STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICINE, )
)
Petitioner, )
)
vs. ) CASE NO. 87-2453
)
JOSEFINO P. BARGAS, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
This matter came on for hearing in Chiefland, Florida, before Robert T. Benton II, Hearing Officer of the Division of Administrative Hearings, on November 30, 1988. The Division of Administrative Hearings received the hearing transcript on December 12, 1988. On January 6, 1989, the parties filed posthearing submissions. The attached appendix addresses proposed findings of fact by number.
The parties are represented by counsel:
For Petitioner: Robert L. Hessman
Rumberger, Kirk, Caldwel, Cabaniss, Burke & Wechsler, P.A.
101 North Monroe Street, Suite 900 Tallahassee, Florida 32301
and Stephanie A. Daniel
1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0729
For Respondent: Peter Langley, III
Post Office Box 486 Bronson, Florida 32621
By second amended administrative complaint dated October 20, 1988, petitioner alleged that respondent "at all times material ... a license[d] physician " "[o]n or about October 25, 1984, ... admitted patient 'H.S.' ... to Florida Hospital ... because of symptoms of upper gastrointestinal bleeding ... [but] failed to maintain a continued intravenous access in the patient ... failed to have the patient typed and cross-matched for blood .... failed to obtain sufficiently frequent hemoglobins and hematocrits ... failed to properly examine, diagnose, and treat the patient ... [and so] failed 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] violated Section 458.331(1)(t), Florida Statutes, in that [he] is guilty of gross or repeated malpractice or the failure 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, in count two, that respondent "admitted patient 'A.S.' ... to Florida Hospital ... [with an] admitting diagnosis ... [of] diabetes"; that respondent "diagnosed the patient as suffering from septicemia [but] failed to order the proper type of insulin coverage; and/or ... failed to provide insulin coverage when the patient's blood sugar was elevated; and/or ... failed to order a sufficient number of blood sugars, and/or ... failed to properly examine, diagnose, and treat the patient
... [and so] failed 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] violated Section 458.331(1)(t), Florida Statutes, in that [he] is guilty of gross or repeated malpractice or the failure 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."
STATEMENT OF THE ISSUE
Whether the Board of Medicine should take disciplinary action against respondent for the reasons alleged in the administrative complaint?
FINDINGS OF FACT
Josefino P. Bargas holds license No. ME 0029440. He has been a licensed physician in Florida at all pertinent times, engaging in the general practice of medicine in central Florida.
Internal Bleeding
On October 25, 1984, Dr. Bargas admitted then 67-year old Mr. H.S. to Florida Hospital in Apopka. When the patient reached a medical floor at 3:40 that afternoon, Dr. Bargas assumed responsibility for H.S.'s care, taking over from staff in the emergency room, where H.S. had appeared that morning at 11:25. By 4:30 on the afternoon of October 25, 1984, H.S.'s pulse rate had fallen to 77.
In the emergency room, Dr. Murphy had ordered "1,000 cc's of D5, half normal saline started with a 200 angio cath in the right wrist with a three-way stopcock ... [which one of petitioner's experts assumed] was in anticipation of giving him blood." T.102. Emergency room staff carried these orders out. The saline solution (with dextrose) was administered in response to apparent dehydration. An apparatus with a larger bore is ordinarily used for blood transfusions.
When he arrived at the hospital, H.S. complained of melena and reported a history of ulcers. He had been taking Tagamet for epigastric pain. His pallor, his pulse rate of 104, his hemoglobin of 11.2 grams per liter and his hematocrit of 34% all pointed to decreased blood volume, reduced hemoglobin, and significant bleeding.
Dr. Bargas ordered hemoglobin and hematocrit assessments once daily, and a single prothrombin time test, the results of which demonstrated that H.S.'s blood took longer than normal to clot, possibly a side effect of Tagamet. Nurses' notes reflected that stools H.S. passed after he was admitted contained blood. One was the subject of a laboratory test Dr. Bargas ordered to determine blood content; the result was 4+, the maximum indication.
On October 26, 1984, Dr. Bargas wrote, on H.S.'s chart, "Bleeding still present?" Nothing about H.S.'s pulse, respiration, blood pressure nor anything in his demeanor indicated significant additional blood loss, although he complained of dizziness when he stood. The same day Dr. Bargas entered written orders, including "DC IV fluids," which signified, "Discontinue intravenous fluids."
At two o'clock on the afternoon on the 26th, a nurse discontinued fluids and removed the apparatus through which they had entered H.S.'s vein. Dr. Bargas did not order another to replace it.
Unless otherwise specified, a doctor's orders to discontinue intravenous fluids may be construed as a directive to discontinue intravenous access, which can be a conduit for infection. But Geraldine Petrone, for 13 years Director of Nursing at Williston Memorial Hospital, would not remove intravenous access without inquiry of the physician, if she saw "DC IV fluids" in a patient's chart.
By 4:35 on the afternoon of October 26, 1984, the laboratory had reported to the floor that day's test results, including a hemoglobin of 7.2 grams per liter. But this had not been charted when Dr. Bargas made rounds at
85 that evening, and he did not inquire as to the laboratory results. The hospital laboratory is open 24 hours a day on an "on call" basis. Customarily, staff acts affirmatively to bring test results as significant as these to the attention of the treating physician.
Before Dr. Bargas' arrival the following morning at 10:30, the nursing staff also learned the October 27 blood test results. Alarmed particularly at one of them, a hemoglobin of 5.5 grams per liter, and unable to reach Dr. Bargas, a conscientious nurse told the chief of staff about the situation. He ordered that four liters of blood be "typed and cross-matched," and that H.S. be given two units of blood. Only after Dr. Bargas arrived, however, did the transfusion begin.
The drop in hemoglobin from 11.2 to 5.5 grams per liter reflected a loss of at least half the volume of H.S.'s blood, a "potential crisis situation." T. 87. Because hemoglobin measurements are "always behind in a patient that is bleeding," (T.87) hemoglobin and hematocrit testing only at 24- hour intervals is not adequate. When a patient is bleeding internally, minimum acceptable practice requires monitoring at intervals of "[s]ix hours at the outside, probably four," id., unless significant bleeding is known to have stopped.
It would also have been better practice to order blood-typing, cross- matching, and intravenous access as precautionary measures or, as regards access, at least to have held off on ordering discontinuance of the access already in place (notwithstanding its straitness.) If evidence exists that a patient is actively bleeding, cross-matching should be done right away. T. 176.
Physicians order blood typed and cross-matched as a precaution, in case an emergency transfusion proves necessary, even though blood that is not used must be wasted. "[P]eople can go into shock at any time." Reddy Deposition, p.11. Typing and cross-matching take about a half hour. Sometimes veins collapse before access is established, making it impossible to accomplish a transfusion, although such venal collapse is extremely rare. Reddy Deposition.
Diabetes with Infection
On October 26, 1984, Dr. Bargas admitted Mr. A.S., 51 years old at the time and disabled, to Florida Hospital. In the history he took on admission, Dr. Bargas noted that A.S. was taking "NPH insulin 25 units," Petitioner's Exhibit No. 4, twice daily. Although A.S. may have begun this regimen only a week or two before admission, he had taken insulin orally for a period of years, and was "an insulin-dependent diabetic." Londono Deposition, p.14; McClelland Deposition, p.13.
"He obviously was a pretty sick type of individual. He was dehydrated. He was febrile. He was nauseous. He was vomiting. And he had what seemed to be a rotten foot." Id., p.11. Septicemia, a blood borne infection apparently attributable to A.S.'s infected, ulcerated right leg, was among A.S.'s medical problems Dr. Bargas recognized on his admission to hospital. "With high blood sugars, there can be problems with white blood cell response to infection." McClelland Deposition, p.9.
Insulin makes glucose in the blood available for use by cells, normalizing blood levels. When he entered the hospital, A.S.'s blood sugar level was elevated. Blood sugar levels at "a controlled diabetes level" range between 60 or 70 and 120 or 200 milligrams per milliliter. Londono deposition,
p.12. An elevated blood sugar level is not critical or life-threatening in itself, unless it exceeds 500 milligrams per milliliter. Id., pp.11, 12.
N.P.H. insulin "lasts" 24 to 36 hours, but regular insulin has a half-life of less than 30 minutes. Blood glucose levels oscillate in response to regular insulin, in no less than two to three hours, and, in response to "long acting insulin anywhere between 8 and 24 hours." Londono Deposition, p.21.
On A.S.'s admission, Dr. Bargas ordered urinalysis and a blood sugar test "stat." He prescribed regular insulin, depending on the urinalysis results. Dr. Bargas wrote:
Rx urine for sugar & acetone and give regular insulin accordingly
4+ 20 units
3+ 15
2+ 10
1+ 0
Petitioner's Exhibit No. 4, p.123A.
Because blood tests for glucose levels are much more precise than urine tests, which only approximate blood glucose levels, Dr. Bargas' prescription for "insulin ... on a sliding scale for urine," Londono Deposition, p.15, left something to be desired.
Dr. Bargas ordered urine tests for sugar and acetone four times a day, and blood tests, which are more expensive, once daily. As with A.S., a patient may be unable to void on schedule. Urine collects in the bladder over time; accordingly, urine test results for glucose reflect an average, which may be misleading. The volume of blood moving through the kidney affects the concentration of glucose in the urine. Renal thresholds (the levels at which glucose leaves the blood to enter the urine) vary among individuals. The correlation between glucose levels in blood and urine is particularly
problematic when a diabetic is acutely ill. Infection can cause elevated blood glucose levels, and affect kidney function. Test results known to Dr. Bargas indicated A.S. had impaired kidney function.
At four o'clock on the afternoon of the 26th, the "clinitest" for sugar in A.S.'s urine yielded a result of "3+." A.S. received 15 units of regular insulin an hour and a half later. A contemporaneous blood test indicated 398 milligrams of glucose per milliliter of blood. At seven o'clock (or half past) on the evening of October 26, 1984, A.S. received a second dose of 15 units of regular insulin. T.48; Petitioner's Exhibit No. 4, p.220.
Between six and seven the following morning and again at ten, A.S. was unable to produce a urine specimen. A blood test on a sample taken at ten o'clock indicated 264 milligrams of sugar per milliliter of blood. Tests on urine samples taken later on the 27th, at half past noon, at five o'clock and at seven o'clock yielded "+1." In keeping with Dr. Bargas orders, no insulin was administered to A.S. that day.
A blood sample taken at quarter past two on the morning of October 28, 1984, in conformity with Dr. Bargas' order to test "stat.," indicated 399 milligrams of sugar per milliliter of A.S.'s blood. The laboratory apprised Dr. Bargas of these results. At 4:30 on the morning of the 28th, a urine test yielded a "3+." Three hours later A.S. received 15 units of regular insulin, his first insulin in some 36 hours. At no time did test results reflect ketosis.
Even for general practitioners in Apopka in 1984, the failure to order more frequent blood sugar tests, and insulin coverage as indicated by such tests, for an insulin-dependent diabetic suffering from septicemia and a foot infection fell below minimum levels of acceptable practice. Dr. Bargas' approach, although once very common, was "antiquated" even than. His use of regular insulin, rather than N.P.H. insulin was appropriate. But allowing 36 hours to elapse between doses of regular insulin, and failing to order insulin promptly on learning the results of the tests the morning of the 28th, fell below standards.
CONCLUSIONS OF LAW
After respondent requested a formal administrative hearing, the Board of Medicine referred the matter to the Division of Administrative Hearings for proceedings, in accordance with Section 120.57(1)(a)1., Florida Statutes (1987). Accordingly, "the division has jurisdiction of the formal proceeding." Section 120.57(1)(b)3., Florida Statutes (1987).
The Department of Professional Regulation has alleged "[g]ross or repeated malpractice or the failure 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." Section 458.331(1)(t), Florida Statutes (1988 Supp.) This statutory provision specifies that it "shall not be construed so as to require more than one instance, event, or act ... [or] to require that a physician be incompetent to be disciplined pursuant to this paragraph." Section 458.331(t), Florida Statutes (1988 Supp.).
"When the board [of medicine] finds any person guilty of any of the grounds set forth in subsection (1), it may enter an order imposing one or more of the following penalties:
Revocation or suspension of a license.
Restriction of practice.
Imposition of an administrative fine not to exceed $5000 for each count.
Issuance of a reprimand.
Placement of the physician on probation.
Section 458.331(2), Florida Statutes (1988 Supp.). Although it is necessary to "establish grounds for revocation or suspension of [a medical] license by clear and convincing evidence," Section 458.331(3), Florida Statutes (1988 Supp.), imposition of any other penalty only requires that "the greater weight of the evidence ... establish the existence of grounds for disciplinary action." Section 458.331(3), Florida Statutes (1988 Supp.).
License revocation proceedings have been said to be "`penal' in nature." State ex rel. Vining vs. Florida Real Estate Commission, 281 So.2d 487,
491 (Fla. 1973); Kozerowitz vs. Florida Real Estate Commission, 289 So.2d 391 (Fla. 1974); Bach vs. Florida State Board of Dentistry, 378 So.2d 34 (Fla. 1st DCA 1979)(reh. den. 1980). Strict procedural protections apply in disciplinary cases, and the prosecuting agency's burden is to prove its case clearly and convincingly. Ferris vs. Turlington 510 So.2d 292 (Fla. 1987). See Addington vs. Texas, 441 U.S. 426 (1979); Ferris vs. Austin, 487 So.2d 1163 (Fla. 5th DCA 1986); Anheuser-Busch, Inc. vs. Department of Business Regulation, 393 So.2d 1177 (Fla. 1st DCA 1981); Walker vs. State Board of Optometry, 322 So.2d 612 (Fla. 3rd DCA 1975); Reid vs. Florida Real Estate Commission, 188 So.2d 846, 851 (Fla. 2nd DCA 1966). A licensee's breach of duty justifies revocation only if the duty has a "substantial basis," Bowling vs. Department of Insurance, 394 So.2d 165, 173 (Fla. 1st DCA 1981) in the evidence, unless applicable statutes and rules create a clear duty, which the evidence shows has been breached.
As regards H.S., petitioner alleges Dr. Bargas' treatment fell below acceptable standards because he did not order that blood be typed and cross- matched in case a transfusion proved necessary; because he did not maintain intravenous access; and because he did not order hemoglobins and hematocrits with sufficient frequency. Neither the original hemoglobin test results nor Dr. Bargas' clinical observations gave indications that would cause his failure to order intravenous access, typing and cross-matching to fall below minimum acceptable standards. But he lacked the information more frequent testing would have afforded (and, as it happened, the information testing he did order should have furnished) and seems not to have taken the nurses' notes reflecting bloody stools into account. Dr. Bargas admitted he should have ordered cross-matching if there was any evidence of active bleeding.
Petitioner established by a preponderance of the evidence that Dr. Bargas' failure to order blood tests at more frequent intervals, and to take steps to learn the results of all the tests he had ordered, when he did not know whether H.S.'s internal bleeding had stopped, fell below minimum acceptable standards. Petitioner established by clear and convincing evidence that his failure either to order more frequent tests (and to act to discover the results of the test on October 26) or to order typing, cross-matching and intravenous access fell below the level of treatment recognized by a reasonably prudent general practitioner as being acceptable under similar conditions or circumstances.
As regards A.S., petitioner alleges that Dr. Bargas treatment fell below acceptable standards because he did not prescribe sufficient insulin when
glucose levels in A.S.'s blood were elevated, did not order blood tests often enough and "failed to order the proper type of insulin coverage." Petitioner established by a preponderance of the evidence that letting A.S. go 36 hours without insulin fell below minimum acceptable standards and that Dr. Bargas' reliance on urine tests, rather than more frequent blood tests, was outmoded. But the evidence fell short of clear and convincing proof of count two.
It is, accordingly, in consonance with Rule 21M-20.001(t) Florida Administrative Code,
RECOMMENDED:
That the Board of Medicine suspend Josefino P. Bargas license to practice medicine for sixty (60) days, and thereafter until he has completed at least three (3) days instruction on the management of diabetes, and paid a one thousand dollar ($1,000) fine; and that, once his license is reinstated, he be placed on probation for a year, on condition that a representative of the Board of Medicine review a sample of his charts monthly to determine that they demonstrate that he is practicing at least minimally acceptable medicine.
DONE AND ENTERED this 24th day of May, 1989, in Tallahassee, Florida.
ROBERT T. BENTON, II
Hearing Officer
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, FL 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 24th day of May, 1989.
APPENDIX
Petitioner's proposed findings of fact Nos. 1 through 6, 8 through 14, 16
through 30, 37, 40, 45, 46, 50, 51, 53 through 57, 63, 65, 69, 73, and 74 have been adopted, in substance, insofar as material.
With respect to petitioner's proposed finding of fact No. 7, the test were done after admission.
With respect to petitioner's proposed finding of fact No. 15, Dr. McBride ordered that two units be administered.
Petitioner's proposed findings of fact Nos. 31, 32, 33, 38, 39, 47, 48, 58,
59, 60, 61, 62, 64, 66, 71 and 72 relate to subordinate matters.
Petitioner's proposed findings of fact Nos. 34, 35, 36, 41, 42, 43, 44, 49 and 52 accurately recite the substance of the witnesses' testimony they report.
With respect to petitioner's proposed finding of fact No. 68 the test results were not charted when he was at the hospital that evening.
With response to petitioner's proposed finding of fact No. 70, he testified that he did not even believe he might be bleeding.
With response to petitioner's proposed finding of fact No. 75, Dr. Bargas' testimony did raise resal questions of this kind.
Respondent's proposed findings of fact Nos. 4, 5, 7, 8, 12, 14, 15, 18, 19,
20 have been adopted, in substance, insofar as material.
Respondent's proposed findings of fact Nos. 1, 3, 6, 11, 16, 17 and 22 have been rejected, as unsupported by the weight of the evidence.
With respect to respondent's proposed finding of fact No. 2, H.S. was not stabilized and his wishes, which were not proven, are not determinative.
With respect to respondent's proposed finding of fact No. 9, clinical observations here included bloody stools and indicated more frequent testing.
With respect to respondent's proposed finding of fact No. 13, whatever Dr.
Reddy would have done, minimum standards were not met.
With respect to respondent's proposed finding of fact No. 21, a preponderance of the evidence established, although not clearly and convincingly, that failure to order more frequent blood test fell below standards.
COPIES FURNISHED:
Robert L. Hessman Rumberger, Kirk, Caldwell,
Cabaniss, Burke & Wechsler, P. A.
101 North Monroe Street, Suite 900 Tallahassee, Florida 32301
Stephanie A. Daniel
1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0729
Peter Langley, III Post Office Box 486 Bronson, Florida 32621
Dorothy Faircloth, Executive Director Board of Medicine, Department of
Professional Regulation
1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0729
=================================================================
AGENCY FINAL ORDER
=================================================================
DEPARTMENT OF PROFESSIONAL REGULATION BOARD OF MEDICINE
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
DPR CASE NUMBER: 0057230
vs DOAH CASE NUMBER: 87-2453
LICENSE NUMBER: ME 0029440
JOSEFINO P. BARGAS, M.D.,
Respondent.
/
FINAL ORDER
This cause came before the Board of Medicine (Board) pursuant to Section 120.57(1)(b)9, Florida Statutes, on August 5, 1989, in Orlando, Florida, for the purpose of considering the Hearing Officer's Recommended Order (a copy of which is attached hereto as Exhibit A) in the above-styled cause. Petitioner, Department of Professional Regulation, was represented by Stephanie A. Daniel, Attorney at Law. Respondent was present and represented by Peter Langley, III, Attorney at Law.
Upon review of the Recommended Order, the argument of the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.
FINDINGS OF FACT
Findings of fact set forth in the Recommended Order are approved and adopted and incorporated herein.
There is competent substantial evidence to support the findings of fact.
CONCLUSIONS OF LAW
The Board has jurisdiction of this matter pursuant to Section 120.57(1), Florida Statutes, and Chapter 458, Florida Statutes.
The conclusions of law set forth in the Recommended Order are approved and adopted and incorporated herein, with the exception that the last sentence of the paragraph at the top of page 12 is rejected on the basis that Bowling has been overruled by Ferris. Further, the Board concludes that the term "preponderance of the evidence," as used by the Hearing Officer in this case, is synonymous with the term "greater weight of evidence," as used in Section 488.331(3), Florida Statutes (1988 Supp.).
There is competent substantial evidence to support the conclusions of law by the Board.
PENALTY
Upon a complete review of the record in this case, the Board determines that the penalty recommended by the Hearing Officer be REJECTED. The reason for altering the penalty is that although the Hearing Officer focused on the fact that the events at issue occurred several years ago, Respondent's testimony reflects that he still lacks necessary medical knowledge, as evidenced in pages 190-192 of the transcript of the hearing. The public cannot be protected unless Respondent obtains immediate retraining in acute care.
WHEREFORE,
IT IS HEREBY ORDERED AND ADJUDGED that
Respondent's license to practice medicine is REPRIMANDED.
Respondent shall pay an administrative fine in the amount of $1,000.00 to the Executive Director within 30 days of the date this Order is filed.
Respondent's license to practice medicine in the State of Florida is SUSPENDED for a period of 60 days. However, said suspension shall be stayed upon Respondent's satisfactory demonstration to the Probation Committee or the Chairman of the Probation Committee of completion of 50 hours of Category I Continuing Medical Education courses in critical care medicine.
Upon reinstatement from suspension, Respondent's license to practice medicine in the State of Florida is placed on PROBATION for a period of five year, subject to the following terms and conditions:
Respondent shall comply with all state and federal statutes, rules and regulations pertaining to the practice of medicine, including Chapters 455, 458, and 893, Florida Statutes, and Rules 21M, Florida Administrative Code.
Respondent shall appear before the Probation Committee at the first meeting after said probation commences, at the last meeting of the Probation Committee preceding termination of probation, and at such other times as requested by the Committee.
In the event Respondent leaves the State of Florida for a period of thirty (30) days or more, or otherwise does not engage in the active practice of medicine in Florida, then certain provisions of Respondent's probation (and only those provisions of said probation) shall be tolled as enumerated below and shall remain in a tolled status until Respondent returns to active practice in the State of Florida. Respondent must keep current residence and business addresses on file with the Board. Respondent shall notify the Board within ten
(10) days of any changes of said addresses. Furthermore, Respondent shall notify the Board within ten (10) days in the event that Respondent leaves the active practice of medicine in Florida.
In the event that Respondent leaves the active practice of medicine in this state for a period of thirty days or more, the following provisions of his probation shall be tolled:
The time period of probation shall be tolled.
The provisions regarding supervision whether direct or indirect by another physician, included in paragraph
5.e. below.
The provision regarding preparation of investigative reports detailing compliance with this Stipulation shall be tolled. See paragraph 5.j. below.
Respondent shall practice only under the indirect supervision of a physician fully licensed under Chapter 458 to be approved by the Board or its Probationer's Committee. Respondent shall have the monitoring physician with him at his first probation appearance before the Probationer's Committee. Prior to approval off the monitoring physician by the Committee, the Respondent shall provide to the monitoring physician a copy of the Administrative Complaint and Final Order filed in this case. Failure of the Respondent or the monitoring physician to appear at the scheduled Probation Committee meeting shall constitute a violation of the Board's Final Order. Prior to the approval of the monitoring physician by the Committee, Respondent shall submit to the Committee a current curriculum vitae and a description of the current practice from the proposed monitoring physician. Said materials shall be received by the Board office no later than fourteen days before Respondent's first scheduled Probation appearance. The attached definition of a monitoring physician is incorporated herein. The responsibilities of the monitoring physician shall include:
Submit quarterly reports, in affidavit form, which shall include:
Brief statement of why physician is on probation.
Description of probationer's practice.
Brief statement of probationer's compliance with terms of probation.
Brief description of probationer's relationship with monitoring physician.
Detail any problems which may have arisen with probationer.
Respondent shall be responsible for ensuring that the monitoring physician submits the required reports.
Review 25 percent of Respondent's patient records selected on a random basis at least once every two weeks.
Report to the Board any violations by the probationer of Chapter 455 and 458, Florida Statutes, and the rules promulgated pursuant thereto.
The Board shall delegate to the Chairman of the Probation Committee the authority to temporarily approve a monitoring physician. However, such approval shall remain in effect only until the next meeting of the Probation Committee.
Respondent shall submit quarterly reports in affidavit form, the contents of which shall be specified by the Board. The reports shall include:
Brief statement of why physician is on probation.
Practice location.
Describe current practice (type and composition).
Brief statement of compliance with probation terms.
Describe relationship with monitoring physician.
Advise Board of any problems.
Within three months of beginning probation, Respondent must complete a three-day course in treatment and management of diabetes, such course to be approved in advance by the Chair of the Probation Committee.
Respondent shall attend 200 hours of Category I Continuing Medical Education courses per year in the area of Family Practice, 100 hours to be earned during the first two years of probation, and 100 hours during the remainder. Respondent must document completion of the CME, but is not required to obtain approval prior to completion of said courses. These hours shall be in addition to those hours required for renewal of licensure.
During this period of probation, semiannual investigative reports will be compiled by the Department concerning Respondent's compliance with the terms and conditions of probation and the rules and statutes regulating the practice of medicine.
Respondent shall pay all costs necessary to comply with the terms of the Final Order issued based on this proceeding. Such costs include, but are not limited to, the cost of preparation of investigative reports detailing compliance with the terms of this proceeding, the cost of analysis of any blood or urine specimens submitted pursuant to the Final Order entered as a result of this proceeding, and administrative costs directly associated with Respondent's probation. See Section 458.331(2), Florida Statutes (1988 Supp.).
This Order takes effect upon filing with the Clerk of the Department of Professional Regulation.
DONE AND ORDERED this 17th day of August 1989.
BOARD OF MEDICINE
FUAD S. ASHKAR, M.D. CHAIRMAN
NOTICE OF RIGHT TO JUDICIAL REVIEW
A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES. REVIEW PROCEEDINGS ARE GOVERNED BY THE FLORIDA RULES OF APPELLATE PROCEDURE. SUCH PROCEEDINGS ARE COMMENCED BY FILING ONE COPY OF A NOTICED OF APPEAL WITH THE AGENCY. CLERK OF THE DEPARTMENT OF PROFESSIONAL REGULATION AND A SECOND COPY, ACCOMPANIED BY FILING FEES PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL, FIRST
DISTRICT, OR WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE PARTY RESIDES. THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Order has been provided by certified mail to Josefino P. Bargas, M.D., 1405 NW 94th Street, Gainesville, Florida 32606 and Peter Langley, III, Attorney at Law, Post Office Box 486, Bronson, Florida 32621, by U.S. Mail to Robert T. Benton, II, Hearing Officer, Division of Administrative Hearings, The DeSoto Building, 1230 Apalachee Parkway, Tallahassee, Florida 32399-1550; and by interoffice delivery to Stephanie A. Daniel, Attorney at Law, Department of Professional Regulation, 1940 North Monroe Street, Tallahassee, Florida 32399-0792 at or before 5:00 P.M., this 21st day of August, 1989.
| Issue Date | Proceedings |
|---|---|
| May 24, 1989 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Aug. 17, 1989 | Agency Final Order | |
| May 24, 1989 | Recommended Order | Physician mismanaged a patient with internal bleeding and another who was diabetic and had septicemia. Discipline warranted. |
