Judges: R. T. CARPENTER
Agency: Department of Business and Professional Regulation
Latest Update: Aug. 29, 1990
Summary: Respondent didn't properly diagnose patient suffering form severe sickness. Recommend civil fine for not practicing with reasonable prudence.
82-0815STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICAL ) EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 82-815
)
STANLEY P. WEGRYN, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
This matter came on for hearing on October 26, 1982, in Fort Myers, Florida, before the Division of Administrative Hearings and its duly appointed Hearing Officer, R. T. Carpenter. The parties were represented by:
For Petitioner: J. Riley Davis, Esquire
Post Office Box 1796 Tallahassee, Florida 32302
For Respondent: Leonard A. Carson, Esquire
Post Office Box 1528 Tallahassee, Florida 32302
This matter arose on Petitioner's Administrative Complaint charging Respondent with failure to practice medicine with the requisite level of care, skill and treatment by (1) having prescribed the drug Tagamet for severe intestinal pain of unknown etiology; (2) by having failed to personally diagnose and examine a patient suffering from severe abdominal pain and swelling; and (3) in attempting to make a differential diagnosis of a patient's persistent abdominal pain without having ordered a blood test and/or conducted or ordered other tests.
The parties submitted proposed findings of fact and conclusions of law. To the extent these proposed findings have not been adopted or otherwise incorporated herein, they have been rejected as irrelevant or inconsistent with the evidence.
FINDINGS OF FACT
Respondent is a physician licensed to practice medicine in Florida. His office is located on Sanibel Island in Lee County.
A Sanibel Island tourist, Mrs. Marion Wallace, presented herself as a patient at Respondent's office on the morning of March 2, 1981. She complained of abdominal pain and swelling.
Mrs. Wallace was seen by Mr. Kern Barrow, a physician's assistant employed by Respondent. Barrow conducted a physical examination of Mrs. Wallace's abdominal region and took her medical history, noting abdominal distension, abdominal pain, anorexia, nausea, vomiting and dysuria. She had not been feeling well for several days and had experienced some nausea and vomiting in the early morning hours of March 2, 1981. Barrow conducted a routine physical examination that included examination of the abdominal region, neck, mouth and throat. No medical tests were ordered or conducted by Barrow other than a urinalysis.
Barrow's preliminary diagnosis was viral gastroenteritis or urinary tract infection. He administered ampicillan and prescribed donnagel for her cramping and gaviscon for the abdominal distension or gas. He administered an injection of compazine to prevent further nausea and vomiting. Barrow could not remember consulting with Respondent concerning Mrs. Wallace on March 2, but told her to come back if her condition did not improve. He described Mrs. Wallace as looking ill, but not mortally ill.
Respondent did not see Mrs. Wallace on March 2, but reviewed and initialed the chart prepared by Barrow. Respondent prescribed the medication "Tagamet," but did so only because the patient requested it, claiming to have received relief for gastritus from this medication.
Mrs. Wallace returned to Respondent's office on the morning of March 3, continuing to complain of abdominal pain and swelling. Respondent examined the patient at that time, but did not perform a rectal examination. He did not order a blood test, barium enema or x-ray. He noted "observe" on her chart, but did not schedule a return visit. He tentatively diagnosed her condition as diverticulitis.
Mrs. Wallace, who did not testify in this proceeding, claimed that her condition had worsened between her visits to Respondent's office on March 2 and March 3. This fact was not established by direct evidence. However, on March 4 she presented herself to another Fort Myers area physician who sent her to the hospital emergency room where her condition was diagnosed as "acute abdomen" necessitating immediate surgery.
During the surgery performed on March 4, it was discovered that Mrs. Wallace had a perforated gangrenous appendicitis with abscess formation, peritonitis, and a small bowel obstruction. These are serious and dangerous medical conditions.
The testimony of Respondent and the other physicians who testified in this proceeding established that his tentative diagnosis was not inappropriate given the patient's symptoms. However, his failure to perform tests (such as a blood test for white blood cell count, x-ray, rectal examination or barium enema) was a serious lapse in view of her condition and his tentative diagnosis. His prescribing of Tagamet was not shown to have been improper.
Respondent's use of a physician's assistant for the initial examination was likewise not shown to have been improper. However, Respondent's inability to note any progression of her symptoms between March 2 and 3 resulted from his overreliance on the physician's assistant and failure to conduct even a minimal examination of her on March 2.
CONCLUSIONS OF LAW
Respondent has been charged with violations of Subsection 458.331(1)(t), Florida Statutes (F.S.), which provides as follows:
(t) Gross or repeated malpractice or the failure to practice medicine with that level of care, skill and treatment which
is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. . .
This provision requires a physician to utilize reasonable care, skill and diligence in the diagnosis and treatment of his patient. Subsection 458.331(2), F.S., provides for license revocation or suspension, restriction of practice, fine or reprimand when a physician is guilty of violating the above- quoted provision.
Count II of the Administrative Complaint charges Respondent with a violation of Subsection 458.331(1)(t), F.S., in having failed to personally examine Mrs. Wallace on March 2, but instead having accepted the diagnosis of his assistant. It is contended that the failure of Dr. Wegryn to personally examine and diagnose a patient suffering from severe abdominal pain and swelling falls below the accepted standard of care. The Respondent is guilty of this charge to the extent that he was unable to make a differential diagnosis when he finally examined the patient personally on March 3.
Count I of the Administrative Complaint charges Respondent with having violated Subsection 458.331(1)(t), F.S., in that he prescribed the drug Tagamet for intestinal pain of unknown etiology and failed to order blood tests and/or other tests when Mrs. Wallace presented herself to his office on March 3, 1981, still complaining of persistent abdominal pain and swelling and complaining that the pain and swelling had intensified.
Tagamet is widely prescribed for a variety of digestive tract ailments. Respondent did not prescribe this medication as a treatment for diverticulitis as alleged. Therefore this portion of the Administrative Complaint should be dismissed.
Count III of the Complaint is similar to Count I and also charges Respondent with violating Subsection 458.331(1)(t), F.S. Count III alleges that Dr. Wegryn's examination of Mrs. Wallace on March 3, 1981, fell below the acceptable standard of care in that Respondent suspected diverticulitis on March 3, 1981, but did not conduct further investigation nor did he order tests, such as blood tests, to determine Mrs. Wallace's white blood count and/or a barium enema to help confirm the diagnosis of suspected diverticulitis.
The evidence established that Mrs. Wallace presented herself at Respondent's office for a second time on March 3 complaining of increasing abdominal pain and progressive swelling. At this point, Respondent should have conducted a more thorough investigation, including the ordering of tests. Since diverticulitis was suspected, blood tests and/or a barium enema would have been appropriate. Respondent's failure to conduct such further investigation on March 3 is a violation of Subsection 458.331(1)(t), F.S.
RECOMMENDATION
From the foregoing, it is RECOMMENDED:
That petitioner enter a Final Order (1) finding Respondent guilty of failure to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances; and (2) reprimanding and fining Respondent $1,000.
DONE and ENTERED this 21st day of January, 1983, in Tallahassee, Florida.
R. T. CARPENTER, Hearing Officer Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 21st day of January, 1983.
COPIES FURNISHED:
J. Riley Davis, Esquire Post Office Box 1796 Tallahassee, Florida 32302
Leonard A. Carson, Esquire Post Office Box 1528 Tallahassee, Florida 32302
Dorothy Faircloth, Executive Director Board of Medical Examiners
Dept. of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Samuel R. Shorstein, Secretary Dept. of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
================================================================= AGENCY FINAL ORDER
================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS
DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF MEDICAL EXAMINERS,
Petitioner,
vs. CASE NO. 82-815
STANLEY P. WEGRYN, M.D.,
License Number: 23028,
Respondent.
/
RECOMMENDED ORDER
This matter came before the Board of Medical Examiners (Board hereinafter) pursuant to Section 120.57(1)(b)9., Florida Statutes, on April 9, 1983, in Sarasota, Florida, for the purpose of considering the Recommended Order (a copy of which is attached) issued by the hearing officer and the exceptions thereto filed in the above-styled matter. The Petitioner was represented by Joseph W. Lawrence, II, Esquire. The Respondent was represented by Leonard A. Carson, Esquire After review of the complete record, Respondents Exceptions to Recommended Order, the argument of the parties, and being otherwise fully advised in the premises, the Board makes the following findings and conclusions.
FINDINGS OF FACT
The hearing officer's findings of fact are approved and adopted and are incorporated herein by reference except for the findings that Respondent's failure to perform tests (such as a blood test for white blood cell count, x- ray, rectal examination or barium enema) was a serious lapse in view of Mrs. Wallace's condition and his tentative diagnosis and except for the finding that Respondent's inability to note any progression of Mrs. Wallace's symptoms between March 2 and 3 resulted from his overreliance on the physician's assistant and failure to conduct even a minimal examination of Mrs. Wallace on March 2. The Board finds no competent, substantial evidence in the record to support these findings and to the extent that the Respondent's exceptions object to the hearing officer's findings in this regard the exceptions are accepted. The remaining factual exceptions of the Respondent are rejected as competent, substantial evidence exists to support the other findings of the hearing officer.
There is competent, substantial evidence to support the Board's findings of fact.
CONCLUSIONS OF LAW
The hearing officer's conclusions of law are approved and adopted and are incorporated herein by reference except for the conclusions that Respondent violated subsection 458.331(1)(t), Florida Statutes, as charged in Counts II and III of the Administrative Complaint. There is no competent, substantial evidence to support these conclusions and to the extent that the Respondent's exceptions object to these conclusions the exceptions are accepted. The remaining exceptions of the Respondent are rejected as being without merit.
In view of the Board's conclusions, the Respondent's motion to dismiss is denied on the grounds of mootness.
The hearing officer's recommendation is rejected.
WHEREFORE, it is ORDERED AND ADJUDGED that the Administrative Complaint filed against the Respondent, Stanley P. Wegryn, M.D., be and hereby is dismissed. This Order becomes effective upon filing.
DONE AND ORDERED this 26th day of April, 1983.
BOARD OF MEDICAL EXAMINERS
By DOROTHY FAIRCLOTH
cc: All Counsel of Record. Stanley P. Wegryn, M.D. 4301 Captiva Road
Sanibel Island, Florida 33957
Docket for Case No: 82-000815
Orders for Case No: 82-000815
| Issue Date |
Document |
Summary |
|
Apr. 26, 1983 |
Agency Final Order
|
|
|
Jan. 21, 1983 |
Recommended Order
|
Respondent didn't properly diagnose patient suffering form severe sickness. Recommend civil fine for not practicing with reasonable prudence.
|
