CONSENT AGREEMENT

BETWEEN
KRISTIE LYNNGIBSON
AND
THESTATEMEDICALBOARDOF OHIO
ThisConsentAgreementis enteredinto byand betweenKristieLynnGibson, [Ms. Gibson], and
the StateMedical BoardofOhio [Board],astateagencychargedwithenforcingChapter4731.,
OhioRevisedCode.
Ms. Gibsonenters into this ConsentAgreementbeingfully informedofherrights underChapter
119.,Ohio Revised Code,includingthe right to representationby counsel andtheright to a
formal adjudicativehearingon the issuesconsideredherein.
BASISFORACTION
ThisConsentAgreementis entered intoonthe basisofthe following stipulations,admissions
and understandings:
A. TheBoard is empowered by Section4731.22(B),OhioRevisedCode, to limit,
revoke,suspendacertificate,refuseto registerorreinstateanapplicant,orreprimand
orplaceonprobationtheholderofacertificateforaviolationofSection
4731.22(B)(19),OhioRevised Code,for"[i]nabilityto practiceaccordingto
acceptableand prevailingstandardsofcare by reasonofmental illnessorphysical
illness, including, butnotlimited to, physical deteriorationthatadverselyaffects
cognitive,motor,orperceptiveskills."
B. TheBoardentersintothisConsentAgreement in lieuofformal proceedingsbased
uponthe violationofSection4731.22(B)(l9),OhioRevisedCode,assetforth in
ParagraphE, below,and expresslyreservestherightto instituteformal proceedings
based uponanyotherviolationsofChapter4731. oftheRevisedCode,whether
occurringbeforeoraftertheeffectivedateofthisConsentAgreement.
C. Ms. Gibsonis applyingforalicenseto practicemassagetherapy in the StateofOhio,
and saidapplicationremainspending.
D. Ms. Gibsonstatesthat she is not licensedto practicein anyotherstateorjurisdiction.
E. Ms. Gibsonadmits that,orabout February 10,2011, shewasevaluated by Glenbeigh
Hospital [Glenbeigh],aBoard-approved assessor,for possibleinabilityto practice
issues. Byletterfrom GJenbeighdated February21,2011, theBoardwasadvised that
Ms. Gibsonwas unable to practicemassagetherapydueto PersonalityDisorder, not
CONSENTAGREEMENT
KRfSTIE LYNN GIBSON
PAGE2
otherwisespecified, butthatthe impairmentcould beaddressed by monthly therapy
sessionsforoneyear.
AGREED CONDITIONS
Wherefore, in considerationofthe foregoing and mutual promiseshereinaftersetforth, and in
lieuofany formal proceedingsatthistime,Ms. Gibsonshall be GRANTEDacertificateto
practicemassagetherapy inthe StateofOhio,provided sheotherwise meetsall statutoryand
regulatoryrequirements,anduponreceiptofall necessaryand appropriatedocumentation.
Further,Ms. Gibsonknowinglyand voluntarilyagreeswiththe Boardthatsaidcertificateto
practicemassagetherapyshall besubjectto thefollowing PROBATIONARYterms,conditions
and limitations:
1. Ms. Gibsonshallobeyall federal, state,and locallaws,and all rulesgoverningthe
practiceofmassagetherapy in Ohio.
2. Ms. Gibsonshall submitquarterlydeclarationsunderpenaltyofBoarddisciplinary
actionorcriminalprosecution, statingwhethertherehasbeencompliancewithall the
conditionsofthisConsentAgreement. Thefirstquarterlydeclarationmustbe
received in the Board'sofficeson thefirstdayofthe thirdmonthfollowing themonth
in whichthisConsentAgreementbecomeseffective,orasotherwiserequested bythe
Board. Subsequentquarterlydeclarationsmustbe received intheBoard'sofficeson
orbeforethefirstdayofeverythird month.
3. Ms. Gibsonshallappearin personfor an initial interviewbeforethefull Boardorits
designated representativeduringthethirdmonthfollowingtheeffectivedateofthis
ConsentAgreement,andannuallythereafter,exceptthatsubsequentpersonal
appearanceswhichwould routinelyoccureverythreemonthsthroughouttheduration
ofMs. Gibson'sprobationaryperiodshall be waivedbytheBoardprovidedthat Ms.
Gibsonis otherwisein full compliancewith this ConsentAgreement. Ifan
appearanceismissedoris rescheduled foranyreason,ensuingappearancesshall
revertto beingroutinelyrequired everythree monthsandshall bescheduledbasedon
theappearancedateasoriginallyscheduled.
4. Ms. Gibsonshallobtainpermissionfrom theBoard fordeparturesorabsencesfrom
Ohio. Suchperiodsofabsenceshallnotreducetheprobationaryterm, unless
otherwisedetermined bymotionoftheBoardfor absencesofthree monthsorlonger,
orby the Secretaryorthe SupervisingMemberofthe Board for absencesoflessthan
threemonths, in instanceswheretheBoardcanbeassured thatprobationary
monitoringis otherwisebeingperformed. Further,the Secretaryand Supervising
MemberoftheBoardshall have thediscretionto grantawaiverofpartorall ofthe
probationarytermssetforth in thisConsentAgreementforoccasionalperiodsof
absenceoffourteendaysorless. In theeventthat Ms. Gibsonresidesand/oris
employedata locationthatis withinfifty milesofthegeographic borderof Ohioand
CONSENTAGREEMENT
KR1STJE LYNN GIBSON
PAGE 3
any ofits contiguous states,Ms. Gibson maytravel between Ohioandthatcontiguous
statewithout seekingpriorapproval ofthe SecretaryorSupervisingMemberprovided
thatMs. Gibson is able to otherwisemaintainfull compliancewithall otherterms,
conditionsand limitationssetforth in this ConsentAgreement.
5. Tn the eventMs. Gibson is found by theSecretaryoftheBoard to havefailed to
complywithanyprovisionofthisConsentAgreement,and is so notified ofthat
deficiency in writing,suchperiod(s)ofnoncompliancewill notapplyto the reduction
ofthe probationaryperiodunderthisConsentAgreement.
MONITORING OF TREATMENT
Mental Health Treatment
6. WithinthirtydaysoftheeffectivedateofthisConsentAgreement,Ms. Gibsonshall
submitto the Boardfor its priorapproval the nameandqualificationsofapsychiatrist
ofherchoice. Uponapproval bytheBoard,Ms. Gibsonshall undergoandcontinue
psychiatrictreatment,includingindividual psychotherapy,atleastoncepermonth, or
asotherwisedirectedbythe Board, for oneyear. Ms. Gibsonshallcomplywithher
psychiatrictreatmentplan, includingtakingmedicationsas prescribedand/orordered.
Ms. Gibsonshallensurethatpsychiatricreportsareforwarded by hertreating
psychiatristto the Boardonaquarterlybasis, orasotherwisedirected by theBoard.
ThepsychiatricreportsshallcontaininformationdescribingMs. Gibson'scurrent
treatmentplanandanychangesthathavebeenmade to thetreatmentplansincethe
priorreport; Ms. Gibson'scompliancewithher treatmentplan;Ms. Gibson'smental
status;Ms. Gibson'sprogressin treatment;and resultsofany laboratorystudiesthat
havebeenconducted since thepriorreport. Ms. Gibsonshallensurethat hertreating
psychiatristimmediatelynotifiestheBoardofherfailuretocomplywithher
psychiatrictreatmentplanand/oranydeterminationthatMs. Gibsonisunableto
practicedue to herpsychiatricdisorder. It is Ms. Gibson'sresponsibilitytoensure
thatquarterly reportsarereceived in the Board'sofficesno laterthanthe duedate for
Ms. Gibson'squarterlydeclaration.
The psychotherapyrequiredas partofMs. Gibson'spsychiatrictreatmentpursuantto
thisparagraphmaybedelegated by Ms. Gibson'streatingpsychiatristto an
appropriately licensed mentalhealthprofessional approved inadvancebythe Board,
so longas Ms. Gibson'streatingpsychiatristoversees/supervisessuchpsychotherapy;
includesinformationconcerningMs. Gibson'sparticipationandprogressin
psychotherapyin hisorherquarterlyreports; and continuesto meetpersonallywith
Ms. Gibsonat leastonceeverythreemonths. Shouldthe psychotherapyrequired
pursuantto this provisionbedelegatedto alicensed mentalhealthprofessional,Ms.
Gibsonshall ensurethatpsychotherapyreportsareforwarded byhertreating licensed
mental healthprofessionalto the Boardonaquarterlybasis,oras otherwisedirected
by theBoard. Thepsychotherapy reports shall containinformationdescribingMs.
CONSENT AGREEMENT
KRJSTIE LYNN GIBSON
PAGE4
Gibson's current treatment plan and any changes that have been made to the treatment
plan since the prior report; Ms. Gibson's compliance with her treatment plan; Ms.
Gibson's mental status; Ms. Gibson's progress in treatment; and results of any
laboratory studies that have been conducted since the prior report. Ms. Gibson shall
ensure that her treating licensed mental health professional immediately notifies the
Board of her failure to comply with her psychotherapy treatment plan and/or any
determination that Ms. Gibson is unable to practice due to her psychiatric disorder.
These psychotherapy reports shall be in addition to the reports submitted by Ms.
Gibson's treating psychiatrist. It is Ms. Gibson's responsibility to ensure that all
quarterly reports are received in the Board's offices no later than the due date for Ms.
Gibson's quarterly declaration.
In the event that the designated treating psychiatrist and/or licensed mental health
professional becomes unable or unwilling to serve in this capacity, Ms. Gibson must
immediately so notify the Board in writing. In addition, Ms. Gibson shall make
arrangements acceptable to the Board for another treating psychiatrist and/or licensed
mental health professional within thirty days after the previously designated treating
psychiatrist and/or licensed mental health professional becomes unable or unwilling
to serve, unless otherwise determined by the Board. Furthermore, Ms. Gibson shall
ensure that the previously designated treating psychiatrist and/or licensed mental
health professional also notifies the Board directly of his or her inability to continue
to serve and the reasons therefore.
The Board expressly reserves the right to disapprove any psychiatrist proposed
to serve as Ms. Gibson's designated treating psychiatrist and/or any licensed
mental health professional proposed to serve as Ms. Gibson's designated
treating licensed mental health professional, or to withdraw approval of any
such psychiatrist or licensed mental health professional previously approved to
serve as Ms. Gibson's designated treating psychiatrist or licensed mental health
professional, in the event that the Secretary and Supervising Member of the
Board determine that any such psychiatrist or licensed mental health
professional has demonstrated a lack of cooperation in providing information to
the Board or for any other reason.
The Board retains the right to require, and Ms. Gibson agrees to submit, blood, urine,
breath, saliva and/or hair specimens for analysis of therapeutic levels of medications
that may be prescribed for Ms. Gibson, or for any other purpose, at Ms. Gibson's
expense upon the Board's request and without prior notice. Ms. Gibson's refusal to
submit a specimen upon request of the Board shall result in a minimum of one year of
actual license suspension. Further, the collection of such specimens shall be
witnessed by a representative of the Board, or another person acceptable to the
Secretary or Supervising Member of the Board.
CONSENTAGREEMENT
KRJSTIE LYNN GIBSON
PAGES
Releases
7. Ms. Gibsonshall provideauthorization, throughappropriate writtenconsentforms,
for disclosureofevaluativereports,summaries,and records, ofwhatevernature, by
anyand all partiesthatprovidetreatmentorevaluationfor Ms. Gibson'sfor purposes
ofcomplyingwiththis ConsentAgreement,whethersuchtreatmentorevaluation
occurred beforeoraftertheeffectivedateofthis ConsentAgreement. Totheextent
permittedby law,theabove-mentionedevaluativereports, summaries,andrecordsare
consideredmedical recordsforpurposesofSection 149.43 oftheOhioRevisedCode
andareconfidential pursuantto statute. Ms. Gibsonfurtheragreesto providethe
Boardwrittenconsentpermittinganytreatmentproviderfrom whomsheobtains
treatmentto notifytheBoardintheeventshefails to agreeto orcomplywithany
treatmentcontractoraftercarecontract. Failureto providesuchconsent,or
revocationof suchconsent,shallconstitutea violationofthis ConsentAgreement.
Required Reporting byLicensee
8. Withinthirtydays oftheeffectivedateofthis ConsentAgreement,Ms. Gibsonshall
provideacopyofthis ConsentAgreementto all employersorentitieswithwhichshe
is undercontracttoprovidehealthcareservices(includingbutnot limitedtothird
partypayors)oris receivingtraining,and theChiefofStaffateachhospital whereshe
hasprivilegesorappointments. Further,Ms. Gibsonshall promptlyprovideacopyof
thisConsentAgreementto all employersorentitieswithwhichshecontractsto
providehealthcareservices,orapplies fororreceivestraining, andthe ChiefofStaff
ateachhospital wheresheappliesfor orobtainsprivilegesorappointments. Inthe
eventthatMs. Gibsonprovidesanyhealthcareservicesorhealthcaredirectionor
medicaloversightto anyemergencymedicalservicesorganizationoremergency
medical servicesprovider, withinthirtydaysoftheeffectivedateofthisConsent
AgreementMs. Gibsonshall provideacopyof this ConsentAgreementto theOhio
DepartmentofPublic Safety, DivisionofEmergencyMedical Services. Further,Ms.
GibsonshallprovidetheBoardwithoneofthe followingdocumentsasproofof each
requirednotificationwithinthirtydays ofthedateof eachsuchnotification: (1)the
returnreceiptof certifiedmail withinthirtydaysofreceivingthatreturnreceipt, (2)an
acknowledgementofdeliverybearingtheoriginal inksignatureofthepersonto
whomacopyoftheConsentAgreementwashanddelivered, (3)theoriginal
facsimile-generatedreportconfirmingsuccessful transmissionofacopyofthe
ConsentAgreementtothepersonorentityto whomacopyoftheConsentAgreement
wasfaxed, or(4) anoriginalcomputer-generatedprintoutof electronicmail
communicationdocumentingtheemailtransmissionofacopyoftheConsent
Agreementto thepersonorentitytowhomacopyoftheConsentAgreementwas
emailed.
9. WithinthirtydaysoftheeffectivedateofthisConsentAgreement, Ms. Gibsonshall
provideacopyofthis ConsentAgreementto theproperlicensingauthorityof any
CONSENTAGREEMENT
KRfSTlE LYNN GIBSON
PAGE6
stateorjurisdictionin whichshecurrentlyholdsanyprofessional license,as well as
anyfederal agencyorentity, includingbutnotlimitedto the Drug Enforcement
Agency,through whichshecUlTently holdsany licenseorcertificate. Ms. Gibson
furtheragrees to provideacopyofthis ConsentAgreementattimeofapplication to
the properlicensingauthorityofanystatein whichsheappliesfor anyprofessional
licenseorfor reinstatementofanyprofessionallicense. Further,Ms. Gibsonshall
providetheBoard withoneofthefollowing documentsas proofofeach required
notification withinthirtydaysofthe dateofeachsuchnotification: (l)the return
receiptofcertifiedmail within thirtydaysofreceivingthatreturnreceipt, (2)an
acknowledgementofdeliverybearingthe original ink signatureofthepersonto
whomacopyoftheConsentAgreementwas handdelivered, (3) theoriginal
facsimile-generated reportconfirmingsuccessfultransmissionofacopyofthe
ConsentAgreementtothepersonorentityto whomacopyoftheConsentAgreement
wasfaxed, or(4)an originalcomputer-generatedprintoutofelectronicmail
communicationdocumentingtheemail transmissionofacopyoftheConsent
Agreementto thepersonorentityto whomacopyoftheConsentAgreementwas
emailed.
10. Ms. Gibsonshall notifytheBoard in writingofanychangeofprincipalpractice
addressorresidenceaddress withinthirtydaysofsuchchange.
FAILURE TO COMPLY
If, in the discretionofthe Secretaryand SupervisingMemberoftheBoard, Ms. Gibsonappears
to haveviolatedorbreachedanyterm orconditionofthis ConsentAgreement,theBoard
reservesthe rightto institute formaldisciplinaryproceedings for anyandall possibleviolations
orbreaches, including, but not limitedto, alleged violationsofthelawsofOhiooccurringbefore
theeffectivedateofthis ConsentAgreement.
Ifthe Secretaryand SupervisingMemberoftheBoarddeterminethatthereis clearand
convincingevidencethatMs. Gibsonhas violatedanyterm, conditionorlimitationofthis
ConsentAgreement, Ms. Gibsonagreesthattheviolation,asalleged,alsoconstitutesclearand
convincingevidencethathercontinuedpracticepresentsadangerofimmediateand seriousharm
to thepublicfor purposesofinitiatingasummarysuspension pursuantto Section4731.22(G),
OhioRevisedCode.
DURATIONIMODIFICATION OF TERMS
Ms. Gibsonshall notrequest terminationof thisConsentAgreementfor aminimumoftwoyears.
In addition, Ms. Gibson shall notrequestmodificationto the probationaryterms, limitations,and
conditionscontainedherein foratleastoneyear, exceptthatMs. Gibsonmaymakesuchrequest
with the mutual approval andjointrecommendationofthe Secretaryand SupervisingMember.
prior to signature by the Sec
last date of sign e b
and Supervising Member and shall become effective upon the

LANCE A. TALMAGE, M.D.
Secretary
DATE
4-13-//
CONSENT AGREEMENT
KRISTIE LYNN GIBSON
PAGE 7
Otherwise, the above-described terms, limitations and conditions may be amended or terminated
in writing at any time upon the agreement of both parties.
In the event that the Board initiates future formal proceedings against Ms. Gibson, including but
not limited to issuance of a Notice of Opportunity for Hearing, this Consent Agreement shall
continue in full force and effect until such time that it is superseded by ratification by the Board
of a subsequent Consent Agreement or issuance by the Board of a final Board Order.
In the event that any term, limitation, or condition contained in this Consent Agreement is
determined to be invalid by a court of competent jurisdiction, Ms. Gibson and the Board agree
that all other terms, limitations, and conditions contained in this Consent Agreement shall be
unaffected.
ACKNOWLEDGMENTSILIABILITY RELEASE
Ms. Gibson acknowledges that she has had an opportunity to ask questions concerning the terms
of this Consent Agreement and that all questions asked have been answered in a satisfactory
manner.
Any action initiated by the Board based on alleged violations of this Consent Agreement shall
comply with the Administrative Procedure Act, Chapter 119., Ohio Revised Code.
Ms. Gibson hereby releases the Board, its members, employees, agents, officers and
representatives jointly and severally from any and aJlliability arising from the within matter.
This Consent Agreement shall be considered a public record as that term is used in Section
149.43, Ohio Revised Code. Further, this information may be reported to appropriate
organizations, data banks and governmental bodies. Ms. Gibson acknowledges that her social
security number will be used if this information is so reported and agrees to provide her social
security number to the Board for such purposes.
EFFECTIVE DATE
It is expressly understood that tbis Consent Agreement is subject to ratification by the Board
CONSENT AGREEMENT
KRJSTlELYNN GIBSON
PAGE 8
EnforcementAttorney
DATE