STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL )
REGULATION, Board of Medical ) Examiners, )
)
Petitioner, )
)
vs. ) CASE NO. 83-1554
)
MARIA B. GONZALEZ, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Sharyn L. Smith, held the final hearing in this case on August 16, 17, 18 and 19, 1983, in Fort Lauderdale, Florida. The following appearances were entered:
APPEARANCES
For Petitioner: Spiro T. Kypreos, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Charles B. Patrick, Esquire
1648 South Bayshore Drive Miami, Florida 33133
The issue for determination at the final hearing was whether the medical license of the Respondent Maria B. Gonzalez should be revoked, suspended, or otherwise disciplined for her care and treatment of six patients, five of whom were treated at Hollywood Memorial Hospital in Hollywood, Florida, and one who was treated at International Hospital in Miami, Florida.
At the final hearing, Purificacion D. Catini, a surgical assistant at Memorial Hospital, David Gordon, a surgical assistant at Memorial Hospital, David E. Lessin, a senior attending physician in obstetrics-gynecology at Memorial Hospital, Gary Karch, an anesthesiologist at Memorial Hospital, Raymond
Nolan, an obstetrician and gynecologist at Memorial Hospital, Jean Tease, a nurse/mid-wife at Memorial Hospital, Sanford Yankow, a medical doctor practicing in Miami, Florida who was tendered and qualified as an expert in obstetrics and gynecology, Yvette Ans, an obstetrician and gynecologist at Memorial Hospital, and George Lipton, an anesthesiologist at Memorial Hospital, testified for the Petitioner Department of Professional Regulation. Juan Wester, a general surgeon at Memorial Hospital, Harry Kraff, a medical doctor practicing in Miami, Florida who was tendered and qualified as an expert in obstetrics and gynecology, Elda Ferrer-Guerra, an obstetrician and gynecologist practicing in Miami, Florida, Barbara West, an obstetrical nurse at Doctor's Hospital in
Plantation, Florida, Margaret Fernandez, Caroline Curran, and Barbara Mansfield, all patients of the Respondent, Francisco Sarmiento, a gynecological surgeon at International Hospital, Connie Rodriquez, a registered nurse at Doctor's Hospital, Ramona Cardullo, a patient of the Respondent's residing in Tampa, Florida, and Maria B. Gonzalez, testified for the Respondent. Petitioner's Exhibits 1-5 and Respondent's Exhibits 1-16 were offered and admitted into evidence.
Proposed Recommended Orders containing findings of fact have been submitted by the parties and considered in the preparation of this Recommended Order.
When the parties' findings of fact were consistent with the weight of the credible evidence introduced at final hearing, they were adopted and are reflected in this Recommended Order. To the extent that the findings were not consistent with the weight of the credible evidence, they have been either rejected, or when possible, modified to conform to the evidence. Additionally, proposed findings which were subordinate, cumulative, immaterial or unnecessary have not been adopted.
PRELIMINARY STATEMENT
This case was initiated on May 10, 1983, when the Petitioner issued an Order of Emergency Restriction pursuant to Section 455.225(7), Florida Statutes, directed to the Respondent Gonzalez, which summarily suspended her license in accordance with Section 120.60(7), Florida Statutes. A five-count Administrative Complaint was filed on Many 11, 1983 and forwarded to the Division of Administrative Hearings on May 20, 1983, when the Respondent disputed the allegations of fact contained therein.
By agreement of counsel, this case was set for hearing on August 16-19, 1983, by order entered on June 6, 1983. On June 9, 1983, the Petitioner moved to amend the Administrative Complaint by adding new charges at Counts Six and Seven and revising Count Three of the original Administrative Complaint. The motion to amend was granted on June 22, 1983.
At the beginning of the final hearing, the Petitioner moved to amend the Amended Administrative Complaint by deleting an allegation contained in Count Four. Without objection, this oral amendment was granted. The Petitioner's motion to amend Count Seven of the Amended Administrative Complaint filed July 28, 1983, was also granted without objection. The Petitioner voluntarily dismissed Count Six of the Amended Administrative Complaint.
The Petitioner stipulated at the beginning of the hearing, that it was not seeking revocation of the Respondent's license in this case, but instead was attempting to permanently continue the restrictions contained in the Emergency Order which prohibited her from "... practicing obstetrics in a hospital environment, or performing major surgical procedures."
FINDINGS OF FACT
The Respondent Gonzalez
The Respondent Maria B. Gonzalez is a medical doctor holding Florida license number ME 0028019. She has been licensed to practice medicine in Florida since 1975. Prior to the instant proceeding, her license to practice medicine has never been suspended or revoked.
The Respondent has taken and passed the written test for board certification as a specialist in obstetrics and gynecology, but was refused permission to complete the exam because her privileges had by then been suspended by Hollywood Memorial Hospital.
During the course of her practice in Cuba and Florida, the Respondent has delivered approximately 2,000 babies. To her knowledge, she has never had a maternal or infant death occur during her practice.
The Respondent's practice at Memorial Hospital was highly unusual in that almost half of her patients were Medicaid. As a result, Respondent encountered difficulties in dealing with some of the members of the medical staff at Memorial since she believed that her patients medical interests should take precedence over their ability to pay for services. 1/
The Respondent's provisional staff privileges at Memorial were suspended on July 28, 1982, based upon a review by an ad hoc committee of the hospital's obstetrics and gynecology staff, of six cases, five of which form the basis of the instant proceeding. In deciding to terminate the Respondent, the ad hoc committee considered pertinent medical records and statements from witnesses but did not hear the direct testimony of the Respondent.
When the decision was made by Memorial to terminate the Respondent, the hospital informed the Petitioner of this fact pursuant to Section 458.337, Florida Statutes, which requires that the Department be notified when any physician has been disciplined by a licensed hospital for any act that constitutes a violation of Chapter 458, Florida Statutes.
Count One Aida M. Astiazarian
On December 25, 1981, the Respondent performed a bilateral tubal ligation on Aida M. Astiazarian, a patient who had vaginally delivered an infant several hours prior to the operation. During the procedure, the Respondent was assisted by Dr. Purificacion D. Catini, a surgical assistant. The patient was anesthetized by Dr. Gary Karch.
The tubal ligation on Astiazarian began with the opening of the abdominal cavity. Several adhesions from prior surgery and two small bleeders were noticeable, specifically a bleeder on the anterior abdominal wall and on the anterior surface of the uterus. The Respondent ligated the bleeder on the anterior abdominal wall and controlled the oozing from that source. The Respondent elected not to suture or ligate the oozing on the anterior surface of the uterus as recommended by Dr. Catini and instead used a four-by-four inch section of Gelfoam to control the bleed. The Gelfoam was applied with a laparotomy paid and removed after a few minutes. Believing that hemostasis had been achieved, the Respondent closed the abdominal cavity.
Unlike the Respondent, Dr. Catini believed that hemostasis had not been achieved since she noticed some oozing still occurring after the Gelfoam was applied.
Following the operation the patient's hemoglobin, hematocrit and blood pressure began to fall. The likely cause of these symptoms was an intra- abdominal bleed or ooze. The patient was transfused with several units of blood and discharged from the hospital.
Although a reasonably prudent physician would not close a patient with an active ooze or bleed, the record fails to establish that the Gelfoam was ineffective and the Respondent knew or should have known that hemostasis had not been achieved. 2/ Uterine oozing in a postpartum patient can occur without any negligence by a treating physician. The loss of blood which occurred following this operation is not inconsistent with the Respondent's assertion that hemostasis had occurred and that sometime later the clot had become dislodged, thereby causing the bleed which resulted in the administration of two units of blood.
Count Two Jaclyn R. Osier
On December 28, 1981, the Respondent performed a postpartum tubal ligation on Jaclyn R. Osier. She was assisted during the procedure by Dr. David
Gordon.
During the operation, a tear in the broad ligament occurred and the patient began to hemorrhage profusely.
The tear of the broad ligament which occurred during the procedure was an inherent risk of surgery and does not, by itself, demonstrate negligence by the Respondent.
The Respondent extended the incision and located one of the bleeders; however, due to the nature of the tear and the physical condition of the patient, she was unable to locate and control other bleeders which were deeper in the abdomen.
Due to the blood loss experienced by the patient, Dr. Gordon determined that additional help was needed. He left the operating room and sought assistance from Dr. Raymond Nolan.
When Dr. Nolan arrived, he made an additional extension of the incision and with assistance from the Respondent and Dr. Gordon, he was successful in locating the deep bleeders and achieving hemostasis.
Under the circumstances, it was appropriate medical practice for either the Respondent or Dr. Gordon to seek additional help when the patient's bleeding was not under control. As noted by Dr. Nolan "...Just as two heads are better than one, four hands are better than two." (Tr. at 369.)
Significantly, Dr. Nolan, a surgeon who had operated with the Respondent on this case as well as others, did not believe that the Respondent's license should be revoked based on his actual experiences with the Respondent.
Following this incident, Dr. Nolan did not have any immediate concern that the Respondent had acted improperly. Although Dr. Nolan later voted to suspend the Respondent's hospital privileges at Memorial, his vote was based on the recommendation of the hospital's ad hoc committee rather than his own personal experiences with the Respondent or his own independent review of pertinent medical records.
The intra-operative complication which occurred in this particular case was not the result of the Respondent's negligence. When the Respondent was unable to control the bleeding with Dr. Gordon after the incision had been extended, another surgeon was called to assist. The Respondent's inability to
control the bleed prior to Dr. Nolan being called, does not constitute negligence under the circumstances of this case.
Count Three Linda Jones
On May 28, 1982, at 9:45 p.m., Linda Jones, a high risk and postdate patient was admitted to Memorial.
The Respondent examined the patient on the morning of May 29, 1982, and found her to be in labor.
The practice at Memorial was that provisional staff physicians, such as the Respondent, handle all service or indigent patients. Linda Jones had been handled by Dr. Kast, another provisional staff physician. On the day the Respondent examined the patient, she was covering for Dr. Kast, who had asked as a courtesy to be relieved until 1:30 p.m.
The labor and delivery of pregnant service patients at Memorial are handled by nurse/widwives, unless a complication arises which requires a surgical procedure.
The patient was scheduled for a normal vaginal delivery. She was doing well and was placed on a fetal monitor. At approximately 12:25 p.m., the patient started having episodes of decelerations. Nurse/Midwife Jean Tease, R.N., turned off the Pitocin which had been administered and turned the patient to relieve the decelerations. The patient continued to progress until approximately 1:22 p.m., when rapid decelerations on the fetal monitor were observed.
At approximately 12:00 p.m. the Respondent left Memorial to attend a wedding in Fort Lauderdale which was a twenty minute drive from the hospital. She notified the nursing staff where she was going so that she could respond if needed. 3/
Nurse Tease contacted both Dr. Kast and Respondent when the patient's symptoms began to worsen. The Respondent returned the call and when informed of the problem, advised Tease that she would return to the hospital.
The Respondent was returning to the hospital via Interstate 95 when it began to rain very heavily. Her front brakes froze and her car was immobile.
While it continued to rain, Respondent pulled over on the side of the Interstate and attempted to flag down help. A wrecker operator stopped and towed her car to a service station where it was repaired.
Meanwhile, since the Respondent had not arrived at Memorial as she had stated, Nurse Tease placed a page for any obstetrician in the hospital, and Dr. David Lessin responded. Dr. Lessin performed an emergency cesarean section and produced a living baby.
The Amended Administrative Complaint does not allege that the Respondent was negligent in leaving the hospital; rather it charges that the Respondent breached a duty owed to this patient by failing to come to the hospital until approximately four hours after advising hospital personnel that she was in route.
Due to mechanical problems with her car and the weather, it was impossible for the Respondent to return to the hospital to attend this patient. The Respondent believed that Dr. Kast was on duty after 1:30 p.m., and she knew she could not arrive at the hospital before that time. Under the circumstances, her actions regarding this patient were not negligent.
Count Four Ramona Cardullo
Ramona Cardullo was admitted to Memorial on the morning of May 28, 1982. Mrs. Cardullo was pregnant with her third child who was ultimately successfully delivered by cesarean section.
Prior to this pregnancy, Mrs. Cardullo had experienced significant difficulties during the delivery of her two other children. Her first child, who was born following induced labor in Texas, was a month post-mature. Her second child was delivered at Memorial by another obstetrician following induced labor. The second child was delivered through the use of forceps.
The problems which Mrs. Cardullo encountered in her two previous pregnancies resulted from a uterine dysfunction in which her cervix failed to dilate sufficiently to permit a normal delivery. When Mrs. Cardullo came to the Respondent during her third pregnancy, she related her previous obstetrical history and its attendant difficulties to the Respondent. In addition to her historical problems, Mrs. Cardullo had also gained 80 pounds during her third pregnancy.
When Mrs. Cardullo began her prenatal care, she was living in Hollywood, Florida, with her husband. During her pregnancy, the couple moved to Wauchula, Florida. Since Mrs. Cardullo did not believe that Wauchula had appropriate hospital facilities, she commuted to Fort Lauderdale from Wauchula during the last three months of her pregnancy. The Respondent, however, was unaware that Mrs. Cardullo had moved from Hollywood.
On May 28, 1982, Mrs. Cardullo, while home in Wauchula, began passing membranes and started to go into labor. She informed her husband that she was in labor, and called the Respondent.
After driving from Wauchula, the couple met the Respondent at Memorial where the patient was examined. The examination revealed that Mrs. Cardullo was not dilating and the Respondent told her to begin walking. She walked around the hospital until later that afternoon, when tests were performed by the Respondent to ensure that the baby was okay.
The Respondent put the patient in the labor room and began Pitocin to augment her labor. A nurse in the labor room told Mrs. Cardullo that other patients needed the room more than she did and contacted another physician who ordered the Pitocin to be turned off and the patient sent home.
Mrs. Cardullo and her husband returned to Wauchula while she was still in labor. Approximately three hours after arriving home, Mrs. Cardullo began passing "... a lot of stuff." (Tr. at 900.) Mr. Cardullo called the Respondent, informed her of his wife's condition, and stated that they were coming back to the hospital.
The couple arrived at Memorial on May 30, 1982, and Mrs. Cardullo was readmitted. Although Mrs. Cardullo's labor had continued throughout this period, her cervix had not dilated.
The Respondent discussed a cesarean with the patient, who had requested the procedure be done based on her vaginal experiences in two prior pregnancies, and decided to attempt to dilate the cervix before performing surgery.
Approximately ten hours after Mrs. Cardullo's readmission and five hours after her water had broken, the Respondent came to the conclusion that the Pitocin was not working since the patient's cervix still had not dilated properly and that a cesarean would be necessary.
Mrs. Cardullo had no problems with the cesarean delivery and was pleased with the quality of care she received from the Respondent. Mrs. Cardullo stated that the Respondent was different from other doctors she had encountered in that she believed the Respondent cared about her and her problems.
The Respondent's care and treatment of Mrs. Cardullo was appropriate considering the patient's prior medical history. The only criticism that could be directed toward the Respondent in her handling of the Cardullo case is that she waited too long to perform the cesarean by not giving sufficient consideration to the input from her patient.
Count Five Elina Carrasco
On December 17, 1982, the Respondent performed an abdominal hysterectomy on Elina Carrasco at International Hospital in Miami, Florida. During the procedure the Respondent was assisted by Dr. Francisco Sarmiento.
The patient had a large amount of fibrous tissue and adhesions from prior abdominal surgery which made it difficult for the Respondent to visualize the operative site. The adhesions which surrounded the uterus, bladder, omentum, intestines, the right ovary, a segment of the left fallopian tube, and the abdominal wall, had formed a mass which required dissection to reach the pelvic cavity.
While dissecting the mass of adhesions, the Respondent cut the patient's illiac vein which was located underneath the adhesions, thus causing the operative field to fill with blood. While Dr. Sarmiento placed his finger on the vein to stop the bleed, Respondent requested and placed a hemostatic clamp on the vein and requested a cardiovascular team to assist.
At the time of the surgery, the practice at International was to place regular surgical clamps on a surgical tray rather than non-crushing clamps, when a standard gynecological procedure was performed. Accordingly, the sterile surgical tray which was prepared for this patient did not contain non-crushing clamps, although such clamps were available at the hospital.
The surgical clamp was left on the patient only until the cardiovascular team arrived. Because a crushing clamp had been used, Dr. Junco, the surgeon who repaired the severed vessel, felt that a crush type injury to the underlying artery which was immediately adjacent to the severed vein, had occurred. The pathology report does not indicate that any clots or sections of
artery were removed from the patient, although the operative records indicated two small clots were removed from the artery. The crush injury was not severe in that after the insertion of a fogarty catheter, proximal and distal blood flow was restored without requiring the removal of the crushed portion of the artery.
Dr. Junco closed the vein and repaired the artery. After surgery, the patient improved and was discharged from the hospital on December 30, 1982, in stable condition.
The basis of the charge against the Respondent in her care and treatment of Ms. Carrasco involves essentially one issue; whether it was below the standard of care for the Respondent to clamp the patient's vein with a device which could and did cause a crush injury to an underlying artery, 4/ in order to control bleeding from the illiac vein.
In retrospect, the wiser course in this case would have been to take the time to obtain a non-crushing clamp from the rotating nurse while Dr. Sarmiento controlled the bleed through use of finger pressure. The unfortunate event which occurred in this case did not result from any lack of surgical or other skills by the Respondent. The Petitioner has characterized the Respondent's reaction to the transected artery and use of a hemostatic clamp as panic, while the Respondent has characterized it as a desire to use the first clamp available to control the bleeding as quickly as possible. Additionally, the Respondent needed Dr. Sarmiento to assist and while he was holding the artery, he was obviously unable to offer any other form of help.
Under these circumstances, the Respondent's use of a hemostatic clamp does not demonstrate that she "panicked" in the operating room or that her decision to use the clamp fell below an acceptable standard of care.
Count Seven Deborah J. Cox
On June 6, 1982, the Respondent examined Deborah J. Cox and was present with her in the labor room throughout the patient's labor. The fetus was first on an external and then an internal monitor throughout labor.
The Respondent requested that Dr. Antonio Mata, a neonatologist, be present for the delivery. When Dr. Mata came into the labor room, he checked the fetal monitor and noticed signs of moderate fetal distress.
The combination of Pitocin, which was administered to the patient, and distressive labor, placed stress on the fetus as indicated by the fetal monitoring strips.
The patient was transferred from the labor room to the delivery suite. In an effort to deliver the baby which was exceptionally large, it was necessary for the Respondent to use forceps because the baby's head was high and the mother's uterine surface remained thick even though she was well dilated.
When the forceps were applied, the baby went into severe distress. The Respondent called for an emergency cesarean section, but the operating assistant was not available. Since it was necessary to deliver the baby as quickly as possible to avoid a stillbirth or permanent damage, the Respondent reapplied the forceps and attempted delivery.
The baby was a very difficult delivery due to its size. It became stuck in the birth canal which required that the Respondent rotate its shoulders to effectuate delivery. While manipulating the baby, shoulder dystocia occurred.
The Respondent elected not to perform the cesarean when it was first indicated, because of a hospital rule which prohibited the performance of a cesarean section without the presence of a surgical assistant. Due to the continuing difficulties she had encountered at Memorial, she was understandably reluctant to violate a hospital rule which would have subjected her to additional problems at Memorial.
However, notwithstanding the legitimacy of the Respondent's personal concerns, the best interests of this patient required that a cesarean section be performed as soon as it became evident that the baby was not tolerating labor and that a vaginal delivery would place added and unnecessary stress on both the mother and child. The decision not to perform a cesarean, and instead deliver the baby vaginally through the use of forceps, created a situation which resulted in the fetus being born with an Apgar rating of 0 and possible permanent injury.
By failing to perform a cesarean section when it was medically indicated, the Respondent's care and treatment of Deborah J. Cox fell below acceptable standards of obstetrical practice.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this proceeding. Section 120.57(1), Florida Statutes.
The Respondent is charged with violating Section 458.331(1)(t), Florida Statutes, which empowers the Board of Medical Examiners to take disciplinary action against a physician found guilty of:
[g]ross or repeated malpractice or the failure to practice medicine with that level of care, skill, and treat-
ment which is recognized by a reasonably prudent similar physician as being ac- ceptable under similar conditions and circumstances.
The burden in this proceeding is on the Department to prove the allegations of the Amended Administrative Complaint by clear and convincing evidence. Gans v. Department of Professional and Occupational Regulation, 390 So.2d 107 (Fla. 3d DCA 1980); Walker v. Board of Optometry, 322 So.2d 612 (Fla. 3d DCA 1975); Reid v. Florida Real Estate Commission, 188 So.2d 846 (Fla. 2d DCA 1966). When, as here, it is alleged that a licensee violated a standard of conduct not explicitly fixed by statute or rule, "the critical matters in issue must be shown by evidence which is indubitably as 'substantial' as the consequences." Bowling v. Department of Insurance, 394 So.2d 165, 172 (Fla. 1st DCA 1981).
When the facts of this case are measured against these standards, the record supports a finding that the Respondent violated Section 458.331(1)(t), Florida Statutes, in her care and treatment of Deborah J. Cox, as described in
the findings set forth above relating to Count Seven of the Amended Administrative Complaint. The remaining allegations of professional misconduct in Counts One, Two, Three, Four and Five of the Amended Administrative Complaint have not been established by clear and convincing evidence, and should therefore, be dismissed.
In determining an appropriate penalty, consideration has been given to the Respondent's lengthy career in obstetrics and gynecology and the apparent lack of any maternal or infant deaths associated with that practice. Additionally, the Respondent's willingness to render obstetrical and gynecological care to low income and indigent patients is admirable and noteworthy.
In specific regard to the Cox case, the evidence indicates that the Respondent called for a cesarean and then reversed herself when it became apparent that hospital rules would be violated if she proceeded. Given the previous serious difficulties the Respondent had encountered at Memorial, her decision did not demonstrate an error of skill, but rather one of judgment.
To ensure that the Respondent's judgment is correctly exercised in the foreseeable future, it is appropriate that she be placed on probation for six months and during that time be required to practice under the general supervision of a board certified obstetrician/gynecologist. See Section 458.331(2)(f), Florida Statutes.
Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED:
That the Board of Medical Examiners issue a Final Order finding the Respondent (1) guilty of violating Count Seven of the Amended Administrative Complaint; (2) dismissing Counts One, Two, Three, Four and Five of the Amended Administrative Complaint; and (3) placing her on probation for six months subject to the condition that during this period she be required to practice obstetrics and/or gynecology under the general supervision of a board certified physician.
DONE and ENTERED this 18th day of November, 1983, in Tallahassee, Florida.
SHARYN L. SMITH
Hearing Officer
Department of Administration Division of Administrative Hearings Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301 904/488-9675
Filed with the Clerk of the Division of Administrative Hearings this 18th day of November, 1983.
ENDNOTES
1/ For example, the Respondent testified that a member of the anesthesia department at Memorial had refused to anesthetize her obstetrical patients unless he was paid in cash or could verify that sufficient funds were in the bank to cover a check.
2/ The hospital records of the patient, Respondent's Exhibit 1, indicate that hemostasis was obtained, and no note exists which states that the patient was closed with an active bleed or ooze apparent.
3/ It was not unusual at Memorial for on-call physicians to leave the hospital so long as they left a number where they could be reached.
4/ The Petitioner conceded at the final hearing that the action of the Respondent in transecting the vein was not negligence, but rather a recognized intra-operative complication of this procedure.
COPIES FURNISHED:
Spiro T. Kypreos, Esquire Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Charles B. Patrick, Esquire 1648 South Bayshore Drive Miami, Florida 33133
Dorothy Faircloth, Executive Director Florida Board of Medical Examiners Old Courthouse Square Building
130 North Monroe Street Tallahassee, Florida 32301
Frederick Roche, Secretary Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
================================================================= AGENCY FINAL ORDER
================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
vs. Case No. 83-1554
MARIA B. GONZALEZ, M.D.
License No. 28019
Respondent.
/
FINAL ORDER OF
THE BOARD OF MEDICAL EXAMINERS
This matter cane before the Board of Medical Examiners (Board hereinafter) pursuant to Section 120.57(1)(b)9., Florida Statutes, on February 11, 1984, in Tampa, Florida, for the purpose of considering the hearing officer's Recommended Order (a copy of which is attached hereto) in the above-styled matter and the exceptions filed thereto by the Respondent. The Petitioner was represented by Spiro T. Kypreos, Esquire. The Respondent was represented by Charles Patrick, Esquire. After review of the Recommended Order, Respondent's exceptions, the argument of the parties, and after a review of the complete record in this matter, the Board makes the following findings and conclusions.
FINDINGS OF FACT
The hearing officer's findings of fact are approved and adopted in toto and are incorporated herein by reference.
Respondent takes exception to the hearing officer's finding that Respondent waited too long to perform the cesarean delivery on Mrs. Cardullo. The Board finds that there is competent, substantial evidence to support the hearing officer's finding and the Board further finds that this finding is material to the charges contained in the Amended Administrative Complaint.
Respondent takes exception to the hearing officer's finding in Paragraphs 63 and 64. The Board rejects this exception as there is competent, substantial evidence to support these findings of the hearing officer.
There is competent, substantial evidence to support the Board's findings of fact.
CONCLUSIONS OF LAW
The hearing officer's conclusions of law are approved and adopted in toto and are incorporated herein by reference.
Petitioner's Exceptions to Recommended Order which contests the hearing officer's conclusion that Respondent violated Count VII of the Amended Administrative Complaint are rejected. The Board concludes that the Board's findings of facts support the conclusion that Respondent violated Section 458.331(1)(t), Florida Statutes.
There is competent, substantial evidence to support the Board's conclusions of law.
The hearing officer's recommendation that Respondent be found guilty of violating Count VII of the Amended Administrative Complaint and that the remaining counts be dismissed is approved and adopted. However, following a review of the complete record, the Board believes that the recommended penalty of six (6) months probation should be increased to two (2) years.
WHEREFORE, it is ORDERED AND ADJUDGED that the Respondent is found guilty of violating Section 458.331(1)(t), Florida Statutes, as charged in Count VII of the Amended Administrative Complaint. Respondent is placed on probation for a period of two (2) years beginning the effective date of this Order subject to the condition that during her probation she may practice obstetrics and/or gynecology only under the general supervision of a board certified obstetrician/gynecologist. During her probation, Respondent shall make semi- annual appearances before the Board. This Order becomes effective upon filing.
DONE AND ORDERED this 27th day of February, 1984.
Richard J. Feinstein, M. D. Chairman, Board of Medical
Examiners
| Issue Date | Proceedings |
|---|---|
| Feb. 27, 1984 | Final Order filed. |
| Nov. 18, 1983 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Feb. 27, 1984 | Agency Final Order | |
| Nov. 18, 1983 | Recommended Order | Respondent failed to use good judgment in calling for cesarean then changing mind when saw hospital rules would be violated. Recommnded Order: six month's supervised probation. |
