Excerpts below. Full public record
COMMONWEALTH OF MASSACHUSETTS
Board of Registration in Medicine
Adjudicatory Case No. 2016-011
In the Matter of HEIDI W. ASHIH, M.D.
FINAL DECISION AND ORDER
Through her admission that she committed non-sexual boundary violations with a patient, the Respondent engaged in conduct that places into question her competence to practice medicine, committed misconduct in the practice of medicine, and engaged in conduct that undermines the public confidence in the integrity of the medical profession. Given the findings of fact and conclusions of law set forth by the Recommended Decision, the Board hereby INDEFINITELY SUSPENDS the Respondent’s license to practice medicine.
Findings of Fact
The parties stipulated to the following:
1. Dr. Ashih was born on June 10, 1974. She graduated from the University of North Carolina School of Medicine in 2006. She is certified in psychiatry by the American Board of Psychiatry and Neurology. She has been licensed to practice medicine in Massachusetts under certificate number 239386 since 2009. She does not have hospital privileges at this time. Dr. Ashih is currently not working.
2. Dr. Ashih was employed at the Massachusetts General Hospital (MGH) Psychiatry Service Depression Clinical and Research Program (the clinic) from July 2010 until July 2015, when she resigned.
3. In August 2015, the clinic reported to the Board that Dr. Ashih had resigned after an investigation into allegations that Dr. Ashih had a patient, Patient A, living in her home and that she took the patient, Patient A on a family vacation.
4. Dr. Ashih began treating Patient A, a male, in early 2012 in a group session within the clinic.
5. Patient A was in Dr. Ashih’s group consistently until early 2013, when he suffered some personal losses.
6. Patient A was in distress and needed weekly follow-up appointments.
7. The dean of student services at Patient A’s college reached out to Dr. Ashih to ask if she could help Patient A.
8. Patient A’s psychiatrist and therapist had left the clinic suddenly.
9. In the summer of 2013, Dr. Ashih began seeing Patient A exclusively for individual therapy, group therapy and for psychopharmacology.
10. Dr. Ashih told Board staff that she reached out to her colleagues in the clinic to find a new treatment team for Patient A.
11. In the fall of 2014, two of Dr. Ashih’s colleagues, one a therapist and one a psychopharmacologist, offered to take on Patient A’s care if it was an emergency case although neither had an opening in their respective schedules to see Patient A.
12. Dr. Ashih did not tell either colleague that Patient A’s case was an emergency case and continued as Patient A’s sole provider until May 2015.
13. Over approximately six months, Dr. Ashih asked a resource specialist within the clinic to research whether Dr. Ashih could legally adopt Patient A.
14. On or about the summer of 2014, Dr. Ashih asked her colleagues during a peer group meeting to opine on whether it was a sound decision to adopt Patient A, although he was an adult.
15. Some of Dr. Ashih’s colleagues expressed strong feelings against Dr. Ashih’s interest in adopting Patient A.
16. Between December 2014 and March 2015, office staff at the clinic observed Dr. Ashih having appointments with Patient A after clinic hours.
17. Dr. Ashih was seeing Patient A three times per week, including group therapy.
18. Patient A’s sessions with Dr. Ashih were sometimes longer than any other patient.
19. On at least three occasions, Dr. Ashih had food delivered to her sessions with Patient A after clinic hours.
20. An office staffer would take the food from the delivery person and knock on Dr. Ashih’s door to give it to her.
21. On two occasions, Dr. Ashih answered the door immediately to accept the food.
22. On the last occasion, Dr. Ashih took 50 seconds to open the door; Dr. Ashih opened the door, and stuck only her head and her hand out to receive the food.
23. Patient A moved into Dr. Ashih’s home in January 2015.
24. Dr. Ashih did not notify anyone at MGH that Patient A had moved into her home.
25. In March 2015, Patient A was seen by support staff getting into Dr. Ashih’s car with Dr. Ashih and her family after a therapy session at the clinic.
26. In April 2015, Dr. Ashih and her family were scheduled to go on a Disney vacation.
27. On or about April 2015, an office staffer arrived at work to find what appeared to he a Disney vacation printout of four beach chairs with the names of Dr. Ashih, her husband, her child and Patient A.
28. The staffer reported her findings to her supervisor.
29. MGH conducted an investigation into the allegations.
30. After a number of meetings with MGH administrators, Dr. Ashih still seemed to lack insight into the gravity of her boundary violations with Patient A.
31. Dr. Ashih was told not to discuss the MGH investigation with her patients.
32. Dr. Ashih nonetheless discussed the MGH investigation and her feelings of being treated unfairly by MGH with patients other than Patient A during at least one of her group therapy sessions.
33. In July 2015, Dr. Ashih resigned from MGH.
34. Patient A resided in Dr. Ashih’s home from January 2015 until November 23, 2015, the same day Dr. Ashih was interviewed by Board of Registration in Medicine staff regarding the above allegations.
35. A psychiatrist shall not gratify his or her own needs by exploiting the patient. The psychiatrist shall be ever vigilant about the impact that his or her conduct has upon the boundaries of the doctor-patient relationship, and thus upon the well-being of the patient. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship established with the psychiatrist. See American Psychiatric Association, The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry Section 1(1),
According to the Statement of Allegations, Dr. Ashih engaged in conduct that places into question her competence to practice medicine, G.L. c. 112, § 5, 9th If (c) and 243 CMR 1.03(5)(a)3; committed misconduct in the practice of medicine, CMR 1.03(5)(a)18; lacks good
moral character and has engaged in conduct that undermines confidence in the integrity of the medical profession. Levy v. Board of Registration in Medicine, 378 Mass. 519, 528 (1979); Raymond v. Board of Registration in Medicine, 387 Mass. 708, 713 (1982); and Sugarman v. Board of Registration in Medicine, 422 Mass. 338, 343-44 (1996).
By having Patient A live and vacation with her family, Dr. Ashih crossed a boundary that
must be maintained between a doctor and her patient. There is no need to belabor this point, because Dr. Ashih has acknowledged that she violated a boundary and did so egregiously. See Dr. Ashih’s brief, p. 2, and my Recommended Decision on Dr. Ashih’s temporary suspension. As for why this boundary violation matters, The Principles of Medical Ethics states, “the boundaries of the doctor-patient relationship” are “particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the
relationship” with a psychiatrist. Section 1, annotation 1. Boundaries are not simply theoretical. They maintain “the well-being of the patient.” Id.
By having Patient A live and vacation with her family, Dr. Ashih engaged in conduct that places into question her competence to practice medicine, G.L. c. 112, § 5, 9th If (c) and 243 CMR 1.03(5)(a)3; committed misconduct in the practice of medicine, CMR 1.03(5)(a)] 8; and
engaged in conduct that undermines confidence in the integrity of the medical profession. Levy, 378 Mass. at 528; Raymond, 387 Mass. at 713; and Sugarman, 422 Mass. 343-44.
There is no evidence that Dr. Ashih lacks good moral character. That allegation may be left over from before the BRM narrowed its allegations against Dr. Ashih. I recommend that the BRM not discipline Dr. Ashih on this ground.
The following is not conduct that places into question Dr. Ashih’s competence to practice medicine; misconduct in the practice of medicine; or conduct that undermines confidence in the integrity of the medical profession: considering adopting Patient A or discussing being treated unfairly at one or more of her group therapy sessions.
There is no evidence that Dr. Ashih advanced beyond discussing adopting Patient A. There is no evidence that Dr. Ashih discussed it with Patient A. “[CJonsidering adopting Patient A” (Pet. br. 8) s not conduct or misconduct; it is a thought process. If Dr. Ashih had adopted Patient A or discussed adopting him with him, I would recommend that the BRM discipline her. However, the former didn’t happen, and the latter is not in evidence.
The BRM alleges that Dr. Ashih “discussed Patient A’s case in group session after Patient A was no longer a patient in the group.” (Pet. br. 8.) That is not in evidence; Stipulated Fact 32 states something similar, but not what the BRM alleges. I have only a bare-bones stipulation about this issue. How many times it happened, how long Dr. Ashih discussed Patient A, what Dr. Ashih said and how much detail she went into, why Dr. Ashih did so, her effect on the group or individual members, and why this would be disciplinable conduct are not in evidence. The BRM argues that it is misconduct, but not why. It is not self-evident, and I recommend that the BRM not discipline her on this ground.
There is no evidence that Dr. Ashih “gratiflied]…her own needs” during her conduct with Patient A or exploited him. The Principles of Medical Ethics, Section I, annotation 1.
Conclusion and Order
I recommend that the BRM discipline Dr. Ashih as it sees fit.
DIVISION OF ADMINISTRATIVE LAW APPEALS
NOV — 9 2016