Disciplinary Action against
V. John Gonino, D.O.
Stephen Barrett, M.D.
In 2013 and 2015, V. John Gonino, D.O., who operates the Gonino Center for Healing in Heath, Texas, signed mediated agreed orders to settle charges by the Texas Medical Board that he improperly treated five patients. The 2013 order (shown below), which settled charges related to four patients, states that (a) his records were inadequate, (b) he had failed to address the patients' underlying problems, and (c) he had prescribed "alternative therapies" without appropriate supporting laboratory evidence or informed consent. The treatment included chelation therapy and other intravenous infusions. The agreement required Gonino to revise his disclosure and consent forms, pass a medical jurisprudence examination, complete a record keeping course, and take continuing education courses in integrative medicine, billing, and ethics. The 2015 order settled charges that he had improperly treated a woman with metastatic ovarian cancer. The complaint stated that Gonino (a) said he would "detox her toxins as an alternative to chemo and radiation" and (b) had administered vitamin C, superoxide dismutase, coffee enemas, multicleanse, and chelation therapy, none of which were appropriate or effective." Because the fifth patient's situation pre-dated and was similar to the cases covered in the 2013 order, the board issued a reprimand but imposed no additionalk requirements and said that the action should not be considered to be an independent disciplinary action.
LICENSE NO. J-2032
IN THE MATTER OF THE
V. JOHN GONINO, D.O.
TEXAS MEDICAL BOARD
MEDIATED AGREED ORDER
On the 12 day of April, 2013, came on to be heard before the Texas Medical Board (the "Board"), duly in session, the matter of the license ofV. John Gonino, D.O. ("Respondent").
On October 1, 2010, Respondent appeared by telephone, with counsel Vernon L. Krueger, at an Informal Show Compliance Proceeding and Settlement Conference ("ISC") in response to a letter of invitation from the staff of the Board. The Board's representatives were Timothy Webb, a member of the Board, and Roberta Kalafut, D.O., a member of a District Review Committee. Darrin Dest represented Board staff. Joseph M. Tabaracci prepared this Agreed Order. This matter did not settle and was referred to the State Office of Administrative Hearings ('SOAH").
A second ISC was held on May 23, 2012 in response to a letter of invitation from the staff of the Board. The Board's representatives were, Leah Mabry, M.D. and David Miller, members of a District Review Committee. Christopher Palazola represented Board Staff.
A formal complaint was subsequently filed at the State Office of Administrative Hearings ("SOAH"). Prior to the matter going to hearing the matter was referred to SOAH mediation. As a result of said mediation this order was agreed upon. Allan Shulkin, M.D. represented the Board at the Mediated Settlement Conference. Respondent appeared in person, with counsel Timothy Weitz. Christopher M. Palazola represented Board staff.
Board staff initially charged that Respondent failed to properly diagnose and treat four patients. Board staff charged that Respondent had inadequate medical records and failed to address the underlying complaints of these patients. In addition, Respondent prescribed alternative therapies without objective labs showing adequate indication, and without the informed consent of the patient.
Respondent was also initially charged with prescribing to family members and individuals in which he had a close personal relations without adequate medical records or medical justification for the prescriptions. While Respondent acknowledges treating family members, employees and family members of employees, it was also determined by the Panel that Respondent's office staff may have generated false prescriptions under Respondent's prescribing authority.
Respondent has not previously been the subject of disciplinary action by the Board.
Upon the recommendation of the Board's representatives and with the consent of Respondent, the Board makes the following Findings and Conclusions of Law and enters this Agreed Order.
The Board finds the following:
1. General Findings:
- 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.
- Respondent currently holds Texas Medical License No. J-2032. Respondent was originally issued this license to practice medicine in Texas on November 14, 1992.
- Respondent is primarily engaged in the practice of family medicine. Respondent is board-certified by the American Osteopathic Board of Family Medicine.
- Respondent is 49 years of age.
2. Specific Board Findings:
- Respondent saw each of these patients at issue for various complaints, and diagnosed various conditions including hyperlipidemia, peripheral vascular disease, throat congestion, heavy metal toxicity, fungal infections and toxic exposure.
- Respondent never confirmed the patients' diagnoses with objective measures, and had no objective means of measuring the benefits of his ongoing treatment.
- Respondent treated family members, employees and family members of employees, including the prescription of controlled substances for periods of more than 72 hours.
- Respondent initiated treatment, including IV therapy and chelation therapy, based on his clinical opinion rather than objective evidence. In a number of cases the diagnoses were disproven by both conventional lab testing and evaluations made by other physicians.
- Respondent's consent forms for IV therapy and chelation therapy were inadequate in that they failed to actually document risks with regard to the treatment chosen and followed by Respondent.
3. Mitigating Factors
- Respondent provided statements from the patients that they were satisfied with their therapy.
- The prescriptions issued for family members and employees were for small quantities and limited periods of time, and there were some medical records associated with some of these prescriptions.
- Respondent has incorporated a new informed consent form consistent with Board rule 200.
- 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:
I. The Board has jurisdiction over the subject matter and Respondent pursuant to the Act.
2. 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: 165.1, requiring the maintenance of adequate records, and Board Rule 200, relating to the practice of alternative and complementary medicine.
3. Section 164.051(a)(6) of the Act, as further defined by Board Rule 190.8(1)(C), failure to exercise diligence in one's professional practice, authorizes the Board to take disciplinary action against Respondent, and 190.8(1)(M), inappropriate prescription of dangerous drugs or controlled substances to oneself, family members, or others in which there is a close personal relationship.
4. Section 164.053(a)(8) of the Act authorizes the Board to take disciplinary action against Respondent based on his failing to supervise adequately the activities of those acting under his supervision.
5. 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.
6. Section 164.002(a) of the Act authorizes the Board to resolve and make a disposition of this matter through an Agreed Order.
7. 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.
Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that Respondent shall be subject to the following terms and conditions: Within one (1) year from the date of entry of this Agreed Order, Respondent shall attend and participate a nationally or internationally recognized conference specifically for Integrative medicine which includes 17 hours of Category 1 CME, approved in advance by the Executive Director of the Board. To obtain approval for the conference, Respondent shall submit in writing to the Compliance Division of the Board information on the conference to include at least a reasonably detailed description of the conference content, presenters, location and dates. Respondent shall submit document of attendance and successful completion of this requirement to the Compliance Division of the Board, on or before the expiration of the time limit set forth for attendance of the conference.
2. Respondent shall revise the disclosure and consent forms that are documented in the patient records to include information to the patient that includes the following:
- The objectives, expected outcomes, or goals of the proposed treatment, such as functional improvement, pain relief, or expected psychosocial benefit;
- The risks and benefits of the proposed treatment;
- The extent the proposed treatment could interfere with any ongoing or recommended medical care; and
- A description of the underlying therapeutic basis or mechanism of action of the proposed treatment, written in a manner understandable to the patient, and that includes a statement whether or not the treatment is approved by the United States Food and Drug Administration.
3. Within one year following the date of the entry of this Order, Respondent shall take and pass with a score of 75 or above the Medical Jurisprudence Examination ("JP Exam") given by the Texas Medical Board. Respondent is allowed three attempts to successfully pass each of these examinations.
Respondent's failure to take and pass the JP Exam within three attempts within one year following the date of the entry of this Order shall constitute a violation of this Agreed Order. After a committee of the Board or a panel of Board representatives (Board Representatives), has considered the information related to Respondent's violation of this provision and has determined that Respondent has not fulfilled the requirements of this provision, Respondent's medical license shall be IMMEDIATELY SUSPENDED pursuant to correspondence to Respondent from the Executive Director or Secretary-Treasurer of the Board indicating that Board Representatives have considered the information related to Respondent's violation of this provision and have determined that Respondent has not fulfilled the requirements of this provision. Although Respondent shall be invited to provide information or testimony to the Board Representatives, Respondent specifically waives any administrative due process under the Medical Practice Act, or the Administrative Procedure Act, for the Board Representatives to consider this information. THIS SUSPENSION SHALL BE EFFECTIVE WITHOUT THE NEED FOR A HEARING AT THE STATE OFFICE OF ADMINISTRATIVE HEARINGS OR OTHER ADMINISTRATIVE DUE PROCESS UNDER THE MEDICAL PRACTICE ACT OR THE ADMINISTRATIVE PROCEDURE ACT, AND RESPONDENT SPECIFICALLY WAIVES ANY SUCH HEARING OR DUE PROCESS AND ALL RIGHTS OF APPEAL. Respondent shall be notified of any suspension by certified mail, return receipt requested to Respondent's last known address on file with the Board. If Respondent's license is suspended on such a basis, the suspension shall remain in effect until such time as Respondent takes and passes the JP Exam and subsequently appears before the Board in person and provides sufficient evidence which, in the discretion of the Board, is adequate to show that Respondent possesses the skills and knowledge to safely practice in Texas and is otherwise physically and mentally competent to resume the practice in this state.
4. Within one year from date of the entry of this Order, Respondent shall enroll in and successfully complete the medical recordkeeping course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program, or an equivalent course approved in advance by the Executive Director. To obtain approval for a course other than the PACE course, Respondent shall submit in writing to the Compliance Division of the Board information on the course, to include at least a reasonably detailed description of the course content, faculty, course location, and dates of instruction. Respondent shall submit documentation of attendance and successful completion of this requirement to the Compliance Division of the Board on or before the expiration of the time limit set forth for completion of the course
5. Within one year from the date of the entry of this Order, Respondent shall enroll in and successfully complete 16 hours of continuing medical education (CME), divided into the following subject areas: eight hours in billing and eight hours in ethics. The courses must be approved for Category I credits by the American Medical Association or American Osteopathic Association, and approved in writing in advance by the Executive Director of their designee of the Board. To obtain approval for the course, Respondent shall submit in writing to the Compliance Division of the Board information on the course, to include at least a reasonably detailed description of the course content and faculty, as well as the course location and dates of instruction. Respondent shall submit documentation of attendance and successful completion of this requirement to the Compliance Division of the Board on or before the expiration of the time limit set forth for completion of the course. The CME requirements set forth in this paragraph shall be in addition to all other CME required for licensure maintenance.
6. If Respondent leaves Texas to practice elsewhere or ceases active practice for more than 60 consecutive days, Respondent shall immediately notify the Board in writing. Upon Respondent's return to active practice or return to practice in Texas, Respondent shall notify the Board in writing.
7. Respondent shall comply with all the provisions of the Act and other statutes regulating the Respondent's practice.
8. 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.
9. Respondent shall inform the Board in writing of any change of Respondent's office or mailing address within 10 days of the address change. This information shall be submitted to the Registration Department and the Compliance Department of 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. Respondent agrees that 10 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).
10. Any violation of the terms, conditions, or requirements of this Order by Respondent shall constitute unprofessional conduct likely to deceive or defraud the public, or to injure the public, and shall constitute a basis for disciplinary action by the Board against Respondent pursuant to the Act.
11. Respondent shall be permitted to supervise and delegate prescriptive authority to physician assistants and advanced practice nurses and to supervise surgical assistants.
12. This Order shall terminate upon Respondent's successful completion of ordering paragraph nos. 1, 2, 3, 4 and 5.
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.
THIS ORDER IS A PUBLIC RECORD.
I, V. JOHN GONINO, D.O., 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.
DATED: 5 Aptil, 2013.
V. John Gonino, D.O.
SIGNED AND ENTERED by the presiding officer of the Texas Medical Board on this 12 day of April 2013.
Irvin E. Zeitler, D.O., President
Texas Medical Board
This page was revised on January 20, 2017.