Judges: R. T. CARPENTER
Agency: Department of Business and Professional Regulation
Latest Update: Jul. 26, 1984
Summary: Doctor was grossly deficient in record-keeping though not guilty of fraud or deceit. Recommended three-year probation, first year under supervision of other doctors.
83-0493.PDFSTATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICAL ) EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 83-0493
)
RUDOLF ORGUSAAR, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
This matter came on for hearing on February 7 and 8, 1984, 1/ in Pensacola, Florida, before the Division of Administrative Hearings and its duly appointed Hearing Officer, R. T. Carpenter. The parties were represented by:
For Petitioner: Joseph W. Lawrence, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Melissa Fletcher Allaman, Esquire
ERVIN, VARN, JACOBS, ODOM & KITCHEN
Post Office Box 1170 Tallahassee, Florida 32302-1170
This matter arose on Petitioner's amended administrative complaint charging Respondent with violations of Section 458.331, Florida Statutes (F.S.).
Specifically, Respondent is charged with failure to treat a hospitalized patient with the required degree of skill, and with deficiencies in his hospital medical records.
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.
FINDINGS OF FACT
Respondent is a medical doctor, licensed to practice in Florida, and holds license number ME 0009310, issued by Petitioner. Respondent specializes in family practice and has been board certified by the American Academy of Family Physicians since 1974.
Respondent is on the medical staff of Sacred Heart Hospital in Pensacola. Roger Henson, M.D. is Chairman of the Family Practice Department, and headed an investigation into Respondent's treatment of a patient, case record number 3321, and a general review of hospital records pertaining to
Respondent's patients. Dr. Henson and Doctors Walter Gillispie and John Whitcomb, who are familiar with these records, testified on behalf of Petitioner. Respondent testified in his own behalf and also presented the testimony of Dr. Dimitri Polizo, who conducted a review of these records. All the physicians attested to community standards and practices.
Sacred Heart Hospital medical record number 3321 pertains to a female patient admitted by the emergency room physician on November 22, 1980 with a prior history of diabetes mellitus. She was suffering from diabetic ketoacidosis with dehydration but was initially diagnosed as having gastritis by the emergency room physician. She had been followed by Respondent and was seen in his office two days before the admission with a blood sugar of 150 mg by history. The history prepared later by Respondent noted her admission because she "got real sick" but gave no other reason or symptoms. Her admission occurred at about 2:00 p.m. but it is unclear when she was seen by the admitting physician as the history and physical were undated and no admission or progress notes were provided. Respondent ordered an SMA 17 for the next morning, however the nurse, concerned about the patient's condition, requested an immediate SEA 6.
When Respondent was advised of the serious condition of his patient and the SMA 6 results read to him, he gave a verbal order for NPH insulin 30 units IM at 10:30 p.m. but expressed no willingness to examine the patient. The nurse then asked for and received permission for an immediate medical consult. The consultation was thereafter obtained and this physician treated the patient with intravenous injections of insulin. She subsequently made a successful recovery.
Respondent became involved in this case when he was called by the floor nurse around 2:30 p.m. for orders. Although Petitioner is critical of Respondent's failure to order a blood profile which would have given earlier results and his ordering of a slow acting insulin, his principal lapse involved his complete reliance on the nurse's reports and his failure to visit this patient after taking responsibility for her hospital treatment.
Respondent is separately charged with failure to maintain legible and complete hospital records on 22 patients which he treated at Sacred Heart Hospital between November, 1980 and October, 1981. Testimony of the expert witnesses established that community and hospital medical practice standards require that such records contain admitting impressions, medical histories, physical examination results, all orders signed by the physician, progress notes (daily notes are encouraged but not essential), records of all consultations with results and discharge summaries.
The record of patient no. 80-995746 is unsatisfactory. The patient was admitted on June 27, but there was no admitting impression and no progress note until July 3.
The record of patient no. 80-015446 is unsatisfactorv due to Respondent's failure to note any evaluation of the abnormal urinalysis findings.
The record of patient no. 80-008268 is unsatisfactory in that the patient requested a pap smear and breast examination, but none is noted. Further, there was no admitting impression and no progress notes over a six day period.
The record of patient no. 80-964395 is unsatisfactory. The patient requested a pap smear and breast examination, but none is noted. There was
blood in the patient's stool, but this was not evaluated. There was no information on the physical examination other than "gorss normal," and there were no progress notes, impressions or discharge summary.
The record of patient no. 80-026203 is unsatisfactory. The patient's urinalysis revealed an infection, but there is no record of evaluation or treatment of this condition. There were no progress notes or diagnostic impressions.
The records of patient no. 80-10584 (A and B) covering June and July, 1981, hospitalizations are unsatisfactory. The patient requested a pap smear and breast examination, but none is noted. Further, there were no progress notes between July 15 and 18.
The remaining 16 patient records listed in the amended administrative complaint have various deficiencies including few progress notes, undated examinations, illegible words, and lack of follow-up evaluations. However, none of these records individually fall below community medical practice standards. Collectively, however, the six unsatisfactory records along with the deficiencies in the other records demonstrate that Respondent does not meet acceptable standards of medical practice in his record keeping.
Respondent contends that the Sacred Heart Hospital Medical Records Department should have returned deficient records to him. One of the functions of that department is to "flag" records where personnel note omissions. The Medical Records Department has, in fact, returned deficient records to Respondent and to other physicians who have omitted certain required entries. However, Respondent's attempt to shift his responsibility for record deficiencies to non-medical personnel must be rejected since these individuals are not trained to judge the quality of medical records.
Section 458.331, F.S., provides in part:
The following acts shall consti- tute grounds for which the disciplinary actions specified in subsection (2) may be taken:
* * *
Failing to keep written medical records justifying the course of treatment of the patient, including, but not limited to, patient histories, examination results, and test results.
* * *
Making deceptive, untrue, or fraudulent 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.
* * *
(g) 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 simi- lar physician as being acceptable under
similar conditions and circumstances. The board shall give great weight to the provi- sions of s. 765.45 when enforcing this paragraph.
* * *
When the board finds any person guilty of any of the grounds set forth in subsection (1), it may enter an order imposing one or more of the following penalties:
Refusal to certify to the depart- ment 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, including, 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 supervision of another physician.
Respondent is charged under the above provisions with respect to his treatment of patient, record number 3321, and with unacceptable record keeping on 22 other patients he treated at Sacred Heart Hospital. It was demonstrated that with respect to patient, record no. 3321, Respondent failed to practice medicine with an acceptable level of care in violation of Subsection 458.331(1)(t), F.S. His failure to examine and personally treat this patient after accepting responsibility for her care was unacceptable in view of her condition which was adequately reported to Respondent by the hospital nurse.
Respondent's medical records in the cases of patients record numbers 80-995746, 80-015446, 80-008268, 80-964395, 80 026203 and 80-10584, did not support the courses of treatment and were so deficient as to constitute a failure to practice medicine with the level of care and skill required of a reasonably prudent physician, in violation of Subsections 458.331(1)(n) and (1)(t), F.S.
Deficiencies in the other records identified in the amended administrative complaint were not sufficiently serious to individually violate the above quoted provisions. However, these records considered collectively with those that were found to be unacceptable indicate a laxness in record keeping which must be corrected if Respondent is to continue practicing as a physician in Florida.
There was no evidence that Respondent engaged in any conduct which would constitute a deceptive or fraudulent practice, or a trick or scheme, in violation of Subsection 458.331(1)(1) F.S. This charge must therefore be dismissed.
Respondent should be placed on probation for a period of three years as authorized by Subsection 458.331(2)(f), F.S. This provision also permits the imposition of a requirement that a physician found guilty of violations of Subsection 458.331(1), F.S. may be required to work under the supervision of another physician. Such a requirement should be imposed for a one year period.
RECOMMENDATION
Based on the foregoing, it is
RECOMMENDED that Petitioner enter a final order placing Respondent on probation for a period of three years and require that he practice under the supervision of another physician to be named by Petitioner during the initial year of his probation. 2/
DONE and ENTERED this 24th day of April, 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 24th day of April, 1984.
ENDNOTES
1/ Companion Case, Number 83-2015 was heard on these same dates and is the subject of a separate Recommended Order.
2/ This disciplinary action is intended to be applied concurrently with that recommended in Case No. 83-2015.
COPIES FURNISHED:
Joseph W. Lawrence, Esquire Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Melissa Fletcher Allaman, Esquire ERVIN, VARN, JACOBS, ODOM & KITCHEN
Post Office Box 1170 Tallahassee, Florida 32302-1170
Dorothy Faircloth, Executive Director Board of Medical Examiners
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Fred Roche, Secretary
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
BEFORE THE BOARD OF MEDICAL EXAMINERS DEPARTMENT OF PROFESSIONAL
REGULATION,
Petitioner,
vs. DOAH CASE NO. 83-493 25114
DPR CASE NO. 0026178 83-2015
RUDOLF ORGUSAAR LICENSE NO. 9310,
Respondent.
/
FINAL ORDER OF
THE BOARD OF MEDICAL EXAMINERS
This cause came before the Board of Medical Examiners (Board) pursuant to Section 120.57(1)(b)(9), Florida Statutes on June 9, 1984, in Palm Beach, Florida for the purpose of considering the hearing officer's recommended order (a copy of which is attached hereto) in the above-styled cause. Petitioner, Department of Professional Regulation, was represented by Joseph W. Lawrence, II, Esquire; Respondent, Rudolf Orgusaar, M.D. was represented by Wilfred C. Varn, Esquire and Melissa Fletcher Allaman, Esquire. Upon review of the recommended order, the argument of the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.
FINDINGS OF FACT
The hearing officer's findings of fact are approved and adopted in toto and are incorporated by reference herein.
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 in toto and are incorporated by reference herein.
There is competent substantial evidence to support the Board's conclusions of law.
PENALTY
Based upon a review of the complete record, the Board determines that the penalty recommended by the hearing officer be modified to include a longer period of supervision and a restriction upon Respondent's Schedule II privileges. Therefore, it is hereby
ORDERED AND ADJUDGED that Respondent be placed on probation for 3 years, during which time he shall practice under the supervision of Dimitri Polizo,
in accordance with the Proposed Plan for Supervision (a copy of which is attached hereto and incorporated herein). During the period of probation, Respondent shall appear semiannually before the Board. Quarterly reports of Respondent's practice shall be submitted to the Board by Dr. Polizo. Respondent has waived confidentiality with regard to the investigative reports prepared by the department during the period of probation. The period of probation in this case shall run currently with that period determined in Department of Professional Regulation, Board of Medical Examiners v. Rudolf Orgusaar, M.D., DOAH Case No. 83-2015, DPR Case No. 0025114. This Order takes effect upon filing.
DONE AND ORDERED this 21st day of July, 1984.
Board of Medical Examiners
Richard J. Feinstein Chairman
cc: All Counsel of Record Rudolf Orgusaar, M.D.
=================================================================
AGENCY AMENDED FINAL ORDER
================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
vs. DOAH CASE NO. 83-493
DPR CASE NO. 0025114
RUDOLF ORGUSAAR LICENSE NO. 9310,
Respondent.
/
AMENDED FINAL ORDER OF
THE BOARD OF MEDICAL EXAMINERS
This cause came before the Board of Medical Examiners (Board) pursuant to Section 120.57(1)(b)(9), Florida Statutes on June 9, 1984, in Palm Beach, Florida for the purpose of considering the hearing officer's recommended order (a copy of which is attached hereto) in the above-styled cause. Petitioner, Department of Professional Regulation, was represented by Joseph W. Lawrence, II, Esquire; Respondent, Rudolf Orgusaar, M.D. was represented by Wilfred C. Varn, Esquire and Melissa Fletcher Allaman, Esquire. Upon review of the recommended order, the argument of the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.
FINDINGS OF FACT
The hearing officer's findings of fact are approved and adopted in toto and are incorporated by reference herein.
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 in toto and are incorporated by reference herein.
There is competent substantial evidence to support the Board's conclusions of law.
PENALTY
Based upon review of the complete record, the Board determines that the penalty recommended by the hearing officer be modified to include a longer
period of supervision and a restriction upon Respondent's Schedule II privileges. Therefore, it is hereby
ORDERED AND ADJUDGED that Respondent be placed on probation for 3 years, during which time he shall practice under the supervision of Dimitri Polizo,
M.D. in accordance with the Proposed Plan for Supervision (a copy of which is attached hereto and incorporated herein). During the period of probation Respondent shall appear semiannually before the Board. Quarterly reports of Respondent's practice shall be submitted to the Board by Dr. Polizo. Respondent has waived confidentiality with regard to the investigative reports prepared by the department during the period of probation. The period of probation in this case shall run concurrently with that period determined in Department of Professional Regulation, Board of Medical Examiners v. Rudolf Orgusaar, M.D., DOAH Case No. 83- 2015, DPR Case No. 0026178. This Order takes effect upon filing.
DONE AND ORDERED this 29th day of August, 1984.
Board of Medical Examiners
Richard J. Feinstein Chairman
cc: All Counsel of Record Rudolf Orgusaar, M.D.
Docket for Case No: 83-000493
Orders for Case No: 83-000493
| Issue Date |
Document |
Summary |
|
Jul. 21, 1984 |
Agency Final Order
|
|
|
Apr. 24, 1984 |
Recommended Order
|
Doctor was grossly deficient in record-keeping though not guilty of fraud or deceit. Recommended three-year probation, first year under supervision of other doctors.
|
