STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF HEALTH, )
BOARD OF MEDICINE, )
)
Petitioner, )
)
vs. ) Case No. 97-5039
)
STEVEN A. FIELD, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, a formal hearing was conducted in this case on February 16-17, 1999, in Tampa, Florida, before Lawrence
P. Stevenson, a duly-designated Administrative Law Judge of the Division of Administrative Hearings.
APPEARANCES
For Petitioner: John E. Terrel, Esquire
Agency for Health Care Administration Post Office Box 14229
Tallahassee, Florida 32317-4229
For Respondent: Christopher J. Schulte, Esquire
Shear, Newman, Hahn, Rosenkranz, P.A.
201 East Kennedy Boulevard, Suite 1000 Post Office Box 2378
Tampa, Florida 33601-2378 STATEMENT OF THE ISSUE
The issue presented for decision in this case is whether Respondent should be subjected to discipline for the violations of Chapter 458, Florida Statutes, alleged in the Administrative Complaint issued by Petitioner on April 24, 1997.
PRELIMINARY STATEMENT
By Administrative Complaint dated April 24, 1997 (the "Complaint"), Petitioner alleged that Respondent, a licensed physician, violated provisions of Chapter 458, Florida Statutes, governing medical practice in Florida. The single count of the Complaint relates to the pre-operative and post-operative care of Patient R.M., on whom Respondent performed an arthroscopic procedure to repair a torn medial meniscus in the right knee.
The Complaint alleges that 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 violation of Section 458.331(1)(t), Florida Statutes (1997), in that Respondent failed to perform an appropriate examination of Patient R.M.’s condition during the initial examination; failed to appropriately diagnose Patient R.M.’s condition; failed to attempt conservative treatment prior to performing surgery; failed to perform testing on the saphenous nerve when Patient
R.M. complained of medial side numbness in the right leg after surgery; and failed to refer Patient R.M. to a neurologist for evaluation of a possible saphenous nerve injury.
Respondent contested the allegations of the Complaint and timely requested a formal administrative hearing. Petitioner forwarded the Complaint to the Division of Administrative Hearings on October 29, 1997, requesting the assignment of an
Administrative Law Judge and the conduct of a formal hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. The matter was assigned to the undersigned, who set the case for final hearing on February 17-18, 1998. Three continuances were granted, the hearing ultimately being scheduled for and held on February 16-17, 1999.
At the final hearing, Petitioner presented the testimony of Harry Steinman, M.D., and Richard Hess, the agency investigator. Petitioner also presented the testimony of Patient R.M. by post- hearing deposition filed April 12, 1999. Petitioner’s Exhibits 3-
11 were admitted into evidence.
Respondent testified on his own behalf and presented the testimony of Richard Goldberger, M.D., and filed the deposition transcript of John Okun, M.D. Respondent’s Exhibits 1-5 were admitted into evidence.
A Transcript of the proceeding was filed on March 8, 1999. By stipulation of the parties, the record was held open to take the deposition of Patient R.M., which was filed on April 12, 1999. By further stipulation, the parties agreed to file proposed recommended orders on November 30, 1999. Petitioner’s motion for extension was granted. Petitioner filed a Proposed Recommended Order on December 10, 1999. Respondent filed a Proposed Recommended Order on December 13, 1999.
FINDINGS OF FACT
Based on the oral and documentary evidence adduced at the final hearing, and the entire record in this proceeding, the following findings of fact are made:
Petitioner is the state agency charged with regulating the practice of medicine in the State of Florida, pursuant to Section 20.43, Florida Statutes, and Chapters 455 and 458, Florida Statutes. Pursuant to Section 20.43(3), Florida Statutes, Petitioner has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative, and prosecutorial services required by the Division of Medical Quality Assurance, councils, or boards.
At all times relevant to this proceeding, Respondent was a licensed physician in the State of Florida, having been issued license no. ME 00276678. At the time of Patient R.M.’s treatment, Respondent practiced orthopedic medicine. Respondent voluntarily ceased his orthopedic surgery practice in December 1994. He is currently employed as an assistant professor in the Department of Occupational Medicine at the University of South Florida College of Public Health.
On July 28, 1993, Patient R.M., a 41-year-old female, presented to Respondent for an evaluation of right knee pain. Patient R.M. told Respondent that on November 1, 1992, she twisted her knee at home and heard a pop. Prior to this event, she had no knee problems. She told Respondent that she went to
the emergency room at Brandon Hospital and was evaluated by the emergency room physician. The emergency room physician prescribed pain medication and placed her in a knee brace, gave her crutches, and advised her to see an orthopedic physician.
Patient R.M. told Respondent that she had continued to experience swelling, occasional locking and giving-way of her knee over the intervening months.
Respondent examined Patient R.M.'s right knee. He noted no obvious effusion or swelling, but did note tenderness over the medial joint line. Respondent noted that the right knee had a "full ROM" (range of motion), but his records did not quantify the patient's range of motion.
Respondent noted a "markedly positive" McMurray's test. McMurray's test evaluates the stability of the knee meniscus. A positive McMurray's test is consistent with injury to meniscal structures.
Respondent's records indicated that X-rays of the knee revealed no abnormalities. Respondent did not record the details of the X-rays, such as which planes were pictured or whether the X-rays were of the patella femoral joint or a standing lateral view of the knee.
Respondent's records indicated to no examination or testing of the patella femoral joint. Dr. Harry Steinman, a board-certified orthopedic surgeon, opined that patella femoral problems can masquerade as meniscal problems in some situations,
and that it is thus "mandatory" for the orthopedist to examine the patella femoral joint to rule it out as the locus of pathology.
On the basis of his examination and Patient R.M.'s subjective complaints, Respondent's diagnostic impression was a tear of the medial meniscus, and his recommendation was an arthroscopic examination to evaluate and repair the tear.
Respondent discussed his examination findings and treatment recommendation with Patient R.M. and explained the surgical procedure, including possible risks, complications, and alternatives. Patient R.M. subsequently signed a surgical consent form acknowledging that Respondent explained the necessity of the surgery, its advantages and disadvantages, its possible complications, and possible alternative modes of treatment.
On August 6, 1993, Respondent performed an arthroscopic repair of the meniscus of Patient R.M.'s right knee. Respondent placed two sutures within the body of the meniscus, attaching it to the posterior medial capsule.
Respondent made a second incision in the posterior medial aspect of the right knee. The posterior incision allowed Respondent to expose the capsule of the knee joint so that he could directly view the sutures as he passed them from the inside to the outside of the knee capsule, where he tied down the sutures and repaired the torn meniscus. This direct
visualization was designed to ensure that any neurovascular structures were not impinged by the sutures.
On August 11, 1993, Patient R.M. returned to Respondent for her first post-surgery examination. Respondent noted that the patient seemed to be doing well and her wounds were healing without difficulty. Respondent prescribed a Bledsoe brace, an articulated brace that allows for various ranges of motion, and advised Patient R.M. that she could begin partial weight-bearing with the use of crutches. Respondent advised Patient R.M. to return in three weeks for re-evaluation.
Less than two weeks later, on August 23, 1993, Patient
R.M. returned, complaining of numbness on the medial side of her right calf. On this visit, Patient R.M. was examined by Respondent's partner, Dr. Stuart Goldsmith, not Respondent. Dr. Goldsmith noted no effusion, redness, inflammation, or signs of infection. Dr. Goldsmith noted that Patient R.M. was wearing the Bledsoe brace "significantly tight," which could explain the numbness in the medial side of her calf. He advised the patient to loosen the straps on the brace, continue with range of motion exercises, and return to see Respondent in one week. Patient
R.M. understood and agreed with Dr. Goldsmith's advice, and indicated she would return in one week.
On September 1, 1993, Patient R.M. returned to Respondent for evaluation. She complained of decreased sensation along the medial side of her calf. Respondent noted that his
evaluation revealed "what I determine to be almost normal sensation." Respondent also noted that he wondered whether Patient R.M. had a little irritation of the infrapatellar branch of the saphenous nerve at the site of the anterior medial stab wound. Respondent recommended that Patient R.M. begin range of motion exercises without the Bledsoe brace and commence physical therapy. He advised her to return in three to four weeks for
re-evaluation.
Patient R.M. returned two weeks later, on August 15, 1993, complaining that she heard a pop in the knee the night before. She told Respondent that she had not commenced physical therapy, but had been doing quite well prior to hearing the pop. Respondent noted that "sensation has apparently returned to normal." Respondent noted some tenderness along the medial aspect of the knee joint. He noted no effusion and a full range of motion, though again his records did not quantify the range of motion with numeric values. Respondent concluded that Patient
R.M. had pulled apart some mild scar tissue, and again recommended commencement of physical therapy. He advised her to return in about one month for re-evaluation.
On October 11, 1993, Patient R.M. returned to Respondent for evaluation. She continued to complain of decreased sensation along the anterior medial aspect of her right calf. She told Respondent that she had sensation, but that it was "different." Respondent noted that he wondered if the cause
of this complaint might be that a portion of the infrapatellar branch of the saphenous nerve was nicked during surgery.
Patient R.M. complained of pain extending from the inferior pole of her patella distally. Respondent noted that this pain was alleviated by bringing the patella medially, and that he had ordered a brace that he hoped would offer relief. Respondent advised Patient R.M. to continue therapy at home and to return in a couple of months.
Patient R.M. never returned to Respondent's office. On November 16, 1993, Patient R.M. presented to Dr. John Okun, an orthopedic surgeon, for a second opinion. Dr. Okun took her history and performed an examination, including pinprick and light touch tests, and Tinel's sign, which indicates irritability of a nerve. Respondent testified that he had also performed these tests, but did not note them in his records.
Dr. Okun suspected that a branch of the saphenous nerve had either been transected or caught in a suture during Respondent's operation, and believed that Patient R.M. would be best served by an exploration of the posterior aspect of the knee to see if anything could be done to restore nerve function. Dr. Okun noted that he discussed the situation at length with Patient R.M., advised her of the options, and received her assurance that she would consider the options and call him with any problems or changes.
On December 3, 1993, Dr. Okun performed a surgical exploration of the nerve. He identified a loop of suture wrapped around the saphenous nerve. He removed the suture and freed the tissues surrounding the nerve.
Dr. Okun followed Patient R.M.'s progress until March 1995. She generally reported improvement, but continued to complain of paresthesia and showed positive Tinel's signs in her lower leg. On March 8, 1994, Dr. Okun noted persistent nerve symptoms, and further noted that this was not surprising considering the degree of nerve compression. On May 5, 1994, Dr. Okun noted probable permanent damage to the nerve, but advised waiting another six months to one year before concluding that she had reached maximum improvement.
Dr. Okun testified that, during his course of treatment, he never identified a significant patella tracking problem with Patient R.M.
Dr. Okun also testified that Patient R.M. had a definite medial meniscus tear, and that "it looks like it was repaired fine" by Respondent's arthroscopic procedure. Dr. Steinman agreed at the hearing that there was a tear of the medial meniscus, and noted that Patient R.M. no longer complained of swelling, giving-way, or locking after the arthroscopic procedure.
The evidence at hearing established that the surgical procedure performed by Respondent was within the standard of
care. Respondent repaired a tear of the medial meniscus. The experts agreed that impingement of the saphenous nerve by a suture is a known and relatively common complication of the procedure performed by Respondent, despite the precaution of making an incision in the posterior aspect of the knee to visualize the posterior capsule. The experts further agreed that such impingement of the nerve during this procedure does not, of itself, establish that 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.
Petitioner's allegations thus relate to Respondent's actions prior to and after the surgical procedure itself. The Complaint alleges that, prior to surgery, Respondent failed to perform an appropriate initial examination, failed to appropriately diagnose Patient R.M.'s condition, and failed to attempt conservative therapy prior to performing surgery.
Dr. Steinman testified that Respondent should have examined the patella femoral joint in order to rule that out as a cause of the patient's symptoms. While conceding that Patient R.M.'s symptoms were all consistent with meniscal pathology, and that Respondent arrived at the correct diagnosis, Dr. Steinman opined that the patient was entitled to a full examination irrespective of the final outcome, and that the standard of care required an examination of the patella femoral joint.
Dr. Steinman's testimony is credited on this point. However, the impact of his critique is lessened by that fact that Respondent's diagnosis was correct, the fact that Dr. Richard Goldberger examined the records and concluded that the patient was not suffering from a patella femoral joint problem, and the fact that Dr. Okun, who actually treated Patient R.M. for more than a year, also found no reason to believe that Patient R.M. had a patella tracking problem. Dr. Goldberger further observed that Patient R.M.'s only complaint regarding patellar pain was made after the surgery, not before. Under the circumstances, the worst that can be said of Respondent is that he went directly to the true cause of Patient R.M.'s complaint without affirmatively ruling out another possible cause.
The evidence established that Respondent discussed a conservative course of therapy with Patient R.M. The evidence also established that a conservative course of therapy would have accomplished no tangible improvement in the tear of the medial meniscus. Dr. Richard Goldberger testified that physical therapy was not indicated for this patient. Dr. Goldberger testified that the only reason he would recommend physical therapy in this situation would be for the peace of mind of the patient, to assure a reluctant candidate for surgery that all conservative avenues had been exhausted.
Even Petitioner's expert, Dr. Steinman, agreed that he would have discussed arthroscopy with the patient after the first
visit, given her stated history and examination results. Dr. Steinman testified that after the initial examination, he would not have been convinced the patient had a meniscal tear, and would have recommended other treatments to confirm the diagnosis. However, he also stated that if Respondent was firm in his diagnosis of a meniscal tear, then diagnostic arthroscopy is what orthopedic surgeons generally would recommend.
Respondent noted that Patient R.M.'s right knee showed a normal range of motion, though he did not note numeric values for the range of motion. This was not a deviation from the standard of care because loss of range of motion was not related to Patient R.M.'s pathology. Under the circumstances, it was sufficient for Respondent to note that range of motion was observed and found to be normal.
Respondent failed to describe the X-rays he examined in reaching his diagnosis. Again, this was not a deviation from the standard of care because the information to be found in an X-ray was unrelated to the soft tissue injury that Respondent diagnosed in Patient R.M. Under the circumstances, it was sufficient for Respondent to note that X-rays were taken, examined, and found to be normal.
In summary, Petitioner failed to establish by clear and convincing evidence that Respondent failed to meet the standard of care as regards his pre-operative treatment of Patient R.M.
As to post-operative care, Petitioner alleges that Respondent failed to perform testing on the saphenous nerve when Patient R.M. complained of medial side numbness in the lower right leg, and failed to refer Patient R.M. to a neurologist for evaluation of a possible saphenous nerve injury.
As noted above, Respondent employed a surgical technique by which he made a posterior incision in the knee, exposed the knee capsule, passed the suture from the inside to the outside of the knee, tying the suture under direct visualiztion. Respondent contended that use of this technique allowed him reasonably to assume that no injury to the saphenous nerve had occurred due to a suture being tied directly on it. This assumption explains why Respondent's post-surgery notes record his suspicions of a problem with the infrapatellar branch of the saphenous nerve. Respondent's technique would not have allowed him to observe an injury to the infrapatellar branch, because that injury would have occurred during placement of the surgical port on the medial aspect of the knee.
Dr. Steinman testified that Respondent's observations were inconsistent with Patient R.M.'s complaints. He stated that the infrapatellar branch comes off the medial kneecap and travels in a medial to lateral direction. If the infrapatellar branch was interrupted, the area of numbness or abnormal sensation would have been on the lateral aspect of the patella, whereas the patient's complaints were along the anterior or medial aspect of
the calf and ankle, outside the autonomous area of this nerve. Dr. Steinman testified that Patient R.M.'s complaints could lead only to the conclusion that the sartorial branch of the saphenous nerve had been jeopardized in some way. Dr. Steinman observed that Respondent appeared aware that there was a nerve problem, but that he was in error as to which nerve.
Dr. Steinman testified that Respondent should have commenced some form of testing for a saphenous nerve problem no later than the October 11, 1993, visit, when she reiterated her complaints of decreased sensation along the medial aspect of her right calf and Respondent noted for the second time his suspicions regarding a saphenous nerve problem.
Dr. Okun testified that if he had performed a meniscus repair and the patient presented these symptoms, he would probably have gone back into the knee and tried to snip the suture or at least explore the incision. However, he also testified that if he were comfortable that he had done everything properly and there was not a very high chance that he had trapped a nerve, he would wait for a period of three to six months to see if the problem would resolve on its own. Dr. Okun was unsure whether a definite standard of care could be stated for this situation.
Dr. Okun also testified that whatever damage the nerve sustained was probably done at the time of the initial surgery, and would not get worse from having the constriction of the
suture around it. He stated this was another reason why he might wait to perform a second procedure.
Dr. Steinman strongly disagreed that the surgeon's degree of confidence in his work should play any role in his post-surgical treatment. The fact that the patient has complained of symptoms in a problematic area is evidence enough that there may be a problem, particularly where the complication is as common as this one, regardless of the surgeon's conviction that his suture missed the nerve.
Dr. Goldberger testified that Respondent met the standard of care. Respondent was aware of the complaints of numbness and mentioned them and their severity in his notes. Dr. Goldberger stated that the saphenous is a sensory nerve and is not considered vital. Because the nerve has no motor function, the physician must rely on the subjective complaints of the patient regarding the symptoms. Some patients accept the symptoms and do not feel they are impaired by them. Dr. Goldberger testified that it was reasonable for Respondent to observe the patient's clinical course and pay attention to her complaints, without taking aggressive action.
The weight of the evidence leads to a finding that Respondent might have been more aggressive in treating what he suspected was a saphenous nerve problem, and might have referred Patient R.M. to a neurologist to rule out a systemic problem, but that Respondent did not clearly deviate from the standard of care
in choosing a more conservative course or failing to make a referral.
Dr. Steinman severely criticized Respondent's post- surgical records in their failure to thoroughly document the sensory tests that Respondent testified he performed on Patient
R.M. Respondent was not charged with failure to maintain adequate medical records. Thus, it is not necessary to address the merits of Dr. Steinman's critique of Respondent's medical records.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this cause, pursuant to Sections 120.569, 120.57(1), and 455.225, Florida Statutes.
License revocation and discipline proceedings are penal in nature. The burden of proof on Petitioner in this proceeding was to demonstrate the truthfulness of the allegations in the Complaint by clear and convincing evidence. Section 458.331(3), Florida Statutes; Department of Banking and Finance v. Osborne Stern and Company, 670 So. 2d 932 (Fla. 1996); Ferris v. Turlington, 510 So. 2d 292 (Fla. 1987).
The "clear and convincing" standard 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.
Slomowitz v. Walker, 429 So. 2d 797, 800 (Fla. 4th DCA 1983). The findings in this case were made based on the standard set forth in Osborne Stern and Ferris.
Pursuant to Section 458.331(2), Florida Statutes, the Board of Medicine is authorized to revoke, suspend, or otherwise discipline the license of a physician for violating the following relevant provision of Section 458.331, Florida Statutes:
(1)(t) Gross or repeated malpractice or the failure to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances . . . . As used in this paragraph, "gross malpractice" or "the failure to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances," shall not be construed so as to require more than one instance, event, or act. 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.
Section 458.331(2), Florida Statutes, sets forth the scope of discipline available to the Board of Medicine for violations of Section 458.331(1), Florida Statutes:
Refusal to certify, or certification with restrictions, to the department an application for licensure, certification, or registration.
Revocation or suspension of a license.
Restriction of practice.
Imposition of an administrative fine not to exceed $5,000 for each count or separate offense.
Issuance of a reprimand.
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.
Issuance of a letter of concern.
Corrective action.
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.
The Complaint alleged that Respondent practiced medicine below the standard of care by failing to perform an appropriate examination of Patient R.M. during the initial evaluation, including the failure to note an examination of the patella femoral joint, failure to address range of motion, failure to obtain a significant history as to when the patient
became symptomatic, and failure to note what type of X-rays were obtained during the initial evaluation; failing to appropriately diagnose Patient R.M.'s condition; failing to attempt conservative treatment prior to performing the surgical procedure; failing to test the saphenous nerve when Patient R.M. continued to complain of medial side numbness after surgery; and failing to refer Patient R.M. to a neurologist for evaluation of possible saphenous nerve injury.
Petitioner failed to establish the charge of failure to perform an appropriate initial examination by clear and convincing evidence. The evidence established that Respondent adequately examined Patient R.M. and accurately diagnosed her pathology. Dr. Steinman's criticism would have had more force had the evidence established that Patient R.M. actually had a patella femoral joint problem. The weight of the expert testimony established that she had no such problem, and that her only complaints in that regard occurred after Respondent's arthroscopic procedure on her right knee. Under the circumstances, Respondent's records adequately noted range of motion, X-rays, and Patient R.M.'s history.
Petitioner failed to establish the charge of failure to appropriately diagnose Patient R.M.'s condition. Based on the history and examination findings, Respondent diagnosed a tear of the medial meniscus. Every expert who testified at the hearing, along with Dr. Okun, confirmed that there was a tear of the
medial meniscus and that the arthroscopic procedure performed by Respondent alleviated the symptoms expressed by Patient R.M. prior to surgery.
Petitioner failed to establish the charge of failure to attempt conservative treatment prior to surgery by clear and convincing evidence. Physical therapy would not have addressed the medial meniscal tear. At most, conservative treatment would have assured a reluctant surgical candidate that all other avenues had been explored. There was no evidence that Patient
R.M. was reluctant to proceed with the recommended arthroscopic procedure.
Petitioner failed to establish the charge of failure to perform testing on the saphenous nerve by clear and convincing evidence. More precisely, Petitioner failed to establish that such testing was required to meet the standard of care under the circumstances of this case. Dr. Steinman was strongly convinced that Respondent was too passive in addressing the possible impingement of the saphenous nerve. However, Dr. Goldberger and Dr. Okun found an observational strategy acceptable and within the standard of care. Dr. Okun expressed doubt that a bright- line standard of care can be established as to the aggressiveness required in addressing this problem.
Petitioner failed to establish the charge of failure to refer Patient R.M. to a neurologist by clear and convincing evidence. More precisely, Petitioner failed to establish that
such a referral was required to meet the standard of care under the circumstances of this case. Respondent noted the possible saphenous nerve injury as a possible complication of the arthroscopic procedure, noted the patient's complaints concerning sensation problems in her lower leg, and continued to monitor the patient's condition. Petitioner failed to establish that a neurologist could have done more than Respondent, an orthopedic surgeon familiar with the complications of the procedure he performed on Patient R.M.
Upon the foregoing findings of fact and conclusions of law, it is recommended that the Department of Health, Board of Medicine, enter a final order dismissing the April 24, 1997, Administrative Complaint against the Respondent, Steven A. Field, M.D.
DONE AND ENTERED this 6th day of July, 2000, in Tallahassee, Leon County, Florida.
LAWRENCE P. STEVENSON
Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
(850) 488-9675 SUNCOM 278-9675
Fax Filing (850) 921-6847 www.doah.state.fl.us
Filed with the Clerk of the Division of Administrative Hearings this 6th day of July, 2000.
COPIES FURNISHED:
John E. Terrel, Esquire
Agency for Health Care Administration Post Office Box 14229
Tallahassee, Florida 32317-4229
Christopher J. Schulte, Esquire Shear, Newman, Hahn, Rosenkranz, P.A.
201 East Kennedy Boulevard, Suite 1000 Post Office Box 2378
Tampa, Florida 33601-2378
Angela T. Hall, Agency Clerk Department of Health
4052 Bald Cypress Way Bin A02
Tallahassee, Florida 32399-1701
William W. Large, General Counsel Department of Health
4052 Bald Cypress Way Bin A02
Tallahassee, Florida 32399-1701
Tanya Williams, Executive Director Board of Medicine
Department of Health 4052 Bald Cypress Way
Tallahassee, Florida 32399-1701
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written exceptions within 15 days from the date of 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 |
|---|---|
| Oct. 30, 2000 | Final Order filed. |
| Jul. 06, 2000 | Recommended Order sent out. CASE CLOSED. Hearing held February 16 and 17, 2000. |
| Dec. 13, 1999 | Respondent`s Proposed Recommended Order (For Judge Signature) filed. |
| Dec. 10, 1999 | Petitioner`s Proposed Recommended Order (filed via facsimile). |
| Nov. 29, 1999 | (Petitioner) Motion for Extension of Time to File Proposed Recommended Orders (filed via facsimile). |
| Oct. 26, 1999 | Letter to Judge Stevenson from John Terrel (re;Deposition) (filed via facsimile). |
| Apr. 12, 1999 | Deposition of: Patient R. M. filed. |
| Mar. 16, 1999 | (Petitioner) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Mar. 08, 1999 | (2 Volumes) Transcript filed. |
| Feb. 26, 1999 | Respondent`s Exhibit 3 rec`d |
| Feb. 16, 1999 | CASE STATUS: Hearing Held. |
| Feb. 04, 1999 | Joint Prehearing Stipulation filed. |
| Feb. 04, 1999 | (Petitioner) Notice of Taking Deposition Duces Tecum filed. |
| Feb. 01, 1999 | (S. Collins) Notice of Telephone Hearing (filed via facsimile). |
| Feb. 01, 1999 | (S. Collins) Objection to Time and Date of Telephone Hearing; Cover Letter (filed via facsimile). |
| Jan. 29, 1999 | (Petitioner) Second Amended Notice of Telephone Hearing (filed via facsimile). |
| Jan. 29, 1999 | (Petitioner) Amended Notice of Telephone Hearing (filed via facsimile). |
| Jan. 28, 1999 | (Petitioner) Notice of Telephone Hearing (filed via facsimile). |
| Jan. 22, 1999 | Response to Respondent`s Motion in Limine (filed via facsimile). |
| Jan. 20, 1999 | Respondent`s` Motion in Limine rec`d |
| Jan. 15, 1999 | (Petitioner) Motion for Reasonable Expert Witness Fee (filed via facsimile). |
| Dec. 29, 1998 | (Petitioner) Response to Motion to Invalidate and Quash Subpoena Duces Tecum (filed via facsimile). |
| Dec. 29, 1998 | (Roberta McCarthy) Motion for Oral Argument (filed via facsimile). |
| Dec. 18, 1998 | (Respondent) Third Amended Notice of Taking Deposition filed. |
| Dec. 02, 1998 | (Petitioner) Response to Motion to Invalidate and Quash Subpoena Duces (filed via facsimile). |
| Nov. 30, 1998 | (Respondent) Second Amended Notice of Taking Deposition filed. |
| Nov. 16, 1998 | (Respondent) Amended Notice of Taking Deposition filed. |
| Nov. 05, 1998 | Notice of Hearing sent out. (hearing set for Feb. 16-17, 1999; 9:00am; Tampa) |
| Nov. 02, 1998 | Deposition of: Harry Steinman, M.D.; Condensed Version ; filed. |
| Oct. 27, 1998 | Joint Motion to Reschedule Formal Hearing (filed via facsimile). |
| Oct. 20, 1998 | (Petitioner) Notice of Cancellation of Deposition (filed via facsimile). |
| Oct. 19, 1998 | (R. McCarthy) Motion to Invalidate and Quash Subpoena Duces Tecum (filed via facsimile). |
| Oct. 16, 1998 | Order Continuing Hearing sent out. (hearing cancelled; parties to file suggested hearing information within 10 days) |
| Oct. 16, 1998 | Petitioner`s Motion to Continue (filed via facsimile). |
| Oct. 15, 1998 | (Petitioner) Notice of Taking Deposition filed. |
| Sep. 16, 1998 | (Respondent) Notice of Taking Deposition* filed. |
| Sep. 10, 1998 | (Respondent) Notice of Taking Deposition; (Respondent) Amended Notice of Taking Deposition filed. |
| Sep. 04, 1998 | (Respondent) Response to Petitioner`s Request for Production Response to Request to Produce filed. |
| Jul. 28, 1998 | Notice of Serving Petitioner`s Second Set of Interrogatories and Request for Production of Documents filed. |
| Jul. 28, 1998 | Letter to Judge Stevenson from John Terrell (RE: request for abeyance) (filed via facsimile). |
| May 20, 1998 | (Respondent) (unsigned) Notice of Taking Deposition filed. |
| May 15, 1998 | Order Continuing Hearing sent out. (hearing set for Oct. 22-23, 1998; 9:00am; Tampa) |
| May 15, 1998 | Joint Motion to Continue (filed via facsimile). |
| May 15, 1998 | Respondent`s Response to Petitioner`s Motion to Compel, or, in the Alternative, to Limit Respondent`s Testimony filed. |
| May 15, 1998 | Petitioner`s Motion to Compel Discovery, or in the Alternative to Limit Respondent`s Testimony filed. |
| Mar. 23, 1998 | (Respondent) Notice of Serving Answers to Interrogatories to the Department of Health filed. |
| Feb. 17, 1998 | (Respondent) Response to Request to Produce filed. |
| Dec. 31, 1997 | (Respondent) Objection to Request for Admissions filed. |
| Dec. 30, 1997 | Amended Order Continuing Final Hearing sent out. (hearing set for June 2-3, 1998; 9:00am; Tampa) |
| Dec. 19, 1997 | Notice of Serving Petitioner`s First Set of Request for Admissions, Interrogatories, and Request for Production of Documents (filed via facsimile). |
| Dec. 15, 1997 | Order Continuing Final Hearing sent out. (hearing set for June 2-3, 1998; Tampa) |
| Dec. 08, 1997 | (Respondent) Motion to Reschedule Final Hearing filed. |
| Nov. 19, 1997 | Prehearing Order sent out. |
| Nov. 19, 1997 | Notice of Final Hearing sent out. (hearing set for Feb. 17-18, 1998; 9:30am; Tampa) |
| Nov. 14, 1997 | Joint Response to Initial Order (filed via facsimile). |
| Nov. 04, 1997 | Initial Order issued. |
| Oct. 29, 1997 | Agency Referral Letter; Administrative Complaint; Petition For Hearing; Notice of Appearance (2); Motion To Toll Time (filed via facsimile). |
| Issue Date | Document | Summary |
|---|---|---|
| Oct. 17, 2000 | Agency Final Order | |
| Jul. 06, 2000 | Recommended Order | Agency did not prove by clear and convincing evidence that Respondent`s pre-operative examination and post-operative care of patient receiving repair of torn medial meniscus of right knee failed to meet the standard of care. |
