STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICAL ) EXAMINERS, )

)

Petitioner, )

)

vs. ) CASE NO. 83-3079

)

IVAN ITURRALDE, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, this cause was heard by Linda M. Rigot, the assigned Hearing Officer of the Division of Administrative Hearings, on September 10, 1984, in Miami, Florida. Petitioner's proposed recommended order was filed with the Division on November 30, 1984.

APPEARANCES

Petitioner Department of Professional Regulation, Board of Medical Examiners, was represented by Michael J. Cohen, Esquire, Fort Lauderdale, Florida; and Respondent Ivan Iturralde was represented by William A. Cain and May L. Cain, Attorneys at Law, North Miami, Florida.

Petitioner filed an eleven-count Administrative Complaint seeking to suspend, revoke, or take other disciplinary action against Respondent as licensee and against his license to practice medicine under the laws of the State of Florida. Respondent timely requested a formal hearing on the allegations within that Administrative Complaint. Accordingly, the issues for determination are whether Respondent is guilty of the charges contained in that Administrative Complaint and, if so, what disciplinary action should be taken, if any.

Petitioner presented the testimony of Michele Dawn Heller; Brooks Harle; Dale K. Lindberg, M.D.; Warren Zundell, M.D..; and by way of deposition Michael James Bransfield. Additionally, Petitioner's Exhibits Numbered 1-13 and 16-23 were admitted in evidence. Respondent did not testify, call witnesses, or present evidence other than Respondent's Exhibit Numbered 1, a deposition of Michael James Bransfield taken in the case of Department of Professional Regulation, Board of Medical Examiners v. Juan Ampeuro, M.D., DOAH Case No. 81- 2219.

A proposed recommended order containing findings of fact was submitted by the Petitioner and considered in the preparation of this Recommended Order.

When the Petitioner's findings of fact were consistent with the weight of the credible evidence introduced at final hearing, they were adopted and are reflected in this Recommended Order. To the extent that the findings were not consistent with the weight of the credible evidence, they have been either

rejected, or when possible, modified to conform to the evidence. Additionally, proposed findings which were subordinate, cumulative, immaterial or unnecessary have not been adopted.

FINDINGS OF FACT

1. Respondent is a licensed medical doctor having been issued license number 0028827.

   
   

2. At all times material hereto, Respondent worked at or operated Health Centers, Inc., a clinic which ostensibly treated persons suffering from stress.

   
   

3. At the behest of the Legislature, Petitioner performed a survey of prescriptions for Schedule II controlled substances filled by all pharmacies in the State of Florida. That drug survey revealed that nine different pharmacies in Dade County filled 3,139 prescriptions issued by Respondent between June 1980 and August 1981 for a total of 137,314 tablets of Methaqualone, a Schedule II controlled substance commonly known as quaaludes.

   
   

4. Michael Bransfield visited Respondent at Health Centers, Inc. on July 28, 1980, August 26, 1980, December 2, 1980 and December 31, 1980. On the first visit he received a prescription for 45 quaaludes, and he received a prescription for an additional 40 quaaludes on each subsequent visit.

   
   

5. On September 17, 1980 Bransfield was admitted to Mount Sinai Hospital after an overdose of quaaludes caused him to fall two stories. The hospital records indicate that Methaqualone was in his blood at the time of the injury. "Drug abuse" was listed on the hospital records as both an admission and discharge diagnosis. In addition to the other injuries Bransfield received in his fall, he fractured his skull and was required to undergo brain surgery for the removal of an epidural hematoma. Bransfield had a set of his medical records from Mount Sinai Hospital forwarded to Respondent.

   
   

6. Prior to issuing to Bransfield the 40 quaaludes on December 2, 1980 and the 40 quaaludes on December 31, 1980, Respondent knew that Bransfield had undergone brain surgery as a result of a quaalude overdose. Under the circumstances, issuing prescriptions to Bransfield for quaaludes was life threatening in that it would have been impossible to distinguish a loss of consciousness from drug-induced sleep. Thus, unconsciousness as a result of the head injury would go unnoticed and untreated.

   
   

7. Michele Heller visited Respondent on the following dates and received the following prescriptions from him:

   
   

   August 1, 1980 40 quaaludes

   December 12, 1980 40 quaaludes

   January 9, 1981 40 quaaludes

   February 10, 1981 40 quaaludes

   March 23, 1981 40 quaaludes

   April 22, 1981 45 quaaludes

   May 22, 1981 45 quaaludes

   July 25, 1981 45 quaaludes

   August 29, 1981 45 quaaludes

   September 26, 1981 -0-

   September 29, 1981 45 quaaludes

8. Ana L. Fernandez visited Respondent at Health Centers, Inc. on August 22, 1981 and received a prescription for 45 quaaludes.

   
   

9. Methaqualone is a hypnotic drug, used for the production of sleep. It was used initially for the treatment of insomnia but only on a short-term basis-

   -approximately two weeks--for the reason that it is strongly addictive. By approximately 1980 the use of Methaqualone was largely abandoned by the medical profession since it was well known by that time that Methaqualone was being highly abused, both by drug abusers and by people who wanted to "get high."

   
   

10. Since Methaqualone is a depressant, it is an inappropriate medication for a person who is depressed. The medical records of Bransfield, Fernandez and Heller all indicate that they often suffered from depression.

    
    

11. The medical records of Bransfield, Fernandez and Heller all indicate that Respondent started them on a monthly prescription of either 40 or 45 quaaludes on their very first visit to him although no tests were administered and no laboratory results obtained in order too ascertain if any of those three patients suffered from some physical problem.

    
    

12. The only diagnosis appearing in the medical records of Bransfield, Fernandez or Heller is the word "stress" without any modifiers in explanation of that alleged condition. Additionally, the only "treatment" reflected in Respondent's records of those patients is the monthly prescription of 40 or 45 quaaludes. No other medication was tried, and the only time Respondent failed to prescribe 40 or 45 quaaludes occurred when Heller returned to Respondent's office for her monthly prescription without waiting the required 30 days.

    
    

13. Although Heller's medical records indicated on her first visit to Respondent that she awakened rested, Respondent prescribed for her Methaqualone, a sleep producing drug.

    
    

14. Respondent's records for Bransfield's December 2, 1980 visit indicate that Bransfield reported be was feeling much improved, that he was dealing with his stress, and that he was feeling that he had control over his present life. Yet, Respondent continued to prescribe 80 additional quaaludes after the patient said that he was better.

    
    

15. Respondent's medical records for Bransfield, Fernandez and Heller do not reflect that any of them suffered from any condition for which Methaqualone could be statutori1y prescribed.

    
    

16. The mere prescription of Methaqualone is not an appropriate treatment for stress since it does nothing to identify a patient's stressors so that the patient can effectuate necessary life style changes and/or learn how to deal with those stressors.

    
    

    CONCLUSIONS OF LAW

    
    

17. The Division of Administrative Hearings has jurisdiction over the subject matter hereof and the parties hereto. Section 120.57(1), Florida Statutes (1981).

    
    

18. Counts One, Two, and Three of the Administrative Complaint filed herein charge that Respondent, in his "treatment" of Michele Heller, violated Sections 458.331(1)(n) (failing to keep written medical records justifying the course of treatment of a patient), 458.331(1)(q) (prescribing, dispensing, or

    administering a controlled substance other than in the course of his professional services), and 458.331(1)(cc) (prescribing a compound designated as a Schedule II controlled substance pursuant to Chapter 893, Florida Statutes, to or for any person other than for the specific purposes set forth in that section), Florida Statutes (1981). Petitioner has clearly met its burden of proving Respondent guilty of the allegations contained in Counts One through Three in his treatment of Michele Heller. Respondent's own records failed to justify the course of his treatment, contain information showing that the prescription of Methaqualone to Heller was contraindicated, show that Respondent prescribed to Heller inappropriate and excessive amounts of Methaqualone to such an extent and in such a manner that the prescribing thereof was other than in the course of professional practice, and reveal that Heller suffered from none of the conditions for which the prescription of Methaqualone was statutorily permitted.

    
    

19. Counts Four, Five, and Six of the Administrative Complaint filed herein charge that Respondent, in his "treatment" of Ana Fernandez, violated Sections 458.331(1)(n) (failing to keep written medical records justifying the course of treatment of a patient), 458.331(1)(q) (prescribing, dispensing, or administering a controlled substance other than in the course of his professional services), and 458.331(1)(cc) (prescribing a compound designated as a Schedule II controlled substance pursuant to Chapter 893, Florida Statutes, to or for any person other than for the specific purposes set forth in that section), Florida Statutes (1981). Petitioner has clearly met its burden of proving the statutory violations charged against Respondent in his treatment of Fernandez. Fernandez appeared at Respondent's office on one occasion only.

    Like the others, she said she was depressed. Like the others, Respondent diagnosed her as having stress. Although samples were taken for a number of laboratory tests, before the results of any of those tests were obtained Respondent issued to Fernandez a prescription for 45 quaalude tablets.

    Respondent's records failed to indicate any treatment given to or expected to be given to Fernandez, failed to indicate any justification for the prescription for Methaqualone, failed to indicate that Fernandez suffered from any of the conditions for which Methaqualone could be statutorily prescribed, failed to reflect any diagnosis other than "stress", and failed to give any explanation for the number of quaaludes given to this one-time patient.

    
    

20. Counts Seven, Eight and Nine of the Administrative Complaint filed herein charge that Respondent, in his "treatment" of Michael Bransfield, violated Sections 458.331(1)(n) (failing to keep written medical records justifying the course of treatment of a patient), 458.331(1)(q) (prescribing, dispensing, or administering a controlled substance other than in the course of his professional services), and 458.331(1)(cc) (prescribing a compound designated as a Schedule II controlled substance pursuant to Chapter 893, Florida Statutes, to or for any person other than for the specific purposes set forth in that section), Florida Statutes (1981). Petitioner has clearly met its burden of proving Respondent guilty of the allegations contained in Counts Seven, Eight and Nine of the Administrative Complaint. Respondent's records failed to reflect that Bransfield suffered from any of the conditions for which the statute then in effect permitted the prescribing of Methaqualone. Rather, Respondent's records indicate that the prescription of Methaqualone to Bransfield was contraindicated by Bransfield's own reports to Respondent that he was depressed, that he subsequently felt better, and that he had suffered a severe head injury when he overdosed on quaaludes and was admitted into a hospital as a result of his severe injuries and as a result of being a drug abuser. Even had Bransfield not been a drug abuser, and even had Bransfield not received his head injuries as a result of a quaalude overdose, the prescription

    of Methaqualone to him would have been medically inappropriate by virtue of the fact that he had suffered a recent head injury. As with Heller and Fernandez, Respondent's own records establish the statutory violations with which he is charged in his treatment of Bransfield.

    
    

21. Count Ten of the Administrative Complaint filed herein charges Respondent with violating Section 458.331(1)(t), Florida Statutes (1981), by engaging in gross or repeated malpractice or failing 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. Petitioner has also sustained its burden of proving the allegations in Count Ten through Respondent's own records regarding his mistreatment in the cases of Bransfield, Fernandez and Heller. The prescription of Methaqualone to those patients was not acceptable on any occasion and was grossly unacceptable: over the extended period of time to which Methaqualone was prescribed to Heller, on the first and only visit that Fernandez appeared at Respondent's office, and to Bransfield patient whom Respondent knew had recently suffered a severe head injury as a result of an overdose. Respondent's conduct falls far below that of a reasonably prudent similar physician under similar circumstances.

    
    

22. Count Eleven of the Administrative Complaint charges Respondent with violating Section 458.331(1)(cc), Florida Statutes (1981), by prescribing a compound designated as a Schedule II controlled substance pursuant to Chapter 893, Florida Statutes, to or for any person other than the specific-purposes set forth in that section in that the quantities of Methaqualone prescribed by Respondent to patients at his "stress clinic" were grossly excessive and inappropriate and Respondent's "stress clinic" was designed simply to profit by providing a source for obtaining Methaqualone prescriptions from a licensed medical doctor. The inappropriate and medically unjustified treatment rendered by Respondent to Bransfield, Fernandez, and Heller, together with the fact that 3,139 prescriptions for a total of 137,314 quaaludes issued by Respondent between June 1980 and August 1981 were located at only nine pharmacies in Dade County alone, clearly prove the allegations contained in this Count. No conclusion can logically be reached other than that Respondent prescribed grossly excessive and inappropriate quantities of Methaqualone in violation of Section 458.331(1)(cc), Florida Statutes (1981), as charged in Count Eleven of the Administrative Complaint.

    
    

23. No evidence was introduced in mitigation of any disciplinary action against Respondent. Rather, the evidence is overwhelming that Respondent has grossly abused his license to practice medicine and has rendered "treatment" to patients which is not only in their best interest but which is medically inappropriate and unjustified.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered finding Respondent guilty of the

allegations contained in the Administrative Complaint filed against him and revoking his license to practice medicine under the laws of the State of Florida.

DONE and ORDERED this 8th day of March, 1985 at Tallahassee, Florida.

LINDA M. RIGOT, 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 8th day of March, 1985.

COPIES FURNISHED:

Fred Roche, Secretary

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

Salvatore Carpino, Esquire

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

Michael J. Cohen, Esquire

517 Southwest First Avenue

Fort Lauderdale, Florida 32301

William A. Cain, Esquire May L. Cain, Esquire 11755 Biscayne Boulevard

Suite 401

North Miami, Florida 33181

Docket for Case No: 83-003079

Orders for Case No: 83-003079