STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICINE, )
)
Petitioner, )
vs. ) CASE NO. 87-5414
)
ROLANDO C. JAMILLA, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
A hearing was held in this case before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings, in Ft. Myers, Florida, on July 12, 1989.
APPEARANCES
For the Petitioner: Robert D. Newell, Jr., Esquire
Newell & Stahl, P.A.
817 North Gadsden Street Tallahassee, Florida 32303-6313
For the Respondent: James A. Neel, Esquire
3440 Marinatown Lane, N.W. North Ft. Myers, Florida 33903
STATEMENT OF THE ISSUES
The issue for consideration herein is whether Respondent's license as a physician in Florida should be disciplined because of the misconduct alleged in the Administrative Complaint filed herein.
PRELIMINARY STATEMENT
An Administrative Complaint was filed in this case against the Respondent by the Department of Professional Regulation on behalf of the Board of Medicine on October 5, 1987. The complaint alleged, in three Counts, that Respondent violated several subsections of Section 458.331(1), Florida Statutes by failing to keep adequate medical records; by prescribing a legend drug other than in the course of his practice; and by gross or repeated malpractice or the failure to practice medicine with proper care, skill, and treatment.
Thereafter, on or about October 20, 1987, Respondent filed an Election of Rights form disputing the allegations of fact and requesting a formal hearing.
By letter dated December 3, 1987, the matter was forwarded to the Division of Administrative Hearings for the appointment of a Hearing Officer and on January 26, 1988, the undersigned initially set the case for hearing in Ft.
Myers on July 25, 1988. Several continuances requested by one or the other of
the parties were granted including one for the consideration by the Board of a proposed Stipulation of Settlement. However, the Stipulation was not accepted by the Board and on May 5, 1989, the case was again set for hearing on July 12, 1989, at which time it was held as scheduled.
At the hearing, Petitioner did not call any witnesses, but introduced Petitioner's Exhibits 1 through 3. Petitioner's Exhibit 2 was the deposition of Dr. Matthew Michael Cohen. Respondent testified in his own behalf and presented the testimony of Dr. Tejvir S. Chadha and Dr. Nelson L. Charles. Respondent also introduced Respondent's Exhibits A through F, of which Exhibit D was the deposition of Dr. Vijaya Ratnesar. Subsequent to the hearing, 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, Rolando C. Jamilla, was licensed as a physician in Florida. The Board of Medicine is the state agency charged with the regulation of the practice of medicine in this state.
Respondent's office for the practice of general medicine in located in Ft. Myers, Florida and Respondent is also the medical director at the Lee Convalescent Center, a nursing home for the elderly with between 140 and 160 beds.
Patient A. J. entered the emergency room at Lee Memorial Hospital in Ft. Myers on the afternoon of August 13, 1983, complaining of shortness of breath. A 55 year old male, he previously had been diagnosed as having chronic lung disease, and was a heavy smoker.
The physician on duty in the emergency room, Dr. Gavin, treated A.J. with intravenous aminophylline, a bronchodilator, and ordered a theophylline level drawn.
Theophylline is a medication the level of which can be measured in the patient's serum. It is a drug which falls within the purview of the proscription in Section 458.331(1). The theophylline test ordered by Dr. Gavin indicated that A.J. had a theophylline level of 11.0 mcg/ml.
A normal therapeutic range for theophylline is 10 to 20 mcg/ml. Excessive levels of the substance can result in theophylline toxicity manifested by rapid cardiac rhythm disturbances and possible cardiac arrest. It can also cause neurotoxicity and neurologic seizures.
Respondent first saw A.J. at about midnight after his admission and confirmed the orders previously given by Dr. Gavin, continuing the aminophylline. When he saw A.J. the following day, Respondent continued the aminophylline regimen for another day at which time A.J.'s breathing was much more regular and easy and the aminophylline treatment was discontinued. Respondent did not order an aminophylline level test at that time because, in his opinion, since the therapy was being discontinued, the test would not have been of value.
A.J.'s condition continued to improve after Respondent discontinued the aminophylline therapy on August 15, 1983 and on the morning of August 18, 1983, Respondent indicated his intent to discharge the patient the following day.
However, during that evening, prior to discharge, A.J.'s condition worsened and the proposed discharge for the following day was cancelled by Dr. Bercau, the on-call physician. At this time, A.J. was again suffering severe shortness of
breath, and aminophylline, along with other broncodilators, was again ordered by Dr. Bercau.
Since, on August 19, 1983, A.J. was still experiencing breathing difficulties, Respondent continued the aminophylline therapy and ordered a series of tests be run on the patient which included an electrocardiogram, a chest x-ray, and a CPK (measure of blood enzyme). Respondent also requested that A.J. be seen in consultation by Dr. Charles, a cardiac specialist.
On August 20, 1983, Dr. Bercau, believing that the patient was experiencing cardiac problems, had him transferred to the telemetry unit for continued and detailed monitoring of his cardiac situation and ordered a theophylline level test run on him. This showed that the patient's theophylline level was 36.8 mgc/ml, considered to be in the toxic range. Both Respondent and his expert agreed that at this point, A.J. was experiencing theophylline toxicity.
As a result of the chemical tests, Dr. Bercau ordered the aminophylline therapy be discontinued as of the evening of August 20, 1983 and directed another theophylline level test be run. The result of this test, done on the morning of August 21, 1983, indicated A.J.'s theophylline level had reduced to 27.6 mcg/ml, still considered to be in the toxic range, and the doctor's notes for this day indicate that though the theophylline level was high, it was much better than it had been.
Notwithstanding this entry in the doctor's notes, on August 22, 1983, Respondent again ordered the resumption of aminophylline therapy. The records do not reflect any indication that Respondent attempted to determine his patient's theophylline level before resuming this therapy.
On August 24, 1983, A.J. began to have premature ventricular contractions, a cardiac rhythm disturbance. When Dr. Charles saw the patient that same day, he indicated that these arrhythmias were "most likely" due to the effect of the aminophylline administered. Dr. Charles ordered this drug be discontinued at that time.
On August 30, 1983, A.J. was examined by Dr. Dosani, a pulmonary specialist, who ordered the administration of steroids in an effort to counteract the patient's bronchospasms. This apparently was successful since the patient's condition improved and he was discharged from the hospital on September 3, 1983.
Aminophylline is a drug which can produce cardiac arrythmia and both cardiac and neurological toxicity can be an outgrowth of theophylline toxicity. Respondent admitted at the hearing he was aware that aminophylline can produce cardiac arrythmia.
Respondent's expert, Dr. Chadha, a specialist in lung diseases, utilizes aminophylline on a daily basis since it is widely used in his specialty. Dr. Chadha could find no reason for Respondent to order a theophylline level test when there were no indications of problems manifested to Respondent and he had discontinued the administration of the drug. The patient presented no evidence of toxicity and the two other physicians who were treating the patient at the time both prescribed administration of aminophylline as well
as other medication at the time Respondent did. Petitioner's expert, Dr. Cohen, opined that the prescribing of aminophylline simultaneously with oral choledyl is inappropriate and excessive and life-threatening to the patient.
According to Dr. Chadha, a review of theophylline level test results at Lee Memorial Hospital for June, 1989, revealed that 31% showed a level in excess of the maximum therapeutic level of 20 mgc/ml. In Dr. Chadha's opinion,, levels of this drug within the body are extremely hard to control.
Whereas Dr. Cohen was of the opinion that the Respondent's treatment of his patient, A.J., in these particulars, constituted a failure to practice medicine with the appropriate level of care, skill and treatment recognized as reasonably prudent by similar physicians under similar circumstances, Dr. Ratnesar, an internist testifying as an expert for the Respondent, was of the opinion after reading the medical charts involved, that the care and treatment given in this case by Respondent was well within medical standards. This opinion was confirmed by Dr. Charles, the cardiologist mentioned previously.
Respondent admitted another patient, J.H., to the hospital on August 27, 1983. The admitting documents indicated the patient was being admitted for the treatment of pulmonary distress when in reality as admitted by Respondent at hearing, the hospital admission was primarily a "social admission" necessary as a prerequisite to the placement of the patient in a nursing home. The patient, J.H., was not in any actual pulmonary distress either at the time of admission nor at any time during his stay, and Respondent admits this. Nonetheless, Respondent prescribed Theo-Dur, a theophylline bronchodilator, and Halcion, a tranquilizer, for the patient.
It is well accepted in medical circles that Halcion should be used with caution when a patient is known to have a respiratory condition because the medication effects the central nervous system which, when depressed, can have an adverse effect on the respiratory function.
Dr. Cohen is of the opinion that the prescription of Theo-Dur and Halcion, conjunctively, to the patient was inappropriate and the medical records on this patient fail to indicate a medical basis for it. The records make no reference to diagnostic tests ordered by Respondent for the patient and in Cohen's opinion, they are inadequate and do not justify the treatment provided.
Respondent rebuts this contention urging that the use of the two drugs together is neither contraindicated nor harmful. This position is supported by information from the manufacturer of Halcion that there is no known contraindication for its use with Theo-Dur. In fact, none of the witnesses, including Dr. Cohen, could provide any firm evidence of contraindication in the use of the two drugs. Further, the four physicians who testified on behalf of Respondent were of the opinion that his records regarding this patient were adequate.
Patient C.T. was a 79 year old woman admitted to the hospital on April 13, 1983, suffering from vaginal bleeding. She was admitted from a nursing home where Respondent had been her treating physician. She was a patient in the nursing home as a result of a stroke she sustained in 1976.
Several days prior to her admission to the hospital, Respondent had attempted a pelvic and a bimanual examination of the patient at the nursing home to attempt to confirm the area from which the patient was bleeding. The bimanual examination was unsatisfactory due to her obesity and, because she had
a protruding hernia in the abdominal wall. Upon admission, Respondent did not perform any additional specified area examination of the patient either with a speculum or bimanually because of her advanced age and the fact that her family preferred no further discomfort be imposed on her. As a result, Respondent made a presumptive diagnosis that the patient was suffering from cancer of the uterus/cervix, but this was not confirmed by actual examination. The patient was treated medically to stop the bleeding and she was returned to the nursing home with no further complications.
Though the examination at the nursing home by the Respondent was characterized as satisfactory and though no positive diagnosis could be confirmed of the cause of the bleeding, Respondent failed to request a gynecological consultation for the purpose of further diagnosis. Due to the family's wishes, however and the advanced age of the patient, this may not necessarily constitute a failure to take proper care.
When Dr. Cohen gave his opinion that the failure to do a bimanual and pelvic examination was improper, he was apparently unaware that Respondent had done these examinations at the nursing home three days prior to the patient's admission.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter in this case. Section 120.57(l), Florida Statutes.
Petitioner's Administrative Complaint alleges three Counts relating to violations of Section 458.331(1), Florida Statutes, with regard to each of three patients identified in the complaint. Not all three Counts relate to each patient, however, and discussion of the individual patients will be directed to the specific relevant Count(s).
In general, disciplinary action against a licensee by the Board of Medicine must be based on clear and convincing evidence of the Respondent's wrongdoing. It is this standard which constitutes the Board's burden of proof by which it must establish Respondent'S misconduct. Ferris v. Turlington, 510 So.2d. 292, 295 (Fla. 1987).
Respondent is alleged to have violated subsections (m), (q), and (t) of Section 458.331(1), Florida Statutes as they relate individually to each of the three patients indicated in the complaint. These provisions, where pertinent, permit discipline of a licensee for:
Failing to keep written medical records justifying the course of
treatment of the patient, including, but not limited to, patient histories, examination results, and test results.
* * * Prescribing, dispensing,
administering, mixing, or otherwise preparing a legend drug, including any controlled substance other than in the course of the physician's professional practice. For the purposes of this paragraph, it shall be legally presumed
that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities, is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his intent.
* * *
(t) 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. ... As used in this paragraph, "gross 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," shall not be construed so as to require more than one instance, event, or act.
With regard to Patient A.J., the only evidence directly relating to Respondent's maintenance of the patient records deals with his ordering the resumption of aminophylline therapy on August 22, 1983 without recording his efforts to determine the patient's theophylline level before doing so. The evidence shows that Respondent did not make any effort to determine his patient's theophylline level at the time he ordered the resumption of the aminophylline therapy, and this failure in that regard relates more to the issues defined in Counts II and III than to Count I. Consequently, it can not be said Respondent's records were incomplete.
However, the Respondent's resumption of aminophylline therapy when the patient's medical records already showed a high level of that substance in the blood stream the day before, along with the fact that other bronchodilators were also being used, without first again checking or consulting with a pulmonary specialist was improper and violated subsections (q) and (t) of Section 458.331(1).
With regard to patient J.H., no malpractice is alleged under Count III by Petitioner. However, Petitioner alleges that Respondent's records were inappropriate and that he prescribed drugs outside the course of him medical practice. In support of these allegations, the evidence clearly shows that the patient was admitted to the hospital without any symptoms justifying the administering of the drugs prescribed for him by the Respondent, and the records fail to reflect a basis for their prescription. Consequently, the allegations in Counts I and II, as they pertain to J.H., have been established.
As to Patient C.T., Petitioner agreed that no allegation of misconduct regarding records or the prescription of drugs was involved, but only that Respondent's failure to perform a pelvic and bimanual examination of the patient upon her admission to the hospital constituted a violation of subsection (t) of the pertinent statute.
This is not supported by the evidence. Clearly, three days prior to the patient's admission, Respondent had attempted a pelvic and bimanual examination of the nursing home and because of her physical condition, (obesity and hernia), was unable to successfully do so. It might be argued that upon her admission to the hospital, with the availability of specialist consultation, he should have again attempted these examinations. However, considering the advanced age of the patient, and the fact that her family specifically requested she not be exposed to any additional discomfort or unpleasantness, his failure to do so cannot reasonably be considered a failure of proper care, skill or treatment under the circumstances. His diagnosis of cervical cancer does not outweigh the fact that the medical treatment she was provided corrected her immediate problem and she was shortly discharged back to the nursing home.
Respondent has been found to be in violation of the statute in at least some of the particulars charged. Consequently, a corrective action must be formulated which will be appropriate to the Respondent's situation.
Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore:
RECOMMENDED that Respondent, Rolando C Jamilla, M.D., be placed on probation by the Board of Medicine for a period of two (2) years under such terms and conditions as are specified by the Board, and that as a part thereof, he complete no less than 40 hours of continuing medical education in subjects specified by the Board.
RECOMMENDED this 18th day of September, 1989, in Tallahassee, Florida.
ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 18th day of September, 1989.
APPENDIX TO RECOMMENDED ORDER IN CASE NO. 87-5414
The following constitutes my specific rulings pursuant to Section 120.57(2), Florida statutes, on all of the Proposed Findings of Fact submitted by the parties to this case.
For the Petitioner:
1. Accepted and incorporated herein. 2.-4. Accepted and incorporated herein.
5. Accepted and, as it pertains to failure to monitor theophylline levels, incorporated herein.
6.-11. Accepted and incorporated herein.
12. Accepted and incorporated herein. 13.&14. Accepted and incorporated herein.
Accepted.
Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted except for the finding that the patient's life was endangered.
Rejected.
21.&22. Accepted and incorporated herein.,
Accepted and incorporated herein but not necessarily dispositive.
Accepted.
Accepted and incorporated herein.
Accepted and incorporated herein.
Rejected.
&29. Accepted and incorporated herein.
Accepted and incorporated herein.
Accepted.
Rejected.
Accepted and incorporated herein.
For the Respondent:
1.&2. Accepted and incorporated herein. 3.&4. Accepted and incorporated herein.
5. Accepted and incorporated herein. 6.&7. Accepted and incorporated herein.
8.-11. Not a Finding of Fact but a recitation of testimony.
12.-16. Restatements of the evidence. 17.&18. Accepted and incorporated herein.
19A-D. Not a Finding of Fact but a recitation of testimony.
COPIES FURNISHED:
Robert D. Newell, Jr., Esquire Newell & Stahl, P.A.
817 North Gadsden Street Tallahassee, Florida 32303-6313
James A. Neel, Esquire 3440 Marinatown Lane, N.W.
North Fort Myers, Florida 33903
Kenneth A. Easley, Esquire General Counsel
Department of Professional Regulation
1940 North Monroe Street Tallahassee, Florida 32399-0792
Dorothy Faircloth Executive Director Board of Medicine
1940 North Monroe Street Tallahassee, Florida 32399-0792
=================================================================
AGENCY FINAL ORDER
=================================================================
DEPARTMENT OF PROFESSIONAL REGULATION BOARD OF MEDICINE
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
DPR CASE NUMBER: 0043436
vs DOAH CASE NUMBER: 87-5414
LICENSE NUMBER: ME 0035448
ROLANDO C. JAMILLA, M.D.,
Respondent.
/
FINAL ORDER
This cause came before the Board of Medicine (Board) pursuant to Section 120.57(1)(b)10, Florida Statutes, on December 1, 1989, in Miami, Florida, for the purpose of considering the Hearing Officer's Recommended Order, Petitioner's Exceptions to the Recommended Order, and Respondent's Response to Petitioner's Exceptions (copies of which are attached hereto as Exhibits A, B, and C, respectively) in the above-styled cause. Petitioner, Department of Professional Regulation, was represented by Stephanie A. Daniel, Attorney at Law. Respondent was present and represented by James A. Neel, Attorney at Law.
Upon review of the Recommended Order, the Exceptions and Response thereto, the argument of the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.
FINDINGS OF FACT
Findings of fact set forth in the Recommended Order are approved and adopted and incorporated herein.
There is competent substantial evidence to support the findings of fact.
CONCLUSIONS OF LAW
The Board has jurisdiction of this matter pursuant to Section 120.57(1), Florida Statutes, and Chapter 458, Florida Statutes.
All of the conclusions of law set forth in the Recommended Order, other than that set forth at the bottom of the second page of the conclusions of law, are approved and adopted and incorporated herein. The conclusion of law set forth at the bottom of the second page of the conclusions of law is rejected for the reasons set forth in Petitioner's exception and as stated by Petitioners counsel and the Board's counsel on the record at the hearing. The following conclusion of law is hereby adopted by the Board in lieu of the Hearing Officer's recommended conclusion on this point:
A review of the relevant patient records in this case, reveals that, on August 21,
1983, A.J.'s theophpylline level had reduced to 27.6 mcg./ml. which, although much better than it had been, was still within the toxic range. Notwithstanding this entry in the doctor's notes, on August 22, 1983, Respondent again ordered the resumption of aminophylline therapy. The medical records do not reflect any indication that Respondent attempted to determine his patient's theophylline level before resuming this therapy. The resumption of aminophylline therapy, given the high level of the substance in the blood stream the day before and given the facts and circumstances of this case, was inappropriate. Although the records document Respondent's actions in this matter, they are not adequate to justify the course of treatment of the patient. Pursuant to Section 458.331(1)(m), Florida Statutes, a physician is required to maintain adequate records to justify the course of treatment
of the patient, including but not limited to records of physical examination, patient history, and test results. Pursuant to this statutory provision, a physician is required not only to maintain a record of the physical examinations, patient histories, and laboratory test results which he performs, but is also required to maintain medical records which are adequate to justify his course of treatment. In this case,
although the records may document what was actually done, the records do not justify the resumption of aminophylline therapy in this case. Accordingly, a violation of Section 45.331(1)(m) Florida Statutes, has been established.
There is competent substantial evidence to support the conclusions of
law.
RULINGS ON EXCEPTIONS
Petitioner's Exception is GRANTED on the basis that the Board agrees with and adopts the legal analysis set forth in Petitioner's written exception and stated on the record by Petitioner's attorney and the Board's legal advisor.
PENALTY
Upon a complete review of the record in this case, the Board determines that the penalty recommended by the Hearing Officer be ACCEPTED AND ADOPTED. WHEREFORE,
IT IS HEREBY ORDERED AND ADJUDGED that
Respondent's license to practice medicine in the State of Florida is placed on PROBATION for a period of 2 years, subject to the following terms and conditions:
Respondent shall comply with all state and federal statutes, rules and regulations pertaining to the practice of medicine, including Chapters 455, 458, and 80-3, Florida Statutes, and Rules 21M, Florida Administrative Code.
Respondent shall appear before the Probation Committee at the first meeting after said probation commences, at the last meeting of the Probation Committee preceding termination of probation, and at such other times requested by the Committee.
In the event Respondent leaves the State of Florida for a period of thirty (30) days or more, or otherwise does not engage in the active practice of medicine in Florida, then certain provisions of Respondent's probation (and only those provisions of said probation) shall be tolled as enumerated below and shall remain in a tolled status until Respondent returns to active practice in the State of Florida. Respondent must keep current residence and business addresses on file with the Board. Respondent shall notify the Board within ten
(10) days of any changes of said addresses. Furthermore, Respondent shall notify the Board within ten (10) days in the event that Respondent leaves the active practice of medicine in Florida.
In the event that Respondent leaves the active practice of medicine in this state for a period of thirty days or more, the following provisions of his probation shall be tolled:
The time period of probation shall be tolled.
The provisions regarding supervision whether direct or indirect by another physician, included in paragraphs 5 through 7 below (where applicable)
The provisions regarding preparation of investigative reports detailing compliance with this Stipulation shall be tolled.
See paragraph 10 below.
Respondent shall not practice except under the indirect supervision of a physician fully licensed under Chapter 458 who has been approved by the Board or its Probationer's Committee. Respondent shall have the monitoring physician with him at his first probation appearance before the Probationer's Committee. Prior to approval of the monitoring physician by the Committee, the Respondent
shall provide to the monitoring physician a copy of the Administrative Complaint and Final Order filed in this case. Failure of the Respondent or the monitoring physician to appear at the scheduled Probation Committee meeting shall constitute a violation of the Board Final Order. Prior to the approval of the monitoring physician by the Committee, Respondent shall submit to the Committee a current curriculum vitae and a description of the current practice from the proposed monitoring physician. Said materials shall be received by the Board office no later than fourteen days before Respondent's first scheduled Probation appearance. The attached definition of a monitoring physician is incorporated herein. The responsibilities of the monitoring physician shall include:
Submit quarterly reports, in affidavit form, which shall include:
Brief statement of why physician is on probation.
Description of probationers practice.
Brief statement of probationer's compliance with terms of probation.
Brief description of probationer's relationship with monitoring physician.
Detail any problems which may have arisen with probationer.
Respondent shall be responsible for ensuring that the monitoring physician submits the required reports.
Be available for consultation with Respondent whenever necessary, at a frequency of at least once every two weeks.
Review 25% percent of Respondent's patient records selected on a random basis at least once every two weeks.
Report to the Board any violations by the probationer of Chapter 455 and 458, Florida Statutes, and the rules promulgated pursuant thereto.
The Board shall delegate to the Chairman of the Probationer's Committee the authority to temporarily approve a monitoring/supervising physician. However, such approval shall remain in effect only until the next meeting of the Probationer's Committee.
In view of the need for ongoing and continuous monitoring or supervision, Respondent shall also submit the curriculum vitae and name of an alternate supervising/monitoring physician who shall be approved by the Board or its Probationer's Committee. Such physician shall be licensed pursuant to Chapter 458, Florida Statutes, and shall have the same duties and responsibilities as specified for Respondent's monitoring/supervising physician, during those periods of time when Respondent's monitoring/supervising physician is temporarily unable to provide supervision. Prior to practicing under the indirect supervision of the alternate monitoring physician, Respondent shall so advise the Board in writing. Respondent shall further advise the Board in writing of the period of time during which Respondent shall practice under the indirect supervision of the alternate monitoring physician. Respondent shall not practice unless he is under the supervision of either the approved supervising/monitoring physician or the approved alternate.
Respondent shall submit quarterly reports in affidavit form, the contents of which shall be specified by the Board. The reports shall include:
Brief statement of why physician is on probation.
Practice location
Describe current practice (type and composition)
Brief statement of compliance with probation terms.
Describe relationship with monitoring/supervising physician.
Advise Board of any problems.
Respondent shall attend 50 hours of Category I Continuing Medical Education courses per year in the area of family practice. Respondent shall submit a written plan to the Probationer's Committee for approval prior to completion of said courses. These hours shall be in addition to those hours required for renewal of licensure.
During this period of probation, semi-annual investigative reports will be compiled by the Department of Professional Regulation concerning Respondents compliance with the terms and conditions of probation and the rules and statutes regulating the practice of medicine.
Respondent shall pay all costs necessary to comply with the terms of the Order issued based on this proceeding. Such costs include, but are not limited to, the cost of preparation of investigative reports detailing compliance with the terms of this proceeding, the cost of analysis of any blood or urine specimens submitted pursuant to the Order entered as a result of this proceeding, and administrative costs directly associated with Respondent's probation. See Section 458.331(2), Florida Statutes.
This order takes effect upon filing with the Clerk of the Department of Professional Regulation.
DONE AND ORDERED this 21st day of December 1989.
BOARD OF MEDICINE
FUAD S. ASHFAR, M.D. CHAIRMAN
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Order has been provided by certified mail to Rolando C. Jamilla, M.D., 22 Pine Island Road, Ft. Myers, Florida 33903 and James A. Neel, Attorney at Law, 3440 Marianatown Lane, N.W., North Ft. Myers, Florida 33903; by U.S. Mail to Arnold
H. Pollock, Hearing Officer, Division of Administrative Hearings, The DeSoto Building, 1230 Apalachee Parkway, Tallahassee, Florida 32399-1550; and by interoffice delivery to Stephanie A. Daniel, Attorney at Law, Department of Professional Regulation, 1940 North Monroe Street, Tallahassee, Florida 32399- 0792 at or before 5:00 P.M., this 28th day of December, 1989.
NOTICE OF RIGHT TO JUDICIAL REVIEW
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES. REVIEW PROCEEDINGS ARE GOVERNED BY THE FLORIDA RULES OF APPELLATE PROCEDURE. SUCH PROCEEDINGS ARE COMMENCED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF THE DEPARTMENT OF PROFESSIONAL REGULATION AND A SECOND COPY, ACCOMPANIED BY FILING FEES PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL, FIRST DISTRICT, OR WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE PARTY RESIDES. THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
| Issue Date | Proceedings |
|---|---|
| Sep. 18, 1989 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Dec. 21, 1989 | Agency Final Order | |
| Sep. 18, 1989 | Recommended Order | Doctor who fails to keep appropriate records of patients and who is otherwise guilty of malpractice in administering drugs subject to discipline |
