STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
AGENCY FOR HEALTH CARE )
ADMINISTRATION, )
)
Petitioner, )
)
vs. ) CASE NO. 93-3931
)
HERBERT R. SLAVIN, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Susan B. Kirkland, held a formal hearing in this case on September 21 and 22, 1994, in Fort Lauderdale, Florida.
APPEARANCES
For Petitioner: Albert Peacock, Esquire
Joe Garwood, Esquire
Agency for Health Care Administration 1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0792
For Respondent: Charles L. Curtis, Esquire
1177 South East Third Avenue Fort Lauderdale, Florida 33316
and
Andrea Wolfson, Esquire
4491 South State Road 7, Suite 134
Davie, Florida 33314 STATEMENT OF THE ISSUES
Whether Respondent violated Sections 458.331(1)(t), (v), (m), and (q), Florida Statutes, and if so, what penalty should be imposed.
PRELIMINARY STATEMENT
On March 10, 1993, Petitioner, Agency for Health Care Administration (formerly Department of Professional Regulation), Board of Medicine, filed a twenty-four count complaint against Respondent, Herbert R. Slavin, M.D., alleging that he violated Sections 458.331(1)(t), (v), (m), and (q), Florida Statutes. Specifically the complaint alleged that Respondent in his treatment of six patients kept inadequate records, performed functions he was not competent to perform, failed 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 and in his treatment of five of the six patients prescribed excessively and
inappropriately and, therefore, other than in the course of his professional practice. Respondent requested a formal administrative hearing regarding the allegations in the administrative complaint. The case was forwarded to the Division of Administrative Hearings on July 16, 1993, for assignment to a hearing officer. The case was originally assigned to Hearing Officer David Maloney and was then transferred to Hearing Officer Susan B. Kirkland for final hearing which was scheduled for November 10-12, 1993. On October 13, 1993, Respondent requested a continuance, which was granted. The final hearing was rescheduled for February 2-4, 1994. On January 7, 1994, the parties filed a Joint Motion for Continuance. The motion was granted and the final hearing rescheduled for June 1-3, 1994. On April 11, 1994, Respondent filed a Motion to Compel or Stay Proceedings. The final hearing was rescheduled for September 21- 23, 1994, in order to give the Petitioner time to produce a final order subject matter index.
At the final hearing, Petitioner called Dr. Robert Gillett as an expert witness. Petitioner's Exhibits 2-8 and 11 were admitted in evidence.
Respondent presented the testimony of expert witness, Dr. Albert M. Brady, by videotape deposition. Respondent's Exhibits 1-3, 5-6, 8-19 and 23 were admitted in evidence.
At the final hearing the parties agreed to file their proposed recommended orders within sixty days of the filing of the transcript. The transcript was filed on October 12, 1994. The parties timely filed their proposed recommended orders. The parties's findings of fact are addressed in the Appendix to this Recommended Order.
FINDINGS OF FACT
Respondent, Herbert R. Slavin, M.D. (Dr. Slavin), is and has been at all times material hereto, a licensed physician, having been issued license number ME 0036889 by Petitioner, Agency for Health Care Administration, Board of Medicine, (Board).
Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.30 and Chapters 458 and 455, Florida Statutes.
Dilaudid is defined as a legend drug by Section 465.003(7), Florida Statutes, and contains hydromorphone a Schedule II controlled substance listed in Chapter 893, Florida Statutes.
A substance in Schedule II has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Schedule II is the second most potent category and the first category for which there is any viable medical purpose.
The purpose of Dilaudid is to provide pain relief in the appropriate medical situation.
The Physician's Desk Reference recommends that the usual oral dosage for Dilaudid is two milligrams every four to six hours as necessary. For more severe pain the recommendation is four milligrams or more every four to six hours. According to the Physician's Desk Reference the dosage should be individually adjusted according to severity of pain, patient response and patient size.
PATIENT #1
On September 26, 1990, Patient #1, a 27 year old female, sustained injuries to her back in a motor vehicle accident.
On October 22, 1990, Patient #1 underwent a MRI scan of her cervical spine which indicated moderate disc herniation extending slightly asymmetrically to the left side at the C6-7 level and which also indicated a moderate diffuse disc herniation at the C5-6 level with associated osteophytes off the adjacent vertebral end plates.
On March 12, 1991, Patient #1 saw Dr. Slavin for the first time. She was complaining of low back pain secondary to the motor vehicle accident. She advised Dr. Slavin that she was taking physical therapy three times per week.
Dr. Slavin performed a limited physical examination, noted that the patient's old records should be obtained, and prescribed four milligrams of Dilaudid to be taken orally every four hours. The prescription was for 180 units.
On March 26, 1991, Patient #1 returned to see Dr. Slavin, stating that she had chest congestion, a cough, and some numbness in the back of the right leg. She indicated that her prescription for Dilaudid had been stolen along with her purse on March 13, 1991. Dr. Slavin diagnosed bronchitis, gave her a prescription for an antibiotic, and gave her a prescription for Dilaudid to replace the one that was stolen.
On April 11, 1991, Patient #1 visited Dr. Slavin for the purpose of getting the prescription for Dilaudid refilled. Dr. Slavin did not prescribe a refill because it was too soon since he had given the prescription. Patient #1 signed an acknowledgment dated April 11, 1991 that she was not a Dilaudid addict, that she was taking Dilaudid to control pain caused by a herniated disc, which was originally diagnosed in September, 1990, that she had tried other medications and found Dilaudid to control the pain with the least side effects, that she understood that Dilaudid was an addictive substance, and that she understood that it was unlawful for the drug to be transferred to or be used by anyone other than the person named on the prescription.
On April 25, 1991, Patient #1 again came to Dr. Slavin for a refill on the prescription for Dilaudid. Dr. Slavin prescribed a refill for the same dosage. He noted in the progress notes that he was planning to obtain the patient's old records. Based on the patient's file, Dr. Slavin did receive a report from Dr. Lichstrahl, an orthopedic specialist who had seen Patient #1 in October, 1990 and who had diagnosed the herniated disc. Patient #1's file also contained a report dated March 25, 1991, from Dr. Paul Ginsberg, a specialist in neurology.
On May 20, 1991, Patient #1 came back to see Dr. Slavin for a prescription to refill the Dilaudid. Dr. Slavin did prescribe a refill at the same dosage.
On June 24, 1991, Patient #1 returned to Dr. Slavin for a refill of the Dilaudid. In his progress notes, Dr. Slavin noted that there was a decreased range of motion in all directions for her neck. He prescribed a refill at the same dosage for the Dilaudid and also prescribed Feldene.
Dr. Slavin's office received information from an anonymous source that Patient #1 was receiving Dilaudid from other doctors. This information was verified. Dr. Slavin's office notified Patient #1 that he would no longer prescribe narcotic medication to her.
PATIENT #2
On April 10, 1991, Patient #2, a 47 year old male, came to Dr. Slavin with a history of laminectomy and two herniated discs from accidents that occurred several years prior to the visit. Patient #2 indicated that he had been taking Dilaudid for the last six months, which allowed him to work with the pain. Patient #2 was waiting to have surgery until his health insurance became effective. Medical records furnished by the patient indicated that in 1988 Dr. Kernish had diagnosed a peripheral iliac bulge at L5-S1 and L-4-5 with a probable left posterolateral herniation at L5-S1 causing marked foraminal encroachment. Dr. Slavin noted in the progress notes that on the patient's initial visit, the patient was in distress secondary to back pain. Dr. Slavin prescribed four milligrams of Dilaudid to be taken orally every four hours, the same dosage which the patient had been taking. The prescription was for 180 units.
Patient #2 signed an acknowledgment dated April 10, 1991, that he was not a Dilaudid addict, that he was currently taking Dilaudid for the control of pain related to herniated discs which were diagnosed in 1988, that he had tried other medications but found that Dilaudid controlled his pain with the least side effects, that he knew Dilaudid was an addictive substance, and that he knew that it was unlawful for Dilaudid to be transferred to or be used by anyone other than the person named on the prescription.
On May 20, 1991, Patient #2 came to Dr. Slavin for a prescription to refill the Dilaudid. The progress notes indicated that the patient was scheduled for surgery in July. Again Dr. Slavin noted that Patient #2 was in distress secondary to back pain. Dr. Slavin prescribed a refill of Dilaudid at the same dosage.
On June 25, 1991, Patient #2 again came to Dr. Slavin for a refill of Dilaudid. Again Dr. Slavin noted that the patient was contemplating surgery when his insurance became effective and that the patient was in distress secondary to back pain. Dr. Slavin prescribed 40 units of four milligrams of Dilaudid to be taken orally every four hours. The medication sheet in the patient's file indicates that Dr. Slavin prescribed 40 units at the same dosage on July 3 and 10, 1991.
By memorandum dated July 3, 1991, Dr. Rosenberg advised Dr. Slavin that the radiographic views of Patient #2's spine indicated discogenic disease L4-L5, L5-S1.
PATIENT #3
On April 24, 1991, Patient #3, a 64 year old female visited Dr. Slavin, complaining of shortness of breath, lower back pain, chest pain, and headaches. Her medical history indicated peripheral vascular disease, anemia, arthritis, liver dysfuntion, and left ventricular hypertrophy. In 1990, another doctor had prescribed four milligrams of Dilaudid as needed as well as other medications. Dr. Slavin scheduled the patient for blood tests , x-rays, and other tests. Dr. Slavin prescribed, among other medications, 120 units of four milligrams of Dilaudid.
On April 24, 1991, Patient #3 signed an acknowledgment that she was not an Dilaudid addict, was currently taking Dilaudid for control of back pain secondary to a fall in 1982, had tried other medications and found Dilaudid to be the most effective with the least side effects, knew that Dilaudid was addictive, and knew that it was unlawful for Dilaudid to be transferred or used by anyone other than the person named on the prescription.
Patient #3 was recalled to Dr. Slavin's office on May 1, 1991 for further testing because of anemia. No prescriptions were given and the patient was scheduled for an office visit in one week.
Patient #3 was seen again on May 9, 1991. No prescriptions were given. A bone survey was planned and the patient was to return after the tests.
On May 22, 1991, Patient #3 returned for a refill of medications and to get the results of the bone survey. The bone survey had not been returned so an office visit was scheduled for a week later to review the bone survey. Dr. Slavin prescribed 120 units of four milligrams of Dilaudid.
Patient #3 returned on June 4, 1991 for the follow up on the bone survey. Dr. Slavin planned to refer her to Dr. Kalman, an oncologist. No medications were prescribed.
On June 24, 1991, Patient #3 returned for a refill of medication. The progress notes do not reflect whether Dr. Slavin prescribed any refills. The patient had not made an appointment with Dr. Kalman and she was reminded that it was important to do so. Dr. Slavin noted on the progress notes that the x-rays showed a disc narrowing at L4-5. The impression of the radiologist was degenerative disc disease at L4-L5. Dr. Slavin ordered a CT scan of the lumbar spine. By letter dated July 1, 1991, Dr. Robbins advised the CT scan indicated that Patient #3 had a slight narrowing at the L4-L5 intervertebral disc space, but there was no definite evidence of herniated disc or spinal stenosis.
On July 19, 1991, Patient #3 returned to Dr. Slavin for a follow up visit. She was to see Dr. Kalman and return to Dr. Slavin in one month. The progress notes do not indicate whether any medications were prescribed.
By letter dated July 31, 1991, Dr. Kalman advised Dr. Slavin that he had examined Patient #3. He indicated that results of some of the tests were still pending. By letter dated August 6, 1991, Dr. Kalman advised Dr. Slavin of the test results. Dr. Kalman suspected that Patient #3 had anemia of chronic disease secondary to rheumatoid arthritis. He further stated: "The markedly elevated rheumatoid factor titer as well as the markedly elevated sedimentation rate suggest extremely active disease and likely accounts for the patient's back pains." Dr. Kalman indicated the patient had not returned for a follow up visit. By letter dated August 16, 1991, Dr. Kalman advised Dr. Slavin that the patient had cancelled a number of follow up visits. Dr. Kalman had advised her by telephone that she may have an active case of rheumatoid arthritis and that she should return to Dr. Slavin.
On August 20, 1991, Patient #3 made an office visit for follow up of medical problems and a refill of the pain medication. Dr. Slavin prescribed 120 units of 4 milligrams of Dilaudid and some vitamins. The patient was to return in one month.
On September 24, 1991, Patient #3 returned for a follow up visit, refill of her pain medication, and due to pain in her left eye. Dr. Slavin prescribed Dilaudid at the same dosage and some drops for her eyes. She was to return in one month.
On October 25, 1991, Patient #3 returned for a follow up visit. Dr. Slavin prescribed the same dosage of Dilaudid as on the previous visit. She was to return in one month.
On November 25, 1991, Patient #3 came to Dr. Slavin for a follow up visit. He prescribed the same dosage of Dilaudid. She was scheduled for a visit in one month.
On December 12, 1991, Patient #3 visited Dr. Slavin to get a refill of Dilaudid, stating that she had dropped the last thirty pills down the sink. Dr. Slavin prescribed 120 units of 4 milligrams of Dilaudid and 100 units of 40 milligrams of Lasix.
PATIENT #4
On March 4, 1991, Patient #4, a 44 year old male, saw Dr. Slavin and complained of chest congestion, sores on the scalp, and pain in the left hand in the area where he had previously suffered severe burn and traumatic amputation of the left fifth finger. Dr. Slavin noted that the lungs were clear to auscultation with good breath sounds bilaterally. Dr. Slavin diagnosed bronchitis, impetigo, and phantom pain. He prescribed augmentin.
On March 26, 1991, Patient #4 returned for a refill of pain medication and because he was still experiencing chest congestion. Dr. Slavin diagnosed chronic pain syndrome and bronchitis. He prescribed 180 units of four milligrams of Dilaudid and erthromycin, an antibiotic.
On April 24, 1991, Patient #4 returned to Dr. Slavin for a refill on the pain medication and because he had sores on his scalp associated with broken hair shafts. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid and Lotrisone cream.
On April 24, 1991, Patient #4 signed an acknowledgment that he was not a Dilaudid addict, was currently taking Dilaudid for control of pain in his left hand caused by an injury in 1976, had tried other medications but found that Dilaudid was the most effective with the least side effects, knew that Dilaudid was addictive, and knew that it was unlawful for Dilaudid to be transferred to or used by anyone other than the person named on the prescription.
On May 30, 1991, Patient #4 returned to Dr. Slavin for a refill on the pain medication. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid.
On July 2, 1991, Dr. Slavin saw Patient #4 for a refill of the pain medication. Dr. Slavin diagnosed chronic pain syndrome, ulnar neuropathy and hypertension. He prescribed 90 units of Dilaudid and Hytrin. The patient was to return in two weeks to have his blood pressure rechecked.
On July 30, 1991, Patient #4 returned for a refill of his pain medication. His blood pressure was lower than the previous visit. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid.
On September 3, 1991, Patient #4 returned for a refill of Dilaudid. Dr. Slavin prescribed 180 units of 4 milligrams and noted that the patient was trying to diminish his dosage frequency.
On November 26, 1991, Patient #4 returned for a refill of Dilaudid and complained of an infected wound on his left elbow. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid, Lotrisone Cream, and Duricef.
On December 24, 1991, Patient #4 returned for a refill of Dilaudid. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid.
PATIENT #5
On April 5, 1991, Patient #5, a 28 year old male saw Dr. Slavin for pain in his lower to middle back which recently had been exacerbated by a fall off a curb while he was in his wheelchair. Patient #5 has been a paraplegic since 1989 as a result of a gunshot wound. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid and Cipro.
Dr. Slavin noted on the problem list that Patient # 5 had chronic urinary infections. It could not be determined from the records whether Patient #5 had an urinary infection when he initially presented himself to Dr. Slavin. Cipro and Bactrim are drugs which are used to treat urinary infections.
Patient #5 returned to see Dr. Slavin on April 23, 1991. He was complaining of having dark red blood from his rectum on one occasion, pain in the lower part of his abdomen, and not having a bowel movement in the last two days. Dr. Slavin advised the patient to have an enema and to take a laxative. The doctor also prescribed 180 units of 4 milligrams of Dilaudid, Cipro, Bactrim, and Valium. Under normal circumstances a physician would at least examine the rectal area and check the patient's stool. Dr. Slavin did neither.
Patient #5 signed an acknowledgment dated April 23, 1991, stating that he was not a Dilaudid addict, that he was currently taking Dilaudid for back pain, that he had tried other medications and found that Dilaudid controlled the pain with the least side effects, that he knew Dilaudid was an addictive substance, and that he knew that it was unlawful for Dilaudid to be transferred to or used by anyone other than the person named on the prescription.
On May 14, 1991, Patient #5 again saw Dr. Slavin. The patient indicated that he would be out of town for six weeks and needed to have the pain medication refilled. Dr. Slavin prescribed 180 units of 4 milligrams of Dilaudid. The medical records contain no mention of the previous blood in the rectum. The matter, thus, remained medically unresolved as to what the issues were, whether they were addressed, and what the follow-up was, if any.
PATIENT #6
On May 1, 1991, Patient #6, a 40 year old male, saw Dr. Slavin and complained of back pain secondary to an injury in 1981 which caused spinal stenosis with neurogenic claudication pain. The patient had presented to Dr. Slavin a letter dated November 16, 1987 from the Department of Labor and Employment Security, advising Patient #6 that he had been adjudicated as permanently and totally disabled; a neurologic report dated July 28, 1982; and a radiology consultation report dated August 5, 1987. Dr. Slavin noted on the
patient's progress notes that myelogram indicated a defect at the L3-4 disc level. He also noted that the patient had a surgical scar over the LS spine. Dr. Slavin prescribed 120 units of 4 milligrams of Dilaudid, and Robaxin.
On May 1, 1991, Patient #6 signed an acknowledgment that he was not a Dilaudid addict, was currently taking Dilaudid for control of back pain caused by spinal stenosis sustained in a work related injury in 1981 when he fell 18 feet in a sitting position, had tried other medications and found Dilaudid to be the most effective with the least side effects, knew that Dilaudid was addictive, and knew that it was unlawful for Dilaudid to be transferred to or used by anyone other than the person named on the prescription.
Dr. Slavin again saw Patient #6 on June 3, 1991, and prescribed 120 units of 4 milligrams of Dilaudid for chronic low back pain. The doctor noted that he planned to repeat the MRI of the LS spine.
On July 3, 1991, Patient #6 returned for a refill of his medication. Dr. Slavin prescribed 60 units of 4 milligrams of Dilaudid and Robaxin.
On July 22, 1991, Dr. Slavin again saw Patient #6 for a refill of the pain medication. Dr. Slavin prescribed 60 units of 4 milligrams of Dilaudid.
Dr. Slavin saw Patient #6 on August 20, 1991 for a refill of the pain medication. The doctor noted in the progress notes that the patient had extensive hypertrophic and degenerative bone and disc disease at virtually all levels of the LS spine. He prescribed 120 units of 4 milligrams of Dilaudid.
On September 19, October 23, November 22, and December 20, 1991, Patient #6 visited Dr. Slavin for a refill of his pain medication. On each occasion, Dr. Slavin prescribed 120 units of 4 milligrams of Dilaudid.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to and the subject matter of this proceeding. Section 120.57(1), Florida Statutes.
Disciplinary licensing proceedings are penal in nature. State ex rel. Vining v. Florida Real Estate Commission, 281 So. 2d 487 (Fla. 1973).
Petitioner has the burden of establishing by clear and convincing evidence that Respondent has violated Sections 458.331(1) (m), (q), (t), and (v), Florida Statutes. Ferris v. Turlington, 510 So. 2d 292 (Fla. 1st DCA 1987).
Sections 458.331(1) (m), (q), (t), and (v), Florida Statutes, provide:
The following acts shall constitute grounds for which the disciplinary actions specified in subsection (2) may be taken:
* * *
(m) Failing to keep written medical records justifying the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed or administered;
and reports of consultations and hospitalizations.
* * *
(q) 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' 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. The board shall give great weight to the provisions of s.
766.102 when enforcing this paragraph. As used
in this paragraph, "repeated malpractice" includes, but is not limited to, three or more claims for medical malpractice within the previous 5-year period resulting in indemnities being paid in excess of $10,000 each to the claimant in a judgment or settlement and which incidents
involved negligent conduct by the physician. 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 as to require more than one instance, event, or act. Nothing in this paragraph shall be construed to require that
a physician be incompetent to practice medicine
in order to be disciplined pursuant to this paragraph.
* * *
(v) Practicing or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities which the licensee knows or has reason to know that he is not competent to perform.
Count One of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(m), Florida Statutes by failing to keep written medical records justifying the course of treatment of Patient #1 in that Dr. Slavin failed to document adequate patient histories, examination results, test results and/or reports of consultations to justify his prescriptions of Dilaudid. Petitioner has established by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(m). Dr. Slavin did not adequately document Patient #1's medical history in the patient's initial visit to Slavin. If he performed an orthopedic examination, the results of the examination were inadequately documented in the written medical records to justify the prescriptions of Dilaudid.
Count Two of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(t), Florida Statutes, in that Dr. Slavin failed to perform any orthopedic examinations during any of Patient #1's follow up visits and failed to refer Patient #1 to any orthopedics or chronic pain management specialists. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(t). The medical records are inadequate to establish on the initial visit to what extent an orthopedic examination was performed. Patient #1 had already been seen by an orthopedic specialist and a neurological specialist prior to seeing Dr. Slavin. Those specialists findings confirm that there was cause for Patient #1 to be experiencing pain.
Count Three of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(v), Florida Statutes, by prescribing excessive quantities of Dilaudid to Patient #1 in that he prescribed approximately 900 units of Dilaudid without performing any orthopedic examination of Patient #1's back to justify the prescription. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(v). Patient #1 presented herself as experiencing low back pain on the initial visit to Dr. Slavin. The dosage of Dilaudid was within the range recommended by the PDR. Patient #1 had been seen by an orthopedic specialist and a neurological specialist and the findings of the specialists were sent to Dr. Slavin.
The Administrative Complaint did not contain a Count Four.
Count Five of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(t), Florida Statutes, by failing to adequately assess Patient #2's condition in that Dr. Slavin failed to document Patient #2's temperature, document an adequate medical history, perform an orthopedic examination or order an orthopedic consult. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(t). Dr. Slavin's failure to take the temperature did not result in a failure to adequately assess Patient #2's condition, a disc herniation L4-5/L5-S1. Dr. Slavin did document that Patient #2 had had a laminectomy, had suffered a second injury causing two more herniated discs, was taking Dilaudid, and was planning surgery when his insurance became effective. Dr. Slavin had the benefit of a report dated March 5, 1985 concerning the laminectomy and a report dated January 11, 1988 concerning the other herniated discs. Dr. Slavin referred Patient #2 to a radiologist, who reported to Dr. Slavin on July 3, 1991, that Patient #2 had discogenic disease at L4-L5, L5-S1.
Count Six of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(m), Florida Statutes, by failing to keep medical records justifying the course of treatment of Patient #2 in that Dr. Slavin failed to document Patient #2's temperature, failed to document an adequate medical history, failed to document an orthopedic examination or an orthopedic consult. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(m).
Count Seven of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(q), Florida Statutes, by prescribing approximately
400 units of Dilaudid to Patient #2 without performing any orthopedic examination of Patient #2 to justify the prescription. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(q). The dosage prescribed was within the recommended dosage in the PDR. Patient #2 had given Dr. Slavin reports from other physicians indicating that Patient #2 had herniated discs. Slavin observed that Patient #2 had had a
laminectomy. The radiologist report in July, 1991, confirmed that Patient #2 had discogenic disease at L4-L5, L5-S1. Dr. Slavin noted that the patient was in distress secondary to back pain and that the patient was currently taking Dilaludid which enabled the patient to work. Based on these factors, the failure to do an orthopedic exam is not in violation of Section 458.331(1)(q).
Count Eight of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(v), Florida Statutes, by attempting to treat Patient #2 without consulting any other specialists when Dr. Slavin had no educational credentials to qualify him as an expert in the fields of either chronic pain management or disc and back diseases. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(v).
No competent substantial evidence was presented to establish that Dr. Slavin was practicing beyond the scope permitted by law or that he was accepting and performing professional responsibilities that he knew or had reason to know that he was not competent to perform.
Count Nine of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(m), Florida Statutes, by failing to keep written medical records justifying the course of treatment for Patient #3 in that Dr. Slavin failed to document any orthopedic examinations of Patient #3. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(m). Dr. Slavin ordered extensive tests of Patient #3 and the reports of the tests are in the patient's file. The tests of the lumbosacral spine showed degenerative disc disease L4-L5.
Count Ten of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(t), Florida Statutes, by failing to perform any orthopedic examinations during any of Patient #3's follow-up visits, by failing to refer Patient #3 to any orthopedic or chronic pain management specialists, and by failing to treat Patient #3 with any alternative therapies when Patient #3's lower back pain persisted and her CT scan of the lumbar spine found no evidence of a herniated disc or spinal stenosis. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(t). Dr. Slavin referred Patient #3 to a radiologist for testing and to an internal medicine specialist. The internist found that Patient #3 had an active case of rhuematoid arthritis which likely accounted for her back pain.
Count Eleven of the Administrative Complaint alleged that Dr. Slavin violated 458.331(1)(q), Florida Statutes, by prescribing Dilaudid in excessive quantities which was not in the best interests of Patient #3 in that Dr. Slavin failed to perform any orthopedic examinations of Patient #3's back to justify the prescription. Petitioner has failed to establish that Dr. Slavin violated Section 458.331(1)(q). The dosage prescribed was within the recommended dosage of PDR. Dr. Slavin referred Patient #3 to a radiologist for extensive testing and to an internist. The internist found that Patient #3's rhuematoid arthritis was most likely the cause of the lower back pain.
Count Twelve of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(v), Florida Statutes, by attempting to treat Patient #3 without consulting with any other specialists when Dr. Slavin had no educational credentials to qualify him as an expert in the fields of either chronic pain management or disc and back diseases. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(v). No competent substantial evidence was presented to establish
that Dr. Slavin was practicing beyond the scope permitted by law or that he was performing professional responsibilities that he knew or had reason to know that he was not competent to perform.
Count Thirteen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(t), Florida Statutes, by failing to record Patient #4's temperature, failing to perform a chest examination of Patient #4, failing to order a chest x-ray of Patient #4 and failing to refer Patient #4 to a chronic pain specialist. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(t). Dr. Slavin made a chest examination of the patient and his findings did not warrant the ordering of a chest x-ray. The failure to record Patient #4's temperature does not rise to a level of a violation of Section 458.331(1)(t). The record does not establish that Dr. Slavin was not qualified to deal with chronic pain and therefore there is no competent evidence establishing that a referral should have been made to another physician for the treatment of chronic pain.
Count Fourteen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(q), Florida Statutes, by inappropriately prescribing Dilaudid in excessive quantities to Patient #4 which was not in the best interest of Patient #4 in that Dr. Slavin failed to first refer Patient #4 to a chronic pain specialist for consultation in order to verify the appropriateness of the prescriptions of Dilaudid. The dosage of Dilaudid prescribed by Dr. Slavin for Patient #4 was within the dosage recommended by PDR. Petitioner has failed to establish that Dr. Slavin violated Section 458.331(1)(q).
Count Fifteen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(v), Florida Statutes, when Dr. Slavin attempted to treat Patient #4 without consulting with any other specialists when Dr. Slavin had no educational credentials to qualify him as an expert in the field of chronic pain management. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(v). There was no competent substantial evidence to establish that Dr. Slavin was practicing beyond the scope permitted by law or performing professional responsibilities which he knew or had reason to know that he was not competent to perform.
Count Sixteen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(m), Florida Statutes, by failing to keep written medical records justifying the course of treatment of Patient #4 in that Dr. Slavin failed to document an adequate physical examination in Patient #4's file, failed to document any referrals to chronic pain specialists regarding Patient #4's complaint of chronic hand pain, and failed to do the following despite Patient #4's complaint of chest congestion: document Patient #4's temperature, perform a chest examination, or order a chest x-ray. Petitioner has failed to establish that Slavin violated Section 458.331(1)(m). The patient's file has documentation of the patient's medical history and the physical examination of the patient is documented. Dr. Slavin did perform a chest examination. A chest x-ray was not necessary nor was there a necessity for referral to another physician for chronic pain management.
Count Seventeen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(t), Florida Statutes, by failing to include an orthopedic examination of Patient #5 when he performed a physical examination of Patient #5, failing to refer Patient #5 to a chronic pain or a disc disease specialist, failing to render a diagnosis of Patient #5's condition, failing to perform a rectal examination or order Patient #5 to undergo a stool guaiac test or lower endoscopy when Patient #5 complained of rectal bleeding, and failing to
make a working diagnosis of the etiology of Patient #5's rectal bleeding prior to prescribing the antibacterial agents Cipro 500 mg and Bactrim. According to Dr. Slavin's own expert witness, Dr. Slavin should have performed a rectal examination of Patient #5 when the patient presented with rectal bleeding. Dr. Slavin failed to perform a rectal examination. Patient #5 was a paraplegic who had suffered a gunshot wound and had decompressive back surgery. The evidence does not establish that an orthopedic examination would have revealed anything more. The evidence did establish that a lower endoscopy was not necessary at the time the patient presented the complaint of rectal bleeding. The evidence does not establish that Cipro and Bactrim were prescribed for the rectal bleeding. According to Petitioner's expert witness those drugs can be prescribed for urinary tract infections. Petitioner has established by clear and convincing evidence that Dr. Slavin failed to practice medicine with that level of care, skill, and treatment which is recognized as being acceptable under similar conditions and circumstances when he failed to perform a rectal examination and order a stool specimen on Patient #5. Thus, Slavin violated Section 458.331(1)(t).
Count Eighteen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(m), Florida Statutes, by failing to keep written medical records justifying the course of treatment of Patient #5 in that Dr. Slavin failed to document a diagnosis of Patient #5's condition to justify the prescriptions of Dilaudid, failed to document any positive physical findings relating to an infection in order to justify the prescription of Cipro, and failing to document a working diagnosis of the etiology of Patient #5's rectal bleeding to justify the prescription for Bactrim. The written medical records were sufficient to justify the prescriptions for Dilaudid. Patient #5 was a paraplegic who had suffered a gunshot wound in the back, had decompressive back surgery, and had recently fallen out of his wheelchair thereby exacerbating the pain in the lower to middle back. Dr. Slavin had noted on the problem list that Patient #5 had chronic urinary infections; however it is not clear from the records whether he was experiencing a urinary tract infection on his initial visit to Dr. Slavin. The records did not diagnose the etiology of Patient #5's rectal bleeding. Petitioner's own witness testified that Cipro and Bactrim could be prescribed for urinary tract infections; however the medical records do not indicate whether these drugs were for a urinary infection or for the rectal bleeding. Petitioner has established by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(m)
Count Nineteen of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(q), Florida Statutes, by inappropriately prescribing Dilaudid in excessive quantities which was not in the best interest of Patient #5 in that Dr. Slavin failed to perform any orthopedic examinations of Patient #5's back to justify the prescription of Dilaudid. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin inappropriately prescribed Dilaudid in excessive quantities to Patient #5.
Count Twenty of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(v), Florida Statutes, by attempting to treat Patient #5's chronic lower back pain condition without first consulting with any other chronic pain or orthopedic specialists when Dr. Slavin had no educational credentials to qualify him as an expert in the fields of either chronic pain management or disc and back diseases. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin practiced beyond the scope permitted by law or performed professional responsibilities which he knew or should have know that he was not competent to perform.
Count Twenty-One of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(t), Florida Statutes, by failing to adequately assess Patient #6's condition in that Slavin failed to refer Patient #6 to chronic pain management or orthopedic specialists, failed to order Patient #6 to undergo further diagnostic testing such as a magnetic resonance imagery (MRI) scan of Patient #6's spine, failed to record Patient #6's temperature, and failed to change his plan of treatment when Patient #6' chronic back pain persisted. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(t). Dr. Slavin did adequately assess Patient #6's condition. The progress notes of June 3, 1991 indicate that Dr. Slavin had ordered a repeat MRI of LS spine. The progress note of August 20 indicate that there was "extensive hypertrophic and degenerative bone and disc disease at virtually all levels of the LS spine." Thus, it would appear that there was some indication to Dr. Slavin that the disc problem was no longer confined to L3-L4 disc level. There was not evidence presented to establish how Dr. Slavin's plan of treatment should have been changed.
Count Twenty-Two of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(q), Florida Statutes, by inappropriately prescribing Dilaudid in excessive quantities which was not in the best interest of Patient #6 in that Dr. Slavin failed to first order any consultations with chronic back pain and orthopedic specialists or perform any orthopedic examinations of Patient #6's back to justify the prescription of Dilaudid. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(q). The dosage of Dilaudid prescribed was within the dosage recommended by PDR. Dr. Slavin had the benefit of prior medical records to indicate that Patient #6 had spinal stenosis.
Count Twenty-Three of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(m), Florida Statutes, by failing to keep written medical records justifying the course of treatment of Patient #6 in that Dr. Slavin failed to document the following in Patient #6's medical records: a diagnosis of Patient #6's condition, any referrals for consultations with chronic pain or orthopedic specialists, any orders for further diagnostic testing such as a MRI scan of Patient #6's spine, and any record of Patient #6's temperature. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin violated Section 458.331(1)(m).
Count Twenty-Four of the Administrative Complaint alleged that Dr. Slavin violated Section 458.331(1)(v), Florida Statutes, by attempting to treat Patient #6 without consulting with any other specialists when Dr. Slavin had no educational credentials to qualify him as an expert in the fields of either chronic pain management or orthopedics. Petitioner has failed to establish by clear and convincing evidence that Dr. Slavin practiced beyond the scope permitted by law or that he performed professional responsibilities that he knew or should have known he was not competent to perform.
Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered dismissing Counts 2, 3, 5, 6, 7,
8, 9, 10, 11, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23, and 24 of the
Administrative Complaint, finding that Herbert R. Slavin, M.D. violated Section 458.331(1)(m), Florida Statutes, by failing to keep written medical records to justify the course of treatment for Patient #1 and Patient #5, finding that Herbert R. Slavin, M.D. violated Section 458.331(1)(t), Florida Statutes, by
failing to practice medicine with that level of care, skill, and treatment which is recognized as being acceptable under similar conditions and circumstances in the treatment of Patient #5, imposing an Administrative fine of $1,000 for each violation (total of $3,000), placing Herbert R. Slavin, M.D. on probation for one year during which time the records of Dr. Slavin shall be monitored by a monitoring physician approved by the Board of Medicine, and requiring that Herbert R. Slavin, M.D. be required to attend Category I continuing education course in Risk Management and Medical Records.
DONE AND ENTERED this 1st day of March, 1995, in Tallahassee, Leon County, Florida.
SUSAN B. KIRKLAND
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 1st day of March, 1995.
APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-3931
To comply with the requirements of Section 120.59(2), Florida Statutes (1993), the following rulings are made on the parties' proposed findings of fact:
Petitioner's Proposed Findings of Fact.
Paragraphs 1-4: Accepted in substance.
Paragraphs 5-6: Rejected as unnecessary.
Paragraph 7: Accepted in substance.
Paragraphs 8-11: Rejected as unnecessary.
Paragraphs 12-14: Accepted in substance.
Paragraph 15: Rejected that there was no orthopedic examination; the medical records do not indicate whether there was one or not. Rejected that the neurological examination was questionable. The remainder of the paragraph is accepted in substance.
Paragraphs 16-17: Rejected as unnecessary.
Paragraph 18: Accepted in substance.
Paragraphs 19-20: Rejected as not supported by clear and convincing evidence.
Paragraphs 21-23: Accepted in substance.
Paragraph 24: The second sentence is rejected as unnecessary. The remainder of the paragraph is accepted in substance.
Paragraph 25: Accepted in substance.
Paragraph 26: Accepted that Slavin continued to prescribe Dilaudid. Rejected as unnecessary the remainder of the paragraph. The radiographic views of the patient's spine indicated discogenic disc disease.
Paragraphs 27-30: Rejected as not established by clear and convincing evidence.
Paragraph 31: Accepted in substance.
Paragraph 32: Rejected as not supported by the record that he performed a sparse medical history. The remainder of the paragraph is accepted in substance.
Paragraphs 33-34: Accepted in substance.
Paragraphs 35-38: Rejected as not established by clear and convincing evidence.
Paragraph 40: Accepted in substance.
Paragraph 41: The last sentence is accepted in substance. The first sentence is rejected as subordinate to the facts actually found.
Paragraph 42: The first sentence is accepted in substance. The last sentence is rejected as subordinate to the facts actually found.
Paragraph 43: Accepted in substance.
Paragraphs 44-45: Rejected as subordinate to the facts actually found.
Paragraph 46: Accepted in substance.
Paragraphs 47-50: Rejected as not supported by clear and convincing evidence.
Paragraphs 51-52: Accepted in substance.
Paragraph 53: Rejected as not supported by the medical records except as to the orthopedic examination for which there is no mention in the medical records.
Paragraph 54: Accepted to the extent that the medical records do not clearly establish that the patient was suffering from an urinary infection, although it was listed on the problem list. Cipro can be used to treat an urinary infection.
Paragraph 55: Accepted in substance.
Paragraph 56: See response to paragraph 54.
Paragraphs 57-59: Accepted in substance.
Paragraphs 60-61: Rejected as not supported by clear and convincing evidence.
Paragraphs 62-63: Accepted in substance except as to the date 1882, which should be 1982.
Paragraph 64: The first sentence is accepted except as to height which is subordinate to the facts actually found. The second sentence reference to temperature is accepted. The remainder of the second sentence is rejected as not supported by the record, the record indicates that Dr. Slavin also considered a more recent myleogram which confirmed the problems at L3-L4 disc levels. The last sentence is rejected as subordinate to the facts actually found.
Paragraph 65-69: Rejected as not supported by clear and convincing evidence.
Respondent's Proposed Findings of Fact.
Paragraph 1: Accepted in substance.
Paragraphs 2-10: These paragraphs relate to the motion to stay, which is ruled on in a separate order.
Paragraph 11: Accepted that Dr. Gillett was tendered and excepted as an expert in the field of internal medicine. Rejected that the doctor was provisionally accepted.
Paragraph 12: Rejected as subordinate to the facts actually found.
Paragraphs 13-17: Accepted in substance.
Paragraph 18: The first sentence is accepted in substance. The second sentence is accepted to the extent that some physicians limit their practice to chronic pain management but rejected to the extent that it is subordinate to the facts found since there was not competent evidence presented that Dr. Slavin holds himself out to be a specialist in chronic pain management. Dr. Gillet assumed that to be so but had no evidence as to that fact. Dr. Brady thought that Dr. Slavin was a family practice physician.
Paragraph 19: The first sentence is accepted in substance. The second sentence is rejected as subordinate to the facts actually found.
Paragraph 20: Accepted in substance.
Paragraph 21: Accepted in substance as it relates to all but Patient #s 1 and 5. Rejected as to Patient #s 1 and 5 as not supported by the evidence.
Paragraph 22: The first and last parts of the first sentence are accepted in substance. The middle part of the first sentence is rejected as not supported by the record.
Paragraphs 23-24: Rejected as subordinate to the facts actually found.
Paragraph 25: Accepted in substance as it relates to all patients except #s 1 and 5. Rejected as not supported by the evidence as it relates to Patient #s 1 and 5.
Paragraphs 26 and 27: Rejected as subordinate to the facts actually found.
COPIES FURNISHED:
Albert Peacock, Esquire
Agency For Health Care Administration 1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0792
Charles L. Curtis
1177 Southeast Third Avenue Fort Lauderdale, Florida 33316
Andrea L. Wolfson, Esquire Suite 314
4491 South State Road 7
David, Florida 33314
Arthur C. Wallberg Assistant Attorney General
Office of the Attorney General PL-01 The Capitol
Tallahassee, Florida 32399-1050
Dr. Marm Harris Executive Director Board of Medicine
1940 North Monroe Street Tallahassee, Florida 32399-0770
Tom Wallace
Agency For Health Care Administration The Atrium, Suite 301
325 John Knox Road Tallahassee, Florida 32303
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written exceptions to this recommended order. All agencies allow each party at least ten days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the final order in this case concerning agency rules on the deadline for filing exceptions to this recommended order. Any exceptions to this recommended order should be filed with the agency that will issue the final order in this case.
| Issue Date | Proceedings |
|---|---|
| May 02, 1995 | Final Order filed. |
| Apr. 24, 1995 | Final Order filed. |
| Mar. 20, 1995 | (Respondent) Motion for Continuance of Consideration of Final Order; Respondent`s Exceptions to Recommended Order filed. |
| Mar. 01, 1995 | Recommended Order sent out. CASE CLOSED. Hearing held 09/21-22/95. |
| Mar. 01, 1995 | Order Denying Motion to Compel Or Stay Proceedings sent out. (Motions denied) |
| Dec. 20, 1994 | Petitioner`s Response To Respondent`s Motion To Strike Portions Of Petitioner`s Proposed Order filed. |
| Dec. 19, 1994 | Respondent`s Memorandum In Opposition To Motion To Supplement The Record and To Take Official Recognition filed. |
| Dec. 19, 1994 | Respondent`s Motion To Strike Portions Of Petitioner`s Proposed Order filed. |
| Dec. 16, 1994 | Respondent`s Memorandum In Opposition To Motion To Supplement The Record and To Take Official Recognition filed. |
| Dec. 12, 1994 | (Petitioner) Notice Of Filing; Petitioner`s Proposed Order Denying The Respondent`s Motion To Compel Or Stay Proceedings filed. |
| Dec. 12, 1994 | (Petitioner) Notice Of Filing; Petitioner`s Proposed Recommended Order filed. |
| Dec. 12, 1994 | Respondent`s Proposed Recommended Order filed. |
| Dec. 07, 1994 | (Petitioner) Motion To Supplement The Record and To Take Official Recognition filed. |
| Oct. 12, 1994 | Transcripts (Volumes I, II, III, IV/tagged) filed. |
| Sep. 29, 1994 | Respondent`s Exhibit-2 (one box) w/cover ltr filed. |
| Sep. 26, 1994 | (no enclosures) Letter to SBK from Charles L. Curtis filed. |
| Sep. 22, 1994 | CASE STATUS: Hearing Held. |
| Sep. 21, 1994 | Respondent`s Motion for Judicial Notice; Respondent`s Objection to Motion for Judicial Notice filed. |
| Sep. 20, 1994 | (Petitioner) Motion in Limine filed. |
| Sep. 16, 1994 | Notice of Taking Deposition (Video Taped) filed. (From Charles L. Curtis) |
| Sep. 16, 1994 | Joint Pre-trial Hearing Stipulation filed. |
| Sep. 16, 1994 | Petitioner`s Motion for Judicial Notice filed. |
| Sep. 15, 1994 | Notice of Taking Deposition Duces Tecum filed. (From Charles L. Curtis) |
| Sep. 15, 1994 | (AHCA) Notice of Appearance; Notice of Taking Deposition filed. |
| Sep. 12, 1994 | Notice of Taking Deposition Duces Tecum filed. (From Charles L. Curtis) |
| Sep. 12, 1994 | (Respondent) Request for Release/Waiver of Confidentiality w/Respondent`s Third Request for Production filed. |
| Sep. 08, 1994 | (Petitioner) Notice of Taking Deposition filed. |
| Aug. 31, 1994 | Petitioner`s Supplemental Response to Respondent`s Interrogatories filed. |
| Aug. 22, 1994 | Petitioner`s Response to Respondent`s Third Request for Production; Petitioner`s Response to Respondent`s Interrogatories; Petitioner`s Response to Respondent`s Third Request for Production; Petitioner`s Response to Respondent`s Interrogatories filed. |
| Aug. 10, 1994 | Order of Substitution of Parties sent out. (AHCA be substituted as the party of interest for Business and Professional Regulation) |
| Aug. 03, 1994 | Order Granting Motion for Continuance of Hearing of Respondent`s Motion to Compel sent out. (it is ordered that Respondent`s Motion to Compel will be heard on 9/21/94) |
| Aug. 03, 1994 | Petitioner`s Notice of Filing Depositions In Support Motion for Continuance; Deposition of Randy Collette ; Deposition of Larry McPherson filed. |
| Aug. 01, 1994 | (Respondent) Motion for Continuance of Hearing on Respondent`s Motion to Compel w/Exhibit-A filed. |
| Jul. 29, 1994 | (Petitioner) Response to Motion for Continuance filed. |
| Jul. 25, 1994 | Respondent`s Third Request for Production filed. |
| Jul. 25, 1994 | (Respondent) Notice of Serving First Interrogatories to Petitioner filed. |
| Jul. 14, 1994 | (Respondent) Notice of Withdrawal of Witnesses Subpoena filed. |
| Jul. 07, 1994 | Amended Notice of Telephonic Conference sent out. (telephone conference will be held at 10:30am; 8/1/94) |
| Jul. 06, 1994 | Order sent out. (Petitioners and counsel for Ms. Smith & Ms. Brown shall have an opportunity to renew or amend the pending Motions to quash) |
| Jul. 05, 1994 | (Petitioner) Notice of Hearing filed. |
| Jul. 05, 1994 | (Petitioner) Motion to Quash filed. |
| Jul. 01, 1994 | (2) Subpoena (Duces Tecum) filed. (From Charles L. Curtis) |
| Jul. 01, 1994 | Motion to Quash filed. (From Arthur C. Wallberg) |
| Jul. 01, 1994 | Notice of Hearing filed. (From Arthur C. Wallaberg) |
| Jun. 30, 1994 | Motion to Quash Subpoena and to Deny Respondent`s Request to Depose A Witness filed. |
| Jun. 23, 1994 | Subpoena Duces Tecum; Notice of Taking Deposition filed. (From Charles L. Curtis) |
| Jun. 15, 1994 | (Respondent) Notice of Absence From State; Notice of Omission From Mailing List filed. |
| Jun. 09, 1994 | Petitioner`s Amended Response To Respondent`s Second Request for Production filed. |
| Jun. 08, 1994 | Amended Notice of Telephonic Conference sent out. (set for 9/1/94; 10:00am) |
| Jun. 06, 1994 | CC Notice of Telephonic Conference w/cover ltr filed. (From William L. Epstein) |
| Jun. 02, 1994 | Letter to SBK from C. Curtis (RE: request for continuance) filed. |
| May 25, 1994 | Notice of Telephonic Conference sent out. (conference set for 6/8/94; 10:00am) |
| May 17, 1994 | Respondent`s Motion to Compel filed. |
| May 12, 1994 | Petitioner`s Response to Respondent`s Second Request for Production filed. |
| Apr. 27, 1994 | Order Continuing Hearing sent out. (hearing rescheduled for 9/21-23/94; 9:00am; Ft. Lauderdale) |
| Apr. 26, 1994 | Order Granting Stipulation for Substitution of Counsel sent out. |
| Apr. 25, 1994 | (Petitioner) Notice of Filing; Final Order Indexing Subject Matter Listing filed. |
| Apr. 22, 1994 | Letter to SBK from C.L. Curtis (RE: Motion hearing for 4/26/94) filed. |
| Apr. 18, 1994 | Notice of Telephonic Conference sent out. (Conference set for 4/26/94; 2:00pm) |
| Apr. 18, 1994 | (Petitioner) Notice of Taking Deposition Duces Tecum (without subpoena); Cover Letter filed. |
| Apr. 15, 1994 | Stipulation for Substitution of Counsel; Order Granting Stipulation for Substitution of Counsel; (Cover Letter from CL Curtis to DMM) filed. |
| Apr. 14, 1994 | Petitioner`s Response To Respondent`s Motion To Compel, Or Stay Proceedings filed. |
| Apr. 12, 1994 | Respondent`s Second Request to Produce; Respondent`s Motion to Compel or Stay Proceedings w/Exhibits A&B; Motion for Oral Argument/Delay in Ruling Upon Motion filed. |
| Apr. 11, 1994 | (Respondent) Motion for Oral Argument/Delay in Ruling Upon Motion; Respondent`s Second Request to Produce; Respondent`s Motion to Compel or Stay Proceedings w/Exhibits A&B filed. |
| Feb. 03, 1994 | Petitioner`s Notice of Having Answered Respondent`s Interrogatories; Petitioner`s Response to Respondent`s First Set of Interrogatories filed. |
| Jan. 24, 1994 | Petitioner`s Response to Respondent`s Request for Production filed. |
| Jan. 10, 1994 | Order Granting Motion for Continuance and Rescheduling Hearing sent out. (hearing rescheduled for 6/1-3/94; 9:00am; Ft. Lauderdale) |
| Jan. 07, 1994 | Joint Motion for Continuance filed. |
| Dec. 23, 1993 | Respondent`s Notice of Serving Interrogatories to Petitioner filed. |
| Oct. 15, 1993 | Order Granting Motion for Continuance and Rescheduling Hearing sent out. (hearing rescheduled for 2/2-4/94; 9:00am; Ft. Lauderdale) |
| Oct. 13, 1993 | Respondent`s Motion for Continuance; Notice of Appearance filed. |
| Aug. 04, 1993 | Prehearing Order sent out. |
| Aug. 04, 1993 | Notice of Hearing sent out. (hearing set for Nov. 10-12, 1993; 9:30am; Ft. Laud) |
| Aug. 04, 1993 | Order sent out. (Respondent`s Motion to Dismiss is Denied) |
| Aug. 02, 1993 | (Respondent) Motion to Dismiss w/(unsigned) Proposed Joint Response filed. |
| Jul. 29, 1993 | Petitioner`s Response to Motion to Dismiss filed. |
| Jul. 28, 1993 | Joint Response to Initial Order filed. |
| Jul. 22, 1993 | (Respondent) Motion to Dismiss filed. |
| Jul. 22, 1993 | Initial Order issued. |
| Jul. 16, 1993 | Agency referral letter; Administrative Complaint; Election of Rights;(DBPR) Notice of Appearance filed. |
| Issue Date | Document | Summary |
|---|---|---|
| Apr. 20, 1995 | Agency Final Order | |
| Mar. 01, 1995 | Recommended Order | Doctor guilty of failing to keep adequate medical records for two patients and failure to practice medicine with care etc for one patient. |
DEPARTMENT OF HEALTH, BOARD OF MEDICINE vs JACINTA IRENE GILLIS, M.D., 93-003931 (1993)
DEPARTMENT OF HEALTH, BOARD OF MEDICINE vs JACINTA IRENE GILLIS, M.D., 93-003931 (1993)
DEPARTMENT OF HEALTH, BOARD OF MEDICINE vs PHILIP K. SPRINGER, M.D., 93-003931 (1993)
DEPARTMENT OF HEALTH, BOARD OF MEDICINE vs ROBERT B. DEHGAN, M.D., 93-003931 (1993)
DEPARTMENT OF HEALTH, BOARD OF MEDICINE vs ROBERT L. HOOD, M.D., 93-003931 (1993)
