STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION (BOARD OF MEDICAL ) EXAMINERS), )
)
Petitioner, )
)
vs. ) DOAH CASE NO. 86-2399
)
OSBEY L. SAYLER, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, a formal hearing was conducted in this case before Michael M. Parrish, a duly designated Hearing Officer of the Division of Administrative Hearings, on October 29, 1986, at Jacksonville, Florida. At the hearing the parties were represented by the following counsel:
FOR PETITIONER: David R. Terry, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
FOR RESPONDENT: Robert P. Smith, Jr., Esquire
HOPPING BOYD GREEN & SAMS
420 First Florida Bank Building Post Office Box 6526 Tallahassee, Florida 32314
ISSUE
This is a case in which the Petitioner seeks disciplinary action by the Board of Medical Examiners against a licensed physician on the basis of allegations that Respondent, in the course of treating the patient Robert Dahlke, violated Section 458.331(1)(t), Florida Statutes, by
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.
The specific factual allegation is that "Respondent, in his postoperative treatment of Mr. Dahlke, allowed the pressure bandages to remain unchanged for too long of a period, and failed to remove the bandages and inspect the area when the patient complained of pain and swelling." Administrative complaint, Paragraph 4.
INTRODUCTION
Respondent was permitted as the outset of the hearing to file Additional Defenses, pleading in bar the statute of limitations and the unconstitutionality of Section 458.331(1)(t), Florida Statutes.
Petitioner presented testimony of the patient, Mr. Dahlke, and that of Dr. Alexander Braze, who was qualified to express expert opinions. The Petitioner also authenticated through custodial witnesses, and introduced in evidence without objection, the Baptist Medical Center records of Mr. Dahlke's admissions and treatment October 7 through 10, 1981, and October 22 through November 6, 1981, and Dr. Sayler's office records of his treatment of Mr. Dahlke as an outpatient before and after surgery.
The Respondent presented his own testimony and that of Dr. Kerry Rifkin, who was qualified to express expert opinions.
At the close of the hearing the Department elected to order a transcript of the proceedings and the Hearing Officer granted the parties a 10-day period from the filing of the transcript within which to file their posthearing submissions including proposed recommended orders. The transcript was filed on November 25, 1986, and both parties filed timely proposed recommended orders containing proposed findings of fact and conclusions of law.
The posthearing submissions of the parties have been given careful consideration in the preparation of this Recommended Order. Specific rulings on each of the proposed findings of fact submitted by both parties are contained in the Appendix attached to and incorporated in this Recommended Order.
FINDINGS OF FACT
Based on the Administrative Complaint, the Answer, the exhibits received in evidence, and the testimony of the witnesses at the formal hearing, I make the following findings of fact.
The Department of Professional Regulation is the state agency charged with regulating the practice of physicians pursuant to Section 20.30, Florida Statutes, and Chapters 455 and 458, Florida Statutes.
At all times material hereto, Osbey L. Sayler, M.D., was a licensed physician in the state of Florida, having been issued license number ME 0018472.
Since 1975 and at all times material hereto, the Respondent has conducted his medical practice in the specialty of general surgery in Jacksonville area hospitals and from an office at Orange Park, Florida. Respondent is suitably educated for and board-certified to his specialty, has been a Fellow of the American College of Surgeons since 1973, and regularly attends medical and surgical programs currently approved for professionals in this state.
On October 8, 1981, for the relief of Mr. Dahlke's symptomatic varicose veins in the right leg, Respondent, at Baptist Medical Center, performed a surgical stripping of the greater and lesser saphenous veins in that leg. Mr. Dahlke initially consulted Respondent in his office on August 3 of that year, by reference from another physician, after the patient had undergone injections of the veins in his left leg by yet another physician. These injections had not relieved Mr. Dahlke's symptoms as he desired. Mr. Dahlke's varicose vein
condition had recurred in recent years after surgery in the '60's and had become painful in his normal vocational activities as a cook and, later, as an assistant food administrator. Both occupations required considerable standing and walking.
Respondent, on August 3, suitably advised Mr. Dahlke of the potential benefits and risks of surgery, advised him to wear elastic stockings temporarily for both therapeutic and diagnostic purposes, and arranged for the patient to have a venogram on August 4. In Respondent's judgment, a venogram was desirable to rule out thrombophlebitis in the deep veins or defects in the valves, either of which could render surgery ineffective or otherwise inadvisable. Respondent conservatively medicated the patient to reduce irritation and avoid potential infection in the left leg injection sites and saw the patient again on August 25 and September 8 before consenting on September 29 to admit him on October 7 for surgery at Baptist Medical Center, the patient's choice for convenient access by his family.
On the evening of his admission and again before the morning's surgery, Mr. Dahlke bathed thoroughly using Phisohex as Respondent had directed. After hospital personnel shaved his right leg and groin area, the surgery proceeded without complication under a general anesthetic. Respondent properly prepared the surgical sites with a thorough Betadine swab and made an incision through the old scar in Mr. Dahlke's groin on the right, above the femoral junction. There he excised the superficial veins and tied them off after finding no other irregularity. Respondent then made incisions over the varicose veins at the interior right ankle and behind the knee--these having been marked previously, while the patient was standing-- and by a conventional stripping instrument removed from within the vein the tissue characteristic of this disorder. Multiple incisions were then made on the lower leg anteriorly, and localized varicose veins were removed and ligated. His leg then wrapped in a sterile towel, the patient was turned over on a sterile sheet and, again through a number of incisions, the varicose veins were stripped or removed. This accomplished, the incisions were closed; the groin by sutures internally, then stainless steel staples, and some 15 to 25 incisions at the knee and lower leg incisions by staples. Four-by-four sterile dressings were taped over the groin closure and 30 to 50 more gauze dressings were secured over the leg incisions, first by a sterile wrap of Kurlix gauze, then by a continuous self-adhering elastic bandage (Coban) wound snugly from above the toes to just above the knee. With prophylactic medication against thrombosis, the patient recovered uneventfully in the recovery room.
On the day after surgery, October 9, Respondent Sayler examined the patient's groin incision and changed its dressing, but, in keeping with his practice in such cases, did not cut away and replace the elastic leg wrapping and dressings. Unless cause for earlier removal is indicated, Dr. Sayler prefers to maintain the self-adhering leg wrap as, in effect, a soft cast until the leg incision staples may safely be removed about 14 days after surgery. A follow-up visit to Respondent's office for that purpose was scheduled for Mr. Dahlke on October 22. In Dr. Sayler's opinion, the continuous light pressure of the elastic wrap encourages the return of blood in the leg circulatory system affected by the surgery; and he prefers to avoid disturbing the dressings over stapled incisions until enough healing is achieved for removal of the staples. The Respondent's preferred procedure of leaving the wrapping on the leg for approximately two weeks without removing it is one of several acceptable methods of care.
An incision in the skin is more susceptible to infection than skin which has no cut in it. Thus, each of the 15 to 25 incisions on Mr. Dahlke's right leg was more susceptible to infection than uncut skin. The staples Respondent used to close the incisions penetrated the dermis and epidermis. Respondent used between 50 and 75 staples to close the numerous incisions on Mr.' Dahlke's right leg. When varicose vein surgery is done, there is nearly always a certain amount of oozing from the small incisions that are made. This can create a pool of blood which can become a good medium for bacterial cultures such as staphylococci. The foregoing notwithstanding, infections following varicose vein surgery are not very common and the infection suffered by Mr. Dahlke was a very rare type of infection for that type of surgery.
Respondent authorized Mr. Dahlke's discharge from the hospital on the morning of October 10, 1981. Respondent did not visit Mr. Dahlke or examine his leg or groin on October 10, 1981. Respondent did, however, obtain information about Mr. Dahlke's progress, and condition from the hospital staff prior to authorizing his discharge. During the latter part of the first week following Mr. Dahlke's discharge from the hospital, his leg began to swell and he experienced pain. About a week after his uneventful discharge from the hospital on October 10, Mr. Dahlke telephoned Respondent's office with a complaint of pain and swelling in his leg. Pain and expressions of pain attending such surgery are normal and of ambiguous diagnostic significance. Mr. Dahlke's report of pain is not a big factor in this case. Respondent's responsive message to Mr. Dahlke was to elevate the leg, take his pain medicine, and call again if necessary.
Dr. Dahlke did call again, and Respondent saw him at the office on short notice on Monday, October 19, 1981. Mr. Dahlke's complaints were recorded by Respondent's nurse as "leg swollen postoperatively" and by Respondent as "ankle pain" and "Right groin wound red & swollen past 3-4 days." Respondent closely examined the entire leg and ankle wrapping, verified good circulation to the toes, and recorded his impression of the ankle pain as "moderate," which is not atypical of such cases of multiple ankle incisions. There was no visible oozing through the leg bandage and there was no "foul odor" from the leg. Respondent did not unwrap the leg bandage on October 19, 1981. The contemporaneous office records of October 19, 1981, bearing an independent entry by Respondent's nurse as well as by Respondent, have no notation of stench or oozing bandages. Respondent uncovered the groin incision, which is more susceptible to infection than the other incisions, and observed what he recorded as "red indurated skin around groin wound." The skin around the groin wound was somewhat red, like a cellulitis, which is a mild infection of the skin. That kind of mild infection is not uncommon in that particular incision. Respondent removed the staples there and with a sterile Q-tip opened 2 cm. of the incision to see if there was any pus or sign of infection in the wound itself.
Respondent did not see any pus in the wound and so noted in his records. As a precautionary measure, he inserted a small pad of antibacterial gauze to allow drainage if anything should develop at the site of the groin wound. He redressed the site and prescribed the antibiotic Ceclor in prophylactic oral dosages until the patient's scheduled reexamination three days thence.
It was the skin surface around the wound, not the wound itself, that Respondent found to be mildly infected by cellulitis on the 19th. Respondent probed the wound itself because he suspected not so much infection as the possibility of infection. That groin incision was well removed both anatomically and by surgical relationship from the leg incisions. Dr. Sayler satisfactorily explained the questioned October 22 record entry of "less
purulent." It meant, in context, "less infected-looking or less redness, less cellulitis" on the skin surrounding the wound itself, where no pus was seen.
Mr. Dahlke returned to Respondent's office on October 22, 1981, for his scheduled appointment. During the office visit on October 22, 1981, the Respondent removed the bandage from Dahlke's right leg. This was the first time since the surgery had been performed on October 8, 1981, that Respondent had removed the leg bandage. When Respondent removed the bandage from Mr. Dahlke's leg, he discovered that the leg was seriously infected. The medical records maintained by Respondent concerning his treatment of Mr. Dahlke on October 22, 1981, show that when he removed the bandage from Mr. Dahlke's leg, he discovered infections of the wounds behind the knee and around the ankle. On October 22, 1981, there was also some sloughing of dead skin behind the knee. After discovering the infections in the leg, Respondent immediately arranged for Mr. Dahlke to be readmitted to Baptist Medical Center.
Mr. Dahlke's infection was exceedingly rare; one not to be expected in the normal course. Mr. Dahlke did not have an elevated temperature on either his October 19 visit or his October 22 visit. An elevated temperature is a usual through not infallible sign of infection. The infection revealed by removing Mr. Dahlke's legwrap on October 22 was treated decisively.
Respondent's care did not cause that infection, which was a Staphylococcus aureus resistant to Methicillin and peculiar to hospital environments.
Fortuitously, the antibiotic Dr. Sayler administered prophylactically on October
19 was of the class that finally proved effective against Mr. Dahlke's infection. The sloughing of dead skin behind the kneecap did not result from infection at all; rather it was an ordinary surgical risk of local trauma in the superficial vein tissues. Finally, Respondent's discovery of Mr. Dahlke's leg infection on the 22nd, rather than the 19th, was not shown to have worsened the infection or complicated its treatment and eventual remission.
If a patient is experiencing pain, swelling, oozing, and foul odor from the surgical site following vein stripping surgery, routine principles of care would require that the bandages be removed and the area examined. Respondent's actions were consistent with such routine. principles because he removed the bandages and examined the area the first time the patient appeared in his office with pain, swelling, oozing, and a foul odor, which was on October 22, 1981.
CONCLUSIONS OF LAW
Based on the foregoing findings of fact and on the applicable legal principles, I make the following conclusions of law:
The Division of Administrative Hearings has jurisdiction over the subject matter of and the parties to this case. Sec. 120.57(1), Fla. Stat.
The additional defenses filed by Respondent at the commencement of the hearing include the contention that this proceeding is barred by the four-year statute of limitations, Section 95.11(3) or (4), Florida Statutes. As candidly noted by Respondent's counsel, that defense has previously been held insufficient as a matter of law. Fazad v. Dept. of Professional Regulation, 433 So.2d 373 (Fla. 1st DCA 1983); Donaldson v. State, Department of Health and Rehab. Serv., 425 So.2d 145 (Fla. 1st DCA 1983); Landes v. Dept. of Professional Reg., 441 So.2d 686 (Fla. 2d DCA 1983), rev. den. 451 So.2d 849. Although I must follow the established law on this issue and conclude that the statute of limitations is not a bar to the prosecution of this case, I feel
constrained to note that if it should become popular to litigate stale administrative claims, the courts may well wish to revisit the question of whether such claims should be barred, if not by a statute of limitations, then perhaps by the doctrine of laches.
The second of the Respondent's additional defenses raises a challenge to the constitutionality of Section 458.331(1)(t), Florida Statutes. In this regard it is sufficient to note that the Hearing Officers of the Division of Administrative Hearings are without authority to rule upon the constitutionality of statutes.
Section 458.331(1)(t), Florida Statutes (1981), in effect and applicable to Respondent's professional practice at the time of the conduct complained of, enunicates the following pertinent standard for the disciplinary action sought by the Department:
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.
Considering the evidentiary record as a whole, the Department's proof does not persuasively support the charge under either statutory standard. That is true whether the charge is considered as limited to what is alleged in the Administrative complaint, Paragraph 4, or as significantly supplemented by Mr. Dahlke's testimony about visibly oozing bandages and noticeable stench. There is no preponderance of the credible evidence that Respondent was guilty of gross malpractice, or that he failed in this instance 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. It therefore is unnecessary to consider whether the proofs were such as to satisfy more onerous standards for revocation or suspension of a professional license, as distinguished from lesser statutory discipline. See Bowling v. Department of Insurance, 394 So.2d 165, 171 (Fla. 1st DCA 1981); Robinson v. Florida Board of Dentistry, Dept. of Professional Regulation, 447 So.2d 930 (Fla. 3d DCA 1984; Johnson v. Dept. of Professional Regulation, Bd. of Medical Examiners, 9 FLW 2133 (Fla. 1st DCA 1984); Purvis v. Dept. of Professional Regulation, Bd. of Veterinary Medicine, 9 FLW 2406 (Fla. 1st DCA 1984).
With regard to the portion of the Administrative Complaint that charges that Respondent "allowed the pressure bandages to remain unchanged for too long of a period," I have not overlooked the testimony of Petitioner's expert, Dr. Braze, to the effect that it is his practice to remove the pressure bandages at an earlier point following surgery, usually after 48 or 72 hours. However, Dr. Braze declined to categorically state that standards of care required that the pressure bandages be removed that early and he declined to state that a failure to remove bandages that soon would be a departure from acceptable standards of care. (See Transcript, pages 97-100, 141) Thus, there is a lack of proof that Respondent violated accepted standards of care by leaving pressure bandages in place for more than 48 or 72 hours. And, as noted in the findings of fact, the greater weight of the evidence is to the effect that Respondent's preferred practice with regard to leaving pressure bandages in place for approximately two weeks is one of several acceptable methods of care.
With regard to the portion of the Administrative Complaint that charges that Respondent "failed to remove the bandages and inspect the area when patient complained of pain and swelling," it should be noted that Petitioner's expert never testified that complaints of pain and swelling alone required the removal of the pressure bandages. In fact, Petitioner's expert testified, "Pain, I don't think is a big factor here." The big factors in the opinion of Petitioner's expert were excruciating pain, oozing visible on the bandages, and the presence of a foul odor coming from the leg. The questions which were posed to Petitioner's expert in eliciting his opinion included these elements. But the Administrative Complaint contains no mention of excruciating pain, oozing visible on the bandages, or the presence of a foul odor, and, even more importantly, the greater weight of the evidence is to the effect that there was no excruciating pain on October 19, 1981, no oozing visible on the bandages, and no foul odor. Thus, on this issue there is a failure of proof of critical facts which were assumed in the formulation of the opinion of Petitioner's expert.
On the basis of all of the foregoing it is recommended that the Board of Medical Examiners enter a final order dismissing the Administrative Complaint against Dr. Osbey L. Sayler.
DONE AND ENTERED this 21st day of January, 1987, at Tallahassee, Florida.
MICHAEL M. PARRISH, 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 21st day of January, 1987.
APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-2399
The following are my specific rulings on each of the proposed findings of fact submitted by each of the parties.
Findings proposed by Petitioner
Except as specifically noted below, all of the findings proposed by the Petitioner have been accepted either wholly or in substance.
Paragraph 17: Rejected as subordinate and unnecessary detail.
Paragraph 23: Rejected as not supported by competent substantial evidence and, in any event, as constituting irrelevant detail.
Paragraph 26: Rejected as not supported by competent substantial evidence.
Respondent's expert, Dr. Braze, testified to his personal procedures, but did not unequivocally state what is proposed in this paragraph.
Paragraph 27: Rejected as irrelevant in light of other evidence.
Paragraph 30: Although essentially true, this paragraph is rejected as irrelevant in light of other evidence; namely, Respondent's testimony (which is credited) that the groin bandage was removed on October 9, 1981, and changed.
Paragraph 31: Rejected as contrary to the greater weight of the evidence.
This is one of several points on which the testimony of the patient Dahlke conflicted with the testimony of the Respondent. In making my findings of fact I have resolved the vast majority, if not all, of such conflicts in the testimony in favor of the Respondent's version. In so doing I have taken into account a number of matters including, specifically, the fact that in general Mr. Dahlke did not appear to have a very good memory. He especially did not have a good memory for details, for dates, or for time relationships. Mr.
Dahlke's version of events was often contradicted by other evidence that is not in dispute. Some of Mr. Dahlke's recollections were simply contrary to logic. In fairness it should be noted that I do not believe that Mr. Dahlke intended to be deceptive or misleading; to the contrary I believe he was doing his best to recount what he remembered, but that he simply did not have a very good memory after 5 years. In contrast to Mr. Dahlke's testimony, the Respondent appeared to have a good memory for details and was candid when his memory failed him.
Further, the Respondent's version of events was logical and consistent with other evidence.
Paragraph 32: Accepted with modifications in the interest of accuracy. Paragraph 36: Rejected as contrary to the greater weight of the evidence.
(The greater weight of the evidence is that infections of the type suffered by Mr. Dahlke are very rare and that there is a difference in medical opinion as to how soon dressings should be removed.)
Paragraph 38: The first two lines of this paragraph are accepted. The last line is rejected as contrary to the greater weight of the evidence. (See Transcript P. 72, lines 13 and 14.)
Paragraphs 40 and 41: Rejected because this conclusionary proposed finding includes facts which are contrary to the greater weight of the evidence.
Paragraph 43: Rejected as contrary to the greater weight of the evidence. (No odor or oozing was evident when Mr. Dahlke was seen on October 19, 1981.)
Paragraphs 44, 45, and 46: Rejected as not supported by competent substantial evidence and as contrary to the greater weight of the evidence. (See the answer at Transcript P. 108, line 24; "could be" is quite different from "strong indication.")
Paragraph 50: Rejected as contrary to the greater weight of the evidence and as not supported by persuasive competent substantial evidence. This is another point on which there is conflict between the testimony of Mr. Dahlke and the testimony of the Respondent. I have accepted the Respondent's version as the more credible of the two.
Paragraph 52: Essentially true, but rejected as irrelevant in light of other evidence; namely, Respondent's testimony (which is credited) that he did examine Mr. Dahlke's leg and observed that there was no oozing and no odor.
Paragraph 53: Rejected as not supported by competent substantial evidence and as contrary to the greater weight of the evidence. The finding proposed in this paragraph is broader than the testimony and broader than can be inferred by logic.
Paragraph 54: Essentially true, but rejected as subordinate and irrelevant details.
Paragraphs 55 and 56: Rejected as contrary to the greater weight of the evidence; I have found that Respondent did examine Dr. Dahlke's leg on October 19, 1981.
Paragraph 57: Accepted with additional findings in the interest of clarity and accuracy.
Paragraph 61: Accepted in substance with the "although" clause deleted and with additional findings in the interest of clarity and accuracy.
Paragraph 62: Rejected because this conclusionary proposed finding includes facts which are contrary to the greater weight of the evidence.
Paragraph 64: Rejected because this conclusionary proposed finding includes facts which are contrary to the greater weight of the evidence.
Paragraph 66: Rejected as irrelevant and also because the proposed finding is a broader statement than the testimony upon which it is based.
Paragraph 67: Rejected as not supported by persuasive competent substantial evidence in critical part and, therefore, also irrelevant.
Paragraph 68: Rejected because this conclusionary proposed finding includes facts which are contrary to the greater weight of the evidence.
Paragraphs 69, 70, and 71: Essentially accurate, but rejected as constituting subordinate and irrelevant details.
Paragraph 72: Rejected as constituting argument rather than proposed findings of fact. In any event, the argument is irrelevant because I have credited Respondent's testimony on this point.
Paragraph 75: Accepted through the first two lines and the first word on the third line. The remainder is rejected as contrary to the greater weight of the evidence.
Paragraph 78: Rejected as contrary to the greater weight of the evidence. Paragraph 79: Rejected as contrary to the greater weight of the evidence.
(See Transcript P. 169.)
Paragraph 80: Rejected as contrary to the greater weight of the evidence. Paragraphs 82 and 83: Rejected as irrelevant.
Paragraph 84: Rejected as not supported by competent substantial evidence and as irrelevant.
Paragraph 85: Rejected as constituting argument for the most part, and as irrelevant.
Paragraph 86: Rejected as not supported by persuasive competent substantial evidence and as irrelevant.
Paragraphs 87 and 88: Essentially accurate, but rejected as irrelevant. Paragraph 89: Rejected as contrary to the greater weight of the evidence. Paragraph 90: Essentially accurate, but rejected as irrelevant.
Findings proposed by Respondent
Paragraphs 1, 2, 3, 4, 5, and 6: Accepted with a few minor modifications in the interest of clarity.
Paragraph 7: The first four sentences of this paragraph are accepted with a few minor modifications in the interest of clarity and accuracy. The remainder of this paragraph is for the most part rejected as a proposed finding because it consists primarily of argument and summaries of testimony rather than proposed findings. (The arguments are essentially well taken, but they belong somewhere other than in the findings of fact.)
Paragraph 8: Accepted in substance with deletion of specific references to testimony of Dr. Braze, which references are subordinate and unnecessary.
Paragraph 9: Accepted with deletion of some subordinate and unnecessary comments.
Paragraph 10: Rejected as a proposed finding because it consists primarily of argument, albeit argument about the evidence. Nevertheless, argument belongs somewhere other than in the findings of fact. I have addressed the issues raised by this and other arguments in the Conclusions of Law portion of this Recommended Order.
Paragraph 11: The first three lines and the first word of the fourth line are accepted. The remainder of this paragraph is for the most part rejected as a proposed finding because it consists primarily of summaries of testimony and argument rather than proposed findings.
Paragraph 12: This paragraph and its three subparts(a), (b), and (c), are all rejected as proposed findings because this paragraph and its subparts consist primarily of summaries of testimony and arguments about why that
testimony should not be relied upon for findings of fact. This paragraph and its subparts might best be described as argument against making certain findings of fact. The argument is essentially well taken, but it belongs somewhere other than in the findings of fact.
Paragraph 13: The third, fourth, fifth, and sixth sentences of this paragraph are accepted in substance, with some unnecessary material deleted. The remainder of this paragraph is rejected as findings of fact because it consists primarily of arguments.
Paragraph 14: Accepted in substance with unnecessary editorial comments deleted.
COPIES FURNISHED:
Robert P. Smith, Jr., Esquire
420 Lewis State Bank Building Post Office Box 6526 Tallahassee, Florida 32314
David R. Terry, Esquire Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
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
Wings Slocum Benton, General Counsel Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| Jan. 21, 1987 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Apr. 13, 1987 | Agency Final Order | |
| Jan. 21, 1987 | Recommended Order | Evidence was insufficient to prove allegations of malpractice by doctor. |
