STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF HEALTH, BOARD OF ) MEDICINE, )
)
Petitioner, )
)
vs. ) Case No. 99-2322
)
HERMAN MILLER, JR., M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
A formal hearing was held in this case on March 31, 2000, in Jacksonville, Florida, and on May 18, 2000, by video teleconference, with video sites located in Jacksonville, Florida, and Tallahassee, Florida, before the Division of Administrative Hearings, by its designated Administrative Law Judge, Suzanne F. Hood.
APPEARANCES
For Petitioner: Richard M. Ellis, Esquire
Agency for Health Care Administration Post Office Box 14229
Tallahassee, Florida 32317-4229
For Respondent: Roy Lewis, Esquire
203 Washington Street Jacksonville, Florida 32202
STATEMENT OF THE ISSUES
The issues are whether Respondent violated Section 458.331(1)(t), Florida Statutes, and if so, what penalty should be imposed.
PRELIMINARY STATEMENT
On May 10, 1999, Petitioner Department of Health, Board of Medicine (Petitioner) filed an Administrative Complaint against Respondent Herman Miller, Jr., M.D. (Respondent). Said complaint alleged that Respondent had 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, with regard to a patient hereinafter referred to as "S.S." On May 21, 1999, Respondent filed an Answer to Administrative Complaint and requested an administrative hearing to contest the factual allegations set forth in the Administrative Complaint.
Petitioner referred the case to the Division of Administrative Hearings on May 25, 2000.
On May 27, 1999, the Division of Administrative Hearings issued an Initial Order. The parties filed a Joint Motion for Extension of Time in which to Respond to Initial Order on June 3, 1999. This motion was granted by order dated June 8, 1999.
The Petitioner filed a Response to Initial Order on July 6, 1999. The response requested that the case be set for formal hearing in October 1999.
The undersigned issued a Notice of Video Hearing and Order of Instructions on July 15, 1999. The notice advised the parties that the case would be heard on October 22, 1999.
On September 20, 1999, Respondent filed a Motion for Continuance. Petitioner filed a response to the motion on September 21, 1999. The undersigned issued an Order Granting Continuance and Placing the Case in Abeyance on September 23, 1999.
On October 15, 1999, Petitioner filed a Motion for Taking Official Recognition of Department of Professional Regulation v. Herman Miller, Jr., M.D., DBR Case Number 89-002212 (Final Order, February 18, 1991). That same day, Petitioner filed a Motion for Order Setting Hearing, or, Alternatively, Remanding Case to Department of Health for Entry of Default Order Against Respondent.
The undersigned issued a Second Notice of Hearing on October 19, 1999. The notice advised the parties that the formal hearing would be conducted on March 31, 2000.
On November 2, 1999, Respondent filed a Response to Petitioner's Motion for Taking Official Recognition.
On December 14, 1999, Petitioner filed an Agreed-to Motion for Entry of Order of Prehearing Instructions. The undersigned issued an Order of Pre-hearing Instructions on December 16, 1999.
On February 11, 2000, Petitioner filed a Second Motion for Taking Official Recognition of Department of Professional Regulation v. Lewis Sydney Wolf, M.D., DPR Case Numbers 89-13024 and 90-00292 (Final Order, February 25, 1992), and DOAH Case Number 91-2169 (Recommended Order, December 17, 1991).
On February 22, 2000, Respondent filed a Motion for Taking Official Recognition of Department of Business and Professional Regulation v. Paul Rabenack, M.D., DBPR Case Number 90-09983
(Final Order, October 8, 1993).
On March 13, 2000, Respondent filed a Motion for Taking Official Recognition of Probable Cause Panel's Findings.
Respondent also filed a Motion for Taking Official Recognition of the administrative hearing transcript in Department of Professional Regulation v. Lewis Sydney Wolf, M.D., DPR Case Numbers 89-13024 and 90-00292 (Final Order, February 25, 1992), and DOAH Case Number 91-2169 (Recommended Order, December 17, 1991).
On March 30, 2000, Respondent filed a Motion for Attorney's Fees and Costs.
When the hearing commenced on March 31, 2000, the undersigned heard oral argument on the various pending motions for official recognition. All of the motions were granted. The undersigned reserved ruling on Respondent's Motion for Attorney's Fees and Costs. Said motion is hereby denied based on a finding that Petitioner did not participate in the proceeding for an improper purpose. Section 120.595, Florida Statutes.
During the hearing on March 31, 2000, Petitioner presented the testimony of one expert witness and offered Exhibit Numbers P1-P5, which were accepted into evidence. Respondent presented the testimony of three expert witnesses and offered no exhibits.
The hearing was not concluded on March 31, 2000.
Therefore, the undersigned issued an Order dated April 3, 2000. Said Order required the parties to file a joint status report on or before April 13, advising the undersigned of mutually convenient dates for further proceedings.
On April 12, 2000, the parties filed an Agreed-to Response to Order Continuing Hearing. Subsequently, the undersigned issued a Notice of Hearing dated April 20, 2000, scheduling further proceedings on May 18, 2000.
On April 28, 2000, the court reporter filed the transcript of the March 31, 2000, proceeding.
An Amended Notice of Hearing by Video Teleconference was issued on May 12, 2000. This amended notice only changed the location of the hearing.
On May 25, 2000, the court reporter filed the transcript of the May 18, 2000, proceeding.
Petitioner filed its Proposed Recommended Order on May 26, 2000. Respondent filed his Proposed Recommended Order on
June 1, 2000.
FINDINGS OF FACT
Petitioner is the state agency that regulates the practice of medicine and licenses medical doctors pursuant to Chapter 458, Florida Statutes.
Respondent is a licensed physician, holding license number ME 0034692.
S.S. has one child who was born in 1987. S.S. delivered the child vaginally after a term pregnancy (40 weeks) and 16 hours of labor.
In January 1991, S.S. had cyrosurgery of the cervix as a result of an abnormal pap smear. Cyrosurgery is a procedure in which a metal probe is placed against the cervix. The metal probe is then super-cooled with liquid carbon dioxide to freeze and destroy cells on the cervix. Cyrosurgery causes severe scarring of the cervix to the point that it may interfere with the natural process of labor.
S.S. was a new patient of H. Wyatt McNeill, M.D. on April 24, 1991. At that time, S.S. was 22 years old. She was five feet and nine inches tall and weighed almost 147 pounds.
In February 1992, Dr. McNeill inserted Norplant in the subcutaneous tissue of S.S.'s arm. Norplant is a contraceptive that consists of six cylinders. The cylinders release a drug that interferes with the development of pregnancy. It has various side effects that include irregular bleeding patterns. Norplant users may have regular periods, irregular periods, or no periods at all. Norplant has the same failure rate as the "pill."
On October 1, 1992, S.S. had an appointment with Dr.
McNeill. She was complaining of lower abdominal pain. She had not had a period since the Norplant was inserted. Dr. McNeill prescribed Anaprox DS for probable uterine cramps.
On June 1, 1994, S.S. saw Dr. McNeill again. She was still using Norplant. Her periods were regular and predictable at that time.
Dr. McNeill saw S.S. for an annual gynecological examination on March 13, 1995. Her weight had increased to 163 pounds. S.S. informed Dr. McNeill that she had intermittent mild lower-left quadrant abdominal pain, which may have been related to her menstrual cycle. S.S. still had the Norplant in place and was having monthly periods.
S.S.'s next appointment with Dr. McNeill was on October 30, 1995. She again complained of lower abdominal pain. She also reported a positive home pregnancy test. A pregnancy test performed in Dr. McNeill's office also was positive.
A positive pregnancy test does not indicate a live fetus. If the placenta is still functioning, it can take 60 days or more after the delivery of a dead fetus to clear the placental hormone out of the blood system.
S.S. told Dr. McNeill that she had a history of irregular bleeding until the three prior months. Her visual appearance did not indicate that she was pregnant. In other words, she was not "showing" as one would expect in a pregnancy of 30 weeks or more.
S.S. did not report that she had felt any fetal movement or quickening. "Quickening" is the first feeling of fluttering within the uterus that is normally felt between 18-20 weeks of pregnancy.
Dr. McNeill then performed a bimanual pelvic examination and noted in his chart that S.S.'s uterus felt 12 weeks in size. The fundus of the uterus was halfway between the umbilicus and the symphysis pubis, indicating that S.S. was approximately 12 weeks pregnant. If the fundus had been level with the umbilicus, it would have evidenced a pregnancy of 20 weeks or five months.
Next, Dr. McNeill performed a brief transvaginal sonogram (TVS) or ultrasound scan, saw some fluid inside the uterine cavity, and confirmed that S.S. had an intrauterine as opposed to an ectopic pregnancy. Dr. McNeill never saw the fetus in the TVS. He did not attempt to determine the gestational age of the fetus using the sonogram.
S.S. wanted to terminate the pregnancy. Dr. McNeill, did not perform terminations of pregnancies. Therefore, he noted in his chart that S.S. would be referred to Respondent.
While S.S. was in Dr. McNeill's office, he called Respondent on the phone. Dr. McNeill told Respondent the following: (1) Dr. McNeill had performed a bimanual pelvic examination of S.S.; (2) Dr. McNeill had done a TVS scan on S.S.; (3) S.S. was 12 weeks or three months pregnant by examination and by scan; (4) S.S.'s pregnancy was intrauterine;
(5) S.S. was a Norplant failure; and (6) S.S. wanted to terminate the pregnancy. Respondent agreed to see S.S. the next day.
On October 31, 1995, S.S. went to Respondent's office to terminate the pregnancy. The history she provided indicated that she was unsure of the exact date of her last menstrual period, but that it was in August of 1995.
A physical examination revealed that S.S. was 27 years old, that she was five feet, 10 inches tall, and that she
weighed 173 pounds. S.S. reported that she initially thought her weight gain of 15-20 pounds was due to her use of Norplant. Respondent noted in his chart that Dr. McNeill referred S.S., after a sonogram, which indicated a 12-week pregnancy.
Respondent performed a bimanual pelvic examination of
S.S. Her fundal height was below her umbillicus. She did not have a gravid abdomen. If she had been 30 weeks pregnant, the fundus of the uterus would have been between her umbilicus and her rib cage. In that event, she would have appeared pregnant to a layperson.
During Respondent's pelvic examination of S.S., he did not detect any fetal movement. Generally, a physician will feel fetal movement in patients who are 20 weeks pregnant unless they are morbidly obese. In this case, S.S. was not a difficult patient to examine.
After performing a bimanual pelvic examination, Respondent noted in his chart that S.S. was "12 weeks by scan,
16 by size." Respondent performed the pelvic examination with the intent of determining the position and contour of the uterus as well as its size. He did not attach any significance to difference in the size of the uterus as reported by Dr. McNeill and as determined by his own examination because he had experienced such discrepancies in prior cases. It is an accepted standard in medical practice that determinations of
gestational age by obstetricians performing separate bimanual pelvic examinations on the same patient can vary plus or minus four weeks.
A TVS is more accurate than a bimanual pelvic examination in determining the gestational age of a fetus. Therefore, Respondent was justified in concluding that S.S. was
12 weeks pregnant based on Dr. McNeill's statements. This is true despite Respondent's personal findings to the contrary.
Respondent did not perform a TVS on S.S. His references to "12 weeks" and/or "12 weeks by scan" all relate to Dr. McNeill's statement during the prior telephone conversation. The standard of care for obstetricians and gynecologists does not require a TVS to determine gestational age before performing a pregnancy termination.
When Respondent commenced the termination procedure, he believed S.S.'s pregnancy was in its first trimester. He originally intended to perform the abortion using a dilatation and evacuation with suction procedure. He selected a size 12 cannula, or suction tube, only to remove fluid and to bring tissue within the grasp of his forceps. Respondent never uses a larger cannula due to the risk of injuring a patient.
After sedating S.S. and performing a paracervical block, Respondent dilated the uterus. The process of dilation artificially ruptured the membranes of the amniotic sac.
Respondent then observed a discharge of amniotic fluid, port wine in color. There was more amniotic fluid than one would expect in a 12-week gestation.
The port wine color of the amniotic fluid indicated fetal demise at an undetermined time prior to the termination procedure. Amniotic fluid normally is clear to yellowish in color. Fetal demise causes placental separation with leakage of bloody fluid into the amniotic fluid. The darker the fluid, the longer the period of fetal demise. There is no evidence that Respondent, by rupturing the membranes, did anything which caused or contributed to the fetal death.
At that point, Respondent performed another bimanual pelvic examination. The examination, under sedation, revealed that S.S. was approximately 18 to 19 weeks pregnant. Respondent also saw the cord, which was the size of a pencil, indicating more than a 12 week pregnancy. He then decided that S.S. should be admitted to the hospital to complete the procedure using pitocin augmentation. This was necessary to avoid any complications such as perforation or bleeding.
Respondent advised S.S. of his decision to admit her to the hospital and she agreed. Respondent also called Dr. McNeill to inform him about the discrepancy in gestational age as revealed by the TVS and its actual size.
Respondent subsequently admitted S.S. to the hospital's obstetrical/gynecological nursing floor on 23-hour observation. His admission note indicates that the fundal height was 19 centimeters. Around 20 weeks of pregnancy and beyond, the fundal height in centimeters usually equals the gestational age in weeks.
After admission to the hospital, S.S. underwent a complete blood count. Her white blood count was abnormally high with a "left shift." The rupture of membranes during a normal pregnancy termination does not cause a white count to elevate or shift left. A non-viable pregnancy that is attempting to spontaneously abort without success will cause that result.
Pursuant to Respondent's order, pitocin was administered to S.S. to stimulate uterine contractions. Soon thereafter, S.S. began to complain of lower abdominal pain, indicating the start of labor. Seven hours later, S.S. delivered a stillborn fetus. As a general rule, a non-term pregnancy would not deliver that rapidly unless there were some underlying processes, such as intrauterine fetal demise.
The fetus was delivered with the cord intact. Then the placenta was delivered intact. The nurse's notes do not indicate that the cord was ever cut and clamped, which would have been the practice in a delivery room on the labor floor.
A labor and delivery nurse came to the floor with a scale. The nurse's notes state that the fetus weighed three pounds, twelve ounces. However, there is no evidence that the fetus was weighed separate and apart from the cord and placenta.
A birth weight of three pounds, twelve ounces, is consistent with a gestational age of thirty-two weeks to thirty- four weeks. Even so, intrauterine fetal demise results in fetal absorption of amniotic fluid, which will increase its weight. A placenta alone can account for up to 40 percent to 45 percent of the fetal body weight.
Weight alone is not medically appropriate to determine gestational age. Other factors that should be considered include the following: fused eyes, fetal creasing, scrotal folds, breast buds, skin, foot length, hand size hair, and etc. In this case, the evidence is not clear and convincing that the fetus was 32-34 weeks, based solely on a recorded birth weight that may or may not have included the cord and placenta. This is especially true in light of persuasive evidence indicating that the fetus was less than 20 weeks and that fetal demise took place before the termination procedure.
S.S. suffered no hemorrhaging, hypertension, loss of fertility, failure of blood to coagulate, shock, uterine perforation, exploratory laparotomy or a total abdominal
hysterectomy as a result of the procedure performed by Respondent.
The fetus was sent to the morgue and subsequently discharged to a funeral home. An autopsy was not performed. There were no pathology reports created regarding the fetus.
Respondent saw S.S. at the hospital on the morning of November 1, 1995. He discharged her to go home later a couple of hours later.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this proceeding. Section 120.569, 120.57(1), and 458.331, Florida Statutes.
Section 458.331(1)(t), Florida Statutes, requires a licensed medical doctor 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 has the burden of proving by clear and convincing evidence that Respondent failed to practice medicine in accordance with requirements of Section 458.331(l)(t), Florida Statutes, when he initiated the procedure to terminate S.S.'s pregnancy. Ferris v. Turlington, 510 So. 2d 292 (Fla.
1987).
In this case, persuasive evidence indicates that Respondent met the statutory standard of care. Based on Dr. McNeill's statement that the fetus was 12 weeks by examination and scan, Respondent was justified in proceeding with the abortion despite his own finding that the fetus was 16 weeks. After rupturing the membranes and observing a large amount of amniotic fluid, Respondent performed another examination while
S.S. was sedated. Respondent's second examination revealed that the fetus was closer to 19 weeks. He then properly stopped the abortion procedure in his office and admitted S.S. to the hospital.
There is no clear and convincing evidence that the fetus alone weighed three pounds, twelve ounces. On the other hand, there is persuasive evidence that intrauterine fetal demise occurred prior to the termination procedure and that a dead fetus absorbs amniotic fluid.
Chapter 390, Florida Statutes, sets forth the law in Florida on the issue of termination of pregnancies. Section 390.0111(4) states as follows:
4) STANDARD OF MEDICAL CARE TO BE USED DURING VIABILITY.--If a termination of pregnancy is performed during viability, no person who performs or induces the termination of pregnancy shall fail to use that degree of professional skill, care, and diligence to preserve the life and health of the fetus which such person would be required to exercise in order to preserve
the life and health of any fetus intended to be born and not aborted. "Viability" means that stage of fetal development when the life of the unborn child may with a reasonable degree of medical probability be continued indefinitely outside the womb.
Notwithstanding the provisions of this subsection, the woman's life and health shall constitute an overriding and superior consideration to the concern for the life and health of the fetus when such concerns are in conflict.
Section 390.011(1), Florida Statutes, defines abortion as follows:
"Abortion" means the termination of human pregnancy with an intention other than to produce a live birth or to remove a dead fetus.
There is no evidence that S.S.'s fetus was viable at the time Respondent initiated the termination procedure. There is credible evidence that S.S.'s fetus was not viable at less than 20 weeks. Under the facts presented here, Respondent cannot be faulted for the care he provided S.S.
Based on the forgoing Findings of Fact and Conclusions of Law, it is
RECOMMENDED:
That Petitioner enter a final order dismissing all charges against Respondent.
DONE AND ENTERED this 28th day of June, 2000, in Tallahassee, Florida.
SUZANNE F. HOOD
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 28th day of June, 2000.
COPIES FURNISHED:
Richard M. Ellis, Esquire
Agency for Health Care Administration Post Office Box 14229
Tallahassee, Florida 32317-4229
Roy Lewis, Esquire
203 Washington Street Jacksonville, Florida 32202
Angela T. Hall, Agency Clerk 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, Bin A02 Tallahassee, Florida 32399-1701
William W. Large, General Counsel Department of Health
4052 Bald Cypress Way, Bin A02 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 |
|---|---|
| Sep. 15, 2000 | Final Order filed. |
| Jun. 28, 2000 | Recommended Order sent out. CASE CLOSED. Hearing held May 18, 2000. |
| Jun. 27, 2000 | Notice of Substitution of Counsel (filed by R. Byerts) filed. |
| Jun. 01, 2000 | Proposed Recommended Order (R. Lewis) filed. |
| May 26, 2000 | Notice if Filing Petitioner`s Proposed Recommended Order; Petitioner`s Proposed Recommended Order filed. |
| May 24, 2000 | Continuation of Testimony and proceedings by Video Teleconference filed. |
| May 23, 2000 | Notice to Respondent that Transcript has Been Filed filed. |
| May 23, 2000 | CASE STATUS: Hearing Held; see case file for applicable time frames. |
| May 12, 2000 | Amended Notice of Hearing by Video Teleconference sent out. (hearing set for May 18, 2000; 8:15 a.m.; Jacksonville and Tallahassee, FL, amended as to location) |
| Apr. 28, 2000 | Transcript (2 volumes) filed. |
| Apr. 20, 2000 | Notice of Hearing sent out. (hearing set for May 18, 2000; 10:00 a.m.; Jacksonville, FL) |
| Apr. 12, 2000 | Agreed-to Response to Order Continuing Hearing (filed via facsimile). |
| Apr. 03, 2000 | Order sent out. (hearing cancelled, parties to advise status by 04/13/2000) |
| Mar. 31, 2000 | Hearing Partially Held, continued to date not certain. |
| Mar. 31, 2000 | (Respondent) Motion for Attorney`s Fees and Costs filed. |
| Mar. 30, 2000 | (Respondent) Motion for Attorney`s Fees and Costs (filed via facsimile). |
| Mar. 20, 2000 | (R. Lewis) Notice of Filing; (3) Return of Service; (3) Subpoena Duces Tecum filed. |
| Mar. 14, 2000 | (R. Ellis, R. Lewis) Prehearing Stipulation filed. |
| Mar. 13, 2000 | (R. Lewis) Motion for Taking Official Recognition filed. |
| Mar. 13, 2000 | (Respondent) Motion for Taking Official Recognition of the Probable Cause Panel`s Findings filed. |
| Feb. 22, 2000 | Respondent`s Motion for Taking Official Recognition filed. |
| Feb. 22, 2000 | Respondent`s Notice of Service of Supplemental Answers to Petitioner`s First Set of Interrogatories; Respondent`s Supplemental Answers to Petitioners First Set of Interrogatories filed. |
| Feb. 11, 2000 | Petitioner`s Second Motion for Taking of Official Recognition filed. |
| Dec. 16, 1999 | Order of Pre-hearing Instructions sent out. |
| Dec. 14, 1999 | Agreed-to Motion for Entry of Order of Prehearing Instructions (filed via facsimile). |
| Nov. 09, 1999 | Notice of Propounding Respondent`s First Supplemental Interrogatory Number 1 to Petitioner; First Supplemental Interrogatory to Petitioner filed. |
| Nov. 08, 1999 | (Respondent) Second Request for Production filed. |
| Nov. 02, 1999 | Respondent`s Response to Petitioner`s Motion for Taking of Official Recognition filed. |
| Oct. 19, 1999 | Second Notice of Hearing sent out. (hearing set for March 31, 2000; 9:00 a.m.; Jacksonville, FL) |
| Oct. 15, 1999 | (Petitioner) Notice of Filing of Respondent`s Answer to the Administrative Complaint; Answer to Administrative Complaint; Motion for Taking of Official Recognition filed. |
| Oct. 15, 1999 | Petitioner`s Motion for Order Setting Hearing, or, Alternatively, Remanding Case to Department of Health for Entry of Default Order Against Respondent filed. |
| Sep. 23, 1999 | Order Granting Continuance and Placing Case in Abeyance sent out. (Parties to advise status by October 22, 1999.) |
| Sep. 21, 1999 | Petitioner`s Response to Motion for Continuance (filed via facsimile). |
| Sep. 20, 1999 | (Respondent) Motion for Continuance filed. |
| Sep. 13, 1999 | (Respondent) Notice of Filing Respondent`s Answers to Petitioner`s First Request for Admissions filed. |
| Sep. 13, 1999 | Respondent`s Response to Petitioner`s First Request for Production of Documents; Respondent`s Notice of Service of Answers to Petitioner`s Interrogatories Dated 08/11/99 Numbered 1-10 filed. |
| Aug. 09, 1999 | (Respondent) Request for Production; (Respondent) Notice of Propounding First Interrogatories to Petitioner filed. |
| Jul. 15, 1999 | Notice of Video Hearing and Order of Instructions sent out. (Video Hearing set for 1:00am; Tallahassee & Jacksonville; 10/22/99) |
| Jul. 07, 1999 | (Petitioner) Response to Initial Order (filed via facsimile). |
| Jun. 08, 1999 | Order Granting Extension of Time in Which to Respond to Initial Order sent out. (parties shall report status by 7/5/99) |
| Jun. 03, 1999 | Joint Motion for Extension of Time in Which to Respond to Initial Order (filed via facsimile). |
| May 27, 1999 | Initial Order issued. |
| May 25, 1999 | Agency Referral Letter; Administrative Complaint; Election of Rights; Answer to Administrative Complaint filed. |
| Issue Date | Document | Summary |
|---|---|---|
| Sep. 14, 2000 | Agency Final Order | |
| Jun. 28, 2000 | Recommended Order | Petitioner did not violate statutory standard of care when he initiated the procedure to terminate a pregnancy; persuasive evidence indicated that intrauterine fetal demise occurred prior to that time. |
