pray em, STATE OF FLORIDA po Be DEPARTMENT OF HEALTH = 00s SAN 27 AMIN: 57 DEPARTMENT OF HEALTH, BVieie ls i ADMINIS TRAV Ve Petitioner, HEARINGS Vs. CASE NUMBER: 97-12130 JEAN ELLEN BERNHOLTZ, 00 -¢Y¢7 Respondent, / ADMINISTRATIVE COMPLAINT COMES NOW, the Petitioner, Department of Health, hereinafter referred to as “Petitioner”, and files this Administrative Complaint before the Board of Psychology, against JEAN ELLEN BERNHOLTZ, hereinafter referred to as “Respondent”, and alleges: 1. Petitioner is the state agency charged with regulating the practice of psycholos, pursuant to Section 20.43, Florida Statutes; Chapter 455, Florida Statutes, and Chapter 49(. Florida Statues. Pursuant to the authority of Section 20.43(3)(g), Florida Statutes, the Petitioner has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative and prosecutorial services required by the Division of Me councils, or boards, as appropriate. dical Quality Assurance, 2. Respondent is, and has been at all times material hereto, a licensed Psychologist in the State of Florida, having been issued license number PY 0005131. Respondent’s last kncwn address is 1521 NW 9" Street, Boca Raton, FL 33486. 3. On or about June 1996, Department of Health and Rehabilitative Services required that J.S., the father of two (2) children, be evaluated at Southeast Psychotherapy for the purpose of determining child custody. U UW 4. On or about June 3, 1997, J.S. presented to Southeast Psychotherapy and was administered the MMPI-2. J.S. did not speak with the Respondent at that time. 5. On or about June 4, 1997, J.S. presented to Southeast Psychotherapy and was administered the Child Abuse Potential Inventory test. J.S. did not speak with the Respondent at that time. 6. At no time material hereto, did the Respondent meet with the children’s mother. 7. Subsequent to the administration of the aforementioned tests, referred to in paragraphs four (4) and five (5), the Respondent submitted her evaluation of J.S. to Department of Children and Family Services.! 8. Subsequent to the submission of the Respondent’s evaluation, Department of Children and Family Services restricted J.S. to supervised visitation of his children. COUNT I 9. Petitioner realleges and incorporates by reference the allegations contained in paragraphs one (1) through eight (8) as if fully stated herein. 10. Based on the foregoing, the Respondent is subject to discipline pursuant to Section 490.009(2)(q), Florida Statutes, for violating rule 64B19-19.0025, Florida Administrative Code, for failing to properly chronicle document services. COUNT II 11. Petitioner realleges and incorporates by reference the allegations contained in paragraphs one (1) through eight (8) as if fully stated herein. ' Due to the organizational changes instituted by Ch. 96-403, Laws of Florida, the Department of Children and Family Services now performs this function. U U 12. Based on the foregoing, the Respondent is subject to discipline pursuant to Section 490.009(2)(q), Florida Statutes, for violating 64B19-18.007(1), Florida Administrative Code, by not evaluating the mother prior to submission of her evaluation. COUNT Il 13. Petitioner realleges and incorporates by reference the allegations contained in paragraphs one (1) through eight (8) as if fully stated herein. 14. Based on the foregoing, the Respondent is subject to discipline pursuant to Section | 490.009(2)(s), Florida Statutes, for failing to meet the minimum standards of performance in professional activities when measured against generally prevailing peer performance. U Cnn WHEREFORE, Petitioner respectfully requests the Board of Psychology to enter an order imposing one or more of the following penalties: revocation or suspension of the Respondent’s license, restriction of the Respondent’s practice, imposition of an admin a reprimand, placement of the Respondent on probation, and/or any o deems appropriate. SIGNED tig th day of _[ {ius ta) , 1999. Robert G. Brooks, M.D. Secretary Department of Nancy M. Snurkows > strative fine, issuance of er relief that the Board £D + OF HEALTH CLERK 9. Oem Chief Attorney General Counsel’s Office-MQA Allied Health COUNSEL FOR PETITIONER: James A.G. Davey Jr., Senior Attorney Fla. Bar. No. 141717 Agency for Health Care Administration Post Office Box 14229 Tallahassee, FL 32317-4229 Phone (850) 487-9694 Fax (850) 414-1991 JAGD/tu F i OQ]. -¢ EPARTME! PCP DATE: 01-12 99 D Bish PCP PANEL: Juliet Lewis Dr. Ana Rivas-Vazquez CLERK - DATE. B74

Docket for Case No: 00-000447