STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

KEITH ANTHONY GRESHAM, )

)

Petitioner, )

)

vs. ) Case No. 85-0726

) BOARD OF MEDICAL EXAMINERS, )

)

Respondent. )

)

RECOMMENDED ORDER

Final hearing in the above-styled case was held in Orlando, Florida, on September 22, 1986, before Mary Clark, Hearing Officer of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Robert W. Blunt, Esquire

1516 East Hillcrest Street Suite 201, Hillcrest Plaza Orlando, FL 32803

For Respondent: M. Catherine Lannon, Esquire

Assistant Attorney General Department of Legal Affairs Room LL-04, The Capitol Tallahassee, FL 32399-1050

BACKGROUND AND PROCEDURAL MATTERS

This proceeding commenced with Petitioner's request for a formal hearing after the Board of Medical Examiners denied his application for licensure by endorsement.

At the hearing Petitioner testified in his own behalf and presented two additional witnesses: Neil Simon, Esq., counsel for Ross University; and M. Saleem Jeewa, M.D. Three exhibits were admitted; the third was admitted over the objection of Respondent as to authenticity.

Respondent called one witness, Miriam H. Cauthan, custodian of records at Polk General Hospital. Respondent's two composite exhibits, its application file and Polk General Hospital's file on Keith Gresham, were admitted without objection.

Respondent's oral motion to remove the Department of Professional Regulation from the caption of the case was granted. Likewise, the Petitioner's motion to amend paragraph 5 of his petition in order to allege licensure in Pennsylvania, rather than New York, was also granted.

Both parties submitted post-hearing proposed recommended orders and Petitioner submitted written closing argument. These have been carefully considered in the preparation of this recommended order, and specific rulings on the proposed findings of fact are found in the attached Appendix.

ISSUE

The issue in this proceeding is whether the Petitioner, Keith Gresham, M.D., is entitled to licensure by endorsement to practice medicine in the State of Florida. The Board's Order of Denial, dated January 9, 1985, states as grounds:

Your application and supporting documentation does [sic] not provide satisfactory information regarding your medical education. Additionally, there are discrepancies in the documentation which has been provided.

The issues at the final hearing focused on the clinical clerkships undertaken by Dr. Gresham at Polk General Hospital in Bartow, Florida in 1981. Discrepancies in dates of those clerkships found in file documents submitted to the Board, and the absence of a signature on one clerkship evaluation raised the question of the applicant's credibility and candor and whether and when those clerkships actually occurred. Another issue was the efficacy and validity of the clerkships at Polk General Hospital as a whole. (See characterization of issues in opening statement of counsel for Petitioner, transcript, P. 6,

1. Counsel for Respondent concurred with the characterization, (transcript, P. 8.)

   
   

   FINDINGS OF FACT

   1. Keith Gresham attended medical school at Universidad Central de Este in the Dominican Republic from September 1978 through December 1979. He transferred to Ross University (formerly University of Dominica) in Dominica, British West Indies in February 1980, and received his medical degree, from that institution in June 1982.

      
      

   2. He has been licensed to practice medicine in Pennsylvania since September 1983. He has completed a three- year residency in OB/GYN at Jersey City Medical Center in New Jersey.

      
      

   3. Keith Gresham applied to the Florida Board of Medical Examiners for licensure by endorsement in November 1983. Part of the documentation required to support his application was documentation of the various clinical clerkships which comprised a portion of his medical education.

      
      

   4. Ross University has an office in New York City. Many of its students engage in clerkships in hospitals in the Northeast. Because his home was in Orlando, Keith Gresham made arrangements for some clerkships in Florida hospitals. Ross University approved those arrangements and maintained files on the evaluations made at the hospitals.

      
      

   5. These evaluations and other documentation of the clinical clerkships undertaken by Keith Gresham at Polk General Hospital in 1981 are hopelessly confused. Dr. Gresham was engaged in clinical clerkships at Orlando Regional Medical Center (ORMC) prior to his service at Polk General. There is clear evidence in the file of the Board of Medical Examiners that the final clerkship at ORMC was completed on May 29, 1981. (Respondent's Composite Exhibit #l)

      
      

   6. There is conflicting evidence in the Board~s file and throughout the record of this proceeding as to when the clerkships at Polk General commenced:

      
      

      1. An evaluation of Gresham's OB/GYN clerkship, signed by

         M. C. Monreal, M.D. on 8/7/81, shows that the period was from May 18 to July 27. This evaluation is on a Polk County form. (Petitioner's Exhibit #1)

         
         

      2. Another evaluation of the same OB/GYN clerkship is on a University of Dominica form, is signed by Norberto de Guzman, M.D., and indicates that the dates of clerkship were May: 18 to July 31.

         
         

      3. A notation on the Polk General Hospital file folder on Keith Gresham indicates that the starting date was June 9. (Transcript, P. 117)

         
         

      4. The first chart entry by Keith Gresham on a patient's chart at Polk General is June 9. (transcript, P. 118

         
         

      5. At the final hearing Keith Gresham testified that he commenced his clerkship at Polk County General Hospital at the beginning of June, 1981. (transcript, pp. 15, 134)

         
         

      6. On May 20, 1986, Keith Gresham wrote a letter to Miriam Cauthan, the custodian of records at Polk General, asking that she verify the dates of his clerkships for his application for a New Jersey license. His letter noted that his OB/GYN rotation was from "5/18/81-7/27/81." (Respondent's Exhibit #2)

      
      

   7. Dr. Gresham attempted to explain the discrepancies by testifying that, while he was supposed to start at Polk General on May 18, he decided to stay in Orlando for an additional two weeks. ORMC had a good teaching program and he was able to pick up some electives credit by finishing the month in Orlando.

      
      

   8. This explanation is belied by his letter of application for clerkship addressed to the Director of Medical Education at Polk General. The letter is dated May 19, 1981. An application form in the Polk General Hospital file for Keith Gresham states that the date requested for his rotation is "8/8/81." (Respondent's Exhibit #2)

      
      

   9. Dr. Gresham testified that the reason he put incorrect dates in his letter to Miriam Cauthan was that he knew that those were the dates shown in her file and he did not expect her to change what was written in her records, even though the dates were not correct. That misguided effort not to confuse matters utterly backfired and only piqued Ms. Cauthan's suspicions about the records for this student. (transcript, P. 105)

      
      

   10. There are other, more minor discrepancies in the clerkship dates. After his OB/GYN experience, Keith Gresham rotated immediately into a pediatrics clerkship at Polk General. The supervisor of that training, George Pilapel, M.D., completed two evaluation forms. The first, dated September 15, 1981, on Polk General Hospital stationary, indicates the dates of rotation were July 28-September 15. The second, dated September 17, 1981, on a University of Dominica School of Medicine form,

       states that the dates were August 3, 1981 to September 13 1981. Dr. Gresham could not explain the discrepancies in those two forms. He testified that the dates on the University form were correct and he had not seen the hospital's version of the evaluation.

       
       

   11. A psychiatry clerkship followed the pediatrics training for Keith Gresham at Polk General. The single evaluation is on a University of Dominica form. It is dated 10/20/81 and the name of the evaluator is given as Dr. Saleem Jeewa. The dates of the clerkship stated on the form are September 14, 1981 to October 25, 1981.

       
       

   12. During the application process, when asked to authenticate the form, Dr. Jeewa noted that he had not signed it and that the typewritten name under the signature line was not how he would address himself. He wrote a letter to Miriam Cauthan on October 1, 1984, advising her of his concerns that the evaluation was "highly irregular." (Respondent's Exhibit #2)

       
       

   13. At the final hearing, when confronted with the original of the evaluation form obtained from the University files, Dr. Jeewa identified the handwriting on the evaluation (numerica scores and the date) as his own. Miriam Cauthan found documentation that Keith Gresham was in the psychiatry rotation as there are notations by him in psychiatric patient files from 9/14/81 through 10/23/81.

       
       

   14. The file from Polk General on Keith Gresham was incomplete and until he furnished her with copies, Miriam Cauthan did not have the evaluations on the University forms for the OB/GYN and psychiatry clerkships. At the time that Gresham was at Polk General, the clerkship records were maintained by the hospital medical director, J. D. McPike, M.D. Keith Gresham's files were found by Miriam Cauthan in a locked file in Dr. McPike's office, along with those of other medical students whose files were subpoenaed by the U.S. Postal Authority in conjunction with an investigation of a degree-selling scheme involving Dr. McPike. At no time was it suggested that Keith Gresham's clerkships at Polk General were part of the fraud.

       
       

   15. The only reliable evidence in the record of this proceeding regarding the quality of the clerkships at Polk General Hospital is that the supervision of students was very loose. In her review of patient files to verify Keith Gresham's clerkships, Miriam Cauthan found numerous instances of OB/GYN

       entries signed by this student when he was not in the OB/GYN service. Students were allowed to sit in lectures on their own, whether or not the subject was the clerkship to which they were assigned at the time.

       
       

   16. Most revealing, however, was Dr. Jeewa's testimony as to his relationship to the medical students at Polk General.

       Dr. Jeewa was the Medical Director of the Peace River Center for Personal Development in Lakeland, Florida, a federally funded non-profit out-patient facility. During 1980, through part of 1982, Polk General Hospital did not have a full-time psychiatrist for its in-patient unit. Dr. Jeewa spent about 9 hours a week helping to care for the Polk General patients. He refused to characterize his relationship to the psychiatry clerks as "supervisor." Rather, the students would "stick around" while he was doing rounds and most would also come on a voluntary basis to the Peace River clinic once or twice a week. They would do initial histories and physical examinations of patients, but he didn't check them. Dr. Jeewa called the clerkship a "passing through" (transcript, P. 74) After the student felt they completed the appropriate number of weeks they would submit an evaluation form for him to sign. In Keith Gresham's case, he apparently filled out the form on October 20th, even before the clerkship was completed. He would sign whatever they gave him and would complete the numerical scores, but he never gave a negative evaluation. In Dr. Jeewa's opinion, the six weeks of rotation in psychiatry at Polk General was not worth the paper on which the evaluation was written. (transcript, P. 89)

       
       

   17. Neil S. Simon is General Counsel for Ross University. He brought files from the University's New York office given to him by the Registrar. He testified regarding the practices of the University relating to supervision of clerkships. He was not associated with Ross University when Keith Gresham was a student and his testimony regarding the relationship between the University and Polk General Hospital during that period was based on hearsay and conjecture.

       
       

   18. Keith Gresham clearly established his participation in three clerkships at Polk General Hospital sometime between May or June 1981, and the end of October 1981. Those clerkships were OB/GYN, Pediatrics and Psychiatry, in that order. He never established the precise dates that each began and terminated. The questions as to the source and authority for the various dates on the evaluations were never resolved.

   19. While Dr. Jeewa's identification of his own handwriting on the psychiatry evaluation form and testimony regarding psychiatric patient chart entries by Keith Gresham resolved any question as to his actual participation in that clerkship, the misgivings regarding the quality of that clerkship and the level of supervision at Polk General were only exacerbated by Dr. Jeewa. No other supervisors from the hospital were presented to counter his sweeping indictment of the program.

       
       

   20. The defects in documentation provided by Dr. Gresham appear to result from past carelessness by those responsible for his records (including himself) rather than outright fraud. However, the cloud on his credibility cannot be removed until the discrepancies have been adequately explained.

       
       

       CONCLUSIONS OF LAW

       
       

   21. The Division of Administrative Hearings has jurisdiction over the subject matter and parties to this proceeding. Section 120.57(1), F.S.

       
       

   22. An applicant for medical licensure by endorsement has the burden of demonstrating to the Board of Medical Examiners that he has met the qualifications for licensure in Sections

       458.311 and 458.313, F.S. "The board shall not . . . cause a license to be issued to a person it has deemed unqualified, until such time as it is satisfied that . . . such person is capable of safely engaging in the practice of medicine." Subsection 458.331(3), F.S.

       
       

   23. Failure to provide documentation to clear up discrepancies regarding one's medical education in an application for licensure by endorsement is an appropriate basis for the board's denial of that application. Maravel vs. Department of Professional Regulation, Board of Medical Examiners 11 FALW 2188 (1st DCA opinion filed October 14, 1986).

       
       

   24. Keith Gresham failed to meet his burden of proving entitlement to licensure by endorsement under Chapter 458, F.S.

       
       

   25. Petitioner argues that any deficiencies in his clinical training have been "cured" by his successful completion of a three-year residency in OB/GYN at Jersey City Medical Center. No evidence was produced to show that this was an "approved" residency as provided in Rule 21M-22 018(3)(d), F.A.C.

RECOMMENDATION

Based upon the foregoing, it is recommended that Keith' Gresham's application for licensure by endorsement be DENIED.

DONE and RECOMMENDED this 15th day of December, 1986, in Tallahassee, Florida.

Hearings

Hearings

MARY CLARK

Hearing Officer

Division of Administrative

The Oakland Building 2009 Apalachee Parkway

Tallahassee, FL 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative

this l5 day of December, 1986.

COPIES FURNISHED:

Robert W. Blunt, Esquire 1516 E. Hillcrest Street Suite 201, Hillcrest Plaza Orlando, FL 32803

M. Catherine Lannon, Esq. Assistant Attorney General Department of Legal Affairs Room LL-04, The Capitol Tallahassee, FL 32399-1050

Fred Roche, Secretary Department of Professional Regulation

130 N. Monroe Street Tallahassee, FL 32301

Dorothy Faircloth Executive Director

Board of Medical Examiners Department of Professional Regulation

130 N. Monroe Street Tallahassee, FL 32301

APPENDIX

The following constitutes my rulings on the proposed findings of fact submitted by the parties:

PETITIONER'S PROPOSED FINDINGS OF FACT

1-3. That Dr. Gresham participated in clerkships at Polk General is adopted as a finding

in paragraph #9.

1. Adopted in paragraph #4.

   
   

2. Rejected as addressed in conclusion of law #5.

   
   

3. Rejected as inconsistent with the weight of the evidence.

RESPONDENT 'S PROPOSED FINDINGS OF FACT

1-2. Adopted in part in paragraph #2. The details regarding the several appearances before the board are unnecessary.

1. Adopted in substance in paragraphs #4,

   5 and 6.

   
   

2. That Keith Gresham failed to meet his burden of proof is addressed in paragraph #10 and conclusion of law #4. The remainder of the proposed finding is unnecessary.

   
   

3. Adopted in part in paragraph #7 and 8, otherwise rejected as unnecessary.

   
   

4. Adopted in substance in paragraph #7.

6-7. Adopted in substance in paragraph #8.

8. Addressed in conclusion of law #5.

Docket for Case No: 85-000726

Orders for Case No: 85-000726