In the first case, Dr. Richard Kravitz, who works at the Veterans Administration Hospital in West Haven and a private office in Hamden, came under scrutiny in August of 2018 after a female patient in his private practice reported that he had failed to inform her about side effects from the medication he prescribed, according to a consent order approved by the board.

The woman contended in a letter to the board that Kravitz prescribed toxic levels of Lithium for three years but never sought blood tests, even though she complained of neurological symptoms. He also prescribed a “cocktail” of five other drugs, leaving the woman with side effects that changed her personality and appearance, she said.

An investigation into the allegations revealed that Kravitz had failed to order laboratory testing for the woman and failed to document her treatments for three years, beginning in December 2015, documents said.

Under a consent order, Kravitz must pay a $10,000 fine and follow the stipulations of an 18-month probation period including attending classes in proper documentation and laboratory monitoring of prescriptions.

Kravtiz admitted to the allegations but contested the board’s requirement that his work at the VA be monitored by an independent third party during the probation period on the grounds the incident was related to is private practice, according to letter sent to the Department of Public Health (DPH).

The board also fined a Madison physician for violating the terms of a consent order issued in 2013 barring him from examining female patients without a chaperone present.

Dr. Si-Hoi Lam was disciplined by the board in 2013 after a female patient testified that he had “massaged” her vaginal area inappropriately during a medical examination prior to a lumpectomy in 2008.

At the time, the board issued Lam a $5,000 fine and placed his license under a permanent restriction barring him from examining female patients alone.

A medical student reported to DPH in August 2020 that Lam had examined four female patients without a chaperone on July 22 and 23, 2020, documents said.

Lam asked the board in a May 2020 letter to remove the restriction, saying that he had fulfilled all the requirements of the discipline and the restriction was impacting his ability to practice medicine in Connecticut and New York where he also holds a license.

The board agreed in June 2020 to Lam’s request for a hearing on whether the restriction can be removed. But Lam voluntarily submitted a withdrawal of the request on Feb. 2 after learning about the new investigation.

On Tuesday, Lam was issued a $5,000 fine and ordered not to violate the restriction on his license again.

The board also ordered a Newington woman to “cease and desist” practicing medicine without a license after the Central Connecticut Health District reported she was giving Botox injections for a fee.

Ermelinda Rrumbullaku was providing shots of Lidocaine, a pain reliever, Botox and Belotero, both cosmetic fillers to reduce wrinkles and lines, to people for compensation in 2018 and 2019, according to DPH documents. Rrumbullaku does not have a license to practice medicine or surgery, officials said.

Under a consent order, Rrumbullaku’s name will be submitted to the National Practitioner Data Bank and she must stop giving the shots unless she has a valid medical license.

The board found in its memorandum of decision that Dr. Si Hoi Lam had “acted illegally, incompetently and/or negligently in the practice of medicine” during a pre-operative exam of the patient on Dec. 19, 2008.

His license was placed on probation for six months, and he was ordered to take a course on medical ethics and boundaries. The board also imposed a permanent order that Lam must have a female employee present when examining any female patient.

During a pre-surgery visit with Lam before having a breast lumpectomy, the patient said that after a nurse left the room, he “caressed” her breasts, rather than doing the normal exam she was used to, state Department of Public Health records show.

When the patient told Lam she had tripped over a vacuum cleaner and had been hit in her chest, she said he then asked her to stand up, pulled her pants down to her knees and said he was going to check for bruises on her legs, records show.  She said Lam then massaged the outside of her underwear, then moved his hand under her underwear and massaged her clitoral area, records said. After completing some paperwork, the patient said Lam massaged her clitoral area again until she questioned why he needed to keep doing it, records said.

Lam denied that he touched her in an inappropriate way and said he conducted a normal breast exam and examined her legs for blood clots and the lymph nodes in her groin as required in the pre-surgery visit, records show. The patient said the groin examination made her feel “in shock,” records show.

After a hearing, the board concluded it had insufficient evidence that the breast exam was inappropriate, but it found that Lam “significantly deviated” from the standard of care when examining the patient’s lymph nodes, records state.

Records show the board found the patient’s testimony about the sexual contact to be “credible and reliable.” Lam had said the patient’s anxiety about the operation may have affected her judgment, but the board disagreed.

Other factors cited in the board’s decision were that Lam did not have a female assistant present during the exam, did not explain the type of touching he would be doing and did not document that he had examined her breasts or lymph nodes that day.

In other business Tuesday, the board accepted a consent order that prohibits a Bristol obstetrician from performing surgery except for procedures done under anesthesia in an office and bars her from delivering babies or caring for pregnant women beyond their 22^nd week.

State records show that on Jan. 12, 2011, Dr. Victoria Biondi was performing a hysterectomy at Bristol Hospital when she could not find the tip of a scalpel. She did not have an X-ray done in the operating room to find the broken instrument but instead closed the surgical site and sent the patient to the recovery room, records show. Once there, Biondi ordered an X-ray.

The patient was informed of the missing scalpel and it was found and removed the next day, William Gerrish, DPH’s spokesman, said.

The hospital reported the incident to DPH. During the investigation, Biondi voluntarily surrendered her privileges to perform surgery at Bristol Hospital and John Dempsey Hospital in Farmington, records show. She also agreed not to perform deliveries or care for pregnant women beyond their 22^nd week at either hospital, records show.

The consent order states that Biondi did not admit any wrongdoing but agreed to the medical board’s penalty.

Board member Dr. Robert Green said after the vote on Biondi that the incident was “fairly egregious” and that he would have liked to see a stiffer penalty imposed.

The board also declined to reconsider its decision from last month to fine a Milford psychiatrist $15,000 for sending personal texts to a patient.

In September, the board had also reprimanded Dr. Ljudmil Kljusev for inviting the female patient in 2007 to meet him at a restaurant, for sending the texts and for calling her “Sweety,” DPH records show.

The board considered the behavior a violation of professional boundaries. Through a new lawyer, Kljusev asked the board to reconsider its conclusion that the texts were unrelated to treatment and were of a personal nature. Attorney Anthony Sasso of Fairfield wrote to the board that the text messages were “an effort to support a very fragile patient” and that the patient is the one who initiated the messages. DPH staff attorney Diane Wilan argued in writing against reopening the case, and the board agreed.

Assistant Attorney General Daniel Shapiro said Kljusev’s lawyer has asked for the request to be tabled Tuesday, but the board declined to do so.