California Medical Board Charges Psychiatrist Lindsay R. Kiriakos with Sexual Misconduct

August 30, 2021

On February 18, 2021, the Medical Board of California published and Accusation against Los Angeles psychiatrist Lindsay Ramzi Kiriakos for sexual misconduct and other violations involving a 29-year-old female patient identified as “Patient 1.”

The Board’s document states that Kiriakos continued to see and treat the patient even after he was aware of both the patient’s romantic/sexual attraction toward him as well as his own such attraction toward her.

He additionally continued to see the patient even after he had referred her to another therapist.

During a video treatment session, Kiriakos asked the patient to show him her breasts. In another instance, he told the patient he’d like to ejaculate on her.

During an in-person session, Kiriakos unzipped the Patient’s dress and engaged in contact which, while not strictly sexual (e.g. intercourse), was nonetheless sexual in nature. (This occurred on the day before his pregnant wife gave birth.)

The Board also charged Kiriakos with failure to keep accurate and adequate records on Patient 1.

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The full text of the Board’s Accusation follows:

Patient 1, a 29-year-old female, sought out Respondent [Kiriakos] for psychiatric treatment which began on or about March 2, 2018. Patient 1 presented with symptoms of panic attacks/panic disorder manifested by increased heart rate, shakiness, nausea, chest tightness, menstrual symptoms, and mild agoraphobia. The patient also gave a history of sexual abuse by her domestic partner, chronic anxiety, difficulty with concentration, and a presumptive diagnosis of attention deficit hyperactivity disorder (ADHD) which is what Patient 1 was told by a prior psychiatrist, in 2017. The patient related that she had been taking Ritalin, as needed, and had trials of multiple antidepressants, including Zoloft and Paxil for anxiety, which she told Respondent were not helpful.

Respondent did not contact and/or did not document contacting Patient 1's previous provider or providers. Respondent did not assess and did not document assessing in more detail the patient's prior antidepressant trials. Respondent did not perform and did not document a complete history to validate the diagnosis of ADHD. Respondent did not use and did not document any validated metrics to score the severity of several pre-established domains, such as task completion, procrastination, or interrupting, that are elements of the criteria which assist in forming the diagnosis of ADHD.

Respondent diagnosed Patient 1 with panic disorder, agoraphobia, generalized anxiety disorder, and chronic depression. Once again, Respondent failed to elicit and/or document a sufficient history and physical examination to support these diagnoses.

Respondent prescribed Valium on a routine basis for Patient 1's anxiety without obtaining and/or documenting Patient 1's informed consent. Respondent did not document his reasoning for his decision to prescribe Valium, as opposed to any other medication, to Patient 1.  

Respondent also told Patient 1 to continue taking Ritalin 20mg on a pm basis (as needed).

Throughout Respondent's treatment of Patient 1, Respondent did not assess the effectiveness of these medications and did not verify, document verifying, or document reasons for not verifying Patient 1's controlled medication compliance as required by Health and Safety Code, section 11165.4.

Respondent also arranged to see Patient 1 approximately every 7 days for in-person therapy. Respondent claimed that he was rendering cognitive behavioral therapy to Patient 1. However, Respondent documented in Patient 1's therapy notes that he engaged in some form of role playing and exposure therapy, which are not the tenets of cognitive behavioral therapy and do not have a place in standard treatment of the conditions Respondent diagnosed Patient 1 with.

Additionally, between March 23, 2018 and April 15, 2018, Respondent's therapy notes refer to many items that one would see in psychodynamic/interpersonal therapy, such as references to problems with Patient 1's mother, issues with her boyfriend moving out, and superficial cutting; items not normally addressed in cognitive behavioral therapy. During this time, Respondent did not clearly document in what fashion he was medicating the patient, what compliance she had with her medications, and the level to which she was experiencing any symptoms of the diagnoses Respondent ascribed to Patient 1. Respondent also proactively sought out, reviewed and/or analyzed Patient 1's social media activity, including photographs, and other social media users' reactions, which he discussed with Patient I during therapy sessions.

On or about May 31, 2018, Respondent noted that Patient 1 developed a "transferential" attraction to him. On or about June 8, 2018, Respondent noted his own, countertransference, attraction to the Patient 1. Respondent documented a "curbside consult," and referral to a marriage and family therapist. In his interview with the Board investigators, Respondent explained that he felt the need to refer the patient out at this early stage, however the patient refused. This refusal was not documented. Respondent failed to consider, and did not document a consideration, that it was contingent upon him as the physician to insist to the patient that the treatment was in fact compromised. If Patient 1 refused the referral, it also became contingent upon him to offer a series of referrals and to recuse himself from further treatment.

But that is not what Respondent did. Respondent continued to provide psychotherapy to Patient 1 after he documented in her chart that he would establish "firm boundaries."

On or about June 15, 2018, Respondent prescribed to Patient 1 Seroquel, an antipsychotic medication that is prescribed off-label to insomnia patients for its sedative' effect.

Respondent documented in Patient l's chart that Seroquel was prescribed for insomnia, however, Respondent did not document or explain his reasoning for this choice of medication.

From September 20,2018 through January 10,2019, Respondent's weekly sessions with Patient 1 are documented as brief and unchanging mental status exams that include a limited commentary about the patient's life events. These records do not reflect cognitive behavior therapy. The manner of Respondent's record keeping made it is extremely difficult to ascertain what treatment the patient was actually receiving and whether she was making any progress.

Starting on January 10, 2019, Respondent began to chart that Patient l's tendency to pursue men in relationships required firm boundaries and, again, documented that he referred Patient 1 to a marriage and family therapist. In addition, Respondent engaged in a supervisory experience with another psychiatrist to discuss transference/countertransference issues. In Respondent's records for Patient 1, there is a paucity of information as to what actually transpired, what actions the patient had taken, what attempts there were to set boundaries with the patient, and what guidance in supervision was given to him.

On or about January 24, 2019, Respondent charted in Patient 1's records a discussion of transference/countertransference issues and a "possible referral to another psychiatrist if the situation intensifies." Respondent's records contained no explanation about what occurred.

Respondent's records for Patient 1 do not clearly establish whether a transfer of her therapy to a marriage and family therapist was already underway. However, despite making attempts to transfer Patient 1's therapy, Respondent continued to see Patient 1. On or about January 28, 2019, Respondent charted that a "clear significant boundary violation" on his part occurred, 10 which had an anti-therapeutic effect on Patient 1. No details were recorded. After that event Respondent began efforts to refer the patient to another psychiatrist for medication management.

Yet, even after attempting to arrange a referral, Respondent continued to have contacts with Patient 1, in-person on February 12, 2019 and March 6, 2019, as well as by text messages and video conferences.

Respondent's admissions during his interview with the Board's investigators, the text messages exchanged between Respondent and Patient 1, and Patient 1's complaint to the Board, show a steady erosion and eventual disregard for professional boundaries by Respondent while he was providing psychotherapy to Patient 1 as follows:

A) Respondent described himself to Patient 1 as a "pick-up artist".

B) Respondent told Patient 1, during therapy, that he and Patient 1 would "probably be hooking up" if they were single.

C) During the course of treatment Respondent discussed a video-game chat room to Patient 1 which led Patient 1 to join the chat room and communicate with Respondent in a sexually provocative manner. Respondent did not know that he was communicating with a patient until she told him during therapy. After she informed him, Respondent continued to render therapy to Patient 1. Respondent provided updated chat room information to Patient 1 in a text message at or near the time Patient 1's care was transferred to other providers.

D) During a video therapy session Respondent asked Patient 1 to show him her breasts.

E) Respondent accessed Patient 1's social media, including photos, and discussed them with the patient during therapy.

F) Respondent told Patient 1 that he would like to ejaculate on her.

G) During an in-person therapy session on or about January 28, 2019, Patient 1 described the anti-therapeutic incident as follows:

"Our session took place the day before his son was to be born. I specified to him no touching, no kissing. He told me to stand and tum around - I did. He unzipped my dress and breathed along my back and neck, and then told me to sit down and breathed along my inner thighs. During this, he did touch me. He tried to convince me we could continue to see each other, and I declined. He ki~sed my forehead and I left. Afterwards, he texted me asking if he could come to my house for another session, and I declined."

In his interview with the Board's investigators, Respondent described this incident as follows: "I recall that portion of the -- the session which -- and I thought that that was the – the most inappropriate ... at some point, the patient stood up, kind of made conversation, and I said, well, what -- you know, what are you doing? And she said, well, stand next to me. And I was like well, what do you want? She was like, trust me. I'm going to show you how good my boundaries are. And so, I stood next to her. And we didn't touch, but somehow it progressed to me -- um -- tracking her skin with -- with -- uh -- with my -- with my -- uh -- with my lips, you know, with my face as if I was going to kiss her, but I didn't. And -- uh -- I ended up -- uh -- tracking the parts of her body that were exposed. She was wearing -- um -- a revealing dress, so it was her -- uh -- so, I do recall that being her neck, her left -- her arms, and her legs, the – the parts that were revealed by the dress. And then, I sat back down, and she sat back down. And that -- that I recall as being the most -- uh -- the most intense it got on a -- um -- on a physical level."

Even though Respondent purported to have referred Patient 1 to other providers, he remained involved in her care and remained in contact with Patient 1. However, these contacts were inappropriate and outside of the standard of care. On or about February 5, 2019, Patient 1 showed Respondent a portion of a screenplay she wrote soon after her treatment with Respondent began in which one of the characters was a psychiatrist, based on Respondent, who was seduced by his patient. Patient 1 described that character as "rather handsome" in her screenplay. Respondent, in a text message told Patient 1 that she had a typo, and the word “rather" should have been "extremely."

Even after attempting to refer Patient 1 to other providers, Respondent continued to engage with her in a flirtatious manner, telling her that he was still her psychiatrist and offering her to have additional therapy sessions in-person. When Patient 1 expressed reluctance to communicate with Respondent, he continued to contact her, telling Patient 1 that he missed his "favorite patient" and offering to have additional interactions with her. Respondent convinced Patient 1 to have a video session on or about February 26, 2019. The session was interrupted by Respondent's spouse and ended abruptly. On February 27, 2019, Respondent texted the followi.ng to Patient 1: "Thanks for taking my call last night. (FYI, I had just had dinner with my dad…I was tipsy but not drunk etc.) You asked me what would have happened had we met again. My guess is more of the same ... A mixture of discussion, boundary pushing, confusion and somehow still restraint (the past is the best predictor of the future). I am glad that you said no and that, as a result, things never progressed further than they did. I ended up disclosing to my wife the major details of what happened between us (without mentioning your name). It feels better now to have it out in the open. I am sorry to have put you through such turmoil. You deserved better than that, especially from me."

Source: Accusation in the Matter of the Accusation Against Lindsay Ramzi Kiriakos, M.D., Physician's and Surgeon's Certificate No. A 79342, Case No. 800-2019-063022, Medical Board of California, Feb. 18, 2021.