|(a) Explanations/Conduct. (1) Sexual misconduct is behavior that exploits the physician-patient or physician-staff member relationship in a sexual way. This behavior is non-diagnostic and non-therapeutic, may be verbal or physical, and may include expressions of thoughts and feelings or gestures that are sexual or that reasonably may be construed by a person as sexual. (2) There are three levels of sexual misconduct: sexual violation, sexual impropriety and sexual exploitation. Behavior listed in all three levels may be the basis for disciplinary action by the Board if the Board finds that the behavior was injurious or an exploitation of the physician-patient or physician-staff member relationship. (A) Sexual violation may include physician-patient or physician-staff member sex, whether or not initiated by the patient/staff, and engaging in any conduct with a patient/staff that is sexual or may be reasonably interpreted as sexual, including but not limited to: (i) Sexual intercourse, genital-to-genital contact. (ii) Oral to genital contact. (iii) Oral to anal contact, genital to anal contact. (iv) Kissing in a romantic or sexual manner. (v) Touching breasts, genitals, or any sexualized body part for any purpose other than appropriate examination or treatment, or where the patient/staff has refused or has withdrawn consent. (vi) Encouraging the patient/staff to masturbate in the presence of the physician or masturbation by the physician while the patient/staff is present. (vii) Offering to provide practice-related services, such as drugs, in exchange for sexual favors. (B) Sexual impropriety may comprise behavior, gestures, or expressions that are seductive, sexually suggestive, or sexually demeaning to a patient/staff, including but not limited to: (i) Disrobing or draping practices that reflect a lack of respect for the patient's/staff's privacy, deliberately watching a patient/staff dress or undress, instead of providing privacy for disrobing. (ii) Subjecting a patient/staff to an intimate examination in the presence of medical students or other parties without the explicit consent of the patient/staff or when consent has been withdrawn. (iii) Examination or touching of genitals without the use of gloves. (iv) Inappropriate comments about or to the patient/staff, including but not limited to making sexual comments about a person's body or underclothing, making sexualized or sexually demeaning comments to a patient/staff, criticizing the patient's/staff's sexual orientation (transgender, homosexual, heterosexual, or bisexual), making comments about potential sexual performance during an examination or consultation except when the examination or consultation is pertinent to the issue of sexual function or dysfunction, requesting details of sexual history or sexual likes or dislikes when not clinically indicated for the type of consultation. (v) Engaging in treatment or examination of a patient/staff for other than bona fide health care purposes or in a manner substantially inconsistent with reasonable health care practices. (vi) Using the physician-patient or physician-staff member relationship under the pretext of treatment to solicit a date. (vii) Initiation by the physician of conversation regarding the sexual problems, preferences, or fantasies of the physician. (viii) Examining the patient/staff intimately without consent. (C) Sexual exploitation by a physician is the breakdown of the professionalism in the physician/patient/staff relationship constituting sexual abuse. Sexual exploitation may undermine the therapeutic relationship, may exploit the vulnerability of the patient/staff, and ultimately may be detrimental to the patient's/staff's emotional well-being, including but not limited to: (i) Causing emotional dependency of the patient/staff; (ii) Causing unnecessary dependence outside the therapeutic relationship; (iii) Breach of trust; (iv) Imposing coercive power over the patient/staff. (3) A third impartial person who is the same sex as the patient must be present in the examining room if a patient is asked to disrobe or if the genitalia are examined. (b) Investigation of Sexual Misconduct. (1) A board or private investigator may be used in the investigation of sexual misconduct. The evaluator must release to the Board all records pertaining to the identity, diagnosis, prognosis, and treatment of such physician. Such records should include but not be limited to those records maintained in connection with the performance of any program or activity relating to substance abuse education, prevention, training, treatment, rehabilitation, or research. Upon completion of the evaluation, results must be released to the Board. (2) The physician under investigation may be required to have a complete medical evaluation, including appropriate mental and physical examination. Laboratory examination should include appropriate urine and blood drug screens. (3) The psychiatric history and mental status examination is to be performed by a psychiatrist knowledgeable in the evaluation suspected of sexual misconduct. The examination may include neuropsychological testing. (c) Disciplinary Options for Sexual Misconduct. Sexual violation or impropriety may warrant disciplinary action by the Board up to and including revocation of license granted by the Board. (d) License Reinstatement after Sexual Misconduct. In the event a physician applies for license reinstatement, any petition for reinstatement will include the stipulation that additional mental and physical evaluations may be required prior to the Board's review for reinstatement to ensure the continuing protection of the public.