STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF )
MEDICINE, )
)
Petitioner, )
)
vs. ) CASE NO. 86-4755
)
LUIS JUAREZ, M.D., )
)
Defendant. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, W. Matthew Stevenson, held a formal hearing in this cause on September 14, 15, 16 and 17, 1987 in Miami, Florida. The following appearances were entered:
APPEARANCES
FOR PETITIONER: Peter S. Fleitman, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32399-0750
FOR RESPONDENT: Robert S. Turk, Esquire
One Biscayne Tower, Suite 3400 Miami, Florida 33131-1897
PROCEDURAL BACKGROUND
This cause was previously referred to the Division of Administrative Hearings and assigned to Linda M. Rigot, Hearing Officer, under Case Number 85- 2670. Just prior to a formal hearing, the parties agreed to certain facts and those facts were incorporated into an Amended Administrative Complaint. The Respondent then withdrew his request for a formal hearing, and the file before of the Division of Administrative Hearings was closed. Thereafter, the settlement agreement was submitted to the Board of Medicine (hereinafter "the Board"). In the course of proceedings before the Board, the Board was of the opinion that material facts were still in dispute. Therefore, the Board requested that the Department of Professional Regulation refer the case back to the Division of Administrative Hearings for a formal hearing. The cause was referred back to the Division of Administrative Hearings under the Petitioner's Second Amended Administrative Complaint and set for a formal hearing.
At the formal hearing, the Petitioner presented the testimony of the following witnesses: (Note: Any employment indicated refers to employment on the date of the alleged incident, October 7, 1984) C. Walker, registered nurse at Miami General Hospital("MGH"); W. Saladrigas, homicide detective with the Metro-
Dade Police Department; Officer C. Quintana, Metro-Dade Police Department; M. Dungan, administrative nursing supervisor, MGH; J. Segurola, M.D., emergency- room physician, MGH; E. Delbusto, admissions clerk, MGH; J. Selem, M.D., anesthesiologist, MGH; A. Astrove, M.D., Chairman of the anesthesiology department, MGH; M. Jacobs, M.D., surgeon, MGH; and, the Respondent, Luis Juarez. Petitioner's Exhibit 1 was duly offered and admitted into evidence. In addition, the Petitioner withdrew Count II of the complaint.
The Respondent testified in his own behalf and called the following witnesses: A. Zakharia, M.D., accepted as an expert in the area of trauma surgery; J. Soler-Baillo, M.D., chief of surgery at Hialeah Hospital; R. Comperitore, M.D., general surgeon practicing in the Miami area; R. Cruz, M.D., general surgeon practicing in the Miami area; A. Santelices, M.D., general surgeon with a sub-specialty in critical care, practicing in the Miami area; G.
Lustgarten, M.D., chief of neurosurgery at MGH; and, two of Respondent's former patients. Respondent's Exhibits 1 through 5 were duly offered and admitted into evidence. Joint Exhibits 1 through 3 were admitted into evidence.
The parties have submitted post-hearing Proposed Findings of Fact. A ruling has been made on each proposed Finding of Fact in the Appendix to this Recommended Order.
FINDINGS OF FACT
Based upon my observation of the witnesses and their demeanor while testifying, the documentary evidence received and the entire record compiled herein, I hereby make the following Findings of Fact:
Respondent is, and has been at all times material hereto, a licensed physician in the State of Florida, having been issued license number ME 0040343.
On the morning of October 7, 198A, the Metro-Dade County Rescue Squad called the emergency room at Miami General Hospital and informed the staff that they were enroute to the hospital with a gunshot victim. Dr. Segurola, the emergency room physician, was informed of the victim's condition and immediately ordered a nurse to notify the operating room team and call a surgeon because he knew in advance that "this was going to be a serious surgical case."
At approximately 7:42 a.m., the rescue squad arrived at Miami General Hospital with the victim, Samuel Kaplan. Kaplan was taken to the emergency room suffering from a gunshot wound to the abdomen inflicted by a .32 caliber bullet.
When Kaplan arrived in the emergency room, his systolic blood pressure was approximately 60, he was wearing a MAST suit, he had an intravenous (IV) line going, and he was receiving oxygen. Although Kaplan was conscious and able to speak, his condition was unstable and very serious. Kaplan was initially treated by Dr. Segurola, the emergency room physician. Three nurses, a respiratory therapist and an x-ray technician were also present in the emergency room.
Dr. Segurola conducted a brief physical examination of Kaplan. An entrance wound was found, but there was no exit. After the examination, a second IV line was started in the other arm and a third, central line was started in the subclavin vein. The IV lines were set at maximum or "wide open." The emergency room staff was attempting to rapidly increase Kaplan's blood volume and pressure. Kaplan's hemoglobin level was low (approximately 8 or 9), which is a sign that a patient is anemic due to loss of blood.
At approximately 8:00 a.m., Respondent received a message from his telephone answering service to call Dr. Segurola at the hospital's emergency room.
At approximately 8:02 a.m., the Respondent returied the telephone call and spoke with Dr. Segurola concerning the patient's condition. During the conversation, the Respondent advised Dr. Segurola to contact the operating room team and anesthesiologist to prepare for surgery. The Respondent arrived at the emergency room of Miami General Hospital in response to the call at approximately 8:12 a.m.
Upon the Respondent's arrival at the emergency room, he was informed that Kaplan's blood pressure was 108/50, heart rate 106 and respiration 28. The Respondent spoke to Kaplan and Kaplan stated that he had been shot in the stomach. Respondent then proceeded to conduct a brief, but thorough, physical examination of the patient. When Respondent completed his examination, he was advised that Kaplan's blood pressure was approximately 124/50, heart rate remained at 106 and respiration remained at 28. At this point, the Respondent believed that Kaplan's condition was stabilized. Respondent advised Dr. Segurola that Kaplan should immediately be taken to the operating room for surgery. The Respondent was informed that the operating room was not quite ready and that the anesthesiologist had not arrived. While waiting for the operating room team, Respondent and Dr. Segurola reviewed x-rays of Kaplan. The emergency room nurse continued to take Kaplan's vital signs. Kaplan's blood pressure remained at 124/50.
At approximately 8:20 a.m., while Respondent, Dr. Segurola and others in the emergency room were waiting for confirmation that the operating room was ready, a hospital admissions clerk walked in and informed the emergency room staff that Kaplan belonged to the Health Maintenance Organization ("HMO"). An HMO is a plan in which a patient makes pre-payment for services and is then provided medical services from a designated panel of participating physicians. The emergency room maintained two "on-call" lists, one for HMO surgeons and one for non-HMO surgeons. The Respondent was on the non-HMO list. Dr. Segurola and Respondent had a brief discussion wherein both men acknowledged that under existing hospital policy, the HMO surgeon should have been called. Thereafter, Dr. Segurola informed a nurse to telephone the on-call HMO surgeon. The HMO surgeon on call was Dr. Moises Jacobs.
A secretary in the emergency room placed a call to Dr. Jacobs at approximately 8:25 a.m. Dr. Jacobs returned the phone call between 8:25 a.m. and 8:30 a.m. Dr. Jacobs spoke with Dr. Segurola. While Dr. Segurola was on the phone, Dr. Jose Selem, the anesthesiologist, arrived in the emergency room. Dr. Jacobs told Dr. Segurola to ask the Respondent to take the patient to surgery immediately and stated that he would arrive at the hospital in about 20-
30 minutes. When the Respondent was told of Dr. Jacobs' request he replied that the patient was stable and could wait for Dr. Jacobs. Dr. Selem, the anesthesiologist, also spoke with Dr. Jacobs on the telephone. Dr. Jacobs told Dr. Selem to advise Respondent that Respondent could take the patient to surgery. When Dr. Selem advised Respondent of what Dr. Jacobs has said, the Respondent replied that since Dr. Jacobs was coming to the hospital and Kaplan was an HMO patient, Respondent preferred to wait for Dr. Jacobs, the HMO surgeon. Dr. Selem then left the emergency room and went to the operating room to prepare the necessary instruments.
At approximately 8:30 a.m., the Respondent advised Dr. Segurola that he was going to the hospital cafeteria for a cup of coffee and, if any changes occurred in the patient, he should be contacted. The cafeteria was located across a corridor approximately 20-25 feet from the emergency room. At the time, Kaplan was still alert and his vital signs were being constantly monitored by the nursing staff. Dr. Segurola remained in the emergency room.
The operating room and all necessary personnel were ready for surgery at approximately 8:40 a.m.
Sometime between 8:40 a.m. and 8:45 a.m., one of the nurses told Dr. Segurola that the Respondent's condition was deteriorating and that his blood pressure was dropping. At approximately 8:45 a.m., Kaplan's blood pressure had dropped to 80/50. Dr. Segurola told the nurse to give more blood to Kaplan (a blood transfusion had already been started). Dr. Segurola then went to the cafeteria to speak with Respondent. Dr. Segurola told Respondent that the patient's condition was deteriorating, a blood transfusion had been started, and he feared that Kaplan might die in the emergency room. The Respondent inquired as to how long it had been since Dr. Jacobs had been called and Dr. Segurola responded twenty (20) minutes. Respondent questioned whether it really had been
20 minutes. Both men looked at their watches and determined that it had been about 15 minutes since Dr. Jacobs had been called. Respondent told Dr. Segurola to call the anesthesiologist. Dr. Segurola went back to the emergency room, believing that Respondent was going to immediately follow him there.
When Dr. Segurola arrived back at the emergency room, Kaplan's condition had not improved. Dr. Segurola waited about three (3) more minutes and went back to the cafeteria for the second time. Dr. Segurola again informed the Respondent about Kaplan's deteriorated condition and his fear that Kaplan was going to die in the emergency room. Respondent once more asked Dr. Segurola to call the anesthesiologist. Dr. Segurola told Respondent that the anesthesiologist was there and that "we need you there." Dr. Segurola then went back to the emergency room. The Respondent remained in the cafeteria.
Shortly before 9:00 a.m., while Dr. Segurola was away from the emergency room, Dr. Lustgarten, a neurologist, had just finished his rounds and was leaving the hospital through the emergency room to the parking lot. Dr. Lustgarten looked in on Kaplan to determine if there was any neurological damage. Dr. Lustgarten examined Kaplan and concluded that there was no neurological damage and that, in his opinion, Kaplan's condition was stable with a systolic blood pressure of approximately 100. Dr. Lustgarten left the emergency room just as Dr. Jacobs arrived at approximately 9:00 a.m. Dr. Lustgarten told Dr. Jacobs that Kaplan had no neurological damage. Dr. Jacobs conducted a brief examination of Kaplan and determined that Kaplan needed to be taken to the operating room immediately for surgery. The anesthesiologist, Dr. Selem, had by then been summoned to the emergency room and assisted Dr. Jacobs in an unsuccessful attempt to intubate Kaplan prior to taking him to the operating room.
Shortly after Dr. Jacobs arrived, the Respondent left the cafeteria and headed towards the emergency room. Before Respondent reached the entrance to the emergency room, he was informed by one of the nurses that Dr. Jacobs had arrived. The Respondent stood at the entrance to the emergency room for a brief period and watched as Dr. Jacobs and others attended to Kaplan. Respondent then left the building, went to his car and drove home.
Meanwhile, Dr. Jacobs performed an emergency exploratory laparotomy and left thoracotomy on Kaplan. Between 9:00 am. and 9:15 a.m., after Kaplan was moved from the emergency room to the operating room, his blood pressure went from 90 down to 60, and he went into shock. There are three possible contributing factors for Kaplan's going into shock at this time: (1) moving him may have dislodged ,a blood clot which in all likelihood prevented an earlier complete "bleeding out"; (2) the blood clot may have been diluted by the IV fluid; and (3) the institution of anesthesia. During surgery it was discovered that the bullet had perforated the aorta, a major blood vessel. While still in surgery, Kaplan went into cardiac arrest and was pronounced dead at 10:25 a.m. on October 7, 1984.
At the time that Respondent left the emergency room and went to the hospital cafeteria, Kaplan's vital signs were in a relatively stable condition. Kaplan's vital signs de-stabilized while Respondent was in the hospital cafeteria, and his systolic blood pressure dropped from approximately 120 to approximately 80. At all times prior to being taken to the operating room, Kaplan's vital signs were maintained with the assistance of a MAST suit. A MAST suit is an inflatable device used in the treatment of trauma patients which applies pressure to the body and assists in elevating blood pressure. When the MAST suit is removed, the patient's vital signs will deteriorate again. For this reason, many physicians consider vital signs obtained under such conditions to be false readings, and the MAST suit is usually not removed until the patient is in the operating room.
Although the Respondent suspected that the bullet might have damaged the small bowels and caused some internal bleeding, the Respondent neglected to ask about the amount of fluids Kaplan had received. Kaplan had received over 4 to 5 liters of fluid prior to arriving at the hospital and received an additional 5 liters of fluid while waiting to be taken to surgery. Although this information would have been useful, it would not necessarily have indicated the extent of Kaplan's massive internal bleeding. The amount of fluids that Kaplan received prior to the Respondent leaving the emergency room was not necessarily a sign that Kaplan's condition was unstable.
In the treatment of trauma cases, time is of the essence. A trauma patient with a gunshot-wound to the abdomen should be taken to surgery as soon as possible. In some cases, it may be advantageous to delay surgery in order to stabilize the patient's vital signs or to increase blood volume. Generally, if surgery is performed within the first hour after the injury is sustained (referred to as "the golden hour"), the better the chances of the patient surviving. The golden hour does not apply to injuries of the heart and major blood vessels. In those cases, the patients will "bleed out" in a time much shorter than one hour. Nevertheless, even where the golden hour has passed, the patient should be taken to surgery at the first available opportunity and without delay.
While in the emergency room at Miami General Hospital, Kaplan's condition ranged from "serious" to "critical." From the time that Kaplan was initially admitted to Miami General Hospital his condition was such that he required immediate surgical intervention. A reasonably prudent physician in the Respondent's position would have performed surgery at the first available opportunity and would not have waited for the arrival of another surgeon. Although pursuant to hospital and HMO rules, the HMO surgeon should have been
called first, where an emergency situation exists the first surgeon available is expected to take the patient to surgery, and that physician will be provided payment by the HMO. The Respondent was aware of the hospital's and HMO's policies regarding HMO and non-HMO patients based on prior experience.
The Respondent has never previously been disciplined or investigated by Petitioner or any medical board in any jurisdiction. Respondent maintains an excellent reputation for competence and compassion among his fellow physicians. Respondent is well liked by his patients and has provided medical services in the past to patients with no medical insurance.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to, and subject matter of, these proceedings. Section 120.57(1), Florida Statutes.
The Petitioner, Board of Medicine, is charged with the responsibility of regulating physicians and the practice of medicine in the State of Florida. The Petitioner has alleged that Respondent has violated certain provisions of the Medical Practice Act, Chapter 458, Florida Statutes. The burden of proof in this case is upon Petitioner and the violations alleged must be proven by clear and convincing evidence. See Ferris v. Turlington, 510 So.2nd 292 (Fla. 1987).
In Count I of the Administrative Complaint, the Respondent is charged with 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 physician as being acceptable under similar conditions and circumstances, in violation of Section 458.331(1)(p), Florida Statutes. In particular, the complaint charges that:
Respondent failed to immediately perform surgery on Kaplan, given Kaplan's con-
dition and vital signs; and/or
Respondent failed to recognize that Kaplan's condition was unstable, given Kaplan's condition and vital signs.
The Petitioner established by clear and convincing evidence that Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent physician as being acceptable under similar conditions and circumstances in failing to immediately perform surgery on Kaplan, given Kaplan's condition and vital signs. The evidence was clear that a reasonably prudent similar physician, in light of all relevent surrounding circumstances, would have immediately taken Kaplan to surgery at the first available opportunity and would not have waited for the arrival of another surgeon. The Respondent had properly and correctly recognized that Kaplan should be taken to surgery immediately before he was informed that Kaplan was an HMO patient. The Respondent did not delay surgery to allow Kaplan to achieve optimum resuscitation prior to anesthesia nor for any other medically justifiable reason. The Respondent delayed surgical intervention solely to await the arrival of an HMO participating surgeon. The Respondent engaged in an unethical, unprofessional and dangerous waiting game at the expense of the patient.
The Petitioner did not establish by clear and convincing evidence that Respondent failed to recognize that Kaplan's condition was unstable, given his
condition and vital signs. This allegation must fail because the evidence fell short of showing that Kaplan's condition was "unstable" during the time that he was attended to by Respondent. The testimony produced by the witnesses established no viable definition for the term "unstable" in reference to a patient's medical condition. Dorland's Illustrated Medical Dictionary, Twenty- sixth Edition, defines "stable" as "not moving, fixed, firm; resistant to change." Although Kaplan's overall medical condition was poor, his vital signs were maintained at a relatively fixed level when Respondent decided to leave the emergency room and wait in the hospital cafeteria. In the words of Dr. Zakharia (Respondent's expert witness and Head of Trauma at Jackson Memorial Hospital), Kaplan's condition was "stable for somebody who was shot in the abdomen." Nevertheless, the stability of Kaplan's vital signs, under the circumstances of this case, does not excuse Respondent's failure to immediately take Kaplan to surgery.
In Bourgeouis v. Dade County, 97 So.2d 575 (Fla. 1956), the Supreme Court of Florida held that in order to hold a physician liable for his errors, it must be shown that the course which he pursued was clearly against the course recognized as correct by his profession. The physician is required to use the judgment and form the opinion of one possessed of knowledge and skills common to medical physicians practicing in the same on similar communities. The standard enunciated in Bourgeouis or virtually identical to the standard mandated in The Medical Practice Act, Chapter 458, Florida Statutes. Accordingly, the Petitioner is guilty as alleged in Count I of the Complaint for failing to immediately perform surgery on Kaplan, given Kaplan's condition and vital signs.
Prior to the formal hearing, the Respondent filed a "Motion to Limit Penalties" under the Second Amended Administrative Complaint herein. Pursuant to an earlier Administrative Complaint, the parties had agreed to the factual matters alleged as well as to a specific penalty contained therein. The Board rejected the settlement offer. Thereafter, the Petitioner amended the Administrative Complaint and did not specify a penalty. The Respondent cites no persuasive authority for his Motion to Limit Penalties. The earlier Administrative Complaint contained a specific penalty solely for purposes of settlement negotiations. Because the negotiations were ultimately rejected, the Petitioner was free to timely amend its Administrative Complaint to provide for the full range of appropriate penalties. Nevertheless, in view of the Respondent's excellent reputation and prior good conduct, leniency in the imposition of a penalty would be appropriate.
Based on the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED that the Board of Medicine enter a Final Order placing
Respondent on probation for a period of three (3) years under such terms and conditions as the Board deems appropriate and imposing an administrative fine of
$1,000.
DONE and ORDERED this 11th day of January, 1988.
MATTHEW STEVENSON
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 11th day of January, 1988.
APPENDIX TO RECOMMENDED ORDER IN CASE NO. 86-1029A
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.
Rulings on Proposed Findings of Fact Submitted by the Petitioner
1-13 Adopted as a stipulation between the parties.
(1) Adopted in substance in Finding of Fact 4.
Adopted in Finding of Fact 4.
Adopted in Finding of Fact 14.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Adopted in substance in Finding of Fact 4.
Rejected as subordinate and/or unnecessary.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Adopted in substance in Findings of Fact
13 and 14.
Adopted in substance in Finding of Fact 19.
(1) Adopted in substance in Finding of Fact 4.
Adopted in substance in Finding of Fact 5.
Adopted in substance in Finding of Fact 4.
Adopted in substance in Finding of Fact 4.
Adopted in substance in Finding of Fact 8.
Partially adopted in Finding of
Fact 5. Matters not contained therein are rejected as subordinate and/or as recitation of testimony.
Adopted in substance in Finding of of Fact 5.
Partially adopted in Finding of Fact 10. Matters not contained therein are rejected as subordinate and/or recitation of testimony.
Rejected as a recitation of testimony.
Adopted in substance in Finding of Fact 19.
Adopted in substance in Finding of Fact 19.
Rejected as subordinate.
Adopted in substance in Finding of Fact 12. e.
Rejected as contrary to the weight of the evidence.
Rejected as recitation of testimony.
Adopted in substance in Finding of Fact 20.
Adopted in substance in Finding of Fact 20.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Rejected as subordinate.
Rejected as misleading and/or contrary to the weight of the evidence.
Adopted in substance in Finding of Fact 19.
Rejected as argument and/or a recitation of testimony.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Findings of Fact 8 and 9.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 11.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Adopted in substance in Findings of Fact 13 and 14.
Rejected as subordinate and/or unnecessary.
Addressed in Conclusion of Law section.
Addressed in Conclusion of Law section.
Rulings on Proposed Findings of Fact Submitted by the Respondent
Adopted in substance in Finding of Fact 1.
Rejected as subordinate.
Rejected as subordinate.
Rejected as misleading and/or not supported
by the weight of the | evidence. | |||
5. Adopted in substance | in Finding | of | Fact | 3. |
6. Adopted in substance | in Finding | of | Fact | 6. |
7. Adopted in substance | in Finding | of | Fact | 6. |
8. Adopted in substance | in Finding | of | Fact | 7. |
9. Adopted in substance | in Finding | of | Fact | 7. |
10. Adopted in substance | in Finding | of | Fact | 7. |
11. Adopted in substance | in Finding | of | Fact | 7. |
12. Adopted in substance | in Finding | of | Fact | 8. |
13. Adopted in substance | in Finding | of | Fact | 8. |
a. Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 18.
Rejected as misleading. See Finding of Fact 18.
Partially adopted in Finding of Fact 18. The statement that the MAST suit was "not exerting any pressure on the patient" is re- jected as contrary to the weight of the evidence and highly improbable under the circumstances.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance in Finding of Fact 8.
Adopted in substance of Finding of Fact 8.
Adopted in substance of Finding of Fact 8.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 9.
Rejected as subordinate.
Rejected as subordinate.
Rejected as subordinate.
Rejected as subordinate.
Rejected as subordinate.
Rejected as subordinate.
Adopted in substance in Finding of Fact 9. However, the evidence failed to establish whether Dr. Segurola first suggested that the HMO surgeon be called or whether Respondent first made the suggestion. However, the evidence was clear
that after a brief discussion Dr. Segurola did, in fact, call the HMO surgeon.
Rejected as not supported by believable evidence and/or subordinate.
Rejected as a recitation of testimony and/or subordinate.
Rejected as a recitation of testimony, sub- ordinate and/or unnecessary.
Rejected as a recitation of testimony, sub- ordinate and/or unnecessary.
Adopted in substance in Fining of Fact 21. The last sentence is rejected as misleading.
Adopted in substance in Finding of Fact 9.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Fin4ing of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 10.
Adopted in substance in Finding of Fact 11.
Adopted in substance in Finding of Fact 11.
Rejected as misleading and/or subordinate.
Rejected as misleading and/or subordinate.
Rejected as misleading and/or subordinate.
Adopted in substance in Finding of Fact 12.
Adopted in substance in Finding of Fact 12.
Adopted in substance in Finding of Fact 12.
Rejected as subordinate and/or misleading.
Rejected as subordinate and/or misleading.
Rejected as subordinate and/or misleading.
Adopted in substance in Finding of Fact 13.
Adopted in substance in Finding of Fact 13.
Adopted in substance in Finding of Fact 13.
Adopted in substance in Finding of Fact 13.
Adopted in substance in Finding of Fact 13.
Rejected as contrary to the weight of the evidence.
Rejected as subordinate and/or misleading.
The Respondent was not told that the operating room was ready at 8:40 a.m., however, neither did he ask.
Rejected as misleading and/or contrary to the weight of the evidence.
Adopted in substance in Finding of Fact 14.
Adopted in substance in Finding of Fact 14.
Partially adopted in Finding of Fact 14. The statement that Respondent advised
Dr. Segurola that "he was going to take the patient to surgery" is rejected as contrary to the weight of the evidence.
Adopted in substance in Finding of Fact 14.
Adopted in substance in Finding of Fact 15.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Adopted in substance in Finding of Fact 15.
Adopted in substance in Finding of Fact 15.
Adopted in substance in Finding of Fact 15.
Rejected as subordinate and/or unnecessary.
Adopted in substance in Finding of Fact 16.
Adopted in substance in Finding of Fact 16.
Adopted in substance in Finding of Fact 17.
Addressed in Conclusions of Law section.
Adopted in substance in Finding of Fact 18.
Adopted in substance in Finding of Fact 18.
Adopted in Finding of Fact 17.
Adopted in Finding of Fact 17.
Adopted in Finding of Fact 17.
Adopted in Finding of Fact 17.
Adopted in Finding of Fact 17.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Adopted in substance in Finding of Fact 18.
Adopted in substance in Findings of Fact 17 and 18.
Adopted in substance in Finding of Fact 15.
Rejected as subordinate and/or unnecessary.
Rejected as a recitation of testimony.
Adopted in substance in Finding of Fact 18.
Partially adopted in Finding of Fact 18. The second sentence is rejected as contrary to the weight of the evidence.
Rejected as misleading and contrary to the weight of the evidence.
Rejected as misleading and contrary to the weight of the evidence.
Rejected as subordinate and/or a recitation of testimony.
Adopted in substance in Finding of Fact 19.
Rejected as misleading and/or subordinate.
Rejected as subordinate.
Rejected as misleading and/or contrary to the weight of the evidence.
Addressed in Conclusions of Law section.
Adopted in substance in Finding of Fact 8.
Rejected as argument.
Rejected as contrary to the weight of the evidence and/or misleading.
Rejected as subordinate.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Adopted in substance in Finding of Fact 21.
Rejected as a recitation of testimony.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as subordinate and/or unnecessary.
Rejected as a recitation of testimony.
Rejected as unnecessary and/or subordinate.
Rejected as misleading and/or a recitation of the testimony.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Rejected as a recitation of testimony.
Rejected as misleading and/or subordinate.
Rejected as misleading and/or a recitation of testimony.
Rejected as argument and/or a recitation of testimony.
Rejected as contrary to the weight of the evidence.
Rejected as misleading and/or contrary to the weight of the evidence.
Rejected as contrary to the weight of the evidence.
Addressed in Finding of Fact 22.
Addressed in Finding of Fact 22.
Addressed in Finding of Fact 22.
Addressed in Finding of Fact 22.
Addressed in Finding of Fact 22.
Addressed in Finding of Fact 22.
COPIES FURNISHED:
Robert S. Turk, Esquire
Suite 3400, One Biscayne Tower Two South Biscayne Boulevard Miami, Florida 33131-1897
Peter S. Fleitman, Esquire Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
William O'Neill General Counsel
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Dorothy Faircloth Executive Director Board of Medicine
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| Jan. 11, 1988 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Mar. 01, 1988 | Agency Final Order | |
| Jan. 11, 1988 | Recommended Order | Respondent fined, placed on probation because he engaged in an unethical waiting game by not performing surgery at the first available opportunity. |
