STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL REGULATION, ) BOARD OF MEDICAL EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 86-1048
)
JULIUS A. OKUBOYE, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Consistent with the Notice of Hearing furnished the parties by Hearing Officer Linda M. Rigot on July 6, 1987, a hearing was held in this case before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings, in St. Petersburg, Florida on October 29 and 30, 1987. The issue for consideration was whether Respondent's license as a medical doctor should be disciplined because of the alleged misconduct outlined in the Administrative Complaint.
APPEARANCES
Petitioner: David E. Bryant, Esquire
Suite 2000, Ashley Tower
100 South Ashley Drive Tampa, Florida 33602
Respondent: Glenn M. Woodworth, Esquire
Woodworth and Dugan, Chartered Wittner Centre West
5999 Central Avenue, Suite 103 St. Petersburg, Florida 33710
BACKGROUND INFORMATION
By Administrative Complaint dated March 5, 1986, the Department of Professional Regulation, alleged in three Counts that Respondent was guilty of 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; with failure to keep written medical records justifying the course of treatment of a patient; and by making deceptive, untrue, or fraudulent representations in the practice of medicine or employing a trick or scheme in the practice of medicine when such trick or scheme failed to conform to the generally prevailing standards of treatment in the medical community.
Respondent formally disputed the allegations of fact contained and requested a formal hearing. The file was forwarded to the Division of Administrative Hearings and originally set for hearing on September 9, 1986.
However, Respondent twice requested a continuance and on February 13, 1987, Hearing Officer Rigot, to whom the case had been assigned in the interim, first set the hearing for May 18, 19 and 20, 1987, but after a third continuance, entered the current Notice of Hearing and the hearing was held as finally scheduled by the undersigned to whom the case had been transferred.
At the hearing, Petitioner presented the testimony of Dr. Robert C. Henderson, an expert in the field of Orthopedic surgery; Dr. Daniel W. Frazier, an expert in medical record keeping; and Dr. Lutz Schlike, an expert in orthopedic surgery; and introduced Petitioner's Composite Exhibits 1 and 2, (a) through (f) and Exhibit 3. Respondent testified in his own behalf and presented the testimony of Dr. Charles Weiss and Dr. John E. Bodden, both experts in orthopedic surgery, and by deposition, the testimony of Dr. Enrique Ergas, also an orthopedic surgeon licensed in New York and New Jersey. Respondent's Exhibit A was the deposition of Dr. Ergas. A transcript was filed herein on January 20, 1988, after which both parties submitted proposed Findings of Fact which have been ruled upon in the Appendix to this Recommended Order.
FINDINGS OF FACT
At all times pertinent to the allegations contained herein, the Respondent, Dr. Julius A. Okuboye, was a medical doctor licensed by and in the State of Florida.
In the first of six cases upon which Petitioner bases its case, the patient was receiving medical treatment for a fracture of the right femur, (thigh bone), at Gateway Community Hospital in St. Petersburg, Florida during the period November 21, 1982 and January 13, 1983. Petitioner contends Respondent failed to properly perform the surgical procedure; failed to properly consider alternative courses of treatment; and failed to keep adequate medical records justifying the course of treatment taken.
Respondent reduced the bone fracture here by using a metal plate running lengthwise along the bone in an attempt to brace the fracture by securing it to the bone with, initially, screws. The plate used by the Respondent was too short for the procedure in that it did not extend beyond the upper limits of the fracture by that distance considered by some to be appropriate. Petitioner's first expert felt the use of the plate which was too short and the screws used to affix it, which were too short, was improper practice. In his opinion, the procedure followed by the Respondent herein required the patient to undergo three separate operations rather than one, which unnecessarily exposed this elderly patient to infection and the risk of anesthesia on three separate occasions.
Petitioner's other expert believes that because the Respondent used a plate which was too short for the fracture involved, it was necessary for him to go back in and fix the plate with Parham bands considered by many in the field to be an old-fashioned practice. These bands, when used, tend to devitalize the tissue. He believes that once having used them, however, Respondent should have used more screws to affix the plate and the bands. In addition, the plate did not fix the smaller bone fragments at the bottom of the fracture. Both experts state Respondent should have considered reducing the fracture by the use of traction and bed rest as an alternative to surgery.
On the other hand, Respondent's experts disagreed with Petitioner's experts. One, Dr. Weiss, indicated that Respondent had two choices: (1) a prolonged traction and immobilization which, itself, poses a great risk for an
elderly patient, or (2) the surgical fixation which was chosen. Here, the reduction was good but the plate was too short. Dr. Weiss contends, as was urged by Respondent, that this was beyond his control and while it would have been better to use a longer plate, the Respondent used the correct procedure and the fact that a second and third operation was necessary, was beyond his control. His choice to do them was appropriate. The other expert, Dr. Bodden, pointed out that even though the smaller plate was used, there is no assurance a larger plate would have precluded the second and third operations. He believes that in light of all of the medical problems presented in this case and since the ideal plate was not available, Respondent's choice was prudent.
The length of the plate was improper but in the opinion of Dr. Bodden, the patient's bone structure contributed to the breakage after the plate was installed. Further, the use of Parham bands was not inappropriate. They have been used for many years and are still widely accepted and used. In fact, he uses them himself.
Prior to the surgery, Respondent contacted the operating room charge nurse to determine if the proper plates were available, and was assured by her that a full set of plates was available for the surgery. It was only after entering the operating arena, opening the incision into the patient's leg, and thereafter opening the sterilized and sealed package containing the plates that it was determined the proper plate was not present. Absent a showing to the contrary, it is found it would have been improper to open the plate package in advance of surgery to check since such a procedure would have destroyed the sterile nature of the package. In light of the above, Respondent's actions were appropriate.
As to the issue of the adequacy of Respondent's medical records on other patients, an analysis of the records showed that no discharge summary was prepared by the Respondent nor were progress notes kept by him on December 22, 23, 25, and thereafter for several weeks on an irregular basis. It may be that Respondent was not the primary physician and only the consultant, but the records fail to show who was the responsible physician and who was ultimately responsible for the patient. A consultant should always reflect in the patient records who he is and in what capacity he has seen the patient as well as his area of expertise and the actions he has taken. Here, the Respondent's failure to do so, notwithstanding some expert evidence to the contrary, renders the records kept by him inadequate.
In the case of the patient who was treated by the Respondent as a consultant on a fracture of the left hip at Gateway Community Hospital between October 27, and November 10, 1983, Petitioner's experts have no quarrel with the orthopedic treatment rendered the patient by Respondent. However, Respondent failed to make proper entries in the patient's medical records and the notes therein were made by an internist. Respondent saw the patient on only four of the nine days the patient was hospitalized and in the opinion of the expert, proper practice requires a doctor, or his substitute in the absence of the doctor, to see the patient each day. It may be that this practice, which is generally accepted as appropriate throughout the medical community, is somewhat less significant in the field of orthopedic surgery. Respondent's expert indicated he did not feel constrained to see his patients each day subsequent to surgery so long as he was kept aware of the patients' conditions. While he makes progress notes, he does not dictate discharge summaries or any of the other records since these are prepared by residents based on the notes he has put in the file.
The medical records for this patient show no progress notes by the Respondent on November 1, 3, 4, and 5, 1983, during which time the patient was in the hospital under the Respondent's care. In one expert's opinion, the missing of three consecutive day's progress notes renders the records below standard.
Respondent indicates he saw the patient frequently right after the surgery, but once he was satisfied that her orthopedic problems were progressing satisfactorily, did not see her during the time she was being treated for medical problems unrelated to the orthopedic surgery by an internist. He did write medical notes on the first five postoperative days at the conclusion of which his postoperative care for the orthopedic surgery was completed. Were it not for her unrelated medical problems, the patient would have been released and he did see her once, (Nov.2) prior to her discharge after her medical problem had been resolved. On the basis of all the testimony, it is found that in this case, Dr. Okuboye did not fail to keep proper medical records.
Respondent also saw a patient for a fracture of the left lateral malleolus, (the protuberance on both sides of the ankle joint), and is alleged to have failed to timely perform an examination of the patient; failed to have timely provided treatment; and failed to have performed a complete examination. In this case, Petitioner's expert pointed out that the chart kept by the Respondent failed to show any reference to a knee injury which was disclosed on post-treatment X-rays evaluated by him. Respondent is also alleged to have failed to have cleaned and irrigated the wound which was a part of the injury, and that he administered only an intramuscular injection of antibiotics. In the opinion of the witness, it makes no difference if there was an infection or not. It is, in his opinion; a bad practice to not debride and clean the wound. Further, he was concerned that the patient records kept by the Respondent did not reflect whether the Respondent responded to the emergency room at the time he prescribed the treatment or not. From the review of the records, he could not tell.
Review of the case records by Respondent's expert showed there was no open fracture which required debridement or specific cleaning. The wound was a small abrasion. As a general rule, an injury should be more than 1/2 inch in size or have some bone showing in order to require debridement, (removal of foreign material and dead or damaged tissue). If those conditions are present, proper procedure is to clean the wound and to provide antibiotics, which the Respondent did, and the treatment recommended by him met appropriate standards. This is the better point of view.
As to the records kept by the Respondent, a note regarding the action taken here was dictated by Respondent two days after the patient was discharged. The patient records show a postoperative X-ray was taken by Respondent but there is no indication in the record showing that surgery was done.
The patient was admitted through the emergency room and was sent to the floor even before the Respondent was contacted. As a result, Respondent did not see the patient in the emergency room. The ER notes prepared by someone else refer to an abrasion and an approximately 1/4 inch tear in the skin. The injury was cleaned in the ER and the patient was sent to the floor after which the Respondent was advised by telephone there was a "questionable" fracture of the ankle. In response, Respondent gave orders for immobilization of the wound and administration of antibiotics. The following day, when Respondent saw the patient, he could see no open wound nor could he find evidence of a fracture.
As a result, he discontinued the prescription for antibiotics and discharged the patient who, it should be noted, did not sustain an infection and who did well in his recuperation.
Respondent indicates he had been told by the family physician who admitted the patient and the nurses on the floor, with whom he discussed the patient, that there was no open wound sustained by this patient. On the basis of this information, Respondent prescribed the questioned course of treatment and it would appear it was appropriate and well within standards.
Between November 12, and November 22, 1983, Respondent acted as surgical consultant regarding a patient being treated at Gateway Community Hospital for a metatarsal fracture. Respondent performed an open reduction and internal fixation of the fracture and Petitioner now claims that Respondent failed to keep adequate medical records justifying the course of that patient's treatment.
In that case, Petitioner does not claim improper treatment by the Respondent. However, one expert for Petitioner could not determine with any degree of certainty whether or not the procedure was required because of the absence of pre- operative X-rays and because of the inadequacy of the records for him to look at. The other Petitioner expert agreed that the Respondent took adequate care of the patient but because of the absence of postoperative film, the taking of which is a general practice within the medical community, he was not able to determine, nor would the Respondent be able to determine, whether the surgeon missed anything in performing the surgery.
Respondent's evidence unequivocally contradicted the testimony of both Petitioner's experts. There were X-rays taken prior to the procedure by Respondent which showed a fracture of the outside metatarsus, (long foot bone). He proposed outpatient surgery of one day and reduced the fracture, inserting two pins as security. The postoperative X-rays show proper reduction. In fact, there are several sets of postoperative films and those taken after the holding pins placed in the fracture were removed show good reduction and full healing.
Respondent discharged the patient from orthopedic care after surgery for release the next day if approved by the referring, physician, Dr. Lew. However, Dr. Lew kept the patient in the hospital one or two days after that for a reason not related to the orthopedic surgery done by Respondent. This would tend to explain the reason for there being no follow-up progress notes on the two days following the operative report done by Respondent on November 23.
The failure to keep adequate notes adversely affects the entire care team not just the attending physician, as without adequate notes, the team cannot tell what is going on with the patient. The entire care is summarized in the progress notes and the failure to make notes on time leaves a hole. That cannot be said to have been the case here, however, since the orthopedic treatment of the patient was completed with the dictation of the operative report and the patient was discharged by Respondent. The patient's retention in the hospital for several days more was by another physician on a matter totally unrelated to the Respondent's treatment and Respondent had no responsibility to keep records on that portion of the patient's hospitalization. It cannot be said, then, that Respondent's records were inappropriate in this case.
Respondent is also alleged to have improperly failed to perform a procedure of open reduction and internal fixation of an ankle fracture on a patient treated by him at Gateway Hospital between January 20, and January 25, 1983.
In this case, Petitioner's expert questions whether the inner bone was properly reduced. X-rays taken subsequent to the procedure, show the reduction left a big gap and an irregular joint and the doctor feels the procedure, as it was done, was below standards. The other Petitioner expert concurs. There were two fractures. The smaller, did not need to be fixed since it was less than 1/3 of the ankle area and medical opinion indicates that fractures of less than 1/3 of the area should not be fixed. The other was fixed improperly in that Respondent should have used a tension band instead of a screw. If he had done so, there would have been a better fixation.
Respondent's expert disagrees, pointing out that the postoperative X- rays show the position of the bones as placed by the Respondent, was quite acceptable. The failure to get an anatomic, (as developed by nature), reduction is not indicative of substandard care. It is sometimes not possible to put bones back the way they were prior to the fracture. In the instant case, when the operation and casting were done, the results were acceptable. The doctor concludes this was a very difficult operation to do and under the circumstances, the Respondent's performance met the standards within the community.
Respondent's other expert agrees. This was an extremely difficult fracture of three sections of an ankle. Admittedly, Respondent's work resulted in a slight bone irregularity. A smooth reduction would be ideal, but it is unlikely that an anatomic reduction could be had in this case. No matter how skilled the work, a fracture of this kind is likely to result in some arthritis, and the failure to use a tension band, as suggested by one of Petitioner's experts, as opposed to a screw as chosen by the Respondent is a matter of choice. Neither gives better results and the Respondent's choice here, in these circumstances, was reasonable.
Between December 18 and December 27, 1984, Respondent performed an open reduction and internal fixation of a fractured right hip. Petitioner alleges that Respondent performed a surgical procedure which was unnecessary, failed to properly perform the surgical procedure done, and failed to keep adequate medical records justifying the patient's treatment.
In this case, Respondent inserted a Jewett nail, a non-collapsing nail, into the bone. The bone collapsed and drove the nail up into the end of the bone in an inappropriate manner.
One of Petitioner's experts took issue with Respondent's use of the Jewett nail calling it an outdated device. In his opinion, the Respondent did not plan properly to have the appropriate device on hand when it was needed. His opinion is supported by that of the other Petitioner expert who pointed out that the procedure resulted in an inadequate fixation. He contends the Respondent should have used a collapsible nail and that Respondent's technique of cutting the bone after the collapse was inappropriate and resulted in a shortening of the leg. He believes this procedure was improper and falls below medical standards in the community. He was also of the opinion that Respondent's record keeping in this case was inadequate.
Petitioner's expert in medical records found several problems with Respondent's records on this patient. The initial note was dictated after
surgery instead of when the consult was first done. No progress notes were in the file for those days when the patient was not seen by the Respondent. There was no showing that the patient was seen by someone left in charge by Respondent in his absence. Since medical records provide a history of the case and allow the follow-on staff to provide continuation of care, the evidence showed Respondent's records in this case were below standard.
Respondent's witness, Dr. Weiss, does not believe that the use of the Jewett nail is necessarily inappropriate. The fact that the Jewett nail did not work out for the Respondent in this case and required follow-up surgery, is not necessarily indicative of improper treatment. Studies of similar fractures in elderly patients show that 70% had some deviation and many similar cases show penetration of the head of the bone by the nail such as was the case here. While there are newer nails used by many orthopedic surgeons, the Jewett nail is still appropriate. The physician can avoid penetration at the time of the insertion and Respondent did so, but penetration cannot always be avoided after surgery when weight is placed on the limb.
Respondent's other expert who reviewed this case stated that the fixed nail used by Respondent, if properly used, gives equally good results as the newer collapsible nail. Cutting of the bone is a well known and appropriate procedure in cases where necessary, as here. In evaluating the testimony of the experts, it should be noted that neither of the Board's experts interviewed Respondent or in any way discussed with him his professional reasons for doing what he did. Their opinions given here as expert testimony were based on evaluation of records and X-rays only whereas the opinions of Respondent's experts were based on review of the same documentation and also on interviews with Respondent who was questioned and who expounded on his medical rationale.
Having analyzed the procedure done by the Respondent here and having evaluated the testimony of all witnesses, it is found that the procedure as followed by Respondent did not fall below the appropriate medical standards within the community. However, the allegation regarding Respondent's failure to keep proper medical records has been established.
Respondent is a native of Nigeria, who took his medical training in England, graduating from Kings College Medical school in 1961. He interned in the United States at Bridgeport Hospital, served his residency and as a research fellow in Canada, and returned to the United States for a two year general surgery and three year orthopedic surgery residency at Albert Einstein Medical Center in New York. Respondent came to Florida in 1973 and has been in private practice as a sole practitioner since that time. He is Board eligible in orthopedic surgery and certified in neurological and orthopedic surgery by the American College of Neurological and Orthopedic surgery, not to be confused with the American Board of Orthopedic Surgery. He is also a member of the Royal College of Surgeons.
At one time, Respondent practiced at Gateway Hospital in St. Petersburg where all the cases involved in the proceeding came up and where he was involved in legal action involving a matter he had handled. Respondent won that case but nonetheless, had to sue the hospital to recover his expenses.
When Gateway Hospital was sold to Humana, he was again involved in litigation with the hospital to retain his privilege to practice there. Thereafter, he was called before the hospital committee regarding the instant cases in a staff privilege matter and as a result, the hospital referred them to the Department of Professional Regulation. Respondent believes two factions in the medical community seek his dismissal and the revocation of his license. He presented a
detailed litany of grievances against various members of the hospital staff and others who, he contends, are engaged in a program to destroy him professionally and remove him from the practice of medicine. Since his medical privileges at the hospital have been rescinded, he can no longer accept referrals in orthopedic surgery from other members of the staff at Gateway and as a result, referrals that would ordinarily go to him, are now going to other, more favored members of the staff who retain surgical privileges. He contends his troubles, which culminated in this hearing, are both economically and racially motivated, and also involve an effort to rid the hospital of foreign trained physicians.
There is no evidence to corroborate Respondent's charges and , therefore, the decision regarding his standard of practice and his record keeping must be based on the professional evidence presented at this hearing.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and subject matter in this case. section 120.57(1), Florida statutes.
In Count One of the Administrative Complaint, Petitioner alleges that in his treatment of six different patients, Respondent failed to practice medicine with reasonable care, skill, and treatment by failing to do, in each case, one or more tasks consistent therewith in violation of section 458.331(1)(t), Florida statutes; and in Count Two, alleges that Respondent failed to keep adequate medical records to justify the treatment given, in violation of section 458.331(1)(n).
In the first case, Petitioner alleges that Respondent (a) failed to properly perform the surgical procedures, (b) failed to properly consider alternative forms of treatment, and (c) failed to keep adequate medical records justifying the treatment rendered. This latter allegation, while here included as a basis for alleging improper treatment is, if proven, an independent violation of the statute under a separate category.
As to the two former allegations, the medical evidence presented by the Petitioner, when compared with that introduced by the Respondent, does not establish that he failed to properly perform the procedures or to consider alternatives.
In a disciplinary case such as this, the Petitioner must establish its allegations of misconduct by clear and convincing evidence, Ferris vs. Turlington, 510 So.2d 292, (1987), and this it has failed to do. However, the evidence does establish that the medical records kept by Respondent in this instance were inadequate and constitute a violation of Section 458.331(10(n), which permits discipline of a licensee for, "failing to keep written records justifying the course of treatment of the patient..." as alleged in Count Two of the complaint.
The allegation of failing to keep adequate medical records was also made against Respondent with respect to a second patient. Here, Respondent was able to establish a valid basis for keeping the records as he did and the evidence presented by Petitioner was insufficient to support a findings of guilty as to this allegation.
Respondent is also alleged to have (a) failed to timely perform an examination of his patient, (b) failed to timely provide treatment to the patient, and (c) failed to perform a complete examination of the patient with regard to a third patient seen by him on October 28, 1983. Taken together, it
is alleged as before that this misconduct constitutes a failure to practice medicine with reasonable care, skill and treatment. Again, the medical evidence, when evaluated against the test set in Ferris, supra, falls short of establishing the misconduct alleged. Medical records were not in issue as to this patient.
As to the fourth patient, the adequacy of the medical records is the only issue but here again, based on the evidence presented by both parties, there is insufficient showing that Respondents's record keeping was inadequate.
In the case of the fifth patient in issue, Respondent's records are not questioned but his performance of a surgical procedure is. Here, as in all the other incidents in question, is a situation where Petitioner's experts state the Respondent's work was inadequate and his experts state it was not. Again, when the evidence is weighed, Petitioner's is found wanting. It has not met its burden to establish that in this case, Respondent's performance was not within community standards.
Concerning the sixth patient, again Respondent is alleged to have performed an unnecessary surgical procedure and to have improperly performed it and to have failed to keep adequate medical records. As to the former two allegations, Petitioner did not meet its burden of establishing that Respondent did an unnecessary procedure or did it improperly, in light of the test in Ferris, supra. As to the issue of the records, however, it is clear that Respondent was remiss in his record keeping and in this case, his records were inadequate.
It having been established that Respondent was in several instances in violation of that portion of the statute involving the keeping of medical records, the question remains as to the appropriate action to be taken. The evidence presented in this case shows the Respondent to be a highly skilled orthopedic surgeon whose professional skills are not seriously in issue.
However, it was also established that medical records are an indispensable and crucial part of the treatment program and cannot legitimately be neglected. In this area, Respondent has been shown to be deficient and it is clear that a reminder of his responsibilities is required.
Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore:
RECOMMENDED that Respondent, Julius A. Okuboye, be reprimanded. RECOMMENDED this 23rd day of February, 1988, at Tallahassee, Florida.
ARNOLD H. POLLOCK, Hearings
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 February, 1988.
Appendix to Recommended Order In Case No. 86-1048
The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the proposed Findings of Fact submitted by the parties to this case.
For the Petitioner
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Rejected as contra to the weight of the evidence.
Rejected as contra to the weight of the evidence.
Accepted to the extent that Respondent's reduction was not anatomic but rejected to the extent "it possibly could have been better treated in a cast."
Rejected as contra to the weight of the evidence.
Rejected as to all but last sentence which is irrelevant since the latter portion of the hospitalization discussed here was after patient had been discharged by Respondent and did not relate to orthopedic treatment.
Accepted and incorporated herein.
14-16. Rejected as contra to the weight of the evidence. 17&18. Accepted and incorporated herein.
19. Rejected as contra to the weight of the evidence.
20-21. Rejected as contra to the weight of the evidence.
22. Accepted as to certain records and rejected as to others as discussed in the body of the Recommended Order.
For the Respondent
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted and incorporated herein.
First sentence rejected as a restatement of Petitioner's position. Remainder accepted and incorporated.
First sentence rejected as above. Last sentence accepted and incorporated. Remainder rejected as a restatement of the evidence.
First sentence rejected as above. Second sentence rejected as a restatement of evidence. Third through Sixth sentences accepted and incorporated. seventh rejected as a restatement of Petitioner's position.
Eighth and Ninth sentences accepted and incorporated.
First sentence rejected as above. second sentence accepted. Remainder accepted and incorporated.
First sentence rejected as above. Remainder accepted and incorporated.
First sentence rejected as above. Remainder accepted and incorporated.
Accepted and incorporated.
Rejected as to some cases, accepted as to others as defined in the Findings of Fact herein.
COPIES FURNISHED:
David E. Bryant, Esquire Suite 2000, Ashley Tower
100 South Ashley Drive Tampa, Florida 33602
Glenn M. Woodworth, Esquire Woodworth and Dugan, Chartered Wittner Centre West
5999 Central Avenue
Suite 103
St. Petersburg, Florida 33710
Dorothy Faircloth Executive Director Department of Professional
Regulation
Board of Medical Examiners
130 North Monroe Street Tallahassee, Florida 32399-0750
| Issue Date | Proceedings |
|---|---|
| Feb. 23, 1988 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Jun. 15, 1988 | Agency Final Order | |
| Feb. 23, 1988 | Recommended Order | Failure to keep adequate medical records in two of six cases justified reprimand of doctor's license. |
