STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICAL ) EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 83-357
)
CLYDE T. STONER, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, an administrative hearing was held before the Division of Administrative Hearings and its duly appointed Hearing Officer, R. T. Carpenter, on August 18 and October 24-26, 1983, in Ft. Lauderdale, Florida.
The parties were represented by:
APPEARANCES
For Petitioner: Joseph W. Lawrence, II
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Stephen M. Slepin
1114 East Park Avenue Tallahassee, Florida 32301
INTRODUCTION
By Amended Administrative Complaint, Clyde T. Stoner, M.D., was charged with violations of Chapter 458, Florida Statutes, as a licensed medical doctor in the State of Florida. Specifically, it was alleged that the Respondent, during the period between July, 1980, and December, 1981, prescribed the scheduled controlled substances methaqualone, tuinal, demerol, dilaudid, percodan, dexedrine, desoxyn and preludin to patients for reasons that were not medically justifiable and that said prescriptions were inappropriate or in excessive or inappropriate quantities.
Based on these allegations, Respondent was charged with prescribing controlled substances other than in the course of his professional practice, in violation of Section 458.331(1)(g) F.S. It was further alleged that this conduct violated Section 893.05(1) F.S. and, as such, violated Section 458.331(1)(h) F.S., by prescribing controlled substances in bad faith and not in the course of his professional practice. The factual allegations also were alleged to constitute a trick or scheme in the practice of medicine which failed to conform to the generally prevailing standards of treatment in the medical community, in violation of Section 458.331(1)(l), F.S. Finally, the
Administrative Complaint also alleged that the same factual circumstances constituted a violation of Section 458.331(1)(t) F.S., by the physician's 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.
In support of these allegations, Petitioner presented the testimony of James Golden, John V. Handwerker, M.D., and Dale K. Lindberg, M.D., Exhibits 1 (the prescriptions), 2 (transcripts of interview of Respondent)(TR 325), 3 (the patient records), and 4 (Physician's Desk Reference publications on the drugs in question, concerning their pharmacologic actions, interactions, adverse reactions and dosage levels). Respondent presented the testimony of himself, his wife, and the testimony of five medical doctors, including Ronald Wright, M.D., a medical examiner. One exhibit, the reputation testimony by deposition of a hospital pharmacist, was also received into evidence.
FINDINGS OF FACT
At all times pertinent to the proceeding, Respondent held a license to practice medicine in the State of Florida issued by the Board of Medical Examiners, Department of Professional Regulation.
Brief descriptions of the scheduled controlled substances at issue here are as follows:
Quaalude is the manufacturer's brand name for methaqualone which is now a Schedule 1 controlled substance pursuant to 1983 Florida legislation. Prior to July 1, 1983, it was a Schedule II controlled substance. Methaqualone is a hypnotic agent useful in bringing on sleep. It is an addictive drug, with psychological and physical dependence associated with its use. The usual adult dosage of methaqualone is 150 to 360 mg. at bedtime. It is a soporific which is for short term use in treating insomnia with a stated maximum prescribing time of 2 to 3 weeks. After that approximate period, it is stated to be ineffective as a sleeping medication.
Tuinal is a combination of secobarbital and amobarbital which is useful when prompt and moderately sustained hypnotic effect is required (sedation). Its use may result in psychic and physical dependence. The usual adult dosage is 50 to 200 mg. at bedtime. As in any other central nervous system depressant, tuinal's effect may be addictive.
Demerol is merperidine which is a narcotic analgesic with multiple actions qualitatively similar to those of morphine. It is an opiate characterized by increasing tolerance and physical dependence.
Dilaudid is hydromorphone and has the same pharmacological aspects as other opiates, including demerol.
Dexedrine is a dextro-amphetamine, which is a central nervous system stimulant, a substance that is often abused and can lead to drug dependence. Under Section 458.331(1)(cc), F.S., the prescribing, ordering, dispensing, administering, supplying, selling or giving of any drug which is an amphetamine or sympathomimetic amine drug designated as a Schedule II controlled substance pursuant to Chapter 893, F.S., except for the treatment of narcolepsy and hyperkinesis, and several other diagnoses specifically listed in that statutory provision, became illegal in 1980, and is a basis for disciplinary action by the Board of Medical Examiners.
Percodan is oxycodone and has the same pharmacological aspects as other opiates, including demerol and dilaudid.
Preludin is phenmetrazine and is a sympathomimetic amine with pharmacologic activity similar to amphetamines such as dexadrine, described above.
The above listed drugs are Schedule II controlled substances pursuant to Chapter 893, F.S., which classifies any such drug as a substance which
has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of the substance may lead to severe psy-
chological or physical dependence. . . Section 893.03(2), Florida Statutes.
Between the dates of July 8, 1980, and December 18, 1981, Respondent prescribed for Clara Shires 1,900 tablets of quaaludes, 1,500 tablets of tuinal, 1,700 tablets of demerol, 1,750 tablets of dexedrine and 410 tablets of dilaudid. The prescription history relates that as to the prescriptions for quaalude and tuinal, the majority of the prescriptions were for 100 tablets each, with both drugs being prescribed the same day for the same amounts, and both prescriptions specifically directing the patient to take one tablet at bedtime. Each of the prescriptions for quaalude and tuinal were written, however, at intervals of approximately 30 - 45 days, sometimes at even more frequent intervals, for the same amounts. During this period, Respondent also prescribed dexedrine to be taken one in the morning, again with the prescriptions written for 100 tablets, and again issued at intervals substantially less than each 100 days, some prescriptions issued more frequently than once every 30 days. The demerol prescriptions were in injectable as well as tablet form, and were prescribed in 100 tablet quantities, on a fairly consistent and frequent basis. Dilaudid, another narcotic analgesic, was proscribed in conjunction therewith.
Clara Shires was treated by Respondent for rheumatoid arthritis and anemia, with the arthritis being a progressive and painful disorder. He used large amounts of narcotics to make her functional. He prescribed quaalude and tuinal because they are effective hypnotics. He prescribed dexedrine to give the Patient energy, although she lost weight while using the drug.
Respondent described the patient to the Department of Professional Regulation investigators during the course of their investigation in March, 1982, as an addict who he had unsuccessfully tried to withdraw from drugs a number of times. In another portion of the interview unrelated to Clara Shires, Respondent acknowledged that he wrote 100 quaalude tablet prescriptions too frequently.
Given the frequency of the prescriptions for Clara Shires, the quaalude, tuinal and other prescriptions should have lasted longer between prescribing dates. Furthermore, the prescribing of these two types of hypnotic sleeping agents at the same time was of questionable propriety. Although the patient was directed to take only one pill at bedtime, she was prescribed approximately 3 pills per day over a 11 year period. A similar problem was
exhibited with the dexedrine prescriptions, which instructed the patient to take one tablet a day, although a prescription for three tablets a day was issued.
In light of the diagnosis of narcolepsy (inappropriate sleep disorder), which is a relatively rare disease, the prescriptions for quaalude and tuinal for a patient taking dexedrine is found to be inappropriate. 1/ Based upon Dr. Lindberg's review of the records and his opinion, Respondent utilized medically and excessive amounts of the various drugs for the patient. For example, the patient's lack of appetite and Respondent's diagnosis of malnutrition are findings expected with use of the drugs dexedrine and dexamyl. It should also be noted that only after the enactment of Section 458.331(1)(cc), F.S., did Respondent diagnose the patient's condition on the prescriptions as narcolepsy, whereas previously the prescription was listed as being for "pep."
Many of the scheduled controlled substances prescribed by Respondent were not recorded on the patient charm. Specifically, with respect to the hospitalization of October 16, 1980, hospital records maintained by Respondent did not reveal the extent of his prescribing of scheduled controlled substances and, indeed, he wrote prescriptions for scheduled controlled substances to be filled at community pharmacies while the patient was still hospitalized, thereby effectively concealing the patient's true treatment regimen.
A further charting deficiency was noted for July 8, 1980, where Respondent wrote duplicate prescriptions for quaaludes and demerol, and another prescription for tuinal and dexedrine, with none recorded on the patient chart. The first note in the medical chart of Clara Shires concerning the prescription for dexedrine being other than for "pep" is the notation of May 21, 1981, that the patient had been diagnosed narcoleptic. Narcolepsy is a spontaneous sleep disorder wherein the patient falls into a "R.E.M." sleep immediately which is diagnosable only in a sleep laboratory (where R.E.M. could be determined) . Respondent first diagnosed narcolepsy in May, 1981, after several years of prescribing this drug. The only correlation between the dexedrine and the sleeping medications being prescribed at the same time is to wake the person with the "upper", a highly inappropriate medical justification for dexedrine, but a common "street practice." If the patient indeed had narcolepsy, the quaalude and tuinal sleep medications were highly inappropriate and without medical justification.
Between the dates of July 14, 1980, and September 19, 1980, Respondent prescribed 1,300 quaalude tablets for Paul Shires. His prescription profile relates that he obtained a prescription approximately every 30 days for 100 tablets of 300 mg. quaalude with the specified directions on the prescription to take one at bedtime as needed for sleep.
Respondent began treating this patient in 1974. He previously had a myocardial infraction, had angina pectoris, diabetes mellitis and hyperlipidemia, which caused a great deal of pain. Respondent found that the patient slept comfortably by using quaaludes. In the interview of Respondent by Petitioner's investigators, Dr. Stoner stated that this patient was an addict. The expert testimony of Respondent's witnesses established that there was no medical justification for the prolonged and excessive utilization of methaqualone for this patient.
Between July, 1980, and December, 1981, Respondent prescribed 2,000 tablets of methaqualone and 2,000 tablets of dilaudid for the patient Thomas Lardiere. The prescribing profile reveals that approximately every 25 to 30
days, Respondent concurrently prescribed 100 tablets of each medication to Lardiere throughout this period.
Lardiere first consulted Respondent in 1977. He then had a total disability rating from the Social Security Administration and suffered spinal stenosis with a prior unsuccessful laminectomy operation for this disorder. He was ambulatory but in extreme pain. Respondent prescribed methaqualone to enable the patient to sleep at night, and to relieve him of anxiety from recurrent pain. Dilaudid was also prescribed for pain.
Respondent stated to the Petitioner's investigator that both Lardiere and his wife were addicts. Furthermore, Lardiere had been arrested for a narcotics violation, and this was known to Respondent. Respondent made no tests to detect whether or not Lardiere was taking the prescribed medications or whether he was diverting them.
Between March 18, 1981,and December 24, 1981, Respondent prescribed 800 tablets of methaqualone and 715 tablets of dilaudid for Steven Kennedy. The prescribing profile reveals that approximately every 20 to 30 days, Respondent prescribed 100 tablets of each medication to the patient over the course of this period.
Kennedy first consulted Respondent in early 1981 with severe pain in the right arm (causalgia). Respondent prescribed quaalude for sleep and dilaudid for the chronic pain. A review of Respondent's medical records and the prescriptions at issue here establish that Respondent initially prescribed percodan after the patient related to him that he had previously needed one to two per day for pain. Respondent also prescribed 100 quaaludes. On the second visit, Kennedy stated that he got no relief from the percodan and asked for dilaudid, which Respondent then prescribed in the largest tablet available (4 mg).
Between July 21, 1980, and January 8, 1982, Respondent prescribed 2,300 methaqualone tablets and 1,900 percodan tablets for the patient Jennifer Bischoff. The prescriptions reveal that approximately every 25 to 35 days, Respondent provided a prescription of 100 tablets of each drug to the patient, with directions to take one tablet at bedtime as needed for sleep.
Jennifer Bischoff was 24 years old when she became Respondent's patient. She had had a hysterectomy at age 21 which precipitated an early menopausal stage and emotional difficulties. Respondent prescribed quaaludes and percodan for headaches. She had already tried aspirin and fiornal before she came to Respondent and those drugs did not injure her, and were beneficial.
According to the patient records, Respondent had been informed that this patient was on probation for illegal quaalude possession. As with other patients, the prescriptions were too frequent for a patient who was directed to take only one tablet at bedtime for sleep, but provided enough tablets over the two-year period to average nearly 3 tablets per night.
The records of this patient contained no evidence of consultations with other physicians, such as neurologists, concerning the chronic headaches. Headache is a non-fatal self-limiting disorder. In view of this and because of the danger of utilizing the addictive Schedule II controlled substance percodan, such prescriptions were of questionable medical propriety.
Between July, 1980,and December, 1981, Respondent prescribed for the patient Robert Andrews 1,500 quaaludes, 1,600 dilaudid tablets and 1,400 desoxyn tablets. The prescribing profile demonstrates that every 25 to 30 days the Respondent prescribed 100 tablets of each drug named above for this patient.
Respondent treated Andrews, a 36-year old patient, for pain in his left ankle, both knees, and for narcolepsy. He prescribed dilaudid for the pain, quaalude for rest at night and anxiety. The desoxyn was prescribed for the narcolepsy. Respondent stated to Petitioner's investigator that this patient was addicted and it occurred to him that some of the medications might be sold.
The patient records indicated that on his first visit to Respondent in January, 1980, the patient wanted to lose and regulate his weight. He was taking amphetamines and was given quaaludes for sleep. Narcolepsy was written down on the patient record with a question mark next to the word. The patient record indicates that the patient sleeps often in the daytime and watches his diet. However, there was no investigation of the sleep patterns of the patient to document a finding of narcolepsy, nor did the records substantiate a diagnosis of narcolepsy.
Respondent's prescribing of dilaudid, a highly addictive and dangerous drug, for a nonfatal orthopedic condition in the knees and ankle, was medically unjustified. Further, the three drugs prescribed, given the frequency, amounts, types and durations of the prescribing, constituted a failure of Respondent to practice medicine with an acceptable level of care.
Between July, 1980, and December, 1981, Respondent prescribed 2,950 dilaudid tablets, 800 quaalude tablets and 400 tuinal tablets to the patient B.
J. Anderson. The prescribing history demonstrates that approximately every 7 to
20 days, Respondent wrote 100 tablet prescriptions of dilaudid for this patient, and approximately every 30 to 40 days, he prescribed at least 100 quaalude and/or tuinal tablets.
Anderson was a 40-year old male patient of Respondent's who was seriously handicapped due to a motorcycle accident. The dilaudid was prescribed for the pain resulting from causalgia of the right hand and other pain, while the quaaludes and tuinal were for nighttime sedation and hypnosis.
The patient records established that on the first visit of this patient to Respondent, he not only noted the physical disability but formed the stated medical impression that the individual was drug dependent. The patient, on his initial visit to Respondent's office, was receiving 1 to 2 dilaudid tablets a day for pain, which rapidly increased in frequency under Respondent's care.
Between July, 1980, and December, 1981, Respondent prescribed 1,600 tuinal tablets (to be taken "one at bedtime as needed for sleep") and 1,500 percodan tablets for the patient Ellen Sarondes. The prescribing history demonstrates that this patient was receiving prescriptions for tuinal and percodan approximately every 30 days.
This patient was a 52-year old female who had been taking tuinal for
14 years and was suffering from a kidney disease when she consulted Respondent. She had suffered withdrawal pains from not taking tuinal. Respondent believed that it was medically acceptable to maintain this dependency, and prescribed the percodan for pain.
Between March and May, 1981, Respondent prescribed 400 quaaludes and
300 preludin tablets for the patient Eugene DiGeronimo. Thee prescribing history reflects that 100 quaalude tablets were prescribed every 28 days, with two prescriptions for 100 each of quaalude prescribed on May 13, 1981. On each of these same days, 100 preludin were also prescribed by Respondent.
The patient was obese and consulted Respondent for treatment of his weight problem. Respondent prescribed the quaaludes because the patient could not sleep at night. He prescribed preludin as an appetite suppressant and because it made the patient more alert during the daytime hours. However, Respondent wrote this patient a registered letter telling him that he was using too many drugs, after his pharmacist/uncle called the Respondent.
Although the patient records revealed that Respondent was prescribing preludin for weight control, the prescription of March, 1981, listed the diagnosis for this same prescription as "narcolepsy." However, there was nothing in the patient records to substantiate this diagnosis.
The frequency by which preludin were prescribed was far greater than the directions for usage provided by Respondent. A patient taking the number of preludin tablets being taken by DiGeronimo (225 mg per day) would have difficulty sleeping in the opinion of Petitioner's expert witness, accounting for the methaqualone prescription during the same time period. Again, the dosage level of quaaludes was far in excess of the express directions of the physician. A diagnosis of narcolepsy, if in fact one was made by Respondent, would be inconsistent medically with these prescriptions for large amounts of sleeping medication.
Between July 11, 1980, and December 31, 1981, Respondent prescribed 2,100 tuinal tablets and 6,612 dilaudid tablets for the patient David Markarian. The prescribing history reflects that every 2 to 15 days, Respondent prescribed
100 dilaudid tablets and approximately every 20 to 28 days, prescribed 100 tuinal tablets for this patient.
Markarian was 30 years old and suffered from injuries sustained in a motorcycle accident. Upon consulting Respondent, he was paretic (weak in the limbs) and Respondent prescribed dilaudid so the patient could function and be relieved of the pain.
According to Respondent, the patient was drug dependent. Earlier, Respondent stated to Petitioner's investigator that this patient was an addict.
Review of the medical records revealed nothing to justify the tuinal prescriptions. Furthermore, the tuinal was being taken and prescribed in direct contravention of Respondent's own written directions over a one and one-half year period. Respondent's directions were to take one pill at bedtime for sleep. However, the patient was supplied with almost 31 pills per day. The medical records also indicate the patient, at one time, sought referral to a methadone clinic for his addiction. On his referral to a pain clinic, however, Respondent did not mention the large amount of drugs being prescribed to this patient. (During the 45-day period from August 10 through October 3, 1980, the patient received approximately 15 tablets of dilaudid a day.)
Between July 9, 1980, and December 23, 1981, Respondent prescribed 3,400 dexedrine tablets to the patient Joan Elliott. The prescribing profile indicates that the patient was to take one tablet 4 times a day.
Respondent initially testified at hearing that this 50-year old woman was suffering from narcolepsy or pickwickian syndrome and that these disorders are related. However, on cross-examination, he stated that after his initial testimony, he had learned that narcolepsy and pickwickian syndrome are distinct, the first being a central nervous system disorder, whereas the latter is caused by pressure on the diaphragm and the lack of oxygen and obstruction to the airways. He further admitted that although no one in his family had narcolepsy, he had prescribed dexedrine for his wife who did not suffer from narcolepsy, but on the prescription written by him, he listed the diagnosis as narcolepsy.
None of the subject patients testified in this proceeding nor were they examined by Petitioner's expert witness. Therefore, no finding of actual harm as a result of Respondent's treatment can be made. Furthermore, it was not demonstrated that Respondent profited from the excess drugs he prescribed or that such drugs were illegally resold or distributed.
Much of the evidence Petitioner has urged with respect to Physician desk Reference drug effectiveness must be disregarded. The testimony of Petitioner's and Respondent's medical witnesses established that the drugs at issue here may have longer periods of effectiveness with individual patients than the periods set forth in this reference source.
Respondent established that drug dependency in a patient suffering from chronic, disabling pain may be medically acceptable where no other alternative exists. This does not, however, explain or mitigate that evidence which demonstrated that Respondent habitually prescribed drug amounts far in excess of the dosages he established.
Respondent demonstrated that he enjoys an excellent reputation in the medical community. He has had a long and successful medical career apparently unmarred by previous complaints or disciplinary proceedings.
CONCLUSIONS OF LAW
The applicable statutory provisions are as follows:
458.331 Grounds for disciplinary action; action by the board. -
(1) The following acts shall constitute grounds for which disciplinary actions specified in subsection (2) may be taken:
Failing to perform any statutory or legal obligation placed upon a licensed physician.
Making deceptive, untrue, or fraudu- lent representations in the practice of medicine or employing a trick or scheme
in the practice of medicine when such scheme or trick fails to conform to the generally prevailing standards of treatment in the medical community.
(q) Prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs,
including all controlled substances, inappro- priately or in excessive or inappropriate quantities is not in the best interest of
the patient and is not in the course of the physician's professional practice, without regard to his intent.
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. . .
(cc) Prescribing, ordering, dispensing, administering, supplying, selling, or giving any drug which is an amphetamine or sympatho- mimetic amine drug or a compound designated
as a Schedule II controlled substance, pursuant to Chapter 893, to or for any person except for:
The treatment of narcolepsy; hyperkinesis; behavioral syndrome in children characterized by the developmentally inappropriate symptoms of moderate to severe distractability, short attention span, hyperactivity, emotional lability, and impulsivity; or drug-induced brain dysfunction; or
The differential diagnostic psychiatric evaluation of depression or the treatment of depression shown to be refracto to other therapeutic modalities; or
The clinical investigation of the effects
of such drugs or compounds when an investigative protocol therefor is submitted to, reviewed,
and approved by the board before such investi- gation is begun.
A finding of a violation of the above-cited statutory prohibitions could lead to the imposition by the Board of Medical Examiners of the following disciplinary measures:
When the board finds any person guilty of any of the grounds set forth in sub- section (1), it may enter an order imposing one or more of the following penalties:
Refusal to certify to the department an application for licensure.
Revocation or suspension of a license.
Restriction of practice.
Imposition of an administrative fine not to exceed $1,000 for each count or separate offense.
Issuance of a reprimand.
Placement of the physician on probation for a period of time and subject to such conditions as the board may specify, includ- ing, but not limited to, requiring the physician to submit to treatment, to attend continuing education courses, to submit to reexamination, or to work under the super- vision of another physician.
s. 458.331(2), F.S.
The evidence presented demonstrates that Respondent prescribed controlled substances other than in the course of his professional practice, especially in light of the statutory presumption 2/ that prescribing inappropriately or in excessive or inappropriate quantities constitutes prescribing other than in the course of professional practice.
Petitioner's expert witness testimony and the documentary evidence established that the methaqualone prescriptions provided to these patients far exceeded the use frequencies stated on the prescriptions themselves. Further, in derogation of Section 458.331(1)(cc), F.S., Respondent prescribed amphetamines and sympathomimetic amine compounds (Schedule II) for purposes other than that statutorily authorized, thereby violating Section 458.331(1)(q), F.S.
The evidence presented also demonstrated that Respondent violated Section 458.331(1)(t), F.S., in his 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. By this repeated excessive and inappropriate prescribing of Schedule II controlled substances, Respondent failed to conform to the statutory standard established by Section 458.331(1)(t), F.S.
Each of the prescriptions issued by Dr. Stoner for the patients were written with the intent and understanding that same would be presented to a community pharmacist to be filled, and served a medically appropriate purpose. Certain of the prescriptions listed diagnoses of "narcolepsy" when, in fact, Dr. Stoner knew that the patient was not suffering from that disease. Rather, the diagnosis was written in light of the existence of Section 458.331(1)(cc), F.S. This constitutes a deceptive, untrue and fraudulent representation in the practice of medicine. Furthermore, the general course of conduct of Respondent represented a scheme which failed to conform to the generally prevailing standards of treatment in the medical community. On both these bases, Respondent violated Section 458.331(1)(l), F.S.
Insufficient evidence was presented relating to criminal intent on the part of Dr. Stoner to warrant a finding of bad faith prescribing violative of Section 893.05(1), F.S., so as to violate Section 458.331(1)(h), F.S., as alleged in the Administrative Complaint.
Counsel for Respondent raised objections to the testimony of Petitioner's expert witnesses stating that the standard of practice by which Respondent's conduct is to be judged was the standard of care, skill and treatment which is recognized as acceptable by medical physicians practicing in Broward County. However, in light of the fact that the Florida Legislature has prescribed minimum standards for entrance into the profession of medicine in the State of Florida, and vested in the statewide Board of Medical Examiners the jurisdiction to judge conformance with standards of conduct, the locality ruling urged by the Respondent must fail. Furthermore, Section 768.45, F.S., has effectively abolished the locality rule. Respondent's objections on this issue are therefore overruled.
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 are found to be subordinate, cumulative, immaterial, unnecessary or not supported by the evidence.
Based upon the foregoing, it is
RECOMMENDED that the Petitioner enter a final order reprimanding Respondent, fining him $2,500 and restricting his practice against prescribing, dispensing or administering scheduled controlled substances.
DONE and ORDERED this 4th day of January, 1984, 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 4th day of January, 1984.
ENDNOTES
1/ The diagnosis of narcolepsy was noted by Dr. Lindberg on the October, 1980, prescription for the patient, the first mention of that disease for this patient, when in fact Dr. Stoner testified that he proscribed the drug for the patient for "energy."
2/ Section 458.331(1)(q), F.S.
COPIES FURNISHED:
Joseph W. Lawrence, II, Esquire Department of Professional Regulation
130 N. Monroe Street Tallahassee, Florida 32301
Stephen M. Slepin, Esquire 1114 East Park Avenue Tallahassee, Florida 32301
Fred Roche, Secretary
Department of Professional Regulation
130 N. Monroe Street Tallahassee, Florida 32301
Dorothy Faircloth, Executive Director Board of Medical Examiners
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| May 08, 1990 | Final Order filed. |
| Jan. 04, 1984 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Mar. 14, 1984 | Agency Final Order | |
| Jan. 04, 1984 | Recommended Order | Respondent inappropriately prescribed controlled substances in violation of statute. Recommens fine and restrict prescribing authority. |
