STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE ) ADMINISTRATION, BOARD OF MEDICINE, )

)

Petitioner, )

)

vs. ) CASE NO. 94-3539

)

LEON DOYAN, M.D., )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a formal hearing was conducted in this case on May 10, 1995, at Fort Lauderdale, Florida, before Michael M. Parrish, a duly designated Hearing Officer of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Kenneth J. Metzger, Esquire

Agency for Health Care Administration 1940 North Monroe Street, Suite 60

Tallahassee, Florida 32399-0792

For Respondent: Leon Doyan, M.D., pro se

2817 East Oakland Park Boulevard, Suite 100 Fort Lauderdale, Florida 33306

STATEMENT OF THE ISSUES

This is a license discipline case in which the Petitioner seeks to take disciplinary action against a licensed medical doctor on the basis of alleged violations of subsections (k), (m), (n), and (t) of Section 458.331(1), Florida Statutes (1990 Supp.).

PRELIMINARY STATEMENT

At the formal hearing the Petitioner presented the testimony of three witnesses; an agency investigator, a patient, and an expert in the field of plastic surgery. The Petitioner offered twelve exhibits, all of which were received in evidence. The Respondent testified on his own behalf. He did not call any additional witnesses. The Respondent offered six exhibits, all of which were received in evidence.

At the conclusion of the formal hearing the parties were allowed twenty days from the filing of the transcript within which to file their proposed recommended orders. The transcript of the hearing was filed on June 9, 1995, and by memorandum dated June 12, 1995, the parties were notified that June 29,

1995, would be the deadline for filing their respective proposed recommended orders. Thereafter, on motion by the Petitioner, the deadline was extended for all parties to July 7, 1995.

The Petitioner filed a timely proposed recommended order containing proposed findings of fact and conclusions of law. As of the date of this Recommended Order the Respondent has not filed a proposed recommended order, nor has he filed any similar post-hearing document. 1/ The proposed findings of fact submitted by the Petitioner are specifically addressed in the appendix to this Recommended Order.

FINDINGS OF FACT

1. The Respondent is, and has been at all times material hereto, a licensed physician in the State of Florida having been issued license number ME 0030238. The Respondent's last known address is 2817 East Oakland Park Boulevard, Coral Springs, Florida 33306.

   
   

2. The Respondent's area of practice is cosmetic surgery. Cosmetic surgery is a sub-specialty within the broader specialty known as plastic surgery. In general terms, the specialty of plastic surgery encompasses two sub-specialties; reconstructive surgery and cosmetic surgery. Cosmetic surgery

   is also known as aesthetic surgery. Reconstructive surgery is primarily for the purpose of restoring normalcy to abnormal conditions. Cosmetic or aesthetic surgery is primarily for the purpose of improving normal conditions.

   
   

3. On or about December 13, 1990, Patient Number 1, a 38-year-old female, presented to the Respondent with concerns about bulging and puffiness around her eyes. Patient Number 1's self-referral was in response to an advertisement in which the Respondent offered a free consultation. While waiting in the Respondent's office, Patient Number 1 read some brochures that included information about face-lifts. After reading the brochures, she decided to also ask the Respondent about a face-lift to address what she referred to as "sagging skin under her chin."

   
   

4. During the initial visit with patient Number 1, the Respondent explained to her that he could offer her reduced prices if she agreed to have several cosmetic procedures done at the same time. In this regard, the Respondent inquired of Patient Number 1 as to how she felt about other parts of her body as he began to examine her breasts, legs, thighs, and abdomen.

   
   

5. During the initial visit, Patient Number 1 and the Respondent agreed that the Respondent would perform the following cosmetic surgery procedures on Patient Number 1: (a) surgery on the lower eyelids to remove fat deposits and tighten skin, (b) a face lift, (c) liposuction on the inner thighs to improve thigh contour, (d) injection of fat into the lips, and (e) injection of fat into the breasts. It was agreed that the Respondent would also do some liposuction on Patient Number 1's abdomen if he needed additional fat to inject into the lips or breasts. 2/

   
   

6. The Respondent's medical records document the following assessment or diagnosis of Patient Number 1's condition and concerns: "Drooping face skin needs face lift, agree; fat herniation lower lids bilateral needs fat removal, agree; breasts sagging 3/4 with medium-large (good amount) of volume; bulge fat medial thighs only; rest of body good shape."

7. The Respondent's medical records also document the following plan of treatment: face lift and lower lid fat removal; liposuction medial thighs and/or abdomen and/or anterior thighs; fat injection, cheeks (little), lips, nasolabial fold, and chin; and breasts either inject fat in upper 1/2 or lift in future.

   
   

8. The Respondent initially offered to perform all of the aforementioned procedures as a "package deal" for a total charge of $4,300.00 and offered to lower his charges to $3,500.00 in exchange for Patient Number 1's pledge to refer two (2) friends for consultations as possible candidates for cosmetic surgery.

   
   

9. Subsequently the Respondent lowered his total charge to a year end special deal of $4,000.00 for all of the aforementioned procedures with a requested deposit to hold this special price and agreement that the remainder be paid by the end of the year.

   
   

10. Patient Number 1 paid the Respondent a $500.00 cash deposit (receipt dated December 17, 1990) and the remainder of $3500.00 on December 31, 1990, by two credit cards, all of which was deposited directly into the Respondent's general office account.

    
    

11. On or about December 17, 1990, Patient Number 1 presented to Respondent for a follow-up consultation. At that time the Respondent advised Patient Number 1 that her breasts were too ptotic (droopy) and, therefore, he had decided not to perform the breast augmentation by fat injection procedure; instead, the Respondent advised that a second procedure (i.e., a breast lift) would be required in the future.

    
    

12. The following day, on December 18, 1990, Patient Number 1 was confused by the Respondent's decision not to perform the breast augmentation by fat injection procedure and telephoned Respondent's office and scheduled another appointment with the Respondent to discuss her concerns. Upon Patient Number 1's arrival for the appointment, she raised the issue with Respondent but still was unable to gain any understanding of why Respondent was no longer planning to inject fat into her breasts. Respondent brought up the subject of performing a "breast lift" and showed her pictures of models' breasts in a Playboy magazine and explained that such a procedure would take her from a 7 to a 9 on a scale of 1 to 10.

    
    

13. On or about February 7, 1991, Patient Number 1 presented to Respondent for a final consultation whereupon Respondent took a preoperative (i.e., "before") photograph of Patient Number 1's face.

    
    

14. On or about February 13, 1991, Patient Number 1 presented to Respondent's office for surgery. At the beginning of the procedure the Respondent used a black marker and started making marks on Patient Number 1's face and explained he had to cut her hair in some areas. Respondent also drew circles and marks on her abdomen and thighs which she observed and the Respondent told her that he wished she had gained five pounds. Respondent also told Patient Number 1 that the breast surgery would be done a few weeks later. Prior to leaving the Respondent's office, Patient Number 1 was not informed that the agreed-upon liposuction procedures were not going to be performed.

    
    

15. Patient Number 1 was very sick for a couple of days post-surgery. She noticed the black marks previously described, but did not see any bandages, incisions and/or bruises on her inner thighs or abdomen where the surgery was supposed to have been performed.

16. After a few days when Patient Number 1 was no longer sick she went back to Respondent for a scheduled follow-up appointment and inquired of him about her observations. In response the Respondent said nothing and simply walked out of the room.

    
    

17. Patient Number 1 returned to Respondent for another follow-up examination. At that time, patient Number 1 again attempted to discuss her dissatisfaction with her surgical results with Respondent, including but not limited to his not performing the contouring liposuction on her thighs as agreed and paid for. Respondent once again brushed off her concerns and told her she should quit complaining.

    
    

18. Subsequently, Patient Number 1 returned for yet another office visit where she wanted to talk about her increasing dissatisfaction with the surgical results and her increasing observations (once the postsurgical swelling had gone down) that it was clear that certain agreed-upon procedures were not performed, i.e., her thighs and lips. Respondent initially responded by not talking and by walking out of the room. Upon his return, having received no answers to her questions, Patient Number 1 requested her medical records in order to obtain a second opinion. The Respondent said that was a very bad move on her part and walked out again. A few minutes later he came back in the examining room and asked Patient Number 1 to come into his office. Once in the office, the Respondent advised her that sometimes the fat injections do not work and have to be repeated several times. The Respondent said that he was willing to put some more fat in her lips and to give her some makeup. He also advised her that she had been a very difficult surgical patient and that she should be grateful for the extra time he had spent on her surgery.

    
    

19. Patient Number 1 responded to the Respondent that she had paid for and expected permanent results; that she had trusted Respondent and that she had no desire to have continuous fat injections which were only temporary; and that she did not wear makeup or desire it.

    
    

20. After consulting several cosmetic and/or plastic surgeons, Patient Number 1 revisited the Respondent in May of 1991 to make a final attempt at obtaining an explanation from the Respondent regarding her postsurgical results and an explanation as to why there was no evidence of certain agreed upon procedures having been performed on her. She brought with her several "after" photographs taken by others and attempted to show them to the Respondent to illustrate why she was so dissatisfied. The Respondent refused to look at the photographs, refused to discuss the matter with Patient Number 1, told her he did not want her to come back and told her that he was not going to do breast surgery on her. He then escorted Patient Number 1 to a desk where he instructed his staff to give her a $500.00 check, representing reimbursement for the breast surgery and told her to leave. No discussion took place regarding the liposuction issues.

    
    

21. Cosmetic surgery is no less a surgery than any other form of surgery and all of the principles and practices and basics of surgery and medicine need to be applied in the treatment of cosmetic surgery patients. Cosmetic surgery patients often undergo very complex procedures that require a significant amount of surgical training and experience in order to be performed safely and properly.

    
    

22. The Respondent did not pursue the appropriate plan of treatment for this patient because she had need for face lift surgery, lower eyelid surgery

    and suction lipectomy of the lower extremities. There is no evidence that she received suction lipectomy of the lower extremities even though the medial thigh fat was noted as a preoperative condition, even though a preoperative treatment plan included suction lipectomy of the lower extremity, even though the patient paid for lower extremity suction lipectomy, and even though postoperative instructions included references to pressure garments which are used in lower extremity liposuction. The aforementioned suctional lipectomy referred to is the type of procedure where an incision is made and a large cannula is inserted to suck out fatty tissue to help with contouring of the body and in this case specifically the medial thighs. It is this type of liposuction procedure that Patient Number 1 thought she was going to receive at surgery and did not receive. What Patient Number 1 did receive was the harvesting of small amounts of fat by means of small needle punctures in her anterior thighs to get fat to inject into her face. Such small needle punctures do nothing to contour the inner thighs.

    
    

23. Patient Number 1 does not have any scars in the area of the medial thighs such as would be present if the Respondent had performed the aforementioned contouring liposuction or lipectomy that Patient Number 1 was promised and paid for.

    
    

24. The Respondent made untrue representations related to the practice of medicine because he told the patient he would do an operative procedure and she paid for it and he did not perform the procedure.

    
    

25. The Respondent did not pursue his plan of treatment because the Respondent did not do the proposed liposuction or lipectomy procedure that he told Patient Number 1 he was going to do.

    
    

26. The Respondent exercised influence on the patient to exploit the patient because Patient Number 1 paid for the above procedures and did not receive all of the services she paid for. Further, if the Respondent knew a portion of the fee he collected from Patient Number 1 was for a procedure he did not perform, he should have reimbursed that fee to Patient Number 1, which he did not do.

    
    

27. The Respondent failed to keep written medical records justifying the course of treatment of Patient Number 1 in that the Respondent failed to document an adequate physical examination of Patient Number 1 in his medical records to justify his diagnosis of Patient Number 1 and failed to document an adequate description of Patient Number 1's defects in the medical records to justify his diagnosis and/or plan of treatment in the following respects: There is no mention as to any psychological evaluation of the patient documenting her reasons for undergoing the planned surgery. As to the breast evaluation there is no mention of the ptosis of the breasts, the position of the nipples, any masses, any lumps, any breast drainage, any examination of the armpits, any prior medical history of breast cancer, or whether the patient has had previous surgeries on her breasts. As to the face and neck, no notation is made of the function of the eyes, of where the lids are positioned on the globe; or of the patient's visual acuity. Further, there is no notation regarding the amount of wrinkling on the patient's face. There is also no notation regarding previous surgery or regarding the condition of the patient's neck. The records also fail to document the condition of the patient's upper eyelids.

    
    

28. Additionally, Respondent failed to adequately document Patient Number 1's pre-operative condition in that Respondent's pre-operative photographs provided poor documentation of Patient Number 1's appearance prior to surgery in

    that they are not close enough and they are only from one side. Particularly for eyelid surgery it is necessary to have good photographs of both eyes in order to document the patient's status at the pre-operative examination.

    
    

29. The Respondent also failed to adequately document in Patient Number 1's medical records in the operative note, the surgical procedures and technique used in sufficient detail for the reader to decipher what actually occurred during Patient Number 1's operation. Illustrative of this fact is that the operation performed on Patient Number 1 occurred over a period of five (5) hours and fifty (50) minutes; yet, the operative note is only eleven lines to document what occurred during all that time.

    
    

30. The Respondent failed to practice medicine with that level of care, skill, and treatment which is acceptable under similar conditions and circumstances in that he failed to meet the standard of care in his treatment of Patient Number 1 by failing to perform those procedures for which he billed and collected fees from Patient Number 1 and told her he would perform.

    
    

    CONCLUSIONS OF LAW

    
    

31. The Division of Administrative Hearings has jurisdiction over the subject matter of and the parties to this proceeding. Section 120.57(1), Florida Statutes.

    
    

32. The Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.30, Florida Statutes, Chapter 455, Florida Statutes, and Chapter 458, Florida Statutes.

    
    

33. In a license discipline proceeding of this nature the Petitioner bears the burden of proving its charges by clear and convincing evidence. See Ferris

    v. Turlington, 510 So.2d 292 (Fla. 1987). The nature of clear and convincing evidence has been described as follows in Slomowitz v. Walker, 429 So.2d 797, 800 (Fla. 4th DCA 1983):

    
    

    We therefore hold that clear and convincing evidence requires that the evidence must be found to be credible; the facts to which the witnesses testify must be distinctly remembered; the testimony must be precise and explicit and the witnesses must be lacking in confusion as

    to the facts in issue. The evidence must be of such weight that it produces in the mind of the trier of fact a firm belief or conviction, without hesitancy as to the truth of the allegations sought to be established.

    
    

    See also, Smith v. Department of Health and Rehabilitative Services, 522 So.2d 956 (Fla. 1st DCA 1988), which, at page 958, quotes with approval the above- quoted language from Slomowitz. The Smith cases also includes the following at page 958:

    
    

    "Clear and convincing evidence" is an intermediate standard of proof, more than the "preponderance of the evidence" standard used in most civil cases, and less than the "beyond a reasonable doubt" standard used in criminal cases. See State v.

    Graham, 240 So.2d 486 (Fla. 2d DCA 1970).

34. Section 458.331(1), Florida Statutes (1989), includes the following as acts for which disciplinary action may be taken against a licensed physician:

    
    

    (k) Making deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employing a trick or scheme in the practice of medicine.

    * * *

    1. 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.

    2. Exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs.

    * * *

    (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 so 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.

    
    

35. Section 458.331(2), Florida Statutes (1990 Supp.) reads as follows:

    
    

    1. When the board finds any person guilty of any of the grounds set forth in subsection (1),

       including conduct that would constitute a substantial violation of subsection (1) which occurred prior to licensure, it may enter an order imposing one or more of the following penalties:

       1. Refusal to certify, or certification with restrictions, to the department an application for

          licensure, certification, or registration.

       2. Revocation or suspension of a license.

       3. Restriction of practice.

       4. Imposition of an administrative fine not to exceed $5,000 for each count or separate offense.

       5. Issuance of a reprimand.

       6. Placement of the physician on probation

          for a period of time and subject to such conditions as the board may specify, including, but not limited to, requiring the physician to submit to treatment, to attend continuing education courses, to submit

          to reexamination, or to work under the supervision of another physician.

       7. Issuance of a letter of concern.

       8. Corrective action.

       9. Refund of fees billed to and collected from the patient.

          
          

          In determining what action is appropriate, the board must first consider what sanctions are necessary to protect the public or to compensate the patient. Only after those sanctions have been imposed may the disciplining authority consider and include in the order requirements designed to rehabilitate the physician. All costs associated with compliance with orders issued under this subsection are the obligation of the physician.

          
          

36. Count One of the Administrative Complaint charges the Respondent with a violation of Section 458.331(1)(m), Florida Statutes (1990 Supp.), by "failing to keep written medical records justifying the course of treatment of the patient. . . ." The evidence in this case is sufficient to prove a violation of Section 458.331(l)(m), Florida Statutes. As noted in the findings of fact, there are numerous serious deficiencies in the Respondent's records regarding Patient Number 1. Accordingly, the final order in this case should conclude that the Respondent is guilty of the violation charged in Count One of the Administrative Complaint.

    
    

37. Count Two of the Administrative Complaint charges the Respondent with a violation of Section 458.331(1)(k), Florida Statutes (1990 Supp.), regarding deceptive, untrue, or fraudulent representations. In this regard it is specifically alleged that "in preoperative consultations, Respondent told Patient Number 1 that he would perform liposuction on her lower extremities as well as a breast augmentation when in fact no such procedures were performed during Patient Number 1's surgery on or about February 13, 1991."

38 With regard to so much of Count Two as relates to the breast augmentation procedure, the proof is insufficient to establish a violation, because the Respondent told the patient in advance that he had decided to postpone that procedure; and later, when he decided not to perform the breast augmentation procedure, the Respondent refunded a pro rata portion of the fees that had been paid by Patient Number 1. Thus, the evidence is insufficient to establish any deceptive, untrue, or fraudulent representations regarding the breast augmentation procedure.

1. The liposuction procedure is a different matter. The Respondent agreed to perform liposuction on the patient's thighs, charged a fee for performing the liposuction, and then neither performed that procedure nor returned the fee for that procedure. 3/ This course of conduct constitutes "deceptive, untrue, or fraudulent representations in or related to the practice of medicine." Accordingly, the final order in this case should conclude that the Respondent is guilty of a violation of Section 458.331(l)(k), Florida Statutes, as charged in Count Two of the Administrative Complaint.

   
   

2. Count Three of the Administrative Complaint charges the Respondent with a violation of Section 458.331(1)(n), Florida Statutes (1990 Supp.), regarding exploitation for financial gain. In this regard it is specifically alleged that "Respondent exercised influence on Patient Number 1 in such a manner as to exploit Patient Number 1 for his own financial gain in that Respondent billed Patient Number 1 in advance for liposuction and breast augmentation procedures which were not in fact performed."

   
   

3. With regard to so much of Count Two as relates to the breast augmentation procedure, the proof is insufficient to establish a violation, because, as discussed above, the Respondent told the patient in advance that he had decided to postpone that procedure and later, when he decided not to perform the breast augmentation procedure, the Respondent refunded a pro rata portion of the fees that had been paid by Patient Number 1. Thus, the evidence is insufficient to establish any exploitation of the patient regarding the breast augmentation procedure.

   
   

4. But, as with Count Two discussed above, the liposuction procedure is a different matter. The Respondent agreed to perform liposuction on the patient's thighs, charged a fee for performing the liposuction, and then neither performed that procedure nor returned the fee for that procedure. This course of conduct constitutes exploitation of the patient for the financial gain of the Respondent. Accordingly, the final order in this case should conclude that the Respondent is guilty of a violation of Section 458.331(l)(n), Florida Statutes, as charged in Count Three of the Administrative Complaint.

   
   

5. Count Four of the Administrative Complaint charges the Respondent with a violation of Section 458.331(1)(t), Florida Statutes (1990) Supp.), regarding failure to meet the appropriate standard of care. In this regard it is specifically alleged that:

   
   

   34. Respondent 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 in that Respondent

   failed to meet the standard of care in his treatment of Patient Number 1 by failing to perform those procedures for which he billed Patient Number 1

   and told Patient Number 1 he would perform.

   The standard of care would require a reasonably prudent similar physician in similar conditions and circumstances to perform liposuction and breast augmentation procedures if said physician had billed the patient for same and told the patient that such procedures were to be performed.

6. For reasons set forth in the foregoing discussions of Counts Two and Three, so much of Count Four as relates to the breast augmentation procedure is insufficient to establish a violation of Section 458.331(l)(t), Florida Statutes. The evidence regarding the unperformed liposuction procedure is, however, sufficient to establish the violation charged in Count Four. Accordingly, the final order in this case should conclude that the Respondent is guilty of a violation of Section 458.331(l)(t), Florida Statutes, as charged in Count Four of the Administrative Complaint.

RECOMMENDATION

On the basis of all the foregoing, it is RECOMMENDED that a Final Order be issued in this case concluding that the Respondent is guilty of each of the four violations charged and imposing the following penalties:

1. Suspension of the Respondent's medical license for a period of one year to be followed by one year of supervised probation;

   
   

2. Imposition of an administrative fine in the amount of ten thousand dollars ($10,000.00), and

   
   

3. Requiring payment of restitution to Patient Number 1 in the amount of five hundred dollars ($500.00) for the liposuction which was not performed.

DONE AND ENTERED this 12th day of September 1995 in Tallahassee, Leon County, Florida.

MICHAEL M. PARRISH

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 12th day of September 1995.

ENDNOTES

1/ The only post-hearing document furnished to the Hearing Officer by the Respondent is a copy of the Respondent's letter of May 22, 1995, addressed to Ms. Gloria Henderson. That letter consists primarily of some rather strongly worded criticisms of the manner in which the Agency for Health Care Administration investigates and prosecutes its charges against physicians. That letter does not directly address the substance of any of the evidence offered at the formal hearing, nor does the letter include any portion that appears to be either proposed findings of fact or proposed conclusions of law.

2/ During the course of the formal hearing the Respondent asserted that there was no agreement to perform liposuction on the inner thighs to improve thigh conture. He asserted that the only agreed-upon liposuction was for the purpose

of harvesting fat cells to inject into the patient's face and/or breasts. This conflict in the evidence has been resolved in a manner consistent with the version described by the patient.

3/ As noted above, the Respondent denies that he agreed to perform liposuction on the patient's thighs, but the greater weight of the evidence supports the version described by the patient.

APPENDIX

The following are the specific rulings on all proposed findings of fact submitted by all parties.

Proposed findings submitted by Petitioner: Paragraphs 1 and 2: Accepted in substance.

Paragraph 3: First sentence accepted. The remainder of this paragraph is

rejected as irrelevant to any of the issues raised in this case.

Paragraphs 4, 5, and 6: Accepted.

Paragraph 7: Accepted for the most part, but with a few erroneous details corrected.

Paragraphs 8 through 25: Accepted in whole or in substance.

Paragraphs 26 through 29: Rejected as subordinate and unnecessary details. (These evidentiary details have been considered during the course of making findings of fact, but they are not the type of details that need to be included in findings of fact.)

Paragraphs 30 and 31: Accepted in substance.

Paragraph 32: Accepted in substance, but with a number of subordinate and unnecessary details omitted.

Paragraphs 33 and 34: Accepted in substance.

Paragraphs 35 and 36: Accepted in substance, but with additional clarifying details.

Paragraphs 37 through 40: Accepted in substance.

Proposed findings submitted by Respondent: (None were submitted.)

COPIES FURNISHED:

Kenneth J. Metzger, Esquire

Agency for Health Care Administration Board of Medicine

1940 North Monroe Street, Suite 60

Tallahassee, Florida 32399-0792

Leon Doyan, M.D.

Suite 100

2817 East Oakland Park Boulevard Fort Lauderdale, Florida 33306

Dr. Marm Harris, Executive Director Board of Medicine

Agency for Health Care Administration 1940 North Monroe Street

Tallahassee, Florida 32399-0792

Jerome W. Hoffman, General Counsel Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32309

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.

Docket for Case No: 94-003539

Orders for Case No: 94-003539