Judges: K. N. AYERS
Agency: Department of Health
Latest Update: Jul. 08, 1987
Summary: Evidence failed to support finding of malpractice.
86-2591.PDFSTATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL )
REGULATION, )
)
Petitioner, )
)
vs. ) CASE NO. 86-2591
) DANIEL FRANCIS SANCHEZ, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings by its duly designated Hearing Officer, K. N. Ayers, held a public hearing in the above styled cause on May 21, 1987, at Tampa, Florida.
APPEARANCES
For Petitioner: David E. Bryant, Esquire
1107 East Jackson Street, Suite 104
Tampa, Florida 33602
For Respondent: Norman Stallings, Esquire
Post Office Box 1363 Tampa, Florida 33601
By Administrative Complaint filed July 2, 1986, the Department of Professional Regulation, Petitioner, seeks to revoke, suspend, or otherwise discipline the license of Daniel Francis Sanchez, Respondent, as a medical doctor. As grounds therefor it is alleged that in dealing with patient Alexander Stroganow Respondent is guilty of gross or repeated malpractice or failure to practice medicine with that level of care, skill and treatment recognized by a reasonably prudent physician as being acceptable under similar conditions and circumstances. Specifically, it is alleged that Respondent instructed the patient be taken to a hospital at which he did not have admitting privileges thereby delaying the treatment of the patient.
This case was consolidated with DOAH Case No. 87-0163, Department of Professional Regulation v. Dayton, because both cases involve the same witnesses and treatment of the same patient. The allegations against each Respondent are unrelated to the other Respondent, accordingly separate recommended orders are prepared for each case.
At the hearing, Petitioner called nine witnesses and five exhibits were admitted into evidence. Objection to Exhibit 3 was sustained. At the completion of Petitioner's case, Respondent moved for a directed verdict. He was advised that the Hearing Officer does not have the authority to enter a final order dismissing the charges but such a recommended order would be submitted. Respondent submitted no evidence.
Proposed findings have been submitted by Petitioner. Treatment accorded those proposed findings is contained in the appendix attached hereto and made a part hereof.
FINDINGS OF FACT
At all times relevant hereto Daniel Francis Sanchez was licensed as a physician by the Florida Board of Medical Examiners having been issued license number ME0038795.
At all times relevant hereto Respondent was Regional Medical Director of IMC which operated HMO offices in Hillsborough and Pinellas Counties.
On October 17, 1985, Alexander Stroganow, an 84 year old Russian immigrant and former cossack, who spoke and understood only what English he wanted to, suffered a fall and was taken to the emergency room at Metropolitan General Hospital. He was checked and released without being admitted for inpatient treatment. Later that evening his landlady thought Stroganow needed medical attention and again called the Emergency Medical Service. The ambulance with EMS personnel arrived and concluded Stroganow was no worse than earlier when taken to the emergency room and they refused to transport him again to the hospital. The landlady then called the HRS hotline to report abuse of the elderly.
The following morning, October 18, 1985, an HRS case worker was dispatched to the place where Stroganow lived. She was let in by the landlady and found an 84 year old man who was incontinent, incoherent, apparently paralyzed from the waist down, with whom she could not carry on a conversation to find out what condition he was in. She called for a Cares Unit to come and evaluate the client.
An HRS Cares Unit is a two person team consisting of a social worker and nurse whose primary function is to screen clients for admission to nursing homes and adult congregate living facilities (ACLF). The nurse on the team carries no medical equipment such as a stethoscope, blood pressure cuff, or thermometer, but makes her determination on visual examination only.
Upon arrival of the Cares Unit both members felt Stroganow needed to be placed where he could be attended. A review of his personal effects produced by his landlady showed his income to be over the maximum for which he could qualify for medicaid placement in a nursing home; that he was a member of IMC's Gold- Plus HMO; his social security card; and several medications, some of which had been prescribed by Dr. Dayton, a physician employed by IMC at the South Pasadena Clinic.
The Cares team ruled out ACLF placement for Stroganow at the time because he was not ambulatory but felt he needed to be placed where he could be attended to and not left alone over the coming weekend. To accomplish this, they proceeded to the South Pasadena HMO clinic of IMC to lay the problem on Dr. Dayton, the Assistant Medical Director for IMC in charge of the South Pasadena Clinic.
Stroganow had been a client of the South Pasadena HMO for some time and was well known at the clinic and by EMS personnel. There were two and sometimes three doctors who treated patients at this clinic and, unless the patient
requested a specific doctor, he was treated by the first doctor available. Stroganow had not specifically requested he be treated by Dr. Dayton.
When the Cares team met with Dr. Dayton they advised him that Stroganow had been taken to Metropolitan General Hospital Emergency Room the night before but did not advise Dayton that the EMS team had refused to transport Stroganow to the hospital emergency room a second time the previous evening. Dayton telephoned the emergency room at Metropolitan General to ascertain the medical condition of Stroganow when brought in the evening before. With the information provided by the Cares team and the hospital, Dayton concluded that Stroganow should be given a medical evaluation and the quickest way for that to occur was to call the EMS and have Stroganow taken to an emergency room for evaluation. When the Cares team arrived, Dayton was treating patients at the clinic. A doctor's office, or clinic, is not a desirable place to have an incontinent, incoherent, non- ambulatory patient brought to wait with other patients until a doctor is free to see him. Nor is the clinic equipped to do certain procedures frequently needed in diagnosing the illness and determining treatment needed for an acutely ill patient.
EMS squads usually arrive within minutes of a call to 911 for emergency medical assistance and it was necessary for someone to be with Stroganow with the EMS squad arrived. Accordingly, Dayton suggested that the Cares team return to Stroganow and call 911 for assistance in obtaining a medical evaluation of Stroganow. If called from the HMO office, the EMS squad would have arrived long before the Cares team could have gotten back to Stroganow. Dr. Dayton did not have admitting privileges at any hospital in Pinellas County at this time.
Upon leaving the South Pasadena HMO clinic, the Cares team returned to Stroganow. Enroute, they stopped to call a supervisor at HRS to report that the HMO had not solved their problem. The supervisor then called the Administrator at IMC to tell them that one of their Gold-Plus patients had an emergency situation. Respondent, Dr. Sanchez, called and advised that Dr. Dayton would take care of the problem. Later, around 2:00 p.m. when no ambulance had arrived, the Cares team called 911 from a telephone a block away from Stroganow's residence and arrived back just before the emergency squad. The EMS squad again refused to transport Stroganow to an emergency room and this information was passed back to Sanchez who directed that Stroganow be taken to Lake Seminole Hospital. This was the first time either Dayton or Sanchez was aware that the EMS squad had refused to transport Stroganow to an emergency room.
Although Sanchez did not have admitting privileges at Lake Seminole Hospital, IMC had a contractual agreement with Lake Seminole which provided that certain staff doctors at Lake Seminole would admit patients referred to Lake Seminole by IMC. Pursuant to this contractual arrangement, Stroganow was admitted to Lake Seminole Hospital where he was treated for his injuries and evaluated for his future medical needs.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to, and the subject matter of, these proceedings.
The primary allegation against Respondent Sanchez is that he referred a patient to a hospital at which he did not have admitting privileges. The evidence presented was clear and unrebutted that IMC had a contractual agreement
with Lake Seminole Hospital to accept for admission all patients referred to them by IMC doctors. Accordingly, no credible evidence was presented showing that Respondent Sanchez violated Section 458.331(1)(t) by gross or repeated malpractice or failure to practice medicine at 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 is
RECOMMENDED that all allegations against Dr. Daniel Francis Sanchez contained in the Administrative Complaint filed July 2, 1986, be dismissed.
Entered this 8th day of July, 1987, in Tallahassee, Florida.
K. N. AYERS, 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 July, 1987.
APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-2591
Treatment accorded Petitioner's proposed findings of fact:
1, 4, 18, 19, 20, 21, 24, 25, 29, 30, 31, 32, 37, 38, 39, 41, 42, 43, 44,
45, 46, 49 and 50 are rejected as irrelevant to the charges against Dr. Sanchez.
Included in Hearing Officer #6.
Included in Hearing Officer #3.
Included in Hearing Officer #2.
Included in Hearing Officer #12.
Accepted insofar as included in Hearing Officer #11 otherwise rejected as irrelevant.
Rejected as irrelevant. Since neither doctor had hospital privileges, they could not treat the patient while he was hospitalized.
9, 10, 11, 12, 13, 14, 15, 17, 18, 19, 26, 27, 28, 33, 35, 40, 47 and 48
are rejected as merely relating the testimony of the witnesses and not as findings of fact. The "fact" that a witness testifies to a certain episode is irrelevant unless the testimony is accepted as a fact.
16. Accepted, however not relevant to any issue. 20, 21. Rejected as contrary to the evidence.
Included in Hearing Officer #11.
Accepted insofar as included in Hearing Officer #11, otherwise rejected as uncorroborated hearsay or irrelevant.
34 and 36. Rejected as immaterial to the issues.
COPIES FURNISHED:
David E. Bryant, Esquire 1107 East Jackson Street Suite 104
Tampa, Florida 33601
Norman Stallings, Jr., Esquire
P. O. Box 1363
Tampa, Florida 33602
Van Poole, Secretary Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32399-0750
Joseph A. Sole, General Counsel Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32399-0750
Dorothy Faircloth Executive Director
Board of Medical Examiners
130 North Monroe Street Tallahassee, Florida 32399-0750
Docket for Case No: 86-002591
Orders for Case No: 86-002591
