STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF PROFESSIONAL LICENSING BOARD OF MEDICINE DISCIPLINARY SUBCOMMITTEE In the Matter of THOMAS JAMES GORDON, M.D. License Numbers: 43-01-043145 File Number: 43-16-140069 ADMINISTRATIVE COMPLAINT, The Michigan Department of Licensing and Regulatory Affairs (Complainant) by Kim Gaedeke, Director, Bureau of Professional Licensing, files this Complaint against Thomas James Gordon, M.D. (Respondent) as follows: 4, The Michigan Board of Medicine (Board) is an administrative agency established by the Public Health Code, 1978 PA 368, as amended; MCL 33.1101 et seq. Pursuant to section 16226 of the Public Health Code, supra, the Board's Disciplinary Subcommittee is empowered to discipline licensees for violations of the Public Health Code. 2. Respondent is licensed to practice as a medical doctor in the state of Michigan and holds controlled substance licenses. 3. On April 27, 1992, Respondent was convicted of “Aggravated Assault,” a misdemeanor not punishable by imprisonment for a maximum term of two years, in the 63 Judicial District Court, in Grand Rapids, Michigan in case number $1- 1690-2. Respondent was given a suspended sentenced of 90 days in jail, contingent onsuccessful completion of 18 months’ probation, and ordered to pay fines, costs, and restitution of $777.40. A copy of the conviction documents, marked Exhibit A, is attached and incorporated. 4. On April 12, 2012, Respondent was convicted of “Weapons- Firearms-Possession Under the Influence” and “Domestic Violence,” both misdemeanors not punishable by imprisonment for a maximum term of two years, in the 17" Judicial District Court, in Grand Rapids, Michigan in case number 11-11823-FH. Respondent was sentenced to four days in jail, placed on probation for 18 months with terms, and ordered to pay fines and costs of $1,525.00. A copy of the conviction documents, marked Exhibit B, is attached and incorporated. 5. OnMay 11, 2015, Respondent was convicted of “Disorderly Person Jostling,” a misdemeanor not punishable by imprisonment for a maximum term of two years, in the 63" Judicial District Court, in Grand Rapids, Michigan in case number D133441SM, Respondent was given a suspended sentenced of 90 days in jail, contingent on successful completion of one year of probation, and ordered to pay fines and costs of $935.00. A copy of the conviction documents, marked Exhibit C, is attached and incorporated. 6. On December 3, 2015, Respondent was convicted of “Operating While Intoxicated,” a misdemeanor not punishable by imprisonment for a maximum term of two years, in the 57" Judicial District Court, in Allegan, Michigan in case number 153816SD. Respondent was placed on probation for six months with terms and orderedto pay fines and costs of $1,315.00. A copy of the conviction documents, marked Exhibit D, is attached and incorporated. 7. Respondent failed to notify Complainant of the April 27, 1992; April 12, 2012; May 11, 2015; and December 3, 2015 convictions within 30 days of the date of each conviction. COUNT} Respondent's convictions, as set forth above, constitute a misdemeanor conviction that is reasonably related to or that adversely affects the licensee's ability to practice in a safe and competent manner, in violation of section 16221(b)(xi) of the Public Health Code, supra. COUNT IL Respondent's conduct, as set forth in paragraph 7, evidences a failure to notify Complainant of a conviction within 30 days of the date the conviction as required by section 16222(3) of the Public Health Code, supra, in violation of section 16221(f) of the Public Health Code, supra. This Complaint is based upon files and records maintained by Complainant and the attached Affidavit of Terri Schrauben.Complainant requests that this Complaint be served upon Respondent and that Respondent be offered an opportunity to show compliance with all lawful requirements for retention of the license. If compliance is not shown, Complainant further requests that formal proceedings be commenced pursuant to the Public Health Code, rules promulgated thereunder, and the Administrative Procedures Act of 1969, 1969 PA 306, as amended; MCL 24.201 et seq, Pursuant to section 16231(8) of the Public Health Code, supra, Respondent has 30 days from the date of receipt of this Complaint to submit a written response to the allegations contained herein. The written response shall be submitted to Complainant, Kim Gaedeke, Director, Bureau of Professional Licensing, Department of Licensing and Regulatory Affairs, P.O. Box 30670, Lansing, Michigan 48909. Pursuant to section 16231(9) of the Public Health Code, supra, Respondent's failure to submit a written response within 30 days, as noted above, shall be treated as an admission of the allegations contained herein and shall result in transmittal of this Complaint directly to the Board’s Disciplinary Subcommittee for imposition of an appropriate sanction ie : Kim GaedeKS, Director Dated: BY/ XA/ 27 Bureau of Professional Licensing Attachments. This is the final page of an Administrative Complaint in the matter of Thomas James Gordon, M.D.. File Number 43-16-140069, before the Discipinary Subcommittee of the Michigan Board of Medicine, consisting of four pages, this page included pwe‘steopy all 24d copy -Detordant 101 SAD and copy Site Paco Shrcopy-Provaetor STATE OF MIGHIGAN ae CASENO. 63-2 JUDICIAL DISTRICT YUDGMENT OF SENTENCE JUDICIAL CIRCUIT Cr COMMITMENT TOaN- 91-1690-2 x Ot an waa ut elephant na. Me 10075 =d: eeu ‘ oa oiopi 4300 Cascade Rd. SE Grand Rapids, Michigan 49546 616-774-3570 10 Tho Slate of Michigan Boiendeats pana, ade, and ephono no, THEPEOPLE OF so cascADR TONNSHIP: v : THE COURT FINDS: : i 1. The defendant was found guityon__PREL 27th, 1992 or ha erimo(s) a slated below: scat dae ‘ CONVICTED BY CHARGE CODE(S) count ica [cout suy | CRIME MCL cltationPASC Code Ol | uc {xx AGGRAVATED ASSAULT (PaCC.# 750.81 A) (M.C.D.A.: $750.81; M.S.A, $28,276 (1) ff a 7 Sfare OF icricnae NOLLE CONTENDRE PLEA “Plea inset fa gully ples; uso "NC" fo nc comandere use “rr guy bana TBI] POT 2, Dotendant’ vas réptesonted by an attorney: (REDATNED! RICHARD i. ZAMBOX POSES Gas avid oth ht counsel andr eppohntedcounsel andrew holigenly, andvotomcy seve that ght. 1. Kevin Mckay Cleo ine 69 Distt Cou 138 The convitonsreporible tothe Secretary of Staloundor MCL. 257.782, £3 Conty dary ety hao coy The defendant’ driver licanse number i: inti ut, me ee omen ! iti 4, ITIS ORDERED thal defendat in Testimony Whereot, | have set unto my hand and Da. Serve, days In jail, beginning « Credits glverifon connie cidays vious owe Sig ekg Ge P71 ‘ihe remaining tina in jl to b0 served (nol including good behavior tine) Is____days, prnmnnsda, 1 Delendant may ba released on day parole for the purpose checked during the tnes spoctiad: SY Denciyctox U seeking work Cl working at regular employment —-) allendance at educational institution © medical treatment fe OlbeeFeeeeaeeere eaet Times: “BEFENDANT PAID IN FULL: MAY Ist, 1992) Xb. Pay: $_75.00 _g 100.00 |g 602.40 g_ NONE Total: ¢ 277.40 Feo feet esition ©. Bo confined to jail (in adaton to any other jell term imposed) unt fine and costs are paid, but not to exceed days, Od. Return to this oourt to pay the above fine and costs onor before ays E, CLERK oy in jail, beginning Bae Xe. Be placed on probation for EIGHTEEN months and abide by the terms of probation, ASBHaGlethery GI. Complete the folowing rehabiiative services: Alcohol Highway Safely Educafon Ci Treatment (c outpatient, inpallont, residential, co mental heath) Spocly: DEFENDANT WILL COMPIBTE 12 DAYS OF COMMUNITY SERVIGH WORK, NO INCIDENT'S OF ANGER, ATTEND DOMESTIC CRISIS PROGRAM THROUGH YWCA; 10Kg, Olher: _~oyy DAYS RENT COUNTY JAIL SUSPENSED SF an-cauptsne Wi Z ORIL 27-1993; ORDER. GET SUBSTANCE ABUS! i COMMENDED 5) ire BoReA face anl nde ETS Ree P SE an sed a copy ofthis order to th to creata a criminal hishory renord — esi mink Awiot r\ State Police con Records Division _. 990d(iis eee en Guten Et _ Scop)” Defendant 009) - Gun board need) ‘STATE OF MICHIGAN CASE NO. SUDICIAL pistRact] JUDGMENT OF SENTENCE q77HJupiiac rcumT (COMMITMENT TO JAIL ee raaaaaaae on Gout address ae Court telophane no. mie e100265 ‘180 OTTAWA AVE NW, GRAND RAPIDS Wi 9503 e16-832-s480 oles Report No fa aie a. © Tho State of Michigan [oetendant name, adress, an telephone no. ITHE PEOPLE OF THOMAS JAMES GORDON I ESSE EEE eee v a - aie lerurren 10 os ‘ __4111.013510 00 ‘1608408 THE COURT FINDS: 4, Dofondant was found gully on 94/4212012 ___af th crimes) as stated below: Ee Dale saree = CowwicréD BY [oismsséD CHARGE CODES) ant | Piest | cout | Juy | eye __cante HCL cliationyPACC Code 4 | | _we_hssauctwittia pancenous weAPon reLonious AssauLy) — |reoa2 2fe || MEAPONS - FIREARMS - POSSESSION UNDER THEINELUENCE | 750297 ale lbovestic woLeNcE eos “For ples: nse for gall loa, vse “NOT nao contendere, 0" by prosecutusint, X ropresontod by an attorney: JOHN R. BEASON, 34095 _ 2, Defendant’ L] advised of right to counsel and appointed counsel and knowingly, leligenl and vl Peseta 3. Conviction reportable to Secretary of Siato™. Defendant's driver Fconse number i: FILED 4. Sanctions reporiable to State Police Cl Revoked. Cl suspended oe Crepe aye, 5. HW testing ans sox otenderoistaton completa 5 ese 8. Defendant has been fingerprinted according to MCI. 28,243, JUDGE gi Ve IT 1S ORDERED. ron OE SUtava for goiy Bat mental, For dismissal heen D” fr dismissed cour or NP Tor HonissSd The dus datefor payment is. Dalo ofSentonce Fin, goats, and 1608 na pald within 58 days Ol he de Galo are soc to 20% ato penalty on he amount owd. Only ho tine and some cass may bo salted by senna ince Rick i Deiondant sha serve days in fal beginning ___for flr to pay on time. nt at payments ordoredin this caso are fl sasio,dofondant mst nail the Grit Court lak inwrling of any change of address sath dys of some, a suc eect 2111. Defendant shall be placed on probation for 48 months and abide by the terms of probation. (See separate order.) ‘12, Defendant shall complete the following rehabilitative services. Atcohol Highway Safety Education C] Treatment ((loulpation, 1) inpationt. 1 resident D7. Probation is revoked, L CrReury G7 8. 07 Deferred status is revoked. C] HYTA status is revoked. 9. Defendant is sentenced to jail as folowe: OReportat _ Dale Seterico | “Sontenced | credied To B= Sawa Foioase Adfized aera Begins | Mos. | Days | Mos. | Days | Mos. | Oays fore Foloning Purpose oom 10 Heed |___1[2 Upon payment of fhe and costs ' [To work or seek work 2 | esosaote a] |e 0_|0 Foratiendance at schoo) | 1 For mociel treatment... 2 | owosaore | | 4 La o_|O other: assess eeceaae | 40__Defehdant shall pa cae ‘StaleMinimimn | Crime Vien —_[ Reston | Court Cans ‘Oversight ee [Fine ‘Gther Coat i. sis00 5 35000] sian signe z | |, Cl mental heat.) Specify: 1118. The vehicle used in the offense shall be immobilized or forfeited. (Seo separate one) J 14, The concealed weapon board shall C] suspend for mnesaled Weapon license, permit number (2115, Other: PAYINFULL TODAY DEFENDANT MAY TRAVEL TO SOUTH CAROLINA/G6I19/ (SEAL) oei0sr12 vale PaaS (OL 769.1K, MCL 769.169, MOL 776.22, MCL 780.76, Py he 190828, MCR B27 2288, PGO587Approved, SAO, Original ~ Coun” 2nd copy - Defendant potas ‘st copy - Probation Department 318 copy- Prosecutor STATE OF MICHIGAN CASE NO. / ORDER OF PROBATION (y11823.FH 47th Circuit Court - Kent County OR: MI410025) Court Address: Courthouse, 180 Otlawa Avenue NW Suite 2400 Grand Raps Michigan 49503 ¢ THE PEOPLE OFTHE STATE OF MICHIGAN Kent County CTH 41-11019519-99, CN [Probation Officers MATTHEW J POLDERWAN Ter 1 YEAR @ MONTHS (SENTENCE DATE: osios/20%2) (Offenses: (1) 750.237 - Weapons - Firoarms - Possossion Under the Influence (2) 750°812 - Domestic Violonce [7] sudgment of guitis dotorrod under: [_] MCLS2,7411, Conteoed Substonce Ast Ei mice 762,14, Youthtut Trainee Status [] mt 750.3500, Parental Kidnapping Ack 7 Met 000.1070, O19 Treatment Court IT IS ORDERED thatthe defendant be placed on probation under the supervision of the above named probation officer forthe term Indicated, and the defendant shall H Soe 2 el bean 41, Not late any criminal aw of any unit of government 8. Pay tho following tothe court: ers or 382) Not leave the state without the consent ofthis court Fine... 1,000.00 70m 3° Make a tthfl report tothe probation officer monty, ras often Costs 50.00 as the probation officer may requ, eer In person or in wing, Rost : a 2 required by he probation officer. Crime Viel Assessment. $75.00 4, Noltythe probation officer immediately of any change of Atomey Fee. 3 address or employment satus State Costs, $5100.00 He Dyiy sy t Kat ¢ Stl Abacs teleccen Drag Court Eee. te Lip Ve Other 1s 54,525.00 5, fdja. The due date for paymentis “Te, 5. []>. Total amount duo may be paid instalments of § per and paid in ull bythe due dota stated on the judgement of sentence or by Fines, costs and fees not pa wihin 58 days ofthe dale owed or of any Installment payniGht dale are Subeal toa 20% tate penalty onthe amount owed, 6. Pay asupenision fee tothe Department of Corrections in the amount of §_7Z20.". [1 Toa! amount cue may bo paid in instalments of & per month payable tothe Sale of Michigan. ‘The fee is payable immediately. staring on 7. 02,0 You must not uss or possess alcoholic beverages or other intoxicants. You must not enter bars or other places where the primary purpose is to serve alcoholic beverages for drinking on sito, unless the field agont has frst given you \wditen permission for your employment al a specific location. 02.4 You must comply with the requirements of alcohol testing directed by the field agent. You must not attempt to submit any fraudulent or adulterated samples for testing. You must not hinder, obstruct, tamper, or otherwise interfere with the testing procedures. You must present proper identification at the time of testing 9. 02.8 You must complete outpationt or rosidential substance abuse treatment when you are referced by the field agent, 10. 02.8 You must complete a substanco abuso assessment when you are referted by the field agent. 14. 032 You must complete a psychological evaluation whon you are referred by the field agent. 42, 08:18 You must not engage in any assaullve, abusive, threatening, or talimidating behavior. 48. 042 You must not change residence unless you fist obtain writlan permission from the field agent. 14, 0420 Yourmust not use any object as a weapon. You must not own, use, or have under your control or area of control ‘weapon of any type oF any imitation of a weapon, You rust not be inthe company of anyone you know lo possess these items, Ie te jusoment of gull i defered as states above, the clek ofthe court shall cise the Michigan State Poioe Criminal Justice Information Center of the dsposton as required under MOL 758.16s, ‘CC 24a (2106) ORDER OF PROBATION MCL 600-4803, MOL 708-1, MOL 771.1 el soq., MOL 775.22, MCL 780.828, MCR6.A45, 181USC 622(0KB¥) Gordon, Thomas James- 838637 Se 2. i Page 1 of 2 v 3, PEBEOSeae ( ¢ et ae talon an coy -Deonnt orien : ‘stein -Pratin Dgsonant__anfcopy- Prensa STATE OF MICHIGAN ASE NO ORDER OF PROBATION (4)1111823-FH | srtn cucu Court Kent County 15. 04.21 You musteontac the supervising fl agent no aor than the frst business day falling your placement on pation of release from jal, 16. 04.22 You must comply with written or verbal orders made by the feld agent. 47, 04.23 You mustallow the fisld agent inio your residence at any lime for probation supervision, 18. 04.24 You must submit to @ search of your person and property, including but aot limited to your vehicle, rosidence, and computer, without need of a warrant if the field agent has reasonable cause fo believe you have ilems which violate the condilons of your probation. 19. 04.25 You mustreport any arrest or police contact, loss of employment, or change of residence to the field agent within 24 hhouts, weekends and holidays excepted. 20. 08.4 You must make genuine efforts to find and maintain legitimate employment of a minimum of 30 hours por wook, unless engaged in an alternative program approved by the ficld agent. You must provide ongoing verffeatton of ‘omployment or alternative program to the fold agent, You shall not give reason to be terminated or voluntarily {terminate your employment or allemative program, unless you frst obtain written permission from the feld agent, 21. 08.0 ‘You must serve jal time as follows: 4 days , with credit for 4 days served. 22, 08.11 You must consent to assignment of wages unl court ordered assessments are pald in ful, unless athense drectod by the field agent, 23. 08.18 You must pay § 100 Stale Cost as ordarad by the Cour. 24. 082 You must pay a erime victim's assessment in the amount of § 75 as ordered by the court, 25. 08.4 You must pay court costs of $ 360 as ordered by the court. These costs may be paid at the rate of $ per month. 26. 08.5 You must pay a fine of § 1000 as ordered by tho court. This fina may be paid atthe rate of § per month, 27. 09.22 Possession of a Medical Marjuana Card issued to you under the Michigan Medical Marijuana Act or having applled for a Medical Mariana Card will not allow you to use marijuana while under Kent County Circuit Cour probation, ‘Supervision, You are not to use of possess marijuana, controlled substances, drug paraphernalia or be with anyone Yyou know to possess those items unless you have specific written permission from the judge. Failure to comply with this order may result in a revocation of probation end incarceration, IT IS FUTHER ORDERED: that the Probation Officers of this Court are heretay authorized and empowered Lo effect the apprehension, detention, and confinement of the defendant on reasonable cause to belove he/she has violated a condition af histher probation or for ' have read or heard the above order of probation and héve received a copy. | understand and agree to comply with this order. 26. O85. Date . nents on the probation supewision fee ae aks Paragraph 6 ae SUSPENDED until iim paysnens, fines andl costs assigaedtigher prpprity by MG2.715.22 ave been pa {f the judgment of guilt ie daforrs as staled above, the clerk ofthe court shal advise the Nichia State Police Criminal Jutive Infomation Center of the dispostion as required under MCL 769. 16a, Gordon Thomas ares S887 osasror? tass9 inet) paleo. poy Dat? IDI rina nemSM ubtctaL DISTRICT NO 41120088769 Defendant was found guilty on MAY 11, 2015 of the érime(s) as stated below: CONVICTED BY DISMISS T PLEA* COURT JURY -BY* crIME 8 - 8 — DISORDERLY PERSON J CHARGE CODE(S} MCL CTYALTON/PACE 780,46741 *Plea:insert G for guilty plea; NC for nolo conter lere: Wi for mentally i)} *Dismissed:insert D for by c ust or NP for by prosecutor/plaintifé ‘STATE OF MICHIGAN ed by an attorney: JOHN R. BEASt Defendant was represey 1s onpeneD: Defendant is sentenced to jail as follows: cour oeeat 2 DATE TOTAL JAIL TO BE Release Author zed said CountyReteteaeniPipar ibe cbpy of JAIL SENTENCE CREDIT SERVED for ‘the Fol Lowinghe document is Fiuamopy of the raft now on BEGINS DAY(S) DAY(S) DAY(S){ } Upon payment: Sie eyes i East aera SUSPENDED 30 oO 9 {3 To work or seek wde}estimony Whereot v0, ee { } For sttondance at SeHoepsaas dato ara {1} For medical treatment — __eRgyrigkarcen £ ¥ Other eee — — Fee = Defendant shall pay: ‘by Beputy Clerk —$ STATE CRIME > ATTY FINE FEES ‘OTH ‘TOTAL x $0.00 75.00 300.00 150.00 360.00 935.00 oenat peste ei gaseros The due date for payment. is . Fi costs, and fees not paid within 5S€ days of the due date are subject to a 20% late penalty on the amount owed. Only tho fine and some costs may be satisfied by serving time in Jel Defendant shall serve __ days in jail beginning __ _ for failure to pay on time, Defendant. shall be placed on probation for 12 month: terms of probation. (See separate order.) d abide by the other: a YR REORTING PROBATION. 90 DAY SUSPENDED JAIL SENTEN W/BLL CONDITIONS OF PROBATION. ABSTAIN FROM ALC/DRUGS. NO a: THREATENING BEHAVIOR/PIREARMS OR WEAPONS. APPLY BOND. an peer space -- B238789 te Tudge JEF J. OHARA Bar No. MCL 765,15(2). MCL 769.1, MCL 769.168, MCL 775,22, MCL 780.766. MCI 780.826, MCR 6.427 219 (3/10) JUDGMENT OF SENTENCE/COMMITMENT TO JAIL \i grigine > court 32d co ~/ Defendant Gst%eu (gail ah ce Prosecutar approved, sc30 Bnd Cekl Michigan state rouice caro Sth co. Gum bonrd (SE needed! PAGE 1 STATE OF MICHIGAN CASE NO. 57TH JUDICIAL DISTRICT JUDGMENT OF SENTENCE JUDICIAL CIRCUIT CO comermsnr TO JAIL 153816sD sD oR Cause Nidzcce 113 CHESTNUT-COUNTY BEG-END FL ~~Gaurt Telephone no: MI-0300257 ALbecaN, ME 49010 (268) 673-0358 Police Report No. 2025-15 (the State of Wichigan SaLESGGRETS name, FAGTHT, ane FOTepHONE BO ‘THE PEOPLE OF vy | A826), 94-9247 a ae = — o31500316201_|1goesssn 1 THE COURT FINDS: 2. Defendant was found guilty on DEC, 3, 2015 of the crime(s) as stated below: ate CONVICTED BY ] DISHISSED] CHARGE COBE(S} eount| pear coureygury | BY® CRIME McL citation/Pacc code 1[e [OPERATING HHILE INTOXICATED 257,6251-A FES EP SEY BT Te aT TEE > Defendant (W represented by an attorney: JOHN R. BEASON P-34095 [ aevisea of right to counsel and appointed counsel and kaowingly, thtelligentiy, and voluntarily waived that fight. @ 3.convict to Secretary of State. Defendant's driver's license nunber is Mr EY IS ORDERED (O &. Dideterred status is revoked. [] HYTA status is revoked. ( sinerendant is sentenced to jail as follows: CD Report at a i Date Genteice ] Sentenced | credived fo He serve Release Authored Wlsaae Period Count. Bogine Hon. Days |woa. ypaye |Nos. Days for the Following Purpose rron__To_| [Ci Upon payment of fine/costal + ID 70 work or seek work. |) Por attendance at school..| (C] For medical treatment..... feces (olen sees see SEaLELLLE 10,Defendant, shall. pay: camer srs ian abe Vier eesrrrurron ce costs yom, Arm rena __gnmm mats t 80;00 75.00 200.00 00.08 “ar 315.00 nalance Due! ‘the due date for payment io 2/04/26. Pine, costs, and tees not Pat wienin se daja’ 1°? of the due date ave subject Eo a 208 late penalty’ on the anount oved. Only the fine and fone costs may be satistied by serving time in Jaci. [i] Dezendant shall serve 90 days in'Jait beginning for failure to pay on tine. GH11.defendant shall be placed on probation for__6 months and abide by the tezme, of probation. (H12.pefendant shall conplete the following rehabilitative services Cy Migohol Highway Safety Education [if Treatments ff outpatient) patient] senidentés).) rental besath) Specify (H15. Other: “ALCOHOL ASSESSMENT AND COUNSELING AS ORDERED. MUST ATTEND VIP. 30 DAYS SCRAM / SORERLINK. §500 BOND TO BE APPLIED. oma _ DEC. 3, 2015 (szAL) new r62.14€@1, mots \eo-ak, Nou 769.268, Hot 778.20, Neu 780,766, Nou 780.426, MC 219 (3/10) JUDGMENT OF SENTENC! TTMENT TO JAIL se LadSTATE OF MICHIGAN DEPARTMENT OF LICENSING & REGULATORY AFFAIRS BUREAU OF PROFESSIONAL LICENSING. BOARD OF MEDICINE DISCIPLINARY SUBCOMMITTEE, In the Matter of THOMAS JAMES GORDON, M.D. License Number: 43-01-043145 File Number: 43-16-140069 STATE OF MICHIGAN ) js COUNTY OF INGHAM Al IDAVIT OF TERRI SCHRAUBEN NOW COMES Terri Schrauben, hereafter Affiant, who, after first being duly sworn and upon oath, states on information and belief as follows: Affiant is a Department Analyst in the Legal Affairs Division, Bureau of Professional Ucensing, Department of Licensing & Regulatory Affairs; hereafter Department, and in this capacity is responsible for obtaining certified copies of records of criminal convictions against health professionals licensed to practice a health profession in the state of Michigan. On March 9, 2016, Affiant received certified records of conviction from the 63" Judicial District Court, Grand Rapids, Michigan, indicating that Thomas James Gordon, M.D., hereafter Respondent, was convicted of Aggravated Assault, on April 27, 1992, in Case Number 91-1690-2. On February 1, 2016, Affiant received certified records of conviction from the 17" Circuit Court, Grand Rapids, Michigan, indicating that the Respondent was convicted of Count 2, Weapons — Firearms — Possession Under the Influence, and Count 3, Domestic Violence, on April 12, 2012, in Case Number 11-11823-FH.\ On March 9, 2016, Affiant received certified records of conviction from the 63" District Court, Grands Rapids, Michigan, indicating that the Respondent was convicted of Disorderly Person — Jostling, on May 11, 2015, in Case Number D133441SM. On February 1, 2016, Affiant received certified records of conviction from the 57" District Court, Allegan, Michigan, indicating that the Respondent was convicted of Operating While Intoxicated, on December 3, 2015, in Case Number 153816SD. Upon checking the Department's records relative to Michigan licensure, Affiant learned that Respondent is currently licensed to practice as a Medical Doctor in the state of Michigan. Affiant has not been notified by Respondent of the April 27, 1992, April 12, 2012, May 11, 2015, or December 3, 2015, convictions within 30 days of the date of the convictions. Further Affiant saith not. Ge od en ALE Téiri eye nee and m to before me Poe of AlGrche 2016 BIANKAA. DALY NOTARY PUBLIC - STATE OF tHICHIGAN _ COUNTY OF iNGHaM Blanka A. Daly, Notary Pu My Commision Expies Jy 8, 2020 Ingham County, Michigan My commission expires July 8, 2020, ‘This is the last and final page of an Affidavit of Terri Schrauben in the matter of Thomas James Gordon, M.D., File Number 43-16-140069, before the Discipiinary Subcommittee of the Michigan Board of Medicine, consisting of two pages, this page included.