The Wyoming Board of Medicine last week summarily suspended the license of a family practice doctor in an "emergency action" which the board says was required because the doctor posed "an imminent and immediate threat to the public health, safety and welfare of the people of Wyoming."

David R. Cesko, of Rawlins, is accused of the "unsafe practice of medicine that possibly places patients at life-threatening risk from use of the controlled substances he has prescribed for them," according to the Board's order of summary suspension, dated Oct. 26.

The Board is also concerned by the appearance that Cesko had an inappropriate sexual relationship with a patient, and also attempted on multiple occasions to initiate a sexual relationship with another patient.

"There is also the strong possibility that one or more of the patients who have filled Dr. Cesko's prescriptions in Wyoming may be involved in illegal acquisition and/or diversion of controlled substances," the board wrote in its order.

In an Oct. 27 Facebook post, the Memorial Hospital of Carbon County notified the public that Cesko's family practice will be closed until further notice. Patients with scheduled appointments will be notified and seen at other hospital clinics.

The order details two complaints received by the board on Nov. 2, 2016, which alleged that Cesko prescribed codeine cough syrup for two seven-year-old children without evaluating them.

The complaints were filed by the children's grandmother, who said she found the cough syrup in possession of her daughter -- the children's mother -- identified only as "Jane Doe."

A review of the state's Prescription Drug Monitoring Program confirmed that the two prescriptions were filled on Oct. 24, 2016 at the ShopKo Pharmacy in Rawlins.

On Oct. 27, 2016, Jane Doe's mother turned the bottles of cough syrup over to a special agent of the Wyoming Division of Criminal Investigation. Jane Doe was interviewed by authorities the next day.

A Board investigator wrote a letter to Cesko on Nov. 15, 2016, detailing the allegations and requesting a response within a month.

On Dec. 2, 2016, Jane Doe's mother forwarded additional information showing that on Sept. 11 and Sept. 26, 2016, additional prescriptions for codeine cough syrup were written by Cesko for both children.

Cesko finally responded to the Board on March 3. He claimed that due to medical conditions which had affected the children since birth, he agreed to write prescriptions for the cough syrup.

"[Jane Doe] did ask me for a cough syrup for the girls," his response, as cited within the Board's order, reads. "She stated they had started coughing and was afraid they would have another serious problem."

"I asked her if she had custody of the twins again or if her mother still did. She assured me that she had custody. She stated that her mother only had them while she [Jane Doe] was in prison," Cesko's response continues.

Cesko went on to say he agreed to write the prescriptions without seeing the children, but told Jane Doe that she had to bring them in for an evaluation or at least take them to another doctor.

"After several days had passed and no appointment was made, [Jane Doe] was contacted. It was then I found out that she had lied to me and did not have custody of [Doe Child #2] and [Doe Child #1]," Cesko told the Board.

Agents of the U.S. Drug Enforcement Administration and the Wyoming Division of Criminal Investigation executed a search warrant at Cesko's office in Rawlins on May 17. Cesko surrendered his DEA certificate of registration, which had permitted him to prescribe controlled substances in Schedules II-V.

On Sept. 5, the Board's Executive Director, Kevin Bohnenblust, wrote to Wyoming DCI Director Steve Woodson and asked that DCI help investigate the complaints. Woodson approved the request.

In February 2017, Jane Doe's mother had told DEA and DCI agents that she had confronted Cesko sometime in 2013 about his prescribing Xanax to Jane Doe. The mother said she believed Jane Doe was becoming addicted to it.

Cesko, the mother told agents, replied by saying Jane Doe "was an adult."

The mother also said Jane Doe had been treated for substance abuse at Central Wyoming Counseling Center in Casper before being sent to prison on a drug charge.

In her interview with authorities, Jane Doe reportedly said she went to Cesko on July 21, 2016, and asked to "get her Xanax back." She also asked Cesko for money.

"She said she knew when Dr. Cesko hugged her that she could get everything she wanted," the Board's order reads. Later that day, Jane Doe filled a prescription for Xanax written by Cesko.

Authorities examined Cesko's cell phone and found text messages which indicated that Cesko asked Jane Doe to send him photographs of a sexual nature of herself.

Another text messages sent from Jane Doe to Cesko reads, "Will u plz write a thing for cough syrup for [Doe Child #2] and [Doe Child #1]?... after I get back this weekend for [Doe Child #3's] teeth, I'll let you do what ever u want to me. I just have to have a few shot to try to black out what happened to me."

Following that exchange, the Board says, Jane Doe filled prescriptions for codeine cough syrup written by Cesko.

The Board says several series of text messages between Cesko and Jane Doe indicate that Cesko wrote prescriptions for Jane Doe's children without examining them and knew or should have known that Jane Doe intended to divert the codeine prescriptions for her own use, likely in combination with the Xanax, which would have placed her at high risk for "profound sedation, respiratory depression, coma, and death."

The Board also says that if Cesko's actions are proven to have occurred as alleged, they would constitute sexual misconduct in violation of the Wyoming Medical Practice Act.

In addition to the allegations concerning Cesko's interactions with Jane Doe, the Board also based its suspension of Cesko's license on alleged sexual misconduct between Cesko and patient referred to as "Mary Roe."

On Oct. 3, 2016, Mary Roe had an office appointment with Cesko. Following the appointment, Mary Roe filled two prescriptions: one for the opioid painkiller hydrocodone, and one for the stimulant and appetite suppressant phentermine.

Text messages exchanged the following day by Cesko and Mary Roe, obtained by a DCI agent, show Mary Roe asking why Cesko kissed her.

"Probably shouldn't have. But you were talking about me taking you with me on a trip. The hug was great. It felt right. Sorry it bothered you," Cesko replied.

The conversation, as detailed in the Board's order, continues, with Mary Roe and Cesko discussing the possibility of sleeping together.

Texts between Mary Roe and Cesko from May 9, 2017, show Cesko inviting Mary Roe to "come over and sit in the Jacuzzi and get in the bed and snuggle."

"You comfortable getting naked with me?" Cesko asks.

"I must have skank written on my four [sic] head," Mary Roe responds. She then asks, "Can you help me and then I'll still come in Thursday. Nobody will be driving or any of the sort."

"Straight oxycodone without Tylenol?" Cesko asks. "When do you need the script?"

"Whenever... now?" Roe responds.

That day, according to the prescription drug monitoring program, Mary Roe filled a prescription written by Cesko for oxycodone without acetaminophen.

The Board says that, if proven, the text messages would constitute sexual misconduct and "willful or careless disregard for the health, welfare or safety of a patient."

On Aug. 8, Mary Roe had an office appointment with Cesko regarding a lump she had found in her breast. After examining her with a chaperone present and diagnosing Mary Roe with a benign cyst, Cesko excused the chaperone from the room and reportedly tried to touch Mary Roe's legs, asking, "what do you need?" and "what can I help you with?"

In its order, the Board says it is "extremely concerned" about Cesko's issuance of prescriptions for controlled substances, as well as the appearance of inappropriate sexual relationships, or attempts to initiate such a relationship, with patients.

The Board says the suspension will remain in place pending a formal petition for the revocation of Cesko's license and a contested hearing on the matter.

When asked on Wednesday whether prosecutors will pursue criminal charges against Cesko, the Carbon County Attorney's Office declined to comment.

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