Colorado Medical Board, Petitioner-Appellee, v. Jonathan Singer, D.O., license number DR-00292309, Respondent-Appellant.
Court of Appeals No. 24CA1200
COLORADO COURT OF APPEALS
September 11, 2025
Office of Administrative Courts Case No. ME20180012
Division I
Opinion by JUDGE KUHN
Moultrie and Martinez*, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced September 11, 2025
Philip J. Weiser, Attorney General, Ashley E. Moller, First Assistant Attorney General, Jenna H. Anderson, Senior Assistant Attorney General, Denver, Colorado, for Petitioner-Appellee
Hershey Decker Drake, Kari Hershey, Katherine Brim Hong, Lone Tree, Colorado, for Respondent-Appellant
*Sitting by assignment of the Chief Justice under provisions of
I. Background
¶ 2 Singer obtained his medical degree from the University of Iowa College of Osteopathic Medicine. He was first licensed in Wyoming in 1985. He held a Colorado Medical Board license from 1989 until the Board revoked his license in 2024. Singer held himself out as a “Family Practice Physician and Surgeon,” and his Colorado practice focused on functional medicine.1 Singer was also certified by the American Board of Holistic Medicine and practiced a blend of traditional and alternative medicine.
¶ 3 Singer has had a long history with the Colorado Medical Board (the Board). In the last twenty-five years, the Board has imposed suspensions, probation, education requirements, practice restrictions, and monitoring requirements on his license. In May 1999, the Board issued an amended final board order restricting
¶ 4 Then, in September 2016, Singer entered into a stipulation and order with the Board to resolve seven separate investigations into allegations of unprofessional conduct. Within the 2016 Stipulation, Singer admitted to a single violation of the hormone practice restriction. The 2016 Stipulation also contained a hormone practice restriction similar to the restriction in the 1999 Order, including the prohibition against “all medical decisions and orders” related to hormone replacement therapy and the referral requirements. Additionally, the 2016 Stipulation included a
¶ 5 In 2018, the Board filed a new complaint regarding Singer’s care of Patients A and D. The Board amended its complaint in 2019. Then, after multiple delays, the matter proceeded to a hearing in August 2023. At the hearing, the administrative law judge (ALJ) heard testimony from Singer, Dr. Russak, and Dr. Tarek Arja, the Board’s expert witness.
¶ 6 As relevant to this appeal, the testimony and other evidence presented at the hearing demonstrates that Singer provided multiple treatments to Patient A in 2014 for asthma and acute asthma exacerbations. During an early 2014 visit — when Patient A was having an asthma attack — Singer tested her blood oxygen level and listened to her breathing with a stethoscope. He measured her respiratory function using a “pitch test,” where he
¶ 7 Later in 2014, Singer saw Patient A at his Wyoming office as she was in acute distress from an asthma attack. Her blood oxygen saturation was only 82%, a dangerously low level. He gave her oxygen and epinephrine and, again, conducted a pitch test. He didn’t do an FEF1 test, use a spirometer, or conduct serialized oxygen level testing before sending her home. Additionally, Singer didn’t make a full SOAP4 note for the visit until early 2017, over two years later. At the hearing, Singer admitted that his notetaking and documentation for Patient A’s visit didn’t meet the accepted
¶ 8 As for Patient D, Singer first met with her in March 2018 for hormone imbalances and pain. He had her undergo testing and reviewed the results with her in his Colorado office. Later, he met with her at his Wyoming office, where he prescribed her the hormone testosterone.
¶ 9 After the Wyoming visit, Patient D continued to have complaints of pain, and Singer ordered a CT scan of her abdominal and pelvic regions. He received the radiologist’s report in mid-May and reviewed it the next day. The report stated that Patient D could be suffering from pelvic inflammatory disease, which can be serious. But Singer didn’t inform Patient D of the results of the scan until approximately six weeks later. He then referred her to a gynecologist for further follow-up and treatment. Additionally, while Patient D was in his care, Singer had her stop and start progesterone treatment without ordering tests to determine her hormone levels.
¶ 10 The ALJ found that the Board had demonstrated three counts of unprofessional conduct by Singer. First, Singer failed to meet
¶ 11 The ALJ issued the initial decision revoking Singer’s license, and Singer filed exceptions to the decision with the Board’s hearings panel. The Board’s hearings panel unanimously agreed with the ALJ’s findings and issued a final order revoking Singer’s license to practice medicine in Colorado. This appeal followed.
II. Analysis
¶ 12 Singer contends that the Board erred by (1) failing to prove allegations of substandard practice through testimony of an expert qualified in alternative medicine practices; (2) imposing discipline for medical practice occurring outside Colorado, when such practice is lawful in the other state; and (3) disciplining him for conduct he remedied and that was subject to a prior stipulation. We first set
A. Standard of Review and Applicable Law
¶ 13
¶ 14 “When reviewing final agency actions, we . . . must examine the record in the light most favorable to the agency decision. Whether the record contains substantial evidence to support the agency decision is a question of law.” Rigmaiden v. Colo. Dep‘t of Health Care Pol‘y & Fin., 155 P.3d 498, 501 (Colo. App. 2006).
¶ 15 “In reviewing the agency’s construction [of a statute], we rely on the basic rules of statutory construction, affording the language of the provisions at issue their ordinary and common sense meaning.” City of Commerce City v. Enclave W., Inc., 185 P.3d 174, 178 (Colo. 2008). Our primary task when interpreting a statute is to give effect to the intent of the drafters. Waste Mgmt. of Colo., Inc. v. City of Commerce City, 250 P.3d 722, 725 (Colo. App. 2010). “It
¶ 16 If the statute is ambiguous, we generally give deference to an agency’s reasonable interpretation of a statute that it is authorized to administer and enforce.5 See id. at ¶ 12. But “although we find persuasive an administrative interpretation of statute that is a reasonable construction consistent with public policy, it is for this court to determine all questions of law, interpret applicable statutes, and apply such interpretations to the facts.” Coffman, 102
P.3d at 1005 (first citing City of Aurora v. Bd. of Cnty. Comm’rs, 919 P.2d 198, 203 (Colo. 1996); and then citing Regents of the Univ. of Colo. v. Meyer, 899 P.2d 316, 317 (Colo. App. 1995)). “Likewise, even though an agency construction of statute should be given appropriate deference, its interpretation is not binding on this court.” Id. As a result, while not bound, we may accept the agency’s construction of the law if it’s reasonable and warranted by the record. Sierra Club v. Billingsley, 166 P.3d 309, 312 (Colo. App. 2007).
B. The Board‘s Decision Was Supported by Applicable Expert Testimony
¶ 17 Singer contends that the Board violated
that the licensee practices alternative medicine.”
1. Section 12-240-121(5)(a) Does Not Codify a Field of Medicine
¶ 18 The Board’s final order concluded that
¶ 19
[f]or purposes of this section, “alternative medicine” means those health-care methods of diagnosis, treatment, or healing that are not generally used but that provide a reasonable potential for therapeutic gain in a patient’s medical condition that is not outweighed by the risk of the methods. A licensee who practices alternative medicine shall inform each patient in writing, during the initial patient contact, of the licensee’s education, experience, and credentials related to the alternative medicine practiced by the licensee.
The [B]oard shall not take disciplinary action against a licensee solely on the grounds that the licensee practices alternative medicine.
¶ 20 By its plain language, this section prohibits the Board from disciplining a health care provider solely for using an alternative method of treatment where the potential for therapeutic gain is not outweighed by the risks. Nothing in the statutory text demonstrates an intent to codify alternative medicine as a distinct school of medicine; instead, it restricts the Board from disciplining a practitioner under certain circumstances. And “[w]hen the language is plain, the court must apply the text as written and not force or strain its interpretation.” Williams v. Dep‘t of Pub. Safety, 2015 COA 180, ¶ 22. Further, while the Medical Practice Act does outline the scope of practice, licensing requirements and exceptions, and disciplinary actions that can be taken against medical practitioners for unprofessional conduct, it does not define any specific fields of medicine. See
¶ 21 Thus, we discern no error in the Board’s interpretation that
2. The Board Presented Expert Testimony on the Generally Accepted Standard of Medical Practice
¶ 22
¶ 24 Singer argues that Dr. Arja’s lack of qualifications in alternative or holistic medicine renders his opinions irrelevant
because Singer practices alternative medicine and only an expert qualified in that practice area can testify about whether he met the standard of care.
¶ 25 However, the record does not support Singer’s characterization of his medical practice. Instead, it demonstrates that Singer holds himself out as a “family medicine physician.” His patient forms identify him as a “Family Practice Physician and Surgeon,” and he holds a board certification in family medicine from the American Osteopathic Association. While Singer testified that he practices “a blend of alternative and traditional medicine,” he also qualified that statement, testifying that “I always practice traditional medicine.” Singer’s inclusion of alternative medicine treatment methods within his family medicine practice does not mean that he is not practicing as a family medicine physician. Nor does it mean that the Board lacks the discretion to determine the generally accepted standard of medical practice that applies to his treatment. See id. at 1195-96. We note that the Board’s determination that Singer was a family medicine practitioner also clearly refutes his argument that the Board violated
¶ 26 Additionally, we agree with the Board that “nothing in the record establishes that the treatment of asthma, or the use of epinephrine to treat asthma, constitutes the practice of alternative medicine.” To the contrary, Dr. Russak, Singer’s own expert, testified that while someone could consider the use of epinephrine as nontraditional or functional holistic medicine, “generally injectable drugs are not considered holistic.” Further, the record contains no argument or evidence supporting the position that ordering a CT scan — or delayed reporting of its results — constitutes the practice of alternative medicine.
¶ 27 Based on the record before us, there is substantial factual support for the Board’s implicit determination that Singer specializes in family medicine as a physician and its reliance on Dr. Arja’s expert testimony to determine the generally accepted standard of medical practice for a family medicine practitioner.
¶ 28 Ultimately this case turned on dueling expert testimony, and the ALJ found Dr. Arja’s testimony more persuasive. That
- used a pitch test instead of evaluating FEF1 measured by a spirometer;
- administered epinephrine as a first-line treatment for asthma;
- failed to properly monitor Patient A’s condition after asthma treatment;
- failed to timely address the findings of Patient D’s CT scan;
- failed to convey to Patient D the seriousness and implications of the CT scan’s finding;
- failed to timely refer Patient D to a specialist; and
- stopped Patient D’s progesterone treatment without ordering a blood test of her hormone levels.
¶ 29 Singer does not dispute the evidence supporting these findings in the record. And when there is sufficient evidentiary support for the Board’s determination, we will not disturb it. See Coffman, 102 P.3d at 1005. Thus, the Board’s determination that Singer failed to meet generally accepted standards of practice in violation of section
C. The Board‘s Revocation Didn‘t Exceed Its Jurisdiction
¶ 30 Singer next contends that the Board exceeded its jurisdiction when it determined that he violated a valid Board order and
¶ 31 As stated above, the Board’s 1999 Order and the 2016 Stipulation prohibited Singer from engaging in “all medical decisions and orders” related to hormone replacement therapy, other than progesterone and estrogen. Additionally, both documents required him to refer all patients to another provider for any other types of hormone therapies. However, neither restriction applied to Singer’s Wyoming practice.
¶ 32 The Board concluded that Singer violated the 1999 Order and the 2016 Stipulation when he, while in Colorado, made a treatment decision to prescribe Patient D testosterone and directed her to his Wyoming office where he later wrote the prescription.
¶ 34 In response to Patient D’s complaint to the Board, Singer wrote to the Board that he told Patient D he “could prescribe estrogen and progesterone, but that [he] was not at liberty to prescribe testosterone in [his] Colorado office. [He] offered to see the patient at [his] Cheyenne, Wyoming[,] office, where [he was] able to prescribe such medication, or she could seek the prescription from another provider.” For her part, Patient D recounted the interaction somewhat differently. In her complaint, she said, “I question why having to cross state lines to get a testosterone
prescription only to find out that it could have been prescribed in the state of Colorado.” Further, Singer’s SOAP note, made while in his Colorado office, shows that his treatment plan for Patient D was a “F/U Cheyenne if she desires for low testosterone.”
¶ 35 It is uncontested that Singer did not refer Patient D to another provider for treatment. The evidence in the record, particularly Patient D’s complaint, supports the Board’s conclusion that Singer made the medical decision to treat Patient D with testosterone while in Colorado rather than making a referral. And while we recognize that this may not be the only conclusion the Board could have drawn, it is within the agency’s province to decide what weight to accord to each piece of evidence and to choose among conflicting inferences that may be drawn from it. See Colo.-Ute Elec. Ass’n v. Pub. Utils. Comm’n, 760 P.2d 627, 640 (Colo. 1988).
¶ 36 There is substantial evidence in the record to support the Board’s determination that Singer violated the 1999 Order and the 2016 Stipulation. And because the Board’s determination was based on medical decisions that Singer made in Colorado, it was not a regulation of his Wyoming license. Therefore, the Board did not exceed its jurisdiction. See
¶ 37 Lastly, Singer contends that the Board erred by disciplining him for documentation failures despite these issues being resolved in the 2016 Stipulation. In support, Singer argues that the doctrine of estoppel bars the Board from reconsidering his documentation and that the Board abused its discretion by doing so. We disagree.
Equitable estoppel is designed to achieve justice where four elements are present: (1) the party to be estopped by its conduct must know the facts; (2) that party must intend that the conduct be acted upon or must act so the party asserting estoppel is justified in believing the conduct was so intended; (3) the party asserting estoppel must be ignorant of the true facts; and (4) that party must detrimentally rely on the other party’s conduct.
Bontrager v. La Plata Elec. Ass’n, 68 P.3d 555, 561 (Colo. App. 2003). The record demonstrates that Singer didn’t write the full SOAP note for the September 2014 appointment with Patient A until January 2017, after he received a letter from the Board concerning Patient A’s complaint. So there is a significant question as to whether the Board could have known the full scope of Singer’s documentation for Patient A when he and the Board executed the 2016 Stipulation. Regardless, the 2016 Stipulation didn’t address
¶ 38 Singer’s abuse of discretion argument is equally doomed. The Board found that Singer violated
¶ 39 In essence, Singer asks us to reweigh the evidence in his favor, setting aside his own testimony and the uncontested fact that he edited his notes nearly three years after Patient A’s treatment. That is not our role. The Board’s determination is substantially supported by evidence in the record, and its decision is not
III. Disposition
¶ 40 The Board’s order is affirmed.
JUDGE MOULTRIE and JUSTICE MARTINEZ concur.
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