In a sternly worded order received by attorneys Monday, a judge says the medical license of George Hsu, a doctor in Elgin for some 20 years, should be reinstated if he agrees to additional monitoring.

It is the second time South Central District Judge Sonna Anderson has ordered the state's medical watchdog panel to reinstate Hsu, who was accused by the state Board of Medical Examiners of improper patient treatment.

Anderson said her first order, issued in February, may not have been "crystal clear to the board."

"The (board's) order revoking Dr. Hsu's license was reversed," Anderson wrote. "If it was not explicitly clear in the earlier order, let it be clear now."

She used bold letters in part the order to emphasize her point.

Doug Bahr, an attorney for the medical board, said Anderson's earlier order "at least in the board's opinion, was unclear.

"She has made it clear," Bahr said Monday. "People won't be guessing."

Hsu, 62, said he is open to the additional oversight, something the medical board has said would be unworkable.

Anderson gave the medical board 30 days to come up with a monitoring plan. Her order is dated April 21.

Rolf Sletten, the board's executive secretary, called the judge's order "surprising." He said the panel would meet this week to decide whether it will appeal to the state Supreme Court.

The 12-member Board of Medical Examiners revoked Hsu's medical license for a second time earlier this month, despite Anderson's February ruling.

"Members of the board decided the only way to protect the public was to issue an order of revocation," Sletten said. "They don't do that casually. They take it very serious."

Anderson's order said the board's action was "not in compliance with the court's decision and invited Dr. Hsu to begin the entire appeal process over again."

Hsu, a farmer-turned-doctor, has had strong support in the Elgin area, which has held rallies to help raise money for his legal battle. He still owns clinics in Elgin and Glen Ullin, and has hired doctors to work there while he's gone.

"My lawyers tell me it's good news," Hsu said of Anderson's recent ruling. "I was just hopeful for a just outcome, and I think we got it. Now, I guess it's up to the board."

Hsu's attorneys filed a rarely used writ of mandamus, a filing used to force public officials to take action.

"I have never seen where a judge rules one way and a party just disregards it," said Kent Gravelle, one of Hsu's attorneys. "Usually, if party disagrees, they'll just appeal it."

Gravelle said he expects the medical board to appeal the case to the state Supreme Court.

"I would hope that they would just accept the district court's decision and monitor Dr. Hsu and let it stand at that," Gravelle said. "But if they appeal, we'll be ready."

The board first revoked Hsu's license in November 2004, after suspending it for nine months. The panel said Hsu had "engaged in a continued pattern of inappropriate care" with 10 patients.

The board has said its first responsibility is to protect the public, "not develop experimental remediation programs."

Sletten said the panel had recently provided the judge with more reasons for its actions.

Anderson's order in February said the medical board did not adequately explain why it did not follow an earlier recommendation of Administrative Law Judge Allen Hoberg, who heard arguments from both sides. Hoberg said Hsu's medical license should be revoked unless he agreed to additional monitoring prescribed by the board.

Anderson said "the board attempted to take a second bite at the apple" by referring to a decade-old disciplinary action in an unrelated case. She said that was wrong.

"The procedure of the board in looking outside the official record on appeal to justify its actions have not afforded Dr. Hsu a fair hearing," Anderson wrote.

Hsu and the board both asked Anderson to award them attorney fees. While noting that Hsu prevailed on appeal, Anderson said she would schedule a hearing later to decide the issue.