BEFORE THE IOWA BOARD OF CHIROPRACTIC

___________________________________________________________________________

IN THE MATTER OF: ) DIA NO: 14ICB003
) CASE NO: 12-005
)
STUART HOVEN, D.C. )
License No. 06439 ) FINDINGS OF FACT,
) CONCLUSIONS OF LAW,
RESPONDENT ) DECISION AND ORDER
___________________________________________________________________________

On January 9, 2013, the Iowa Board of Chiropractic (the Board) issued a Decision and
Order indefinitely suspending the chiropractic license of Stuart Hoven, D.C.
(Respondent). On May 30, 2014, Respondent filed an Amended and Substituted
Application for Reinstatement of License. The following Board members were present
for Respondents reinstatement hearing on July 9, 2014: John Calisesi, D.C.,
Chairperson; Aaron Martin, D.C.; Jason Wall, D.C.; Nancy Kahle, D.C.; Rex Jones,
D.C.; Joellen Jensen and Lorraine May, public members. Margaret LaMarche, an
administrative law judge from the Iowa Department of Inspections and Appeals,
assisted the Board in conducting the hearing. Assistant Attorney General Meghan
Gavin represented the public interest. Attorney Michael Sellers represented
Respondent. The hearing was closed to the public at the election of the licensee,
pursuant to Iowa Code section 272C.6(1).

THE RECORD

At the time of hearing, State Exhibits 1-22 and Respondent Exhibits A-L were admitted
into evidence without objection. The record at hearing also included Respondents
Proposed Mentoring Plan and Respondents testimony.

On September 4, 2014, Respondent filed a Notice to the Board, Amended Exhibit List,
and Request for Transmission to Board Members. Respondent asked to add Exhibit M,
which was the September 2, 2014 Judgment from the Clarke County District Court in
his criminal trial for Simple Assault. On September 3, 2014, the State filed an Objection
to Respondents Notice to the Board, Amended Exhibit List, and Request for
Transmission to Board Members. On September 9, 2014, the Board met by telephone
conference call and approved a motion that granted Respondents request to add
Exhibit M to the hearing record.

Case No. 12-005
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FINDINGS OF FACT

Respondents Licensure and Disciplinary History

1. On August 21, 2001, the Board issued Respondent Iowa license number 06439 to
practice chiropractic in the state of Iowa. Respondent opened Winterset Family
Chiropractic in Winterset, Iowa in December 2001. Respondent later opened a satellite
clinic in Osceola, Iowa. Respondent has practiced chiropractic at these two clinics,
except for the period of time that his license has been suspended by the Board.
(Exhibits 5, 10, 17; Respondent testimony).

2. On October 29, 2004, the Board filed its first Statement of Charges against
Respondent. The charges alleged that Respondent made inappropriate contact and
inappropriate comments of a sexual nature to two female patients. (Exhibit 16) An
evidentiary hearing was held before the Board on March 7, 2005. In a Decision and
Order issued on April 27, 2005, the Board determined that Respondent had willfully
and repeatedly touched the breasts of two female patients without a valid clinical
reason for doing so and had made inappropriate comments to the two female patients
about their breasts. The Board indefinitely suspended Respondents license to practice
for repeated and willful departures from minimal standards of practice, for unethical
conduct, and for practice harmful or detrimental to the public. The Board determined
that the license suspension would continue until Respondent: (a) submitted to a
comprehensive evaluation from a Board-approved provider; (b) followed all treatment
recommendations made following the evaluation; and (c) provided an evaluators
statement that he was safe to return to practice. (Exhibit 17).

3. Following issuance of the Boards April 27, 2005 Decision and Order, Respondent
was evaluated at the Center for Marital and Sexual Health (the Center) in Beachwood,
Ohio. The Center issued a report finding that Respondent could safely return to
chiropractic practice with a number of conditions. The conditions included education
on boundaries, requiring a female chaperone in the examination room, offering patient
satisfaction cards, periodic meetings with a Board investigator, and mental health
therapy. (Exhibit 18).

On July 15, 2005, the Board issued an order reinstating Respondents license, subject to
five years of probation and a number of conditions consistent with the
recommendations made by the Center. (Exhibit 19) In April 2006, the Board denied
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Respondents request to amend his reinstatement order to eliminate the female
chaperone requirement. (Exhibit 20).

On July 11, 2007, Respondent appeared before the Board to request termination of his
probation or, in the alternative, elimination of the chaperone requirement. The Board
denied Respondents request to terminate his probation, but granted his request to
eliminate the chaperone requirement. The Board noted that although Respondent had
complied with all terms of the reinstatement order to date, it does not appear he has
accepted full personal responsibility for the misconduct he engaged in, nor does it
appear he is remorseful regarding the harm suffered by his patients in this case.
Respondent served the full 5-year term of his probation and was discharged from
probation on July 15, 2010. (Exhibits 21-22).

4. On April 26, 2012, the Board filed a second Statement of Charges and an
Emergency Adjudicative Order after a female patient reported that Respondent grabbed
her breasts during an examination. The Board later amended the charges to include
similar allegations made by a second female patient. (Exhibits 1-4).

An evidentiary hearing was held on the second Statement of Charges on October 10-11,
2012. On January 9, 2013, the Board issued its final Decision and Order finding that
Respondent committed unethical conduct and practice harmful and detrimental to the
public when he touched the breasts of two female patients. The Board ordered
Respondents license to be suspended indefinitely and directed Respondent to submit
to a comprehensive professional sexual misconduct assessment at the Behavioral
Medicine Institute (BMI) in Atlanta, Georgia. The Board also directed Respondent to
comply with any treatment recommendations made by BMI. (Exhibit 5).

5. Respondent had a comprehensive assessment at BMI from February 4-6, 2013.
Following the assessment, BMI concluded that Respondent was not currently safe to
practice chiropractic care due to his two disciplinary actions involving professional
sexual misconduct. BMI identified multiple contributing factors that led to
Respondents misconduct, including his need to be admired, his lack of empathy for
others, his grandiose sense of self-importance, and his sense of entitlement. According
to the BMI report, Respondent acknowledged that his self-centeredness and sense of
entitlement negatively impacted the manner he approached his prior disciplinary action
with the Board. (Exhibit 6).

The BMI report recommended that Respondent complete a full intensive course of
professional sexual misconduct-specific treatment prior to any consideration of re-
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licensure and listed four providers that offered such treatment. One of the providers
recommended by BMI was the Acumen Institute, which is located in Lawrence Kansas.
The report also recommended that Respondent continue individual psychotherapy to
address his chronic behavioral and characterologic traits that have impacted his
occupational functioning and relational style with others. (Exhibit 6).

The BMI report stated that there was a probability that Respondent could be deemed
safe to practice if he successfully completed the treatment recommendations. The
report also listed a number of conditions that should apply to any future reinstatement.
These conditions included: a) staff surveillance forms, b) patient surveillance forms, c)
female chaperones during examinations of female patients, d) extensive supervision by
a professional mentor, e) polygraphing, and f) reports to the Board. (Exhibit 6).

First (Denied) Application for Reinstatement

6. On March 1, 2013, Respondent filed an application for reinstatement of his
license. In his application, Respondent stated that he had completed the assessment at
BMI and had complied with the recommended treatment through Acumen. The
application asserted that Respondent had complied with all requirements of the Boards
January 9, 2013 order. (Exhibit 7).

Respondent had not in fact complied with all requirements of the Boards January 9,
2013 Decision and Order at the time of this first reinstatement application because he
had only completed four days of his Acumen treatment program. Acumens treatment
plan required Respondent to return to Acumen for additional one-week sessions in June
and September 2013. Respondent was then scheduled to complete treatment with a
final three-day follow-up session scheduled for March 12-14, 2014. (Exhibits 8, 10).

On March 22, 2013, Acumen issued a report stating that Respondent had successfully
participated in and completed the first (immersion) phase of its treatment program
from February 25-March 15, 2013. Based on Respondents treatment response, Acumen
concluded that he was safe to return to practice, as long as he adhered to a number of
recommendations. Acumens recommendations included: a) successfully continuing
the quarterly treatment protocol set by Acumen; b) individual and couples counseling;
and c) a monitored practice including surveillance forms, female chaperones,
professional mentor, maintenance polygraphs, and quarterly reports. (Exhibit 8).

On April 9, 2013, Dr. Peter Graham from Acumen issued a letter concerning
Respondents application for reinstatement. Dr. Graham stated that Acumen had
Case No. 12-005
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developed its recommendation and plan for Respondent based on Respondents ability
to resume practice right away absent some specific public safety objection. Dr.
Graham explained that Acumen intended to use its follow-up sessions, in part, to
monitor Respondents rehabilitation in the context of a practice setting. Dr. Graham
reiterated his belief that Respondent was safe to return to practice under the conditions
previously referenced. However, Dr. Grahams letter recognized that the Board had the
sole authority to reinstate a license. (Exhibit 9).

7. On September 9, 2013, the Board issued its Decision and Order denying
Respondents application for reinstatement. The Board was troubled by the fact that
Respondent filed his application for reinstatement when he had only been in treatment
at Acumen for four days. Based on the record before it, the Board was not convinced
that the basis for Respondents suspension had been sufficiently addressed through
treatment and was not convinced that it was in the public interest for Respondents
license to be reinstated. The Board was not persuaded that Respondent would not
present a danger to the public welfare if he returned to the practice of chiropractic at
that time. The Boards Decision and Order denying reinstatement required Respondent
to comply with the following sequence of conditions before filing any new application
for reinstatement:

Attend and complete all scheduled treatment sessions at Acumen, including the
final follow-up on March 12-14, 2014;
Submit a report from Acumen stating that he is safe to return to practice;
After submitting the Acumen report, return to BMI for a comprehensive follow-
up to allow BMI to reevaluate its prior finding that Respondent was not safe to
practice; and
Submit a report from BMI finding that Respondent is safe to return to practice.

The Boards September 9, 2013 Decision and Order specified that the Boards decision
on another reinstatement application would be based on the Boards consideration of
the legal standard and record made. The Board reserved the right to impose any
practice conditions that the Board believes is needed to protect the public interest.
(Exhibit 10).
The Current Application for Reinstatement

8. On March 14, 2014, Respondent successfully completed all phases of treatment at
Acumen Institute, which included participation in longitudinal treatment, education,
and a coaching program for professional sexual misconduct. Respondents final visit to
Acumen on March 12-14, 2014 included ten hours of group therapy and three hours of
Case No. 12-005
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individual therapy. In its final report, Acumen concluded, within a reasonable degree
of psychological certainty, that Respondent was fit to return to the practice of
chiropractic medicine with the requisite skill, safety, and professionalism, so long as
Respondent followed Acumens recommendations. Acumen outlined the following
elements of its return to work plan for Respondent:

Full-time, informed chaperone for all female patient contacts with
documentation of chaperoning;
Quarterly Staff Surveys collected by someone other than Respondent so that the
surveys can be reviewed by the monitoring person;
Quarterly Patient Surveys (or ongoing random surveys, with collection similar to
staff surveys);
Sexual Harassment-free Workplace Policy;
Ongoing individual psychotherapy focused on character issues and
internalization of the Boards regulatory function and accountability perspective;
Maintenance Polygraphs (location and provider to be determined in consultation
with the Board), at least every six months for a period to be determined by the
Board and focused on the following questions:
o Since your last polygraph, have you sexually fondled or otherwise had
physical sexual contact with a patient in your office?
o Since your last polygraph, have you had sexual contact with a current or
former patient outside the office?
Quarterly Self-reports to the Board with an attitude of open and good faith
communication with the Board about ongoing compliance efforts;
Chiropractic Mentor, including quarterly documentation of what was discussed;
discussion of challenges, practice ideas, professional development, and ongoing
development of broader moral-ethical perspective in practice; review of
concerning cases; practice management; and development and continued use of
alternative perspective of self, modeled on an internalization of the regulatory
function of the Board.

(Exhibits 12, B; Respondent testimony).

9. Respondent returned to BMI for a follow-up evaluation on March 20-21, 2014.
On April 2, 2014, BMI issued its follow up report to the Board. BMI administered a
number of psychological tests, as outlined in its report. Respondents only psychiatric
diagnosis for Respondent was Narcissistic Traits. BMIs report notes that [i]n
contrast to his previous evaluation Respondent demonstrated a greater level of insight
into his sexual behavior and its relation to his sense of entitlement and his distorted
Case No. 12-005
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rationalizations. The report states that Respondent demonstrated more empathy as it
relates to those impacted by his professional sexual misconduct. The BMI report
concluded that Respondent is currently safe to practice chiropractic care, given the
following:

his improved insight into the contributing factors of his sexual behavior;
the identification of ways to avoid and minimize his risk of relapse;
improved understanding of dual agency relationships;
his ability to verbalize how to better set boundaries with patients and staff; and
the proposed establishment of a practice plan to provide external monitoring.

BMI agreed with Acumens return to practice plan for Respondent. BMI recommended
review of the patient and staff survey forms by either Acumen or a Board approved
therapist, with quarterly reports to the Board concerning the survey results. BMI
agreed with Acumens recommendation for maintenance polygraphs but recommended
that the first polygraph be conducted 3 months after Respondent returns to practice.
BMI supported the recommendation that Respondent continue individual
psychotherapy to address his personality issues and also recommended therapy on the
issue of victim empathy as it relates to those individuals negatively impacted by
Respondents professional sexual misconduct. BMI also supported Acumens
recommendation for a Board approved professional mentor within Respondents same
specialty to meet with Respondent on a periodic basis to discuss problematic patients
and practice issues that may arise within his practice. (Exhibits 11, 13, C, H).

10. Respondent has been participating in individual therapy with Ed Ashby, LMHC
since June 2012, and he plans to continue in treatment with Mr. Ashby on a monthly
basis whether or not his license is reinstated. Mr. Ashby provided the Board with a
Therapy Update, dated May 12, 2014, which indicates that the focus of the therapeutic
relationship has been character development. According to Mr. Ashby, Respondent has
made significant strides in self-understanding and has gained a better awareness of the
boundaries for himself and others. Mr. Ashby believes that these therapy outcomes are
indicative of a positive and successful future for Respondent as he prepares to re-enter
the work environment. (Exhibit I; Respondent testimony).

11. Gary Pennebaker, DC is a Minnesota chiropractor who has agreed to serve as
Respondents professional mentor if his license is reinstated. Dr. Pennebaker has more
than 35 years of experience as a licensed chiropractor and has served on the Federation
of Chiropractic Licensing Board, the National Board of Chiropractic Examiners, and the
Minnesota Chiropractic Board of Examiners. Respondent has provided Dr. Pennebaker
Case No. 12-005
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with the Boards Decision and Orders issued in January 2013 and September 2013 and
with all of the evaluations and reports prepared by BMI and Acumen. Dr. Pennebaker
understands that his role would be to mentor Respondent in all aspects of his practice,
including but not limited to discussions of challenges, practice ideas, professional
development, and review of individual cases. If approved as Respondents mentor, Dr.
Pennebaker has agreed to meet with Respondent once per month by phone and once
per quarter face to face. (Exhibits K, L; Respondent testimony).

12. At hearing, Respondent acknowledged that his misconduct has caused great
harm to patients, their families, the communities involved, his own family and staff,
and the chiropractic profession as a whole. Respondent further acknowledged that he
was unfit to return to practice a year ago before completing the treatment program
through Acumen. Respondent testified that he has spent the past year working on
himself as a person, has matured emotionally, and has gained self-awareness and
insight that he believes will enable him to practice chiropractic in a safe manner.
Respondent is willing to abide by all of the monitoring requirements recommended by
Acumen and by BMI and by any restrictions imposed by the Board. (Respondent
testimony; Exhibit A).

CONCLUSIONS OF LAW

The Iowa Board of Chiropractic (the Board) was created by the legislature pursuant to
Iowa Code section 147.13(5) and Iowa Code chapter 151. The Board has the
responsibility to establish qualifications to obtain licensure and to enforce Board
standards through disciplinary actions after a chiropractor is licensed.
1
The Board has a
range of disciplinary options, including revocation, suspension, probation, requiring
additional education or training, civil penalties, and a citation and warning.
2


After the Board suspends or revokes a license, it may consider an application for
reinstatement.
3
A person seeking reinstatement must have complied with all terms of
the order that revoked or suspended the license.
4
If the order did not set forth
conditions, the person must wait at least one year before applying for reinstatement.
5

The reinstatement applicant has the burden of proving that the basis for the revocation

1
Iowa Code sections 147.34, 147.55, 151.3.
2
645 IAC 45.3.
3
645 IAC 11.31.
4
645 IAC 11.31(1).
5
645 IAC 11.31(2).
Case No. 12-005
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or suspension no longer exists and that it is in the public interest for the license to be
reinstated.
6


The preponderance of the evidence established that Respondent has fully complied
with the prerequisites to filing an application for reinstatement, which were established
by the Board in its January 9, 2013 Decision and Order and further clarified in the
September 9, 2013 Decision and Order that denied Respondents first request for
reinstatement. Respondent has now completed all of the required comprehensive
assessments and has fully complied with the treatment recommendations made by the
Acumen Institute. Respondent has returned to BMI for a follow-up evaluation. Both
Acumen and BMI have issued reports recommending reinstatement of Respondents
license, subject to strict monitoring conditions.

The Board must still determine, however, whether the evidence in the record
demonstrates that Respondent has satisfied the legal standard for reinstating his license,
i.e. whether the basis for the suspension no longer exists and whether it is in the public
interest to reinstate his license. This was a very difficult and close decision for the Board
given Respondents history of repeated sexual misconduct. Nevertheless, a quorum of
the Board was persuaded that Respondents license should be reinstated, as
recommended by both Acumen and BMI, subject to stringent conditions and practice
monitoring to protect the public.

Respondent has accepted responsibility for his sexual misconduct and has expressed
remorse, which the majority of the Board believes to be sincere. The professionals who
have worked with Respondent extensively at Acumen and at BMI believe that he is a
changed person, and the Board members who have participated in prior cases involving
Respondent also observed a change in Respondents attitude and demeanor. Both
Acumen and BMI noted that Respondent now has greater insight into his professional
misconduct and its relationship to his personal character traits. Both programs have
concluded that Respondent is currently safe to practice chiropractic, so long as
monitoring conditions are in place.

As acknowledged by Respondent in his testimony at hearing, this is Respondents last
opportunity to demonstrate that he is capable of practicing chiropractic in a competent,
professional, and ethical manner.


6
645 IAC 11.31(4).
Case No. 12-005
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DECISION AND ORDER

IT IS THEREFORE ORDERED that Respondents Iowa chiropractic license, number
06439, is hereby REINSTATED and is immediately placed on PERMANENT
PROBATION, subject to the following terms and conditions:

A. Respondent shall maintain a copy of this Decision and Order in an
accessible area of his office where it is available for review by his employees.
Within ten (10) days of the issuance of this Decision and Order or within ten (10)
days of hire, all of Respondents employees shall provide signed statements to
the Board verifying that they have read this Decision and Order of the Board.

B. Respondent must have a female chaperone present during any and all
contact or interaction that Respondent has with the female patients of his
chiropractic practice. If the female chaperone leaves for any reason, Respondent
shall not remain in the presence of the female patient and must also leave until
the chaperone is able to return.

1. Prior to resuming the practice of chiropractic, Respondent must
obtain Board approval of a written job description for the female
chaperone(s) to be employed by his chiropractic practice. The job
description shall specify the duties and reporting requirements for the
chaperone, consistent with this Decision and Order. All female employees
hired to serve as Respondents chaperone shall sign a copy of the job
description, acknowledging their understanding of their duties and
reporting requirements. Prior to the chaperones first day of work,
Respondent shall submit copies of the job description, signed by the
chaperone.

2. The female chaperone shall not be related to Respondent and shall
not have a personal or social relationship with Respondent or his family
members.

3. Prior to examining or treating any female patients breasts or
genital area, Dr. Hoven shall provide an explanation of the
chiropractic/medical necessity for such examination or treatment and
obtain the patients written consent.

Case No. 12-005
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4. Immediately following Respondents contact(s) with a female
patient, the female chaperone(s) shall sign the patients chart to verify the
chaperones continuous presence during throughout Respondents entire
interaction with the female patient. The Board reserves the right to
request copies of the records of Respondents female patients to verify the
signature and presence of the female chaperone and to verify
Respondents documentation of consent for any examination/treatment of
the breast or genital area of a female patient.

5. Respondent shall provide the female chaperone(s) with contact
information (mailing address, email address, and telephone number) for
the Boards Executive Officer. The chaperone must agree to make an
immediate report to the Boards Executive Officer if she observes any
inappropriate conduct, including but not limited to improper or sexual
touching or comments, during Respondents interactions with female
patients. The female chaperone shall also immediately report any
concerns or complaints expressed by female patients concerning
Respondents conduct. The female chaperone shall also immediately
report any violation or circumvention of the chaperone requirement to the
Board.

C. Each quarter, a minimum of 10 female patients in a one week period shall
be given Board approved Patient Satisfaction Surveys to complete, seal, and
return to Respondents female chaperone(s). The Board reserves the right to
increase the number of patients to receive surveys. The questions on the Patient
Satisfaction Survey shall be developed by BMI and shall be focused on
Respondent and his behavior and interactions with the patient. The female
chaperone shall return the sealed Patient Satisfaction Surveys directly to BMI.
BMI, or a Board-approved alternative, shall evaluate and report the results of the
Patient Satisfaction Surveys to the Board on a quarterly basis.

D. Respondent shall submit to maintenance polygraph testing administered
by Acumen Institute. The first polygraph shall be administered three months
after reinstatement and additional polygraph tests shall be administered every
six months thereafter. Acumen Institute may develop the polygraph questions,
but the questions shall address maintenance of proper boundaries, use of
chaperones, abstinence from inappropriate touching of patients, and abstinence
from making inappropriate sexual comments to patients. The polygraph
examinations will be conducted at Acumen and the results will be included in
Case No. 12-005
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quarterly reports to the Board by Acumen. Polygraph testing will continue until
the Board determines that it is no longer necessary.

E. Respondent shall continue in individual psychotherapy with a Board
approved psychotherapist. The psychotherapist shall be provided a copy of this
Decision and Order of the Board. Therapy sessions shall be conducted at the
frequency recommended by the therapist and shall address Respondents
personality and relationship issues as documented in the BMI and Acumen
reports and shall also address any other issues identified by the psychotherapist.
The psychotherapist shall provide quarterly written reports to the Board
concerning Respondent attendance, participation, and progress in therapy.

F. Respondent shall meet on a monthly basis with Gary Pennebaker, D.C., or
another Board approved professional mentor to discuss problematic patients and
practice issues. Meetings may be conducted by telephone, but Respondent and
his approved mentor shall meet face-to-face at least quarterly. The Board may
increase the required frequency of Respondents meetings with his approved
mentor. The professional mentor must be provided copies of this Decision and
Order of the Board. Respondents approved mentor shall provide quarterly
written reports to the Board detailing his meetings and discussions with
Respondent.

G. Respondent shall establish and maintain a Sexual Harassment-Free
Workplace Policy and shall provide a form for employees to complete and return
to BMI or BMIs approved contractor if they have any concerns about sexual
harassment in the workplace.

H. Respondent shall provide quarterly sworn written reports to the Board,
which shall address Respondents encounters with patients, his interactions with
his staff, his meetings, with his Board approved mentor, his compliance with the
terms of this Decision and Order, and any other issues identified by the Board.

I. Respondent shall appear before the Board within six months of
reinstatement and annually thereafter, or upon request. Respondent shall be
given notice of the date, time, and location for the appearances. Such
appearances will be subject to the waiver provisions of 645 IAC 9.7.

J. Respondent is responsible for all costs of compliance with the terms and
conditions of probation.
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K. Any violation of the terms and conditions of probation shall be grounds
for further discipline, up to and including permanent license revocation.

Dated this 16th day of September, 2014.



John Calisesi, D.C., Chairperson
Iowa Board of Chiropractic

cc: Meghan Gavin, Assistant Attorney General
Michael Sellers, Respondents Attorney

Any aggrieved or adversely affected party may seek judicial review of this decision and
order of the board, pursuant to Iowa Code section 17A.19.