Colorado Medical Board v. Singer
24CA1200
Colo. Ct. App.Sep 11, 2025Background
- Jonathan Singer, D.O., licensed in Colorado since 1989, practiced family/functional medicine and incorporated alternative/holistic treatments; he had a long disciplinary history with the Colorado Medical Board including orders from 1999 and a 2016 stipulation restricting hormone-replacement therapy and requiring referrals for certain hormones.
- The 2016 stipulation included a provision that a further act of unprofessional conduct could result in revocation; Dr. Floyd Russak was appointed as Singer’s practice monitor.
- The Board filed a new complaint (Patients A and D) alleging substandard care, improper cross‑state hormone prescribing, and deficient or falsified medical records; an administrative hearing occurred in August 2023 with expert testimony from Dr. Russak (Singer’s monitor) and Dr. Tarek Arja (Board expert).
- Key factual findings: for Patient A (asthma) Singer used a “pitch test” instead of spirometry (FEV1), administered epinephrine rather than standard first‑line therapy (albuterol), did not adequately monitor vitals/oxygenation, and delayed/documented notes years later; for Patient D he prescribed testosterone after discussions in Colorado and delayed communicating/acting on a CT suggesting pelvic inflammatory disease and stopped/started progesterone without confirming hormone levels.
- The ALJ found three counts of unprofessional conduct: failing to meet generally accepted standards of practice (two counts), violating prior Board orders by directing patient to Wyoming for testosterone, and falsifying or repeatedly failing to make essential entries; the Board adopted the ALJ’s revocation and Singer appealed.
Issues
| Issue | Singer's Argument | Board's Argument | Held |
|---|---|---|---|
| Expert on alternative medicine needed to prove substandard practice | Section 12‑240‑121(5)(a) prevents discipline based solely on alternative medicine; Board needed an expert in alternative/holistic medicine | Singer held out as a family physician; Board relied on traditional family‑medicine standard and offered qualified expert testimony | Court: §12‑240‑121(5)(a) does not create a separate field; Board’s family‑medicine expert sufficed and record supports finding Singer breached standard of care |
| Board exceeded jurisdiction by disciplining for conduct occurring (or prescriptions written) in Wyoming | Lawful under Wyoming license; Colorado cannot discipline extraterritorially | Board: decisions/treatment planning occurred while Singer was in Colorado and violated Colorado orders | Court: Board had jurisdiction because medical decisions were made in Colorado and violated prior Colorado orders; not an impermissible regulation of Wyoming license |
| Discipline for recordkeeping/documentation was barred by prior stipulation or estoppel | 2016 stipulation and prior discipline resolved recordkeeping issues; estoppel/abuse of discretion should prevent relitigation | Board: the 2016 stipulation didn’t address Patient A; late notes emerged later and supported new findings | Court: estoppel fails (stipulation didn’t cover Patient A); evidence supports disciplining for falsified/omitted entries |
| Sufficiency of evidence for revocation | Singer does not contest underlying facts but argues procedural/interpretive errors | Board points to expert testimony and documentary evidence supporting violations and revocation | Court: substantial evidence supports revocation; decision not arbitrary or contrary to law |
Key Cases Cited
- Coffman v. Colorado Common Cause, 102 P.3d 999 (Colo. 2004) (standard for appellate review of agency action)
- Rigmaiden v. Colorado Dep’t of Health Care Policy & Fin., 155 P.3d 498 (Colo. App. 2006) (record reviewed in light most favorable to agency; substantial‑evidence standard)
- City of Commerce City v. Enclave W., Inc., 185 P.3d 174 (Colo. 2008) (statutory construction principles and ordinary meaning)
- McCroskey v. State Board of Medical Examiners, 880 P.2d 1188 (Colo. 1994) (Board discretion to determine generally accepted standard of medical practice)
- Colorado‑Ute Electric Ass’n v. Public Utilities Comm’n, 760 P.2d 627 (Colo. 1988) (agency may choose among conflicting inferences and weigh evidence)
- Baldwin v. Huber, 223 P.3d 150 (Colo. App. 2009) (agency findings supported by record not to be disturbed)