A former University of Michigan-affiliated pediatric rheumatologist who was investigated for having sex with a patient is facing federal child pornography charges, according to a federal complaint unsealed Feb. 12.

Mark Franklin Hoeltzel, 46, stood mute—meaning a not guilty plea was entered for him—in front of U.S. District Magistrate Judge Elizabeth A. Stafford. He is charged with receipt of and possession of child pornography. He faces up to 20 years in prison if convicted as charged.

U.S. Assistant Attorney General Mollie O’Rourke asked that Hoeltzel be immediately detained, which Stafford granted.

Defense attorney Raymond Cassar said he demanded the hearing to argue for his client’s release because he believes Hoeltzel, who had returned from treatment out of state when he was arrested, is not a risk of flight nor is he a risk to the community.

“He was coming back into the state when they arrested him and the government knew that; we had made arrangements for him to come back,” Cassar said. “The biggest reason I want to get him out on bond is to get him back into treatment here in Michigan.

“That’s important for him. The treatment he’s undergoing is important for him. It’s important for his growth and to address the charges,” added Cassar, declining to elaborate on the treatment. “Mark Hoeltzel is a good man. He’s never been in trouble before and I need to remind all . . . readers he is presumed innocent. We are looking forward to our day in court.”

Cassar did not speak about the specific allegations except to acknowledge the charges.

The complaint, filed in U.S. District Court in Detroit, said the investigation began Dec. 4 when Ann Arbor law enforcement learned the state’s Department of Licensing and Regulatory Affairs (LARA) was investigating the Ann Arbor doctor “for having a sexual relationship with a female patient.”

That investigation lead to a search warrant of Hoeltzel’s Ann Arbor home on Dec. 11 where investigators seized a flash drive that contained about 210 images of child pornography and a Dell laptop that contained about 94 images of child pornography, according to a complaint authored by U.S. Homeland Security Investigations Special Agent Michael MacBride, who noted that the images contained about 71 unique files between both devices and the rest were duplicates.

The files, created or accessed between 2008 and May 17, 2017, contained primarily images of minor females with their genitals exposed “in a lascivious manner,” according to the complaint.

Hoeltzel’s patient told authorities in December that she had been treated for rheumatoid arthritis for years and that at age 18 the doctor sent her a text message instructing her to make an appointment with him, according to court documents.

The patient told authorities that during the first appointment, Hoeltzel “grabbed her from behind, pulled her butt into his groin, and rubbed his erect penis on her” and they “engaged in regular and frequent sexual acts” at his clinic and her home, MacBride’s complaint noted.

The complaint further alleges that Hoeltzel discussed his 12- to 15-year-old patients with the woman, describing the teens as “hot.” The woman also said Hoeltzel spent “many occasions” with her at his clinic engaged in sex acts and not providing medical treatment.

MacBride’s complaint describes the complainant as a “vulnerable” person who has a “chronic debilitating condition, which causes her to have a dependency on narcotic prescription pain medication in addition to mental health diagnoses.”

In January, Attorney General Bill Schuette’s office said Hoeltzel began texting the woman, then 17, after he saw her at the clinic when she received treatment from another doctor. Hoeltzel transferred the patient’s care to himself.

Schuette’s office also said Hoeltzel exchanged emails and online messages with an 11-year-old patient he met at a U-M Arthritis Camp in 2004. The exchanges lasted through 2006, and were “flirtatious and suggestive” messages, which the girl’s mother reported to the Arthritis Foundation, who was responsible for the camp.

After the mother reported it, university officials required Hoeltzel to undergo a “boundaries course,” according to the complaint.

As of Monday, Hoeltzel has not been charged in connection with the relationship with his patient or in connection with the allegations about the 11-year-old child.

MacBride said a LARA investigator also reviewed Hoeltzel’s prescriptions for his patient and determined that he prescribed narcotics “beyond and outside of recommendations for a patient” with the woman’s diagnoses.

LARA suspended Hoeltzel’s medical license on Dec. 21 on U-M initially suspended Hoeltzel, whose employment was later terminated.

Jake Jacobson, director of public relations for Children’s Mercy Hospital in Kansas City, Missouri, confirmed Monday that the hospital warned Hoeltzel’s former patients there that he had been accused of sexual misconduct with two Michigan patients.

Hoeltzel worked for the Missouri hospital between 2007 and 2013.

Jacobson said the hospital began a “thorough internal investigation” in late January when it learned about the allegations against Hoeltzel in Michigan. He could not say whether any patients reported misconduct by the doctor nor could he say whether the investigation includes allegations of child pornography.

Cassar said he was not aware of the Children’s Mercy investigation.

This story presented in cooperation with MIRS, a Lansing-based news and information service.