STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL REGULATION, ) BOARD OF MEDICAL EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 83-1819
)
ORLANDO ZALDIVAR, )
)
Respondent. )
) DEPARTMENT OF PROFESSIONAL REGULATION, ) BOARD OF MEDICAL EXAMINERS, )
)
Petitioner, )
)
)
vs. ) CASE NO. 84-3052
)
ORLANDO ZALDIVAR, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, James E. Bradwell, held a public hearing in these consolidated cases on December 17 and 18, 1984, in Miami, Florida. The hearing officially closed on February 15, 1985, the date the parties were afforded leave to submit proposed memoranda supportive of their respective positions.
Additionally, the parties waived the time requirement that a Recommended Order be issued within thirty days following receipt of the transcript or the close of the hearing.
APPEARANCES
For Petitioner: Stephanie A. Daniel, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Harold M. Braxton, Esquire
45 Southwest 36 Court Miami, Florida 33135
ISSUE
The issues presented for decision herein are whether or not the Respondent's physician license number ME 0034228 should be disciplined based on allegations set forth hereinafter in detail, that he violated various provisions
of Section 458.331, Florida Statutes, as set forth in the consolidated administrative complaints filed under DOAH Case Numbers 83-1819 and 84-3052, as amended.
BACKGROUND
On or about April 15, 1983, Petitioner filed an administrative complaint against the Respondent alleging various violations of Section 458.331, Florida Statutes. In response thereto, on or about May 25, 1983, Respondent executed an Election of Rights form requesting a formal hearing. On or about June 1, 1983, Respondent, through counsel, prepared and submitted an answer to the administrative complaint dated April 15, 1983.
On or about January 20, 1984, Petitioner filed a Motion to Amend Complaint seeking to substitute an amended administrative complaint filed on January 20, 1984, for the administrative complaint then filed with the Division of Administrative Hearings. The Motion to Amend Complaint was granted by Order of
Michael Ruff, Hearing Officer, entered on January 25, 1984. As amended, the complaint filed by Petitioner alleged the following statutory violations:
Section 458.327(1)(a) , Florida Statutes, by practicing medicine without an active license;
Section 458.328(2)(b), Florida Statutes, by knowingly concealing information related to violations of Chapter 458, Florida Statutes;
Section 458.331(1)(f), Florida Statutes, by failing to report to the Department any person who the licensee knows is in violation of Chapter 458 or of the rules of the Department or the Board;
Section 458.331(1)(g), Florida Statutes, by aiding, assisting, procuring, or advising any unlicensed person to practice medicine contrary to Chapter 458, Florida Statutes, or to a rule of the Department or the Board;
Section 458.331(1)(h), Florida Statutes, by failing to perform any statutory or legal obligation based upon a licensed physician;
Section 458.331(1)(l) , Florida Statutes, by making deceptive, untrue or fraudulent representations in the practice of medicine or employing a trick or scheme in the practice of medicine when such scheme or trick fails to conform to the generally prevailing standards or treatment in the medical community;
Section 458.331(1)(t), Florida Statutes, by gross of repeated malpractice or failure to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent physician as being acceptable under similar conditions and circumstances. The Board shall give great weight to the provisions of Section 768.45 when enforcing this paragraph;
Section 458.331(1)(n) , Florida Statutes, by delegating professional responsibilities to a person when the licensee delegating such responsibilities knows or has reason to know such person is not qualified by training, experience, or licensure to perform them; and
Section 458.331(1)(x), Florida Statutes, by violating any provisions of Chapter 458, Florida Statutes, a rule of the Board or Department previously entered in a disciplinary hearing or failure to comply with a lawfully issued subpoena.
By Order dated October 22, 1984, DOAH Case Numbers 83- 1819 and 84- 3052 were consolidated and scheduled for hearing. On October 29, 1984, Petitioner filed a Motion to Amend Complaint, seeking technical and minor amendments to the administrative complaints filed under Case Numbers 83-1819 and 84-3052. The Motion to Amend Complaint was granted by Hearing Officer P. Michael Ruff on December 7, 1984.
As amended, the administrative complaint under DOAH Case Number 84- 3052, alleged the following statutory violations:
Section 458.327(1)(a), Florida Statutes, by practicing or attempting to practice medicine without an active license;
Section 458.331(1)(l) Florida Statutes, by gross or repeated malpractice or failing 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; and
Section 458.331(1)(x), Florida Statutes, by violating any provision of Chapter 458, Florida Statutes, a rule of the Department or the Board, or a lawful order of the Board or Department previously entered in a disciplinary hearing or failure to comply with a lawfully issued subpoena.
On or about November 19, 1984, a conference call hearing was held to dispose of a motion to compel discovery filed by Respondent in the above-styled proceedings. During the conference call hearing, Hearing Officer P. Michael Ruff ordered the parties to provide the names and addresses of all witnesses which the parties intended to call to testify at the formal hearing in the proceeding no later than November 28, 1984. Any witnesses not furnished to the opposing party by November 28, 1984, would not be allowed to testify at the formal hearing scheduled in this proceeding. Additionally, P. Michael Ruff, Hearing Officer, placed on the parties the continuing obligation of updating discovery responses. Thereafter, Petitioner moved to amend its witness list by adding two court reporters and a criminologist with the Metro-Dade County Sheriff's Office by a motion dated November 28, 1984. This motion also alluded to the addition of an unnamed handwriting examiner and, by a second motion to amend its witness list dated December 11, 1984, Petitioner named the two court reporters and the handwriting examiner. After hearing argument by both sides, the undersigned Hearing Officer allowed the testimony of those witnesses.
Additionally, Respondent admitted the allegations contained in Count II of the amended administrative complaint (Case No. 83- 1819 at TR page 31) and Petitioner voluntarily dismissed Count I of the amended administrative complaint filed in Case No. 83- 1819.
At the formal hearing, Petitioner presented as its witnesses, Etta Annette Brown, Violetta Lalanne, Patricia Ann Humbert, Edward Norman, Margie Johnson, Audrey J. Lubeck, Nelson Andreu, Frank Norwich, Allan McLeod, M.D., Elaine Prater, Karen Patterson, Georgina Galban, Carmen Moses, George Sanchez, Pedro M. Ramos, M.D., Yvonne Bruno and Debra Plez. Respondent presented as its witnesses Nabil Ghali and Megaly Lorenzo.
Petitioner offered and the undersigned received Petitioner's Exhibits 1 through 9. Additionally, Petitioner was afforded leave to late file an official file search from the Board of Medical Examiners pertaining to Respondent's licensure. The file search contained a scrivener's error and Respondent's
license number was incorrectly listed as ME 0033165 instead of the correct number ME 0034228. A substitute file search was submitted by Petitioner reflecting Respondent's correct license number and was received as Petitioner's Exhibit 10.
The parties have submitted posthearing proposed findings of fact pursuant to Section 120.57(1)(b)4, Florida Statutes. A ruling on each proposed finding of fact has been made either directly or indirectly in this Recommended Order, except where such proposed findings of fact have been rejected as subordinate, cumulative, immaterial or unnecessary.
FINDINGS OF FACT
Based on my observation of the witnesses and their demeanor while testifying, documentary evidence received and the entire record compiled herein, I hereby make the following relevant factual findings.
Respondent is a licensed physician and has been issued license number ME 0034228 in the State of Florida. Between December 31, 1981, and at least December 1982, Respondent's license to practice medicine was placed on inactive status because of nonpayment of licensing fees. (Petitioner's Exhibit 10 and TR page 31)
During the above-referenced time periods, Respondent performed or aided in the performance of medical abortions in Miami, Florida, including ones relating to Janet Lee Miller, Myrtha Baptiste, and Yvonne Bruno. (TR pages 326- 347 and 350- 377)
On dates that Respondent performed or assisted in the performance of medical abortions previously mentioned, Respondent did not have an active license to practice medicine in the State of Florida. Myrtha Baptiste died following an abortion.
In conjunction with criminal investigations of the death of Myrtha Bactiste, Respondent was interviewed by Nelson Andreu, a homicide detective with the City of Miami Police Department and George Sanchez, who was then an investigator with the State Attorney's Office. During the course of those interviews, Respondent advised Andreu and Sanchez that he had personally mailed in the items required for renewal of his license and that, as far as he knew, his license was valid.
Megaly Lorenzo, a secretary in the Santa Rosa Medical Center where Respondent worked in 1981 and 1982, testified that Respondent gave Lorenzo his renewal fees in cash for 1982. Lorenzo did not renew Respondent's license because she forgot to. She informed Respondent of that omission during 1983. (TR pages 309-312) When Megaly Lorenzo renewed a license, she received a wallet-sized license from the Board of Medical Examiners which was then placed in the mirror in the offices at the Santa Rosa Medical Center.
Between approximately January 15, 1981 and December 1982, Respondent worked as a physician at the Women's Care Center located at 5601 Biscayne Boulevard, Miami, Florida. At times material hereto, Hipolito Barreiro was the owner and director of Women's Care Center. At all times material hereto, Hipolito Barreiro was not licensed to practice medicine in the State of Florida. (Petitioner's Exhibit 3 and testimony of Elaine Prater, TR page 268)
Between approximately January 15, 1981, and December 1982, Barreiro was engaged in the practice of medicine at the Women's Care Center located at 5601 Biscayne Boulevard, Miami, Florida. During the relevant time period, Hipolito Barreiro performed various procedures which constitute the practice of medicine. As example, during February 1982, Barreiro inserted an intrauterine contraceptive device into Carmen Moses' cervix. In July 1982, Barreiro gave Patricia Humbert an injection and later performed an abortion on Humbert. In September 1982, Barreiro performed a gynecological examination on Etta Annette Brown to determine the status of her pregnancy. In December, 1982, Respondent performed a vaginal examination on Debra Plez confirming the fact that Plez was
6 1/2 months pregnant. Barreiro gave Plez a prescription, placed an IV in Plez's arm and finally performed an abortion on her (Plez). Elaine Prater, an employee at the Women's Care Center, observed Barreiro perform abortions on several occasions while Respondent was employed as a physician at the Women's Care Center. Respondent would sign patient charts as the physician performing the abortion when, in fact, the abortion was performed by Barreiro. These occurrences would usually take place in those instances where Respondent either arrived at work late or left work early. Additionally, it was noted that Respondent maintained a separate list of those patients on whom he performed an abortion and those patients for whom he had not operated or aborted. Ms. Prater acknowledged that Respondent was confronted on several occasions by her (Prater) and Trudy Ellis about his practice of signing charts for those patients whose abortions he had not performed. Finally, Respondent admitted to Roger Stefins that he knew that Barreiro was not licensed to practice medicine in Florida. Also, evidence reveals that Respondent confronted Barreiro on more than one occasion asking, "Haven't I told you not to examine girls before?" (TR page 80)
As stated, Respondent maintained a separate list of patients on whom he had performed abortions for his own use. (See Petitioner's Exhibits 3 and 4)
On several occasions, Respondent was presented "physician's reports of the termination," for abortions performed by Barreiro and was asked to sign the reports as a "physician" performing the termination. Respondent signed these reports even though he knew that the actual abortions had been performed by Barreiro. (TR pages 269-275)
Respondent knew, or should have known, that the abortions had been performed by Barreiro as he was on duty, and because the patients would already be in the recovery room when he (Respondent) arrived for work. (TR page 278)
During May 1982, Yvonne Bruno, a twenty-eight year old Haitian woman, went to the Women's Care Center for the purpose of having an abortion performed. Initially, Bruno went to the Women's Care Center on May 4, 1982, with $160. She was told to come back to the Center on the following Saturday, May 8, 1982, with
$200. Bruno was not examined during that initial visit. On May 8, 1982, Ms. Bruno returned for the purpose of having an abortion. She only had $190. After arriving at the clinic, Bruno changed into a paper gown. Bruno signed several papers on May 8, 1982. One such paper was a sheet entitled, "Important Information Which Every Patient Should Know Concerning The Termination Of Pregnancy Procedure," which was a form maintained by the Women's Care Center.
On the information sheet, Bruno's last menstrual period was listed as January 23, 1982. The appointment date for Bruno's abortion was listed on the information sheet as "5-9-82." In addition to the information sheet, Bruno also signed a form giving her consent for the Respondent to perform a pelvic examination. The consent form bore the date "5-8-82." Finally, Bruno signed a "Patient Information And Medical History" form which was dated May 9, 1982. (Petitioner's Exhibit 8)
On May 8, 1982, Respondent performed an abortion on Bruno, using the dilation and aspiration method, followed by curretage. During the course of the abortion, Bruno's uterus was perforated. Respondent knew that Bruno's uterus was perforated almost immediately following perforation. (Petitioner's Exhibits 3, 4, 8, 9 and testimony of Pedro Ramos)
On the physician's report of the termination, the term of Yvonne Bruno's pregnancy was listed as twelve (12) weeks. The form indicated that the termination was performed on May 9, 1982. Examination of the facts reveal that this was incorrect. The physician's report of the termination for Bruno indicated that the following complications occurred: "Complications: After aspirations with vacuum, the use of curette reveals perforation of uterus. We stop the operation and the patient is taken to the hospital."
The physician's report of the termination for Bruno was signed by Respondent. (Petitioner's Exhibit 8)
Ms. Bruno awoke after the abortion and was put in the recovery room. She was cold and experienced stomach pain more severe than she ever experienced before. The pain was persistent. Bruno informed the doctor who performed the abortion that she was having pains while she was still in the recovery room at the Women's Care Center. (TR pages 360-362)
While Bruno was in the recovery room, the doctor who performed the abortion told Bruno that she has something in her uterus and that he (the doctor) had cleaned it out. He told Bruno that if she felt any more pain to call him, regardless of time. He also gave Bruno the telephone numbers for his house and the clinic. (TR pages 361, 362)
Ms. Bruno remained at the Women's Care Center in the recovery room only long enough for a taxi to arrive. Immediately upon being taken to the recovery room, her friend, Amelia Ingrid Previle, called for a taxi. Bruno was in the recovery room less than an hour. While in the recovery room, Ms. Bruno's condition was not monitored. That is, no one took her blood pressure, respiration or pulse rates. (TR pages 363, 364 and 367-370)
When the taxi arrived, Ms. Bruno left the Women's Care Center unable to walk because "her feet were so heavy." Therefore, the taxi driver and her friend, Previle, had to help Bruno to her friend's car. (TR pages 362, 363)
It took Ms. Bruno approximately 15 minutes to get home from the Women's Care Center. When she arrived home, she felt intense pain which she credited to the fact that perhaps she had not eaten before she went to the Center. She drank tea and put some ice on her stomach.
Bruno's pain intensified and her friend, Previle, started trying to contact Respondent in the late afternoon on May 8, 1982, by phone. Previle continued to try to contact the doctor until the early morning on May 9, 1982. When Previle finally contacted the doctor, Bruno was directed to come to the Women's Care Center. Bruno did so and, upon arrival at the Women's Care Center, she was given a pill. She was then taken to American Hospital in Miami, Florida. At approximately 6:30 a.m. on May 9, 1982, Hipolito Barreiro contacted Pedro M. Ramos, a physician specializing in gynecology and informed him that he had an abortion clinic. Barreiro also told Ramos that "they" thought that "they" had perforated a uterus during an abortion. Dr. Ramos agreed to meet the patient at the emergency room of American Hospital. (TR pages 326, 327)
Once Dr. Ramos arrived at American Hospital, he attempted to obtain a patient history from Bruno; however, this was difficult because of Bruno's limited ability to speak English. With the help of Barreiro and Previle, Dr. Ramos was able to obtain some information. However, on the patient history, Dr. Ramos made the notation that "unable to verify (past illness) properly. Pt. speaks little english." (TR pages 329, 350-377 and Petitioner's Exhibit 9)
When Dr. Ramos arrived at American Hospital, he was given the following patient history for Bruno: "25-year old black female complaining of abdominal pain of 4-6 hours onset with fever (? chills) with brownish discharge from vagina after an abortion performed on May, 1983 . . ." (Testimony of Pedro Ramos, M.D. and Petitioner's Exhibit 9)
Based on the available information, Dr. Ramos diagnosed Bruno as suffering from a perforated uterus and possibly peritonitis. After performing the necessary laboratory tests, Bruno was taken to surgery for an exploratory laparotomy which revealed a perforated uterus. The uterus was perforated at the fundus on the right side. The perforation was more than 4 centimeters long.
The exploratory laparotomy also revealed fetal parts in Bruno's abdomen. Dr. Ramos found at least the head and spine remaining in Bruno's abdomen. (TR page
329 and Petitioner's Exhibit 9)
After the exploratory laparotomy, Dr. Ramos also determined that, in addition to the items noted above, an inflammation process had begun (peritonitis), affecting Bruno's ovaries. Dr. Ramos removed the fetal parts from Bruno's body, irrigated the area and performed a complete hysterectomy, removing both the ovaries and uterus which were beyond repair.
The head of the fetus removed from Bruno's uterus measured four centimeters by two centimeters. Therefore, Dr. Ramos opined that the fetus would have been approximately 17 to 18 weeks of age. At this stage of development, fetal parts are very hard. When suction is applied to the uterus, the solid parts are moved around. The fetal parts are, at this stage, too large to go through the suction tube and remain in the uterus after suction.
Following the use of suction, curretage follows. The manipulation of the curette in the uterus will then result in movement of the fetal parts. Usually, it is the spine or an arm which actually causes the perforation. By manipulating the fetal parts, the physician can cause the fetal part to perforate the uterine wall which is very soft at this stage.
Bleeding can be ascertained through a monitoring of the patient's vital signs and by observation of the patient's general appearance. (TR page 224)
In determining how long a patient should be monitored after an abortion has been performed, it is important to know the stage of pregnancy. With an early pregnancy, i.e., 10 - 12 weeks, the patient may be observed for a shorter period of time. Where there are no complications, the patient should be observed for between 1/2 to 1 hour. (TR pages 222 - 225)
With an advanced pregnancy, i.e., one in the second trimester, the patient should be monitored for two hours after the abortion is completed. The patient might be monitored for a longer period of time if there are difficulties after the abortion is completed. Monitoring should include checking vital signs such as blood pressure, pulse and respiration rates and checking the patient for hemorrhaging and infection. Usually, with a perforated uterus, the patient
experiences abdominal pain immediately following the abortion. A doctor who recognizes that he has perforated a uterus during an abortion should transfer the patient to the hospital for observation. If a patient complains of severe abdominal pain immediately upon completion of an abortion, the doctor should observe the patient until the pain disappears or until the cause of the pain is determined and dealt with. In this regard, Respondent admitted that he perforated Bruno's uterus during the performance of an abortion. (Petitioner's Exhibit 3, pages 20-23)
Noteworthy is the fact that Respondent, when questioned by Investigator Stefins, an Assistant State Attorney, stated that punctures of the uterine wall should never be treated in the clinic and that on the occasions when he punctured a uterus, he would take that patient to the hospital.
Perforation of a uterus is not, in and of itself, malpractice or negligence.
It is below minimal standards of care, skill and treatment for a reasonably prudent physician to fail to carefully monitor a patient, by checking blood pressure, pulse and respiration rates, as well as checking the patient's general appearance after an abortion performed during the second trimester, for a sufficient period of time to determine the existence of complications. If the patient complains of persistent abdominal pain, it is below minimally acceptable standards of care, skill and treatment, as recognized by reasonably similar prudent physicians, under such conditions as are described above to release the patient without first carefully monitoring the patient until the pain disappears or until cause of the pain can be determined and dealt with. (Testimony of Doctors Ghali and McLeod)
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this proceeding. Section 120.57(1), Florida Statutes.
The parties were duly noticed pursuant to the notice provisions of Chapter 120, Florida Statutes.
The authority of the Petitioner is derived from Chapter 458, Florida Statutes.
The Respondent, a licensed medical doctor, is subject to the disciplinary guides of Chapter 458, Florida Statutes.
Section 458.331(2), Florida Statutes, authorizes the Board of Medical Examiners to revoke, suspend or otherwise discipline the license of any physician found guilty of violating any of the following provisions of Section 458.331(1), Florida Statutes:
failing to report to the Department any person who the licensee knows is in violation of this chapter or of the rules of the Depart- ment or the Board. However, if the licensee verifies that the person is actively partici- pating in a board-approved program for the treatment of a physical or mental condition, he is required only to report such person to
an impaired professional consultant;
aiding, assisting, procuring or advising any unlicensed person to practice medicine contrary to this chapter or to a rule of the Department or the Board;
(l) making deceptive, untrue or fraudulent representations in the practice of medicine
or employing a trick or scheme in the practice of medicine when such scheme or trick fails to conform to the generally prevailing standards of treatment in the medical community;
(t) gross or repeated malpractice or the failure to practice medicine with that level of care, skill and treatment which is recog-
nized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. The Board shall give
great weight to the provisions of Section
768.45 when enforcing this paragraph;
delegating professional responsibilities to a person when the licensee delegating such responsibilities knows or has reason to know that such person is not qualified by training, experience, or licensure to perform them; and
violating any provision of this chapter, a rule of the Board or Department, or a lawful order of the Board or Department previously entered in a disciplinary hearing or failing
to comply with a lawfully issued subpoena of the Department.
Respondent, by practicing medicine without an active license, violated Section 458.327(1)(a), Florida Statutes, and thereby violated Section 458.331(1)(h) and (x), Florida Statutes. /1
Competent and substantial evidence was offered herein to establish that the Respondent aided and assisted Hipolito Barreiro, an unlicensed individual, in the unlicensed practice of medicine and failed to report such unlicensed practice to the Board of Medical Examiners in violation of Sections 458.331(1)(g) and (w) , Florida Statutes. Specifically, evidence reveals that during the period January 15, 1981, and December 1982, Barreiro inserted an intrauterine contraceptive device into Carmen Moses' cervix; during July 1982, Barreiro gave Patricia Humbert an injection and performed an abortion; during September 1982, Barreiro performed a gynecological examination on Etta Annette Brown to determine the status of her pregnancy; and during December 1982, Respondent, inter alia, performed a vaginal examination on Debra Plez, gave her a prescription, placed an IV in Plez's arm and performed an abortion on her. Additionally, the evidence clearly shows that Respondent knowingly assisted Barreiro in the unlicensed practice of medicine by signing patient's charts as the physician performing the abortion when, in fact, the abortions were performed by Barreiro. Based thereon, and the fact that Barreiro admitted to Roger Stefins that he knew that Barreiro was not licensed to practice medicine in Florida, forces the conclusion that he aided and assisted Barreiro in the unlicensed practice of medicine in violation of Section 458.331(1)(f), Florida Statutes, and unlawfully delegated professional responsibilities to Barreiro in violation of Section 458.331(1)(w), Florida Statutes.
Competent and substantial evidence was offered herein to establish that Respondent's treatment of Yvonne Bruno fell below minimally acceptable standards of care, skill and treatment as recognized by reasonably prudent similar physicians as being acceptable under similar conditions and circumstances. Specifically, Respondent lists the date for Bruno's abortion as being performed on May 9, 1982, when, in fact, it was performed on May 8, 1982. Next, Respondent lists the pregnancy time as 12 weeks when the fetal parts removed by Dr. Ramos revealed a pregnancy which then had a term of approximately
17 to 18 weeks. (TR pages 332-334) Next, under complications, Respondent noted that "complications: after aspirations with vacuum, the use of curette reveals perforation of uterus. We stop the operation and the patient is taken to the hospital." A cursory reading of this would indicate that the operation was terminated before completion and the patient was immediately taken to the hospital. However, that statement is false inasmuch as Bruno went to the hospital the day after the abortion was performed when it is clear that Respondent completed the operation knowing that Ms. Bruno's uterus was perforated during the course of the abortion. That being so, Respondent's failure to transfer Bruno to the hospital for treatment when he knew her uterus was perforated, fell below minimally acceptable standards of care, skill and treatment as recognized by reasonably similar prudent physicians under similar facts and circumstances. Thereafter, Respondent failed to provide Bruno post- abortion care which complied with minimally acceptable standards of care, skill and treatment. As noted in the fact section of this Recommended Order, Ms. Bruno experienced severe abdominal pain which persisted from the moment she left the recovery room and, despite this, she was given only minimal observation at the clinic by Respondent. While at the clinic, no one took her blood pressure, pulse or respiration rates. All of the experts in their testimony revealed that a patient, as Ms. Bruno, who complains of abdominal pain immediately following an abortion should be observed until that pain either ceases or the pain is dealt with.. Such monitoring should last for up to several hours. Respondent's failure to properly monitor Bruno's condition amounts to a violation of Section 458.331(1)(t), Florida Statutes. Based thereon, Respondent's conduct amounted to a failure to conform to prevailing standards of treatment in the medical community, as testified to by Doctors Ramos, McLeod and Ghali, and Respondent thereby violated Section 458.331(1)(l) , Florida Statutes.
Based on the foregoing findings of fact and conclusions of law, it is hereby recommended that the Respondent's physician license number ME 0034228 shall be suspended for a period of two years and a civil penalty of $2000 shall be imposed.
RECOMMENDED this 12th day of July, 1985, in Tallahassee, Florida.
JAMES E. BRADWELL
Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 12th day of July, 1985.
ENDNOTE
/1 Respondent offered mitigation testimony through Megaly Lorenzo, which was considered by the undersigned in preparation of this Recommended Order.
COPIES FURNISHED:
Dorothy Faircloth Executive Director
Board of Medical Examiners
130 North Monroe Street Tallahassee, Florida 32301
Stephanie Daniel, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Harold Braxton, Esquire
45 S.W. 36 Court Miami, Florida 33135
| Issue Date | Proceedings |
|---|---|
| Jul. 12, 1985 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Nov. 10, 1986 | Agency Final Order | |
| Jul. 12, 1985 | Recommended Order | Recommend two-year suspension and fine for Medical Doctor who aided unlicensed practice and did not hospitalize at-risk patient. |
