STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL )
REGULATION, )
)
Petitioner, )
)
vs. ) CASE NO. 83-3977
)
JOSE ANTONIO POUTOU, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to written, notice a formal hearing was held in, this case before Larry J. Sartin, duly designated Hearing Officer of the Division of Administrative Hearings, on December 4, 1984, in Miami, Florida.
APPEARANCES
For Petitioner: Joseph W. Lawrence, II,
Chief Attorney
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Jorge Sibila, Esquire
2751 Coral Way
Miami, Florida 33145 BACKGROUND
On July 27, 1983, the Petitioner, the Department of Professional Regulation, filed an Administrative Complaint charging the Respondent Jose Antonio Poutou, M.D., with: (1) exercising influence on a patient or client in such a manner as to exploit the patient or client for financial gain in violation of Section 458.331(1)(o), Florida Statutes; (2) 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 in violation of Section 458.331(1)(l), Florida Statutes; and, (3) committing gross or repeated malpractice or the failure to practice medicine with the level of care, skill and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances in violation of Section 458.331(1)(t), Florida Statutes.
On October 5, 1983, the Petitioner filed a second Administrative Complaint in which the Respondent was charged with having been convicted or found guilty, regardless of adjudication, of a crime which directly relates to the practice of medicine or to the ability to practice medicine in violation of Section 458.331(1)(c), Florida Statutes.
The Respondent disputed the allegations of fact contained in both complaints and requested a formal hearing to contest the charges pursuant to Section 120.57(1), Florida Statutes (1981). Pursuant to the Respondent's requests, the matter was referred to the Division of Administrative Hearings by letter dated December 20, 1983. The case was initially assigned to Sharyn L. Smith. The case was subsequently assigned to Michael M. Parrish. On November 29, 1984, the case was transferred to the undersigned.
At the final hearing, Petitioner presented the testimony of John Handwerker, M.D., who testified as an expert in family and internal medicine. It also offered a certification of licensure of the Respondent (Petitioner's Exhibit 1), a certified copy of the criminal court records at issue (Petitioner's Exhibit 2), and the deposition testimony of the Respondent (Petitioner's Exhibit 3); all were received into evidence.
The Respondent testified on his own behalf and presented the testimony of Lazaro Gonzalez. The Respondent also offered letters of recommendation from business associates and acquaintances (Respondent's Exhibit 1), which were received into evidence.
The parties have submitted proposed findings of fact pursuant to Section 120.57(1)(b)4., Florida Statutes (1983). 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.
The Petitioner and Respondent both proposed several findings of fact with regard to Dr. Handwerker's qualifications. Dr. Handwerker's qualifications, while relevant as to the weight to be given his testimony, are not appropriate "findings of fact" and have, therefore, not been included in this Recommended Order.
ISSUES
The issue to be decided is whether disciplinary action should be taken against the Respondent's license as a medical doctor for the alleged violations of Chapter 458, Florida Statutes (1983), as set forth in the Administrative Complaints?
FINDINGS OF FACT
The Respondent is licensed as a medical doctor with the State of Florida, Board of Medical Examiners. The license, Number 28366, was first issued on February 11, 1976. The Respondent was licensed at all times relevant to this proceeding.
October 5, 1983 Complaint.
On or about July 7, 1982, the State Attorney of the Eleventh Judicial Circuit filed a ten (10) count Information against the Respondent. In the information it was alleged that the Respondent knowingly and unlawfully filed, attempted to file or aided and abetted in the filing of claims for services to recipients of state or federally funded assistance program benefits (the Florida Medicaid Program) in violation of Section 409.325, Florida Statutes. The services, according to the Information, were never rendered.
On April 18, 1983, the State of Florida nolle prossed Counts 3 and 4 of the Information. On June 30, 1983, the State nolle prossed Counts 1, 2, 5, 7 and 9. The same day, the Respondent withdrew his original plea and plead guilt to the remaining counts: 6, 8 and 10 of the Information.
As a result of the Respondent's guilty plea, he was found guilty on counts 6, 8 and 10 and adjudication was withheld. The Respondent was placed on probation for one (1) year and was required to repay $3,500.00 to the Florida Medicaid Program.
The Respondent completed his probation, which was terminated early by the court, and made restitution to the Florida Medicaid Program.
The Respondent stipulated that he plead guilty to Counts 6, 8 and 10 of the Information, that adjudication ways withheld and that the case was disposed of in the manner described above.
According to the Respondent, he plead guilty on the advice of this counsel and as a matter of convenience (to himself and not "to all parties" as suggested by the Respondent in his proposed findings of fact). He did so despite his belief that he was not guilty. The Respondent's proposed finding of fact that his attorney never advised him that he could be in violation of Section 458.331(1)(c), Florida Statutes, irrelevant.
July 27, 1983 Complaint.
On March 24, 1981, the Respondent saw Ana Gonzalez as a patient in his office. Ms. Gonzalez was thirteen years old at the time of her first visit (Ms. Gonzalez's date of birth was incorrectly listed as "8-7-82" in the Respondent's records). Ms. Gonzalez, according to the Respondent's record of Ms. Gonzalez's visits (hereinafter referred to as the "Patient Records") complained of "pain of mild intensity on lower left quadrand [sic], inradiating [sic] to right lower quadrant and left lumbar fossa." The Patient Records, which were all in the same handwriting, 1/ also indicate that Ms. Gonzalez had low back pain, dark urine which looked like blood and a fever of 100.4 degrees. A physical examination of Ms. Gonzalez found nothing abnormal except pain in both lower quadrants of the abdomen and the left lumbar fossa of the back.
The Respondent made a probable diagnosis of pyelonephritis and ordered a SMAC 26, a Complete Blood Count ("C.B.C."), an urinalysis, an E.K.G. and a chest x-ray. The Petitioner has proposed a finding of fact that the chest x-ray and the E.K.G. were not referred to in the Patient Records. This proposed finding is incorrect. The Respondent did, however, order a kidney, urethra and bladder x-ray ("K.U.B.") which was not recorded in the Patient Records. The Respondent also prescribed an antibiotic.
The results of the E.K.G. and the chest x-ray are not noted in the Patient Records; nor does the E.K.G. print-out include any findings. The SMAC
26 showed nothing abnormal. The C.B.C. also showed nothing abnormal and the
K.U.B. was negative. Finally, the urinalysis showed that the patient's urine was yellow, clear and contained no blood.
The charges for the first visit were $30.00 for the examination,
$182.00 for the SMAC 26 (charged at $7.00 per 26 procedures), $6.00 for the urinalysis, $10.00 for the C.B.C., $40.00 for the chest x-ray and $40.00 for the
E.K.G. No charge was made for the K.U.B.
The patient was next seen by the Respondent on March 31, 1981 (erroneously reported as March 31, 1982 in the Patient Records). The Petitioner's proposed finding of fact that the Patient Records were kept in the same pen is therefore incorrect. The Patient Records indicate the following: "The patient is feeling a little better of pain. No fever. Persist urine dark."
The Patient Records do not indicate that Ms. Gonzalez was examined on this visit. The Respondent continued the antibiotic and ordered the following tests: a C.B.C., a K.U.B. and an intravenous pyelogram ("I.V.P."). The I.V.P. was reported as negative in the Patient Records. The C.B.C. again found no abnormalities. The K.U.B., as testified to by the Respondent, was also negative. The Respondent testified that he ordered another K.U.B. on this visit because he again found blood in the patient's urine and because he believed that you can never tell when a test will result in a positive finding.
The Petitioner has proposed the following finding of fact with regard to the March 31, 1981 visit:
Again, the tests results obtained from the laboratory show that the urine is not discolored and that the urine does not contain blood, in contradiction with the handwritten medical record of the Respondent.
Although this proposed finding is correct with regard to tests performed on the March 24, 1981 visit, no urine test was performed on the March 31, 1981 visit.
The charges for the March 31, 1981, visit included $30.00 for the examination, $10.00 for the C.B.C., $40.00 for the K.U.B. and $80.00 for the I.V.P.
The third visit by Ms. Gonzalez was on April 7, 1981. On this visit, Ms. Gonzalez was feeling much better (the "pain was very mild"), but the Respondent determined there was still blood in her urine. The Patient Records again do not indicate the results of any physical examination.
The Respondent ordered an urinalysis which found that her urine was yellow. Although the Respondent testified in his deposition that the Patient Records for the April 7, 1981 visit were complete, billing records show that a charge for an I.V.P. was made for April 7, 1981 which was not recorded in the Patient Records. The Respondent admitted in his deposition that no I.V.P. was performed and stated that the charge for $80.00 was a mistake. The Respondent stated that he did perform a K.U.B. or I.V.P. on this visit because it was too soon after the last K.U.B. and I.V.P. tests. Instead of an I.V.P., the Respondent testified in his deposition that Ms. Gonzalez received physiotherapy for which she should have been charged only $20.00. The physiotherapy was ordered because of the patient's complaints of lower back pain and consisted of heat treatment/ultrasound.
Petitioner, in its proposed findings of fact, indicates that the Respondent took Ms. Gonzalez, off the antibiotic he had prescribed earlier at the April 7, 1981 visit, citing "(Depo., page 20)." This proposed finding is not supported by the record.
Other charges for the April 7, 1981, visit included $30.00 for the examination and $6.00 for the urinalysis.
The next visit by Ms. Gonzalez was on April 14, 1981. The Patient Records do not indicate Ms. Gonzalez's condition or that an examination was performed. The Patient Records only indicate that the Respondent suggested hospitalization of Ms. Gonzalez so that more tests could be made and that her father refused.
The Respondent ordered a K.U.B. (which was negative) and a SMAC 26 (which found no abnormalities). The antibiotic was also changed.
The charges for this visit included $30.00 for the visit, $40.00 for the K.U.B. and $182.00 ($7.00 per 26 procedures) for the SMAC 26. Again the bill included a charge of $80.00 for an I.V.P. which, according to the Respondent, was a mistake in billing. The Respondent actually performed physiotherapy which should have resulted in a $20.00 charge.
The final visit occurred on April 20, 1981. The Patient Records for this visit indicated the following:
I insisted some UROLOGY must consultate this patient and she refused to see another Doctor and culture and sensitivity. She says she does not want to go to the rest room.
She decides pick up the urine. I decide another I.V.P. because persist a mild hematuria [blood].
Mr. Gonzalez again refused to admit his daughter to a hospital as suggested by Respondent. The Respondent recommended hospitalization because his tests were not finding anything and he therefore wanted to run a kidney scan.
There is no indication in the Patient Records as to whether an examination was performed.
The Respondent ordered a K.U.B., an I.V.P. and a C.B.C. The results of these tests are not recorded in the Patient Records but the Respondent has testified that they were negative.
On this visit the Respondent indicated his diagnosis was pyelonephritis, which he described as "kidney infection." Charges for this visit were $30.00 for the examination, $40.00 for the K.U.B., $80.00 for the
I.V.P. and $10.00 for the C.B.C.
Pyelonephritis is an inflammatory reaction of the kidney involving the kidney tissue and the pelvis of the kidney. It is usually accompanied by severe toxicity, a temperature for a child the age of Ms. Gonzalez of 104 to 105 degrees and extreme chills. It is a serious infection.
The diagnosis of pyelonephritis on March 24, 1981 and April 20, 1981, by the Respondent was not medically justified. Ms. Gonzalez did not have any of the symptoms normally associated with pyelonephritis. The results of all of the tests performed by the laboratory 2/ and the Respondent were negative. Laboratory test results conclusively showed that Ms. Gonzalez's urine was yellow, and contained no blood. Additionally, the Respondent should have performed a urine culture, a blood culture and a sensitivity test before
concluding that the patient was suffering from pyelonephritis. The cultures would have determined if there was an organism present and, if so, what type. The sensitivity test would have shown what the organism was sensitive to. None of these tests were performed.
Most of the tests ordered by the Respondent were also not medically justified. The only tests which were clearly medically justified were the SMAC 26, C.B.C. and the urinalysis ordered on March 24, 1981. Most of the remaining tests were not medically justified as hereinafter discussed.
The E.K.G. performed by the Respondent on March 24, 1981, was not medically justified. The Respondent indicated that he ordered an E.K.G. because he was looking for valvular problems with Ms. Gonzalez's heart. An E.K.G., however, only, shows the electrical activity of the heart. The Respondent also testified that the E.K.G. was performed because he suspected a kidney problem. According to the Respondent, if there was a problem with Ms. Gonzalez's kidneys, it could have affected her E.K.G., especially in light of her age. No problem was found according to the Respondent.
The chest x-ray performed on the March 24, 1981 visit was not medically justified. This test resulted in exposure of Ms. Gonzalez to x-rays which could be harmful to her.
The Respondent, based upon his deposition testimony, believes that a chest x-ray should be taken of anyone who comes to his office as a patient and has insurance. With regard to Ms. Gonzalez, he indicated that her parents requested the chest x-ray but admitted there was no medical cause for her to receive a chest x-ray.
The K.U.B. tests performed on March 24, 1981, March 31, 1981, April 14, 1981 and April 20, 1981 and the I.V.P. tests performed on March 31, 1981 and April 20, 1981 were not medically justified. These tests also resulted in exposure of Ms. Gonzalez to x-rays which could be harmful to her; especially the
I.V.P. test which has six to seven times the radiation level of a K.U.B. The
I.V.P. was also a dangerous procedure because it is an invasion procedure (the introduction of a foreign substance to the body). Even the Respondent must have realized the possible problem with the I.V.P. since he indicated that this test was not performed on April 7, 1981, because it was too soon after the test performed on March 31, 1981.
The second SMAC 26 test, performed on April 14, 1981 was not medically justified. The test, according to the Respondent, was performed because the blood in Ms. Gonzalez's urine persisted. The evidence clearly shows that there was no blood in her urine, however.
A SMAC 26 is a single laboratory procedure whereby one blood sample is divided into 26 parts (or some other number of parts) which are diagnosed or read by a machine at the same time. It is not 26 separate tests; it is a single automated test. The method by which the Respondent billed for the SMAC 26 tests performed on March 24, 1981 and April 14, 1981, (charging $7.00 for each of 26 tests) was not justified.
The Respondent billed for the S4AC 26, which gas performed by Central Medical Laboratory, because he believed that the insurance company would pay what he hoped to receive for the test: $60.00-$80.00. If he had only billed
$60.00 for the test he stated that he would only have received $6.00 to $10.00 from the insurance company.
The Petitioner has proposed a finding that the SMAC 26 billing was "outrageously high." The evidence supports a finding that the charge was excessive.
Finally, the C.B.C. tests of March 31 1981 and April `20, 1981 and the physiotherapy performed on April 7, 1981 and April 14, 1981 were not medically justified.
Dr. Handwerker's testimony was consistent with the findings in this Recommended Order with regard to the lack of medical justification for most of the tests. The Respondent stated that he agreed in part and disagreed in part with Dr. Handwerker's testimony. When asked to identify those areas of Dr. Handwerker's testimony he disagreed with, the Respondent unsuccessfully attempted to rebut Dr. Handwerker's testimony with regard to the E.K.G. and chest x-ray and with the fact that the tests were repeated to often. 3/ The Respondent did not attempt to rebut any other part of Dr. Handwerker's testimony, which was based upon his examination of the Patient Records and the Respondent's deposition (she did not examine Ms. Gonzalez).
Based upon the foregoing, it is clear that the Respondent failed to practice medicine in conformance with the generally accepted and prevailing standards of medicine in the medical community. The Respondent also failed to, practice medicine with the level of care, skill and treatment recognized by a reasonably prudent similar physician as being acceptable under similar circumstances and conditions.
The father of Ms. Gonzalez testified on behalf of the Respondent. Mr. Gonzalez stated that he was satisfied with the Respondent's medical care of the Gonzalez family and that he would continue to retain the Respondent. Letters submitted by the Respondent also indicated that friends, associates and his pastor believe the Respondent is honest, experienced, qualified and of high moral and ethical standards.
Although the Respondent testified that he had done the best he could do for Ms. Gonzalez, the unrebutted testimony supports a conclusion that his best was not good enough.
Finally, the Respondent's testimony to the effect that he had not intended to exercise influence over Ms. Gonzalez or to deceive her in his medical treatment of her is not believable in light of the facts.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction of the parties to, and the subject matter of, this proceeding. Section 120.57(1), Florida Statutes (1983).
Section 458.331(2), Florida Statutes (1983), authorizes the Board of Medical Examiners to enter an order imposing one or more of the penalties specified in Section 458.331(2) if the Board finds a person guilty of any of the acts set forth in Section 458.331(1), Florida Statutes (1983). The Respondent has been charged with having committed four of those acts.
The penalties which may be imposed include one or more of the following:
Refusal to certify to the department an application for licensure.
Revocation or suspension of a license.
Restriction of practice.
Imposition of an administrative fine not to exceed $1,000 for each count or separate offense.
Issuance of a reprimand.
Placement of the physician on probation for a period of time and subject to such conditions as the board may specify, including, but not limited to, requiring the physician to submit to treatment, to attend continuing education courses, to submit to reexamination, or to work under the supervision of another physician.
Section 458.331(2), Florida Statutes (1983).
October 5, 1983 Complaint.
In the Administrative Complaint dated October 5, 1983, the Respondent was charged with having committed the act prohibited by Section 458.331(1)(c), Florida Statutes (1983):
Being convicted or found guilty, regardless of adjudication, of a crime in any jurisdiction to the practice of medicine or to the ability to practice medicine. Any plea of nolo contendere shall be considered a conviction for purposes of this chapter.
It is not disputed that the Respondent was found guilty of three counts of knowingly and unlawfully filing, attempting to file or aiding and abetting in the filing of claims for services to recipients of state or federally funded assistance program benefits in violation of Section 409.325, Florida Statutes. The fact that adjudication was withheld is irrelevant under Section 458.331(1)(c), Florida Statutes (1983).
The Respondent has not disputed his conviction but has attempted to show that the only reason he plead guilty was because the attorney who represented him at that time recommended he do so and so that he could resolve the dispute in the most convenient manner. In determing whether Section 458.331(1)(c), Florida Statutes (1983), has been violated, the Respondent's purported reasons for pleading guilty are irrelevant.
The Respondent has also argued that he was unaware that his plea could result in the loss of his medical license. The record only shows that the Respondent was not informed by his attorney of the possible loss of his medical license; the Respondent never stated that he did not know that he might be subject to sanctions. Even if the Respondent was unaware of the possible sanction he might face, such lack of knowledge would be irrelevant. Under the
law, the Respondent has committed a crime and must face the consequences of his act even if he did not know specifically what those consequences might be.
The Respondent was clearly found guilty of a crime directly relating to the practice of medicine in violation of Section 458.331(1)(c), Florida Statutes (1983).
July 27, 1983 Complaint.
In the Administrative Complaint date July 27, 1983, the Respondent was charged with having committed the acts prohibited by Section 458.331(1)(l), (o) and (t), Florida Statutes (1983).
Section 458.331(1)(l), Florida Statutes (1983), prohibits the following act:
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 of trick fails to conform to the generally prevailing standards of treatment in the medical community.
The Respondent, over the course of his treatment of Ms. Gonzalez, ordered numerous tests. Those tests were ordered because of a diagnosis of pyelonephritis which was in turn based soley upon the Respondent's conclusion that there was blood in Ms. Gonzalez1s urine. The Respondent's diagnosis was, however, without medical justification; Ms. Gonzalez's urine was in fact clear and she did not have any of the symptoms of pyelonephritis. The tests ordered by the, Respondent were therefore also without medical justification. This conclusion is further supported by the fact that Ms. Gonzalez appeared to be getting better with each visit since the Patient Records indicated with each subsequent visit that she was suffering less pain.
Despite the lack of medical justification, Respondent ordered a number of test performed on each of the five visit Ms. Gonzales, made to the Respondent's office. All of the tests were billed to the Gonzalez family. Additionally, the Respondent billed for two I.V.P. tests which were not performed instead of charging for physiotherapy. Finally, the Respondent employed a method of billing for the SMAC 26 tests which was not justified.
Section 458.331(1)(o), Florida Statutes (1983), prohibits the following act:
Exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party which shall include, but not limited to, the promoting or selling of services, goods, appliances, or drugs and the promoting or advertising on
any prescription form of a community pharmacy unless the form shall also state "This prescription may be filled at any pharmacy of your choice."
The Respondent performed or ordered the performance of tests which were not medically justified which could have resulted in financial gain to the Respondent. Thus the Respondent promoted or sold services for his financial gain by exercising influence on Ms. Gonzalez in such a manner as to exploit her or her family in violation of Section 458.331(1)(o), Florida Statutes (1983). The Respondent argues that no influence was exercised over the patient or her family. In support of this argument it is suggested that Ms. Gonzalez's parents brought her to the Respondent "out of their own volition," that they were not coerced to accept the treatment, that they did not have to return and that they were not "influenced that these tests would take the child's pain away." These suggested conclusions ignore reality. The Respondent is and holds himself out as a medical doctor. Ms. Gonzalez and her parents justifiably relied upon the Respondent's diagnosis and proposed treatment. While the Gonzalez family and Ms. Gonzalez may not have been forced to follow the Respondent's orders with regard to Ms. Gonzalez's treatment, they were clearly influenced by the fact that the Respondent, a licensed medical doctor whom they justifiably looked to for help, recommended the course of treatment and testing followed.
Finally, Section 458.338(1)(t), Florida Statutes (1983), prohibits the following act:
Gross or repeated malpractice or the failure to practice medicine with the level of care, skill, and treatment which is recognized by a resonably prudent similar physician as being acceptable under similar conditions and circumstances. The board shall give great weight to the provisions of
s. 768.45 when enforcing this paragraph.
The facts in this case demonstrate that the Respondent failed to practice medicine with the level of care, skill and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. The Respondent's treatment of Ms. Gonzalez was based primarily upon his conclusion that there was blood in her urine. This conclusion is totally unfounded based upon the results of the urinalysis test of March 24, 1981 and April 7, 1981. The chest x-ray and E.K.G. were not medically justified even if the Respondent's diagnosis had been correct.
Based on the foregoing Findings of Fact and Conclusions RECOMMENDED:
That Respondent be found guilty of violating Section 458.331(1)(c), Florida Statutes (1983), by being found guilty, regardless of adjudication, of a crime in any jurisdiction which directly relates to the practice of medicine or to the ability to practice medicine. It is further
RECOMMENDED:
That Respondents be found guilty of violating Section 458.331(1)(l), Florida Statutes (1983), by 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. It is further
RECOMMENDED:
That Respondent be found guilty of violating Section 458.331(1)(o), Florida Statutes (1983), by exercising influence on a patient or client in such a manner as to exploit the patient or client for financial gain of himself, as a licensee. It is further
RECOMMENDED:
That Respondent be found guilty of violating Section 458.331(1)(t), Florida Statutes (1983), by failing to practice medicine with the level of care, skill and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. It is further
RECOMMENDED:
That the Respondent's medical license be suspended for a period of one (1) year and that the Respondent be placed on probation for a period of three (3) years, upon reinstatement of his license, subject to such conditions and terms of monitoring and continuing medical education as may then be prescribed by the Board of Medical Examiners.
DONE and ORDERED this 22nd day of February, 1985, in Tallahassee, Florida.
LARRY J. SARTIN
Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
FILED with the Clerk of the Division of Administrative Hearings this 22nd day of February, 1985.
ENDNOTES
1/ A pen with blue ink was used for most of the entries in the Patient Records. A pen with black ink was used for one entry.
2/ The tests clearly performed at a laboratory--Central Medical Laboratory-- included the urinalysis, C.B.C. and SMAC 26 tests.
3/ The Respondent was found to have provided unnecessary services and charged excessive fees by the Dade County Medical Association. The Petitioner was required to obtain additional continuing medical education by the Dade County Medical Association as a result of his treatment of Ms. Gonzalez.
COPIES FURNISHED:
Dorothy Faircloth, Executive Board Director
Department of Professional Regulation Board of Medical Examiners
130 North Monroe Street Tallahassee, Florida
Joseph W. Lawrence, II Chief Attorney
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Mr. Fred Roche, Secretary
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Jorge Sibila, Esquire 2751 Coral Way
Miami, Florida 33145
Salvatore Caprino, General Counsel Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| May 22, 1990 | Final Order filed. |
| Feb. 22, 1985 | Recommended Order sent out. CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Jun. 17, 1985 | Agency Final Order | |
| Feb. 22, 1985 | Recommended Order | Respondent found guilty of crime related to practice, exploited patient, used trick or scheme and failed to use care of prudent similar physician. |
DEPARTMENT OF HEALTH, BOARD OF NURSING vs KARL DEREK NICOLAEV, R.N., 83-003977 (1983)
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DEPARTMENT OF HEALTH, BOARD OF NURSING vs DEBORAH KETZ, 83-003977 (1983)
DEPARTMENT OF HEALTH, BOARD OF NURSING vs MARNIE LYNN WILSON, R.N., 83-003977 (1983)
