STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICAL ) EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 83-2903
)
ORLANDO C. RAMOS, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, an administrative hearing, was held in this cause before P. Michael Ruff, duly designated Hearing Officer of the Division of Administrative Hearings, on January 30, 1984, in Miami, Florida. The appearances were as follows:
APPEARANCES
For Petitioner: Joseph W. Lawrence, II, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Ellis Rubin, Esquire
265 Northeast 26th Terrace Miami, Florida 33137
Pursuant to the Petitioner's administrative complaint as amended pursuant to an order entered January 18, 1984, Orlando C. Ramos, M.D., has been charged with violations of Chapter 458, Florida Statutes. Specifically it is alleged that between the dates of December 16, 1982, and May 25, 1983, on three specific occasions the doctor prescribed 120 tablets of placidyl, 180 tablets of valium, and 120 tablets of darvocet, scheduled controlled substances pursuant to Chapter 893, Florida Statutes. It is alleged that the patient was actually an undercover detective for the Miami Beach Police Department, and that the Respondent failed to perform a proper medical examination of the supposed patient prior to prescribing this medication. It is further alleged that the prescriptions were not for a medically justifiable purpose and that they where inappropriate, and in excessive and inappropriate quantities. Thus, the Petitioner alleges that Section 458.331(1)(q), Florida Statutes, has been violated by the Respondent prescribing a controlled substance other than in the course of his professional practice; that he has violated Section 458.331(1)(h), Florida Statutes, by committing a violation of Section 893.05, Florida Statutes, by the alleged prescription of scheduled controlled substances in bad faith and without the course of his professional practice. The Petitioner further alleges that Section 458.331(1)(1), Florida Statutes, was violated by Respondent in that he employed a trick or scheme in the practice of medicine which failed to
conform to generally prevailing standards of medical practice and lastly, that Section 458.331(1)(t), Florida Statutes, was violated on these three occasions by the Respondent failing to practice medicine with the level of care, skill and treatment recognized by reasonably prudent similar physicians as being acceptable under similar conditions and circumstances.
The Petitioner presented the testimony of the "patient," Steven Jones, a/k/a Steven James, and John Handwerker, M.D., testifying as Petitioner's medical expert. Petitioner's Exhibits 1 through 7 were received into evidence. Respondent testified in his own behalf and presented the testimony of his wife, who is employed as a receptionist and assistant in his office, and his former office assistant, Mrs. Padron. Additionally, the Respondent presented and had admitted, the late-filed deposition of Dr. Alfred March, M.D. The Respondent offered three exhibits which were received into evidence. At the conclusion of the proceeding, the parties requested that it be transcribed and availed themselves of the right to submit proposed findings of fact and conclusions of law. The petitioner timely submitted proposed findings of fact and conclusions of law on April 16, 1984, after the record was ultimately closed with the submission of the above-mentioned deposition of Dr. March. The proposed findings of fact and conclusions of law and supporting arguments have been considered. To the extent that they are in accordance with the findings, conclusions and views stated herein they are accepted. To the extent that the proposed findings, conclusions and arguments asserted are inconsistent herewith, they are rejected. Certain proposed findings and conclusions are omitted as not relevant nor as necessary to a proper determination of the material issues presented. To the extent that the testimony of various witnesses is not in accord with the findings herein, it is not credited. See, Sonny's Italian Restaurant v. Department of Business Regulation, 414 So.2d 1156, 1157 (Fla. 3rd DCA 1982); Sierra Club v. Orlando Utilities Commission, 436 So.2d 383 (Fla. 5th DCA 1983).
The issue to be resolved concerns whether the Respondent committed the statutory violations charged by engaging in conduct which constituted a departure from the standards prescribed by the above statutory subsections, and if he committed such aberrant conduct what, if any, penalty is warranted.
FINDINGS OF FACT
Respondent is a licensed medical doctor holding a license to practice medicine in the State of Florida issued by the Board of Medical Examiners, Department of Professional Regulation. The Petitioner is a governmental agency charged with enforcing the provisions of Chapter 458, Florida Statutes, and related rules which regulate the licensure standards and status pertaining to medical doctors in the State of Florida, and enforcing the practice standards for licensed medical doctors embodied in Chapter 458, Florida Statutes.
Steven Jones has been employed as a detective in the Narcotics Department of the City of Miami Beach Police Department for approximately three and one-half years. He is a ten-year veteran of the law enforcement profession. In December 1982, an investigation was initiated to determine whether allegations of misprescribing scheduled controlled substances made by a confidential informant against Dr. Ramos, the Respondent, were true.
On December 16, 1982, Detective Jones entered the medical offices of the Respondent and asked to see Dr. Ramos. The Respondent's receptionist asked him to fill out a patient information sheet. On this sheet or form he indicated his name was "Steven James." He was then taken to the Respondent's office and
met the Respondent. He told the Respondent that he was a construction worker, had recently experienced turmoil in his domestic life, and also suffered from a lumbo-sacral sprain. The Respondent then asked him if he had back pain and, after asking him general questions about his health and whether he suffered from any major illnesses, took out his prescription pad and wrote prescriptions for three medications. Other than the general questions the doctor asked him about his health, no detailed medical history was taken from Mr. Jones and there was no physical examination performed by Dr. Ramos or anyone else, except that his weight and height were recorded. No blood pressure reading was taken. After Dr. Ramos asked Mr. Jones if he had a backache, to which Mr. Jones responded in the affirmative, Dr. Ramos stated that he would prescribe something for the backache and something for stress that caused the backache, and something to sleep at night. Although no blood pressure was taken, Dr. Ramos did ask the patient how his blood pressure was, and the patient answered that it was "fine." The doctor then prescribed 60 tablets of valium, 60 placidyl tablets and 40 darvocet tablets.
The only medical history provided in writing to the doctor concerned the name, address and employment, medical insurance information and answers to questions on the form concerning allergies. Additionally, the patient noted that he had been taking "valium" or "valium." Upon receiving the prescriptions, Steven Jones paid Dr. Ramos $40 and left his office.
Detective Jones again visited Dr. Ramos' office on February 2, 1983. Upon arriving at the office he was escorted into an examining room by the Respondent's assistant, who was also his wife. While Mr. Jones was seated in the examining room, an assistant placed a blood pressure tourniquet or cuff on the patient's arm, leaving it there four to five minutes, when she ultimately returned to the room and informed Steven Jones that the doctor was ready to see him. The blood pressure tourniquet or arm band was never actually inflated by the Respondent or assistant, and no blood pressure reading was ever taken on this visit. Upon going into the Respondent's office, Mr. Jones was asked by Dr. Ramos about how he was feeling and the "patient" requested stronger pain medication. The doctor refused to do this, saying in effect that the patient, Mr. Jones, would have to be admitted to a hospital before the Respondent could prescribe stronger pain medication. Again, on this office visit no social or medical history was taken, and no physical examination was conducted at all. The Respondent asked the patient if he wanted the same prescriptions he had obtained at his December visit, and the patient answered in the affirmative. There was no discussion between the patient and the Respondent or anyone else concerning the patient's condition or progress between the December visit and this February visit. There was no discussion concerning the need for future treatment. The Respondent simply, at that point, wrote the same prescriptions given at the December visit.
The next visit by Detective Steven Jones, a/k/a Steven James, occurred on May 25, 1983, at the Respondent's medical offices. The same medical assistant recognized Jones immediately when he came into the office and asked him if he was there for the same reason, to which he replied in the affirmative. He was then escorted straight to Dr. Ramos' office, who asked him if he wanted the same medication again, to which he assented. There was no discussion at all about his condition and how it may have progressed since the February visit, nor was there any discussions about future prospects for treatment, what treatment if any, was being considered or what it was designed to accomplish. The Respondent simply wrote three prescriptions once again, for valium, placidyl and darvocet, Schedule IV controlled substances. Except for the first visit, there
was never any discussion of back pain nor any discussion concerning symptoms of insomnia and nervousness in this patient.
Onelia Padron testified for Respondent. She has known the Respondent for many years and has worked for him as a technician for approximately a year. She was working in his office in December 1982, as an x-ray technician and in the performance of blood tests, blood pressure readings and physical therapy. She remembered Detective Jones coming to the office in December 1982, and testified that she did not take a blood pressure reading at the December visit, but did so at the February visit. Her specific memory of taking the blood pressure reading in February was not clear, however. She remembers specifically that his blood pressure was normal at the February visit and testified that she was sure that Dr. Ramos wrote down the blood pressure of the patient in his medical chart for the February visit. The patient medical record of Detective Jones a/k/a James, however, does not reveal that a blood pressure reading was taken at the February visit. Although the witness claims to have taken a blood pressure reading on the patient on his February 1983 visit, the testimony of Detective Jones reveals that no blood pressure reading was taken; although the blood pressure cuff or tourniquet was applied to his arm, it was simply not used. This may account in part for Ms. Padron's mistaken memory of actually taking the blood pressure reading. Her memory may be less than accurate due to passage of time. The testimony of Detective Jones to the effect that no blood pressure reading was taken, when considered with the Respondent's own medical records which do not reveal a blood pressure reading being taken, renders the finding inescapable that no blood pressure reading was taken at the February, 1983 visit and that Ms. Padron, after the passage of over a year, has a less- than-specific, inaccurate memory about the occasion and thus her testimony with regard to this visit is not credible.
Rita Ramos, the Respondent's wife, acts as the office receptionist who makes and maintains the medical records for the Respondent. She performs no medical duties, however, she is well acquainted with her husband's handwriting and, of course, her own handwriting, and established that the word "valium" on Petitioner's Exhibit 2 and the word "valium" on Petitioner's Exhibit 6 were not written by her or her husband. She maintains that she specifically remembers the patient (Detective Jones) coming to visit Dr. Ramos on December 16, 1982, and she specifically remembers the doctor conducting a full physical examination and writing at least four lines of notes in the patient's record. She did not take a blood pressure on this patient in either December or February, however, and could not give an adequate explanation of how she could perform all her administrative record-keeping and maintenance duties and still have time to continually watch through the open door of her husband's office to see the physicals performed on approximately 20 patients a day, including Jones, and especially then to be able to remember the details of that one specific patient's visit in December 1982, over a year prior to the hearing. Although this witness supposedly remembered the doctor "always" conducting physical examinations on the first visit by a patient, and specifically conducting a head, eyes and ears examination on the first visit of Detective Jones, given the inherent interest of the patient in this case, the fact that her memory must be suspect regarding a specific patient's visit on a specific date more than a year prior to the hearing, and her own testimony that no irregularity or memorable occurrence happened during the visit of that patient to stimulate her recall, her memory of that event must be deemed less than accurate and therefore her testimony concerning the physical examination cannot be found credible by this Hearing Officer.
Dr. Ramos testified on his own behalf. He stated that his standard practice is to interview and examine each patient and that he was especially suspicious of the subject patient who came in wearing earrings and boots. He interpreted his abbreviated notes on the patient's chart to reveal that the patient was 5'8" tall and weighed 145 pounds, had a blood pressure of 120 over
80 and a pulse of 80, and a normal sinus rhythm with no heart murmur and no abnormal respiratory signs. The doctor additionally interpreted his handwritten notes containing his own abbreviations, to reveal that the patient's eyes were normal, neck supple, with normal ears, nose, throat and a fair complexion. Although the patient asked for a stronger medication on at least one of the visits, including quaaludes, the doctor refused, informing the patient that he could not legally prescribe such for him in Florida.
The doctor also testified that he remembered that on the second visit in February 1983, Ms. Padron took the blood pressure of the patient. He contends that he did not record the blood pressure reading because it was the same as the first time, that is, the December 1982 visit. No blood pressure was taken or recorded at the December 1982 visit, however, and none is revealed in the doctor's record for that visit. Although the doctor testified that on the February visit he believed that the patient might be trying to trick him and might be an undercover law enforcement officer, he still prescribed the same controlled substance prescribed earlier, with no additional physical examination made nor physical findings recorded in the patient records. He repeated the same instructions as to use of those drugs and the reasons for taking those drugs, but did not record any physical findings related to that visit. By his own admission, he did not ask the patient what had occurred in his medical history between December and February and did not ask questions concerning the success of his previously prescribed course of treatment.
If indeed, the Respondent believed that the patient could be an undercover law enforcement officer and thus attempting to trick the doctor into misprescribing drugs for him, one might think that the doctor would take pains to make a thorough physical examination and to thoroughly record his findings and conclusions in the medical records he maintained, instead of failing to document his physical findings and conclusions and continuing to prescribe those drugs over a period of months. Thus, the testimony of Dr. Ramos is not supportive of a finding that a thorough physical examination, including the taking of blood pressure readings at each patient visit and, (in view of the low back pain complaint) straight leg raise tests, tests for impairment of sensation in extremities and other parameter checks, was actually conducted on the patient.
Dr. John Handwerker, M.D., testified as an expert witness for the Petitioner. He has served as first chairman of the Department of Family Practice at the University of Florida Family and Community Medicine programs.
He is Chairman of the Family Practice Department of Mercy Hospital in Miami, and is assistant professor of pharmacology at the University of Miami. He is knowledgeable regarding generally prevailing and accepted standards of family practice in Dade County and was accepted, without challenge, as an expert in the field of family practice.
The drug Darvocet and Darvocet N-100 is a Schedule IV controlled substance, according to the schedule established in Chapter 893, Florida Statutes. Darvocet is characterized by some habituating influence, together with some problems with withdrawal. Its use is contraindicated with tranquilizers, such as valium, which was also prescribed in conjunction with it by Respondent for the patient involved herein.
Valium, which is known generically as diazepam, is also a Schedule IV controlled substance and is a sedative or anti-anxiety drug with a wide variety of potentially adverse drug interactions, including darvocet. It can be mildly addictive, has a depressant effect on the central nervous system and is also a muscle relaxant.
Placidyl is a short-term drug used in sleep disorders. It is only indicated for use for a maximum of seven days. It is classed as an oral hypnotic, and is a Schedule IV controlled substance pursuant to Chapter 893, Florida Statutes.
Prior to prescribing any of these drugs, a physician should take a full history from a patient, and perform a thorough physical examination. The history should include the patient's chief complaint with questions from the physician to the patient involving areas of past problems with the nervous system, ears, eyes, lungs, chest, respiratory system, GI tract, and urinary tract. The physical examination should involve all body systems, including blood pressure, examination of the head, neck and chest and back regions. Further, if the patient requests these or other drugs specifically, a check should then be made for "track marks" and other evidence of prior drug abuse or usage. If the patient complains of low back pain, there should be a physical examination specifically involving the low back area before prescribing the scheduled controlled substances at issue. The past history is important to determine the duration of the problem, any previous medical treatment, examinations or tests by other physicians regarding the lumbosacral or low back area. A physical examination should be performed designed to elicit indications of neurological involvement, including straight leg raise tests, impairment of sensation tests in the extremities and other neurological inquiries. Such a full history and a physical examination is necessary prior to initiating a course of treatment involving treatment of chronic pain due to the existence of a wide assortment of other treatment modalities which might treat the root of the problem, rather than merely the pain symptoms.
Dr. Handwerker, upon being questioned concerning the December 1982 visit of Detective Jones to the Respondent's office, posing as a 29-year-old construction worker complaining of lower back pain and insomnia, established that if a doctor performed no physical examination of such a patient, or only a cursory one, and took a history which in essence elicited only the complaint of injury (aside from the non-medical personal background information) that it would amount to inappropriate prescribing of the subject drugs if the patient was given these drugs in the manner prescribed to Detective Jones. The Respondent simply made insufficient findings upon which to base the decision to prescribe those drugs. Such prescribing without an adequate physical examination or the obtaining of detailed patient medical history would constitute a failure to conform to the level of care, skill and treatment recognized by reasonably prudent similar physicians under these conditions and circumstances. The continued prescribing of these drugs at the February and May visits of this patient, without any discussion or consideration of the effect the previous course of treatment had had on the patient, other than a simple question by the Respondent concerning how the patient was feeling, also constitutes inappropriate prescribing of scheduled controlled substances and demonstrates a failure to conform to the generally accepted and prevailing standards of medical practice in the Dade County community.
It was similarly established that the medical records failed to justify the course of treatment afforded this patient. Especially regarding the
lack of a physical examination at each visit, and the failure to elicit any further medical history on the latter two visits. Even if a full physical examination and history was conducted on the first visit in December 1982, which was not the case, there would still be required an interim update and recording of physical findings related to the patient's experience since the December visit. Notes should have been made in the patient records regarding how the medications were affecting the patient and his pain problem, including notes reflecting that a physical examination had been performed, involving all vital signs, which was not the case with this patient. Not only does the generally accepted and prevailing standard of medical practice in Dade County require that an initial, thorough physical examination including the blood pressure and pulse and the eliciting of a detailed medical history be performed, as well as update physical examinations at later visits to check the progress of the patient under the treatment program; the failure to note the findings in the patient records constitutes a failure to conform to generally accepted and prevailing standards of medical practice for the Dade County community.
Dr. Alfred March testified as an expert witness for Respondent, but agreed that the same detailed medical history and examination described by Dr. Handwerker is required before the practitioner should prescribe scheduled controlled substances in the same manner as done by the Respondent. Dr. March was unable to ascertain from simply reviewing the medical records of the Respondent, the reason or justification for the prescribing of any of the drugs on the three dates in question, and established that the medical records of the doctor should always justify the course of treatment for a patient. Indeed, Dr. March established that if a patient came in complaining of a backache, then such would be inappropriate prescribing without the performance of x-rays of the affected area and a full neurological examination, neither of which was performed by the Respondent in this case.
Dr. Ramos has never been subjected to disciplinary proceedings in the past, and his past professional record reveals that his medical practice has been characterized by sincere concern for his patients and the highest respect of his colleagues. The subject drugs involved are Schedule IV controlled substances, which are of the class of drugs characterized by the least serious ramifications for patients, if misused. It is to the doctor's credit that when the undercover detective, Mr. Jones, attempted to persuade him to prescribe more powerful medication such as quaaludes, the doctor vigorously protested such a course of treatment and refused to do so, citing his belief that indeed it was illegal to do so in Florida.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction of the subject matter of and the parties to this proceeding. Section 120.57(1), Florida Statutes. The statutory provisions upon which the charges in the administrative complaint are based, and which are pertinent to the aberrant conduct with which the Respondent is charged in this proceeding 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:
* * *
(h) Failing to perform any statutory or
legal obligation placed upon a licensed physician.
* * *
(1) Making deceptive, untrue, or fraudulent representations in the practice of medicine or employing a trick or scheme in the prac- tice 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 pro- fessional 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.
* * *
(n) 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.
* * *
(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. . . .
If the Respondent is found guilty of a violation of the above-cited statutory prohibitions, then the Board of Medical Examiners is empowered by Subsection 2 of the above section to impose one or more of the following penalties, as pertinent hereto: revocation or suspension of licensure, 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 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 examination, or to work under the supervision of another physician.
In proceedings of this type, where an agency seeks to impose discipline upon a licensee in a manner substantially affecting the right of that licensee to practice his profession or livelihood, the Petitioner or agency must prove the allegations of its administrative complaint by clear and convincing evidence. Gans vs. Department of Professional and Occupational Regulation, 397 So.2d 107 (Fla. 3rd DCA 1980); Walker v. Board of Optometry, 322 So.2d 612 (Fla. 3rd DCA 1975); Reid v. Florida Real Estate Commission, 188 So.2d 846 (Fla. 2nd
DCA 1966). That evidence must be as substantial as the consequences or penalty if the charges alleged are proven. Bowling v. Department of Insurance, 394 So.2d 165 (Fla. 1st DCA 1981).
The evidence adduced in this cause clearly demonstrates that the Respondent prescribed controlled substances other than in the course of his professional practice, especially in view of the statutory presumption at Section 458.331(1)(q), Florida Statutes, to the effect that prescribing inappropriately or in excessive or inappropriate quantities constitutes prescribing other than in the course of professional practice. It was clearly established through the expert testimony of Dr. Handwerker and to some extent, Dr. March, and the Respondent's own admissions, as well as the testimony of Detective Jones, that the prescription of the Schedule IV controlled substances involved as to their frequencies, amounts and duration were not medically appropriate, especially given the rather vague "complaint" of the patient regarding nonspecific low back pain. The Respondent failed to give other than a cursory physical examination of the "patient" at the initial visit in December of 1982, failed to take and record his blood pressure as well as other medically required physical findings on that date, and, with regard to the follow-up visits in February and May of 1983, failed to inquire regarding the patient's progress under the previously prescribed coarse of medication treatment, and neglected to physically examine the patient and elicit and record any physical findings on those two later visits, including a blood pressure and pulse reading. The perfunctory manner in which the doctor, upon merely inquiring if the patient wanted the same medication again, promptly issued the same three prescriptions on these two later occasions without such examination and recording of physical findings and more detailed questioning of the patient, reveals clearly that the prescribing was not medically appropriate and that Dr. Ramos thus failed to practice medicine with that level of care, skill and treatment which is recognized by reasonably, prudent similar physicians as being acceptable under similar conditions and circumstances.
Further, aside from the question of the dearth of physical examination and findings made with regard to this patient, the frequency, the amount and the duration of the prescription of these drugs was clearly not medically appropriate given the potential actions and interactions of the drugs and the contraindications for such a lengthy prescription of placidyl, especially, which should only be prescribed for a seven-day period, and never in conjunction with darvocet. Thus, in this regard, the Respondent has clearly violated Section 458.331(1)(q) and (t) to the extent delineated above, although his course of conduct does not reveal gross or repeated malpractice for purposes of that proscribed form of conduct referenced in paragraph (t).
It having been proven, principally by the testimony of Dr. Handwerker, that the course of conduct the Respondent engaged in with regard to his care and treatment of the patient did not conform to the generally prevailing standards of such medical treatment in the Dade County medical community, there is no question that the violation of paragraph (t) has been established. However, it was not shown that any deceptive, untrue or fraudulent representations in the practice of medicine were made with regard to the doctor's care, consultation and treatment involving this patient. Although he failed to measure up to the above standard, he did not employ a trick or scheme in the practice of his medicine with regard to this patient. He merely practiced medicine in a negligent manner, thus failing to measure up to the practice standards embodied in paragraphs (q) and (t). But it has not been proven that any violation of paragraph (1) occurred and the administrative complaint to this extent should be dismissed.
In a similar vein, there was no evidence adduced to indicate that Dr. Ramos prescribed the medication involved in bad faith and for reasons other than his effort to alleviate what he perceived to be the patient's pain and suffering (although he was negligent in the manner in which he went about alleviating that pain and suffering). There was certainly no ulterior purpose involving deception, fraud, malice or other indicia of bad faith such that a violation of Section 893.05(1), Florida Statutes, can be deemed to have been proven. Thus, the administrative complaint, in this regard should also be dismissed.
It was established clearly, however, that the medical records maintained by the Respondent failed to justify the course of treatment accorded the patient in this instance as the testimony of both Petitioner's and Respondent's experts confirm, and thus clearly a violation of Section 458.331(1)(n), Florida Statutes has proven. Because of the violations of Section 458.331(1)(n) and (q) having been established, it is also concluded that a concomitant violation of (h) involving the failure to perform a statutory or legal obligation placed upon a licensed physician, is likewise derivatively been established.
In fairness to the Respondent, the Hearing Officer is mindful of the fact that no previous violations, to the knowledge of this Hearing Officer, have been charged or proven against the Respondent's licensure, that he continually refused to prescribe any stronger medication than Schedule IV drugs to Detective Jones, and that his professional reputation amongst his colleagues with whom he presently practices and with whom he practiced in the past, is one of considerable integrity and professional competence. Being mindful of these considerations and those delineated in Rule 21M20.01, Florida Administrative Code, the penalty recommended below is warranted.
RECOMMENDATION
Having considered the foregoing Findings of Fact and Conclusions of Law, the evidence of record, the candor and demeanor of the witnesses and the pleadings and arguments of the parties, it is, therefor
RECOMMENDED
That a Final Order be entered imposing a written reprimand and one year's probation upon the Respondent, Orlando C. Ramos, and requiring that during the probationary period, he enroll in and complete, to the satisfaction of the Board of Medical Examiners, a continuing medical education course concerned with the appropriate indications for and prescription of, scheduled controlled substances.
DONE and ORDERED this 23rd day of July 1984 in Tallahassee, Florida.
P. MICHAEL RUFF Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
FILED with the Clerk of the Division of Administrative Hearings this 23rd day of July 1984.
COPIES FURNISHED:
Joseph W. Lawrence, II, Esquire Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Ellis Rubin, Esquire
265 Northeast 26th Terrace Miami, Florida 33137
Dorothy Faircloth, Executive Director Board of Medical Examiners
130 North Monroe Street Tallahassee, Florida 32301
Fred M. Roche, Secretary
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
=================================================================
AGENCY FINAL ORDER
================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
vs. DOAH CASE NO. 83-2803
DPR CASE NO. 0032751
ORLANDO RAMOS, M.D., LICENSE NO. 17343,
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 October 13, 1984, in Ft.
Lauderdale, 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, Orlando Ramos, M.D., was represented by Ellis Rubin, 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 in the record 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 incorporated by reference herein.
There is competent substantial evidence in the record to support the Board's conclusions of law.
PENALTY
Based upon a review of the complete record in this case and upon a further consideration of the gravity or the offenses resulting in the disciplinary action, the inappropriate prescribing of controlled substances, the Board
determines that the penalty recommended by the hearing officer be increased. Therefore, it is hereby
ORDERED AND ADJUDGED that Respondent be reprimanded. Respondent shall pay an administrative fine of one thousand dollars ($1,000.00) within thirty (30) days of the filing of this Order. Respondent shall be placed on probation for a period of two years during which time Respondent shall complete, to the satisfaction of the Board, a continuing medical education course concerned with the appropriate indications for, and prescription of, scheduled controlled substances, and appear semiannually before the board. Respondent has waived confidentially with regard to the investigative reports prepared by the department during the probation period. This Order takes effect upon citing.
Respondent may appeal this Final Order within thirty (30) days of its filing pursuant to Section 120.69, Florida Statutes, and the Florida Rules of Appellate Procedure.
DONE AND ORDERED this 27th day of December 1984.
BOARD OF MEDICAL EXAMINERS
Richard J. Feinstein, M.D. Chairman
| Issue Date | Proceedings |
|---|---|
| Dec. 28, 1984 | Final Order filed. |
| Jul. 23, 1984 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Dec. 27, 1984 | Agency Final Order | |
| Jul. 23, 1984 | Recommended Order | Records didn't justify course of treatment. Malpractice and charges relative to fraud not proven. Probation and reprimand Final Order adds fine and education to remedy. |
