STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

IN THE MATTER OF THE REVOCATION )

OR SUSPENSION OF THE LICENSE OF ) CASE NO. 75-294 LAMAR ALTH MACNUTT, D.D.S., )

)

Pursuant to notice, the Division of Administrative Hearings, by its duly designated hearing officer, K. N. Ayers, held a public hearing in the above styled cause on June 9 and 10, 1975 at Clearwater, Florida.

APPEARANCES

For Petitioner: L. Haldane Taylor (Board of Taylor and Brecher

Dentistry) 605 Florida Theatre Building

128 East Forsyth Street Jacksonville, Florida 32202

For Respondent: N. David Korones

(Dr. Macnutt) 311 South Missouri Avenue

Clearwater, Florida RECOMMENDED ORDER

By Accusation filed December 11, 1974 the State Board of Dentistry of the State of Florida seeks to revoke or suspend the license of Lamar Alth MacNutt,

D. D. S., on the grounds that he is unfit for the practice of dentistry. The Accusation contains four counts, Count III of which was withdrawn by the Board at the hearing.

Under Count I Dr. MacNutt is alleged to have violated the standards of his professional practice by rendering himself unfit for the practice of dentistry through being an habitual user of drugs, to wit Darvon and Ritalin.

Under Count II the Board alleges that Dr. MacNutt has violated the standards of his professional practice in that he is grossly incompetent and unable to continue the practice of dentistry in violation of Florida Statutes, s. 466.24(2).

Under Count IV, the Board alleges that Dr. MacNutt has violated the standards of his professional practice and the laws of Florida by prescribing, procuring, and controlling controlled substances, by issuing prescriptions in his name, or for office use, for the use of various drugs which were not necessary or used in the practice of dentistry in violation of ss. 466.22 and

466.24 (2)(3), Florida Statutes.

At the hearing Dr. MacNutt stipulated that for a period of time from 1970 until the investigation by the State Board ceased in 1974, he was continuously using Ritalin and its use was, to a certain extent, for personal illness, that its use rendered him unable to carry on the proper practice of dentistry in 1973 and 1974. Dr. MacNutt further stipulated that the prescriptions for Ritalin were written by him and that he received and used the drugs during 1973 and

1974. He further stipulated that Ritalin was not used in the practice of dentistry.

With respect to Count II, Dr. MacNutt stipulated that in part of 1973, and until investigation was completed in 1974, he had been using Ritalin and had built up a tolerance to the drug so as to render himself incompetent to practice dentistry. When he became aware of the investigation he submitted his license to the Board and was admitted to the Watson Clinic in Lakeland for treatment of his physical condition. Dr. MacNutt further stipulated that the statements that were given to the investigator by various former employees of his be admitted into evidence; and that, if they were called to the witness stand, they would testify to the same as the information contained in the statements given to the investigator. He further stipulated that his condition in 1974 was such that it rendered him unfit through physiological effects to perform dental work in a proper fashion; that he was unable to maintain his office in a professional manner; was unable to maintain employee relationships, and keep dental appointments; and that he permitted certain individuals to perform tasks for which they were not properly trained. Dr. MacNutt did not stipulate that he is an incompetent dentist.

With respect to Count IV, Dr. MacNutt stipulated that the drugs, as alleged, were received by him and were not used in the course of his professional practice. The Ritalin was used by him personally for something not related to the practice of dentistry. Exhibits 2 through 17 were statements of various former employees and pharmacists that were given to the investigator and it was stipulated they be admitted into evidence. These stipulations and admissions constitute a partial plea of guilty to Counts I, II and IV.

Dr. MacNutt testified in mitigation and in his own defense. From early childhood he had been afflicted with asthma and was allergic to various pollens. As a child of tender years he had originally suffered this allergy and had taken treatment to be desensitized. He had no further trouble until his college years in Michigan when his allergies increased and he went through another series of desensitization. He started his dental practice in Clearwater in 1961. His allergies at that time were seasonal and not of significance. In 1964 and 1965, following an automobile accident, he overreacted and ended up feeling very depressed. At this time he went to a Doctor Stewart and the Doctor suggested that he take Ritalin. At that time he found Ritalin appeared to relieve his depression. In 1969, 1970, and 1971 he started having sinus headaches, nasal stuffiness, etc. which created problems. He had been taking antihistamines and decongestants from time to time. In 1970, when his allergies started to get more severe, he was having difficulty with his work and with his depression. At this time he began administering Ritalin to himself. The situation continued to deteriorate until in 1973 he was taking 10 to 12 Ritalin tablets per day. He had also, during this period of time taken, in addition to Ritalin, Darvon. In 1973 and 1974 his dental practice had dropped down to the point where he was handling only one to two patients per day. He was having considerable difficulty in retaining his office help, and during the period 1973 and 1974 he had engaged some 25 employees, most for short periods of time when they would quit. From the statements of these employees that were admitted into evidence, it is clear that they could not tolerate the situation in which they found themselves with what they considered to be the incompetence of Dr. MacNutt during this time.

When Dr. MacNutt became aware of the Board's investigation of his practice and of his use of drugs, he surrendered his license to the Board in a letter which was entered into evidence as Exhibit 1; and thereafter sought medical

advice. He was referred to the Watson Clinic in Lakeland, Florida, where he saw Dr. Walter C. Tabb, a specialist in allergies. Dr. Tabb saw Dr. MacNutt in April, 1974. He ran a series of allergy tests on Dr. MacNutt, and diagnosed him as being extremely allergic. He also exhibited symptoms of depression. Dr.

Tabb recommended that MacNutt enter the hospital for further study, and he also recommended that he see a Doctor Robin Wooten, a psychiatrist. MacNutt was hospitalized for a combination of allergy and depression in May, 1974, and remained in the hospital approximately one week. At this time he did not advise any of the doctors that he had been medicating himself with Ritalin or Darvon.

The stay in the hospital confirmed the diagnosis, and he then embarked upon the usual allergy treatment with antihistamines and allergy shots. MacNutt was again seen at the Watson Clinic in October, 1974. At that time he admitted he had been taking Ritalin and Darvon, and that he needed help. As a result, he was again hospitalized for a period of approximately two weeks. He was transferred to Dr. Wooten's service about two days after entering the hospital and Dr. Wooten continued his treatment. In late October he again entered the hospital as the result of having a seizure during a glucose tolerance test. He had previously had a seizure in the spring of 1974 during a similar test.

Upon his release from the hospital at Watson Clinic in Lakeland, Florida, he returned to Clearwater and remained on the antihistamine and medication that were provided him by the hospital. During this time, he has been able to discontinue the use of Ritalin and Darvon, and to have regained the weight he had lost (some 30 pounds), and his physical health.

Prior to his entry into the hospital for treatment the various witnesses had described Dr. MacNutt as being unsteady, talking with slurred speech, having glassy eyes, and generally appearing to be in a quasi-stuporous state much of the time. He did not appear to be in full contact with his surroundings. He had lapses of memory and spent what appeared to be an overly long period of time on one patient. Furthermore, during this period of time he was having some marital difficulties, which further aggravated his depression. This also led to his becoming more of a loner, even to the extent of neglecting his children. He is the father of five daughters, ages 7 to 14 years, each approximately two years apart.

The testimony of his wife and of Dr. MacNutt is to the effect that following his treatment in the hospital he is now in much better physical condition. He is no longer taking any of the controlled drugs which he had previously prescribed for himself, and his relationship with his family has greatly improved. In fact, his wife indicated that their marital situation was better than it had ever been.

From the stipulations of Dr. MacNutt that he had committed most of the acts alleged in Counts I, II, and IV, I find that he is guilty of Counts I, II, and IV in the allegation.

From the overall testimony and evidence submitted, it would appear that during the period of 1970 to 1974 Dr. MacNutt was continually declining in his health and was becoming more and more reliant upon the drugs which did not provide him the succor to which he aspired. In fact, the combination of drugs he was taking apparently led to a further decline in his health, and increased his depression to the point where he was unable to continue to practice dentistry in a professional manner. It is further apparent that at the time of the hearing, Dr. MacNutt had recovered to the point that he is now capable of properly engaging in the practice of dentistry. He stipulated that if the board saw fit he would surrender his narcotic license. The recommendations which

follow are based upon the hearing officer's belief that Dr. MacNutt is presently capable of continuing the practice of dentistry; however, in view of his past history, there remains the possibility that he may again relapse into his former habits. During 1974 he was definitely incompetent to perform as a dentist, and was performing acts of a nature to bring discredit to the dental profession. It is therefore,

RECOMMENDED that Dr. MacNutt's license be revoked. It is further RECOMMENDED that the revocation be suspended for a period of three years,

at the expiration of which time, unless sooner vacated for good cause shown, Dr. MacNutt be restored to good standing without further action.

DONE and ORDERED this 25th day of July, 1975 in Tallahassee, Florida.

K. N. AYERS, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304

(904) 488-9675

COPIES FURNISHED:

Haldane Taylor N. David Korones

123 E. Forsyth Street 311 South Missouri Avenue

Jacksonville, Florida Clearwater, Florida

Docket for Case No: 75-000294

Orders for Case No: 75-000294