Judges: P. MICHAEL RUFF
Agency: Department of Health
Latest Update: Oct. 28, 1986
Summary: Petitioner trained with students enrolled in relevant residency program but was not enrolled in that residency program does not meet licensure standards.
86-1474.PDFSTATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
JAMES K. HESTER, )
)
Petitioner, )
)
vs. ) CASE NO. 86-1474
) DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF )
MEDICAL EXAMINERS, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to proper notice, this cause came on for formal hearing before P. Michael Ruff, duly designated Hearing Officer, in Tallahassee, Florida, on August 19, 1986. The appearances were as follows:
APPEARANCES
For Petitioner: James K. Hester, pro se
16 Cleveland Place
Palisades Park, New Jersey 07650
For Respondent: M. Catherine Lannon, Esquire
Assistant Attorney General Department of Legal Affairs Room LL-04, The Capitol
Tallahassee, Florida 32399-1050
This cause arose upon the Petitioner's submission of his application for licensure by endorsement as a medical doctor in the State of Florida. His application was denied on the basis that his supervised clinical training was not obtained in either a hospital affiliated with a medical school accredited by the Liaison Committee on Medical Education (LCME) or in a residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the specialty areas in which the clinical training was done. This is a requirement set forth in Rule 21M-22.018 (formerly 22M-22.18), Florida Administrative Code.
The Petitioner requested a formal hearing and the matter was ultimately referred to the Division of Administrative Hearings and the undersigned Hearing Officer. At the hearing the Petitioner presented one witness and three exhibits. The Respondent presented one witness and Composite Exhibits 1 and 2. The parties stipulated at the outset of the hearing that the clinical clerkship performed by the Petitioner at Englewood Hospital in internal medicine was an approved clerkship in compliance with Rule 21M-22.018.
At the conclusion of the hearing the parties requested a transcript and indicated they would file proposed findings of fact and conclusions of law. The
Respondent timely filed its proposed findings of fact and conclusions of law. These proposed findings of fact are treated in the Recommended Order and treated once again in the Appendix attached hereto and incorporated by reference herein.
The issue to be resolved herein concerns whether the Petitioner is eligible for licensure as a medical doctor in the State of Florida. The gravamen of that question concerns whether his supervised clinical training was obtained in a hospital affiliated with a medical school accredited by the LCME or in a residency program accredited by ACGME.
FINDINGS OF FACT
The Petitioner, James K. Hester, applied for licensure as a medical doctor in Florida. The Respondent is an agency of the State of Florida charged with administering and enforcing the statutory and regulatory standards by which physicians enter the practice of medicine in Florida as well as by which the practice of medicine by licensed physicians in Florida is regulated and enforced. The Petitioner's application was for licensure by endorsement. That application was denied on the basis that the Petitioner's supervised clinical training was not obtained in either a hospital affiliated with a medical school accredited by the LCME or in a residency program accredited by the ACGME in a specialty area in which the Petitioner's clinical training was done. This requirement is set forth in Rule 21M-22.018 (a substantial reenactment of former Rule 21M-22.18), Florida Administrative Code, the so-called "clerkship rule." The Petitioner's supervised clinical training at issue in this proceeding involved clerkships in internal medicine, surgery, obstetrics and gynecology, and pediatrics. The Petitioner performed the clerkships in 1983 and 1984. The parties have stipulated that the clinical clerkship performed by the Petitioner at Englewood Hospital in New Jersey in the area of internal medicine was an approved clerkship under the requirements of the above Rule. Therefore, the only clerkships at issue concern those in surgery, obstetrics and gynecology, and pediatrics, which were performed at Englewood Hospital by the Petitioner.
In determining which clerkships comply with the Rule, and thus which hospitals are affiliated with accredited medical schools in certain specialty areas and in determining which residency programs are accredited by the ACGME in specified specialty areas, the board commonly and customarily relies on a directory or compilation of accredited programs which depicts medical training programs on a nationwide basis which are accredited by the ACGME. This compilation is generally relied upon by professionals in the medical education field as well as by medical licensing regulatory agencies nationwide. Its compilations of accredited medical schools and affiliated hospitals and accredited residency programs are compiled by the ACGME which organization in turn is accepted as authoritative in determining such matters, as is depicted on the face of the above-cited Rule. 1/
Englewood Hospital is not affiliated with a medical school which is accredited by the liaison committee on medical education in the specialty areas in which the Petitioner's disputed clinical training was performed. The hospital does not have a residency program accredited by the ACGME in the specialty areas in which the Petitioner's clinical training was performed. Although residents training in a residency program of other hospitals in the area accredited by the ACGME rotated through Englewood Hospital and took training in the relevant specialty areas in which the Petitioner participated, the Petitioner was not a participant or enrolled member in those residency programs of the other hospitals whose residents trained in part at Englewood Hospital. Although the Petitioner participated in some of the clinical training
programs which residents affiliated with training programs at other hospitals participated in at Englewood, in addition to not being enrolled in residency training with those other hospitals and accredited programs, it was not shown he participated in all of the required "rotations" of those accredited training programs which full complement of rotations was the essential basis for the accreditation of those residency programs.
Although Englewood Hospital had a relationship with the unaccredited medical school from which Petitioner graduated and certified the completion of his clerkships at Englewood, the Petitioner's training was not certified by an accredited residency program or hospital, because the Petitioner and his medical school had no affiliation with those accredited hospitals and residency programs who happened to have participants training at Englewood. Thus the Petitioner's clerkships in the disputed specialty areas were not verified as to their completion by any hospital affiliated with an accredited medical school or whose residency program was accredited by the above organization. Englewood Hospital was not approved or accredited for training in surgery, obstetrics and gynecology, or pediatrics for the years 1983-1984 at issue, as clearly shown by Respondent's Exhibit 1 in evidence.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the subject matter of and the parties to this proceeding. Section 120.57, Florida Statutes.
Section 458.311, Florida Statutes, requires, in pertinent part, that an applicant for a medical license by examination must have completed a medical education. Section 458.313(1), Florida Statutes, in turn provides that all qualifications for licensure as set forth in the licensure by examination provisions also apply to applicants for licensure by endorsement.
Rule 21M-22.018 (formerly 21M-22.18), Florida Administrative Code, in effect at the time Petitioner's application was ruled upon required:
"Before any graduate of a medical school not accredited by the Liaison Committee on Medical Education...is admitted to take the written licensure examination or be licensed by endorsement, he or she must demonstrate (in addition to other requirements set forth in Chapter 458, F.S.) that the supervised clinical training received in the United States as part of the curriculum of the medical school, was obtained either in a hospital affiliated with a medical school accredited by the Liaison Committee on Medical Education or in a residency program accredited by the Accreditation Council for Graduate Medical Education in the specialty area in which the clinical training is being obtained."
This rule has been determined to be a proper delegation of legislative authority and a proper application of the medical board's special expertise in the interpretation of the statute it is responsible to implement, as well as being reasonably necessary in order for the board to fulfill its legislatively
mandated duties of determining fitness of applicants to practice medicine in the State. See Newcomer vs. Board of Medical Examiners (DOAH 85-2464R), 7 FALR 5225 (1985) and Villa vs. Board of Medical Examiners (DOAH 85-2861R), 7 FALR 5529 (1985). In these cases the rule has survived challenge on the theory, among others, that the Medical Board is entitled to look behind an applicant's medical degree to ascertain whether the recipient actually obtained a proper "medical education."
Under this Rule, there is a two part test to determine whether a recipient of a medical degree who applies for licensure in Florida has ever actually obtained an appropriate medical education justifying licensure in this State. The first test concerns whether the supervised clinical training a Petitioner underwent was obtained in a hospital affiliated with a medical school accredited by the LCME in the specialty area in which the clinical training is obtained. The above Findings of Fact and the evidence of record demonstrate that, although residents rotated through training at Englewood Hospital while participating in programs sponsored by hospitals which were affiliated with accredited medical schools, that Englewood Hospital was not shown to be affiliated with an accredited medical school accredited by the LCME in those specialty areas (other than internal medicine) in which the Petitioner obtained clinical training and for which areas he is seeking approval by the Respondent. The second test concerns whether the Petitioner performed a clerkship in a residency program accredited itself by the ACGME for the specialty areas in which he did his clinical training. That requirement is also not fulfilled by Petitioner. Although residents from a properly accredited residency program in the specialty areas with which Petitioner is concerned rotated through training at Englewood Hospital where Petitioner did his clerkships, Englewood Hospital, which was affiliated with Petitioner's medical school and at which he did his clerkships, did not itself have a residency program accredited by the ACGME in the relevant specialty areas and Petitioner was not enrolled in the accredited residency program or programs in which those residents training along with Petitioner at Englewood were themselves enrolled.
Finally, it is noted that the Rule requires that the training be part of the curriculum of the medical school from which an applicant graduated. The training received by the Petitioner as part of the curriculum of his medical school was received at Englewood Hospital and verified by Englewood Hospital, that is, its governing body. There is no evidence to demonstrate any relationship or affiliation between the hospitals affiliated with the accredited medical schools which sponsored the other residents at Englewood and the medical school from which the Petitioner graduated. There was no proof that the affiliated and accredited hospitals sent any verification or other documentation to the Petitioner's medical school verifying their involvement or oversight of Petitioner's training nor that those hospitals participated in any way in the curriculum of the medical school from which the Petitioner obtained his degree. It must be concluded, therefore, that Petitioner has not met his burden of establishing compliance with the above Rule and that he obtained a medical education acceptable for licensure in the State of Florida.
RECOMMENDATION
Having considered the foregoing Findings of Fact, Conclusions of Law, the evidence of record, and the candor and demeanor of the witnesses, it is, therefore
RECOMMENDED that a Final Order be entered by the Board of Medical Examiners denying the application of James K. Hester for licensure as a medical doctor in the State of Florida.
DONE and ORDERED this 28th day of October, 1986 in Tallahassee, Florida.
P. MICHAEL RUFF 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 28th day of October, 1986.
ENDNOTE
1/ Relevant portions of this directory were accepted into evidence as Respondent's Exhibits 1 and 2 as exceptions to the hearsay rule as a generally- used and relied-upon published compilation pursuant to Section 90.803(17), Florida Statutes.
APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-1474
Accepted.
Accepted.
Accepted.
Accepted.
Accepted.
Accepted.
COPIES FURNISHED:
James K. Hester
16 Cleveland Place Palisades Park, N.J. 07650
M. Catherine Lannon, Esquire Assistant Attorney General Department of Legal Affairs Room LL-04, The Capitol
Tallahassee, Florida 32399-1050
Fred Roche, Secretary Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Wings Slocum Benton, Esquire General Counsel
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Dorothy Faircloth Executive Director
Board of Medical Examiners Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Docket for Case No: 86-001474
Orders for Case No: 86-001474
| Issue Date |
Document |
Summary |
|
Dec. 16, 1986 |
Agency Final Order
|
|
|
Oct. 28, 1986 |
Recommended Order
|
Petitioner trained with students enrolled in relevant residency program but was not enrolled in that residency program does not meet licensure standards.
|
