified mailwithinthirty daysofreceiving that
return receipt,(2) anacknowledgementofdeliverybearingthe original inksignature
ofthe personto whomacopyoftheConsentAgreementwashand delivered, (3)the
original facsimile-generatedreport confirmingsuccessfultransmissionofacopyof
the ConsentAgreementtothe person orentitytowhom acopyofthe Consent
Agreementwasfaxed, or(4)anoriginal computer-generatedprintoutofelectronic
mail communicationdocumentingtheemailtransmissionofacopyoftheConsent
Agreementtothe personorentitytowhom acopyofthe ConsentAgreementwas
emailed.
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STEP IICONSENTAGREEMENT
. ZEV R:. MAYCON, M.D.
PAGE 12
22. Dr. Mayconshall notify the Board inwriting ofanychange ofprincipalpractice
addressorresidenceaddresswithinthirtydaysofsuch change.
FAILURE TO COMPLY
If,inthediscretionof the Secretaryand SupervisingMemberofthe Board, Dr.Maycon appears
tohaveviolatedorbreachedanyterm orconditionof this ConsentAgreement,the Board
reserves theright to instituteformal disciplinaryproceedingsforanyandallpossibleviolations
orbreaches, including,butnot limitedto,alleged violationsof the lawsofOhiooccurringbefore
the effective date ofthis ConsentAgreement.
If the Secretary and SupervisingMemberoftheBoard determinethat there isclearand
convincingevidencethat Dr.Mayconhas violatedanyterm, conditionorlimitationofthis
ConsentAgreement,Dr. Mayconagreesthat theviolation,asalleged, also constitutesclearand
convincingevidencethat hiscontinuedpracticepresentsadanger ofimmediateandserious harm
tothepublic forpurposesofinitiatingasummary suspensionpursuantto Section4731.22(0),
OhioRevised Code.
DURATIONIMODIFICATION OF TERMS
Dr.Maycon shall notrequestterminationofthis ConsentAgreementforaminimumoffive
years. Inaddition,Dr.Mayconshall notrequest modificationtotheprobationaryterms,
limitations,andconditionscontainedherein foratleastoneyear. Otherwise,the above-described
terms, limitationsandconditionsmaybeamendedorterminatedinwritingatanytime uponthe
agreementofboth parties.
Inthe eventthatthe Boardinitiatesfuture formal proceedingsagainstDr.Maycon, including but
not limited to issuanceofaNoticeofOpportunityforHearing, this ConsentAgreementshall
continueinfull force andeffectuntil suchtime thatitissupersededbyratificationbytheBoard
ofasubsequentConsentAgreementorissuance bytheBoard ofafinal Board Order.
ACKNOWLEDGMENTSILIABILITY RELEASE
Dr.Maycon acknowledgesthat hehashadanopportunitytoask questionsconcerningtheterms
ofthis ConsentAgreementand that allquestionsasked have beenansweredinasatisfactory
manner.
Anyaction initiatedbythe Boardbased onalleged violationsof this ConsentAgreementshall
complywith theAdministrativeProcedureAct, Chapter 119.,Ohio RevisedCode.
Dr.Maycon herebyreleasesthe Board, itsmembers,employees,agents, officersand
representativesjointlyand severallyfromanyandall liability arising from thewithinmatter.
STEP IICONSENTAGREEMENT
.ZEVR.MAYCON, M.D.
PAGE 13
This ConsentAgreementshall beconsideredapublic record asthat term isused in Section
149.43, OhioRevisedCode. Further, this informationmaybereportedtoappropriate
organizations,databanks and governmentalbodies. Dr.Maycon acknowledgesthat his social
securitynumberwill beused ifthis informationissoreported and agrees toprovidehis social
securitynumbertothe Boardfor suchpurposes.
EFFECTIVEDATE
It isexpressly understoodthatthis ConsentAgreementissubjecttoratificationbythe Board
priortosignaturebythe Secretaryand SupervisingMemberand shall becomeeffectiveuponthe
lastdate ofsignaturebelow.
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MARCIEPASTRICK
EnforcementAttorney
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