STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICINE, )

)

Petitioner, )

)

vs. ) CASE NO. 87-5382

)

BERNARDO G. BILANG, M.D., )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the above matter was heard before the Division of Administrative Hearings by its duly designated Hearing Officer, Donald R. Alexander, on April 25, 1989, in Clearwater, Florida.

APPEARANCES

For Petitioner: Bruce D. Lamb, Esquire

730 South Sterling Street, Suite 313

Tampa, Florida 33609-4582

For Respondent: Salvatore A. Carpino, Esquire

One Urban Centre, Suite 750 4830 West Kennedy Boulevard Tampa, Florida 33609

STATEMENT OF THE ISSUES

The issue is whether respondent's license as a medical doctor should be disciplined for the reasons stated in the administrative complaint, as amended.

PRELIMINARY STATEMENT

By administrative complaint filed on November 4, 1987, petitioner, Department of Professional Regulation, Board of Medicine, charged that respondent, Bernardo G. Bilang, a licensed medical doctor, had violated Subsection 458.331(1), Florida Statutes (1985) in several respects. More particularly, the complaint alleged that while treating a patient on February 3, 1986, respondent failed to keep medical records justifying the course of treatment, filed a report which he knew to be false, and failed to practice medicine with that level of care, skill and treatment which is recognized by reasonably prudent similar physicians as being acceptable under similar conditions and circumstances.

Respondent disputed the above allegations and requested a formal hearing pursuant to Subsection 120.57(1), Florida Statutes (1987). The matter was referred by petitioner to the Division of Administrative Hearings on December 4, 1987 with a request that a hearing officer be assigned to conduct a formal

hearing. By notice of hearing dated January 4, 1988 the final hearing was scheduled on April 13, 1988 in Clearwater, Florida. At respondent's request, the matter was rescheduled to May 19, 1988 and again to August 11 and 12, 1988. Upon request of petitioner, it was rescheduled to April 25, 1989 at the same location. On January 4, 1989, the case was transferred from Hearing Officer Diane D. Tremor to the undersigned.

On May 17, 1988 petitioner requested leave to file a second amended complaint. This request was granted by order of the undersigned dated January 12, 1989. The amendment substituted new language in paragraph 19 of the complaint.

At final hearing petitioner presented the testimony of Patricia M. Santo, a records custodian at Norton Plant Hospital, Inc., Shirley K. Lube and Joan D. Smith, both registered nurses, Lucy Ann Yates, an emergency room admitting clerk, Dr. Linda L. Shaffer, an emergency room physician, and Dr. Laurence Neufeld, a Tampa board certified family practitioner and accepted as an expert in medicine. Also, petitioner offered petitioner's exhibits 1-4. All exhibits were received in evidence. Exhibit 3 is the deposition of Dr. Matthew M. Cohen, a Tallahassee board certified family practitioner. Respondent offered respondent's exhibits 1 and 2 which were received in evidence. Exhibit 2 is the deposition of Dr. John M. Brady, which was taken and filed after final hearing. Doctor Brady is a Shreveport, Louisiana board certified internist tendered as an expert in internal medicine.

The transcript of hearing was filed on May 15, 1989. The transcript of the post-hearing deposition was filed on June 14, 1989. Proposed findings of fact and conclusions of law were due by June 29, 1989 and were timely filed by petitioner. None were filed by respondent. A ruling on each proposed finding has been made in the Appendix attached to this Recommended Order.

FINDINGS OF FACT

Based upon all of the evidence, the following findings of fact are determined:

1. At all times relevant hereto, respondent, Bernardo G. Bilang, was a licensed medical doctor having been issued license number 0026846 by petitioner, Department of Professional Regulation, Board of Medicine (DPR or Board). He has been licensed by the Board since July 19, 1976. Respondent presently practices medicine at 1201 South Highland Avenue, Suite 11, Clearwater, Florida. His specialty, if any, is not of record.

   
   

2. Around 10:45 p.m. on February 2, 1986, N.K., a seventy-four year old female, was transported by ambulance to the emergency room of Morton F. Plant Hospital, Inc. (hospital) in Clearwater, Florida. When admitted, she complained of nausea, diarreah, dehydration, vomiting, fatigue and not feeling well. Also, she had experienced some pain in her back. With the exception of the back pain, which had begun more than a day earlier, all other symptoms had begun on February 2.

   
   

3. Doctor Linda L. Shaffer was the emergency room physician on duty on the evening of February 2. Doctor Shaffer initially observed that the patient looked "acutely ill." She examined the patient and found her to be coherent and alert but very weak, as evidenced by her lack of grip strength In slurred speech, the patient answered questions very faintly and generally in one word answers. As might be expected, the patient was dehydrated. Her vital signs at

   11:00 p.m. here as follows: rectal temperature - 104.6 degrees; blood pressure

   • 152 over 96; respiration - 24; and pulse - 101. She also had tenderness across the middle of the back on both sides but did not have a stiff neck. After a preliminary physical examination and history were completed, and while the patient remained in the emergency room area for a few hours, Dr. Shaffer ordered a chest x-ray, electrocardiogram, complete blood count, electrolyte panel, chemical profile, two tests of kidney function, blood cultures, and urinalysis. The patient was then placed on a cardiac monitor, had a foley catheter inserted to obtain a urine speciman, and was given tylenol to reduce her temperature. Also, an IV was started.

     
     

4. After finding the chest to be essentially clear and the abdominal examination negative, Dr. Shaffer diagnosed the patient as follows: "fever/dehydration - possible sepsis?" The latter diagnosis (sepsis) meant the patient may have had either a bacterial or viral infection in her blood stream affecting her entire system in a "generalized way." For a seventy-four year old patient, sepsis is a serious condition and can be life threatening if not promptly treated. The normal treatment for sepsis is antibiotics, fluids, medicines to elevate the blood pressure and reduce the temperature, and occasionally the use of steroids. It is noted, however, that a viral infection will not respond to antibiotics. If the use of antibiotics is indicated, they must be started immediately to kill the infection. After concluding her examination, Dr. Shaffer ruled out the threat of cardiac arrest and believed the patient, although "seriously ill," was not suffering from a terminal ailment. Nonetheless, she was concerned with the patient's low white blood cell count (3500) which was indicative of an infection, and one more likely of a viral nature. At the same time, she knew that influenza "was quite prevalent at the time" and might produce symptoms like those experienced by N.K. However, she stuck by her preliminary diagnosis of a possible bacterial infection.

   
   

5. Respondent was on call the evening of February 2 for patients such as

   N.K. who were admitted to the hospital but had no personal physician. 1/ He was telephoned by Dr. Shaffer at 1:20 a.m. on February 3 concerning the patient's status. After being told the patient's symptoms, vital signs, available test results (which did not include the blood cultures, urine culture and chemistry profile) and Dr. Shaffer's preliminary diagnosis respondent requested Dr. Shaffer to admit N.K. to the hospital. He then gave telephonic orders to the nurse regarding N.K.'s future treatment. At that point, responsibility for the patient shifted to respondent.

   
   

6. Respondent's first orders at 1:25 a.m. were (a) the patient be given nothing by mouth except medications (b) the IV be continued, (c) she be given atrophine and phenergaan intramuscularly if diarrhea occurred, (d) she be given compazine, if necessary, for nausea and vomiting, and (e) she continue to be given ten grains of tylenol every four hours for her fever. The patient was then transferred from a critical care room to a room where more stabilized patients are kept. According to a nurse on duty that evening, she did not consider N.K. to be a "problem" patient who required extra care or attention. It is noted here that the patient records reflect that respondent initially suspected that N.K. might have the flu, a fairly common ailment in the area at that time.

   
   

7. At 1:40 a.m., the patient's vital signs were as follows: blood pressure

   • 124 over 80; respiration rate - 24; and pulse - 92. There is no indication that her temperature was taken at that time but the records indicate that an hour earlier, it had droped to 103.1 degrees. At 2:25 a.m., the patient was moved from an emergency room bed to a semi-private room in the general ward. At

   3:05 a.m., N.K.'s temperature was again checked and found to be 103.5 degrees. At 4:00 am., the patient's condition had begun to seriously deteriorate. She manifested signs of being "very lethargic," that is, it was difficult to awaken her, and she appeared to be weaker on her left side. According to Dr. Shaffer, such a localized weakness was indicative of "some process" involving the patient's brain and spinal cord. Also, N.K. still had a rectal temperature reading of 103.5 degrees. At 5:40 am., N.K.'s fingers and toes became cyanotic, that is, they turned blue in color, indicating a lack of circulation. Also, she was confused and her lethargy continued. By then, her respiration rate had increased to 32, almost twice the normal rate. Her blood pressure (138 over 70) began dropping which was a sign of sepsis shock, that is, the peripheral blood vessels were dilating causing the pressure to drop and circulation to be impaired.

   
   

8. At 6:05 am., the head nurse, believing there to be an emergency situation, spoke with respondent by telephone. She relayed the previous findings from 5:40 a.m. and noted that the patient's temperature had risen to

   104.7 degrees while her blood pressure had dropped to 126 over 70. The nurse did not recall whether she was able to reach respondent immediately or if it took a few minutes for him to return the call. In any event, respondent gave telephonic orders that mandol, a second generation antibiotic, be given to the patient intravenously every six hours, and she be given one gram of solu-cortef, a steroid medication, for shock. Also, he ordered an arterial blood gas analysis and that N.K. be given oxygen by nasal cannula when necessary.

   Although the telephonic orders were given at 6:05 a.m., the drugs had to be requested and obtained (after mixing) from the hospital pharmacy. In some cases, it takes several hours to receive a drug from the pharmacy, particularly during other than normal daytime hours. The steroid IV was eventually started at 6:30 a.m. but the mandol was never received and administered.

   
   

9. When the patient's condition did not improve and actually continued to deteriorate, respondent was telephoned again by a nurse at 6:40 a.m. By then, the patient's entire skin had turned a bluish color indicating very poor circulation. After being briefed by the nurse, including the results of the just received blood gas report, but still without knowing the precise cause of N.K.'s ailment, Dr. Bilang issued a "CMO" order. This means "comfort measures only" and that no aggressive steps, such as resuscitative measures, be taken by hospital personnel to prolong the life of the patient. According to Dr. Shaffer, had resuscitative steps been taken at that time, the patient's chances for survival were around "twenty percent, maybe less." The patient expired at 7:13 a.m. The primary cause of death was listed as meningococcial meningitis, a bacterial infection having a 70% to 80% mortality rate, and a "quite uncommon" infection in a seventy-four year old patient. Laboratory results obtained several days after the patient's death revealed she had gram-negative sepsis. Doctor Bilang arrived at the hospital and pronounced the patient dead at 7:20

   a.m. This was the first time respondent had seen and examined the patient. Respondent then dictated a history and physical examination which appear in the patient records. These reports were based on information previously provided by others. On February 21, 1986 respondent dictated a discharge summary which indicated a pre mortem physical finding. This report was also placed in the expired patient's records.

   
   

10. Several months later, respondent prepared a second physical examination and history for the patient. This was dictated on July 31, 1986 and again was based on the notes of other persons. However, respondent made the following note at the beginning of the physical examination and history: "Disregard above notes. Patient expired prior to my seeing her in the ward."

11. Two medical experts testified on behalf of the Board. They are Drs. Matthew M. Cohen and Laurence Neufeld, both board certified family practitioners in Tallahassee and Tampa, Florida, respectively. A Shreveport, Louisiana board certified internist, Dr. John M. Brady, presented expert testimony on behalf of respondent. In addition, Dr. Linda L. Shaffer, an experienced physician, testified from her perspective as an emergency room physician at the hospital in question. As might be expected, the experts reached differing conclusions regarding respondent's treatment of the patient. Pertinent findings based on the experts' relevant testimony are made below.

    
    

12. There was a consensus among the experts that the emergency room doctor's role is to pass on to the admitting physician all the information the doctor has gathered from the examination and tests. It is then the responsibility of the admitting physician to ask the emergency room doctor appropriate questions concerning the patient, order vital signs to be taken at specified intervals, and give other directions to the monitoring staff (nurses) concerning steps to be taken in the event of changes in the patient's condition. The experts also concluded that the primary physician, in preparing a history and physical examination of the patient, should not rely on the emergency room doctor's notes and findings but should personally conduct his own physical and history in a more thorough manner. This is especially true when, as here, the emergency room physician is unable to conclusively establish the cause of the patient's illness.

    
    

13. In Dr. Cohen's opinion, respondent should have suspected meningitis at the outset of N.K.'s admission. This was because of her lethargy, high fever and back pain, all being symptoms associated with that infection. Doctor Cohen also noted that respondent was cognizant of Dr. Shaffer's preliminary diagnosis of possible sepsis, knew that pneumonia and urinary tract infection were not the causes of the infection, and still had no idea what caused N.K.'s infection. Given these considerations, Dr. Cohen opined that respondent should have ordered further tests to confirm N.K.'s ailment, such as a lumbar puncture (spinal tap), an X-ray of her abdomen, a reexamination of the abdomen or a head scan. Doctor Cohen further suggested that after those tests were completed, it would have been prudent for respondent to "employ a sort of antibiotic recipe for dealing with a septic, elderly person." In other words, he should have used a group of intravenous antibiotics that would cover most of the possible causes for that type of infection. In addition to the foregoing omissions, Dr. Cohen was of the opinion that Dr. Bilang erred further when, after receiving advice from the nurse at 6:05 a.m. and 6:40 a.m. concerning the patient's rapid deterioration in health, he failed to institute aggressive antibiotic therapy and instead prescribed mandol, a drug Dr. Cohen felt was too little, too late. According to Dr. Cohen, respondent compounded his mistakes by issuing a CMO order when the patient did not have a terminal illness and without consulting the patient's family. By engaging in the foregoing conduct, the expert concluded that respondent did not conform with minimally acceptable medical standards in the community.

    
    

14. Doctor Cohen next opined that it was inappropriate for respondent to prepare a history and physical after the patient's death and to base those items on information gathered by others. He labeled these matters "false and misleading" and a deviation from the standard expected of a doctor.

    
    

15. Doctor Neufeld initially pointed out that respondent erred by failing to start a broad spectrum (third generation) antibiotic regimen when he assumed responsibility for the patient at 1:20 a.m. According to the witness, such a

    regimen was called for because respondent was aware of the patient's age, high fever, slurred speech, dehydrated condition, the very strong possibility of sepsis, and his own inability to promptly obtain blood cultures from the laboratory to aid in confirming or ruling out various ailments. Further, respondent had no concrete evidence that the patient was suffering from the flu, an illness he initially thought N.K. might have. Even if respondent was unsure if the infection was viral or bacterial, Dr. Neufeld pointed out that respondent nonetheless should have assumed the patient was septic and started an antibiotic regimen until the cultures were received from the laboratory or the fever subsided. Moreover, even if the patient had a viral infection, the antibiotics would not have harmed her. By respondent waiting until 6:05 a.m., and then ordering mandol rather than a stronger drug, Dr. Neufeld opined that respondent fell below the minimum standard of care for community physicians. Doctor Neufeld stated further that respondent deviated from the same standard of care by issuing a CMO order when the patient did not have a terminal illness. Doctor Neufeld echoed Dr. Cohen's sentiments that the prevailing community standards did not call for a CMO order unless the patient was afflicted with a terminal, irreversible illness and only after a physical examination had been performed by the physician.

    
    

16. Doctor Neufeld found the physical examination documented by Dr. Bilang on pages 10 and 11 and the accompanying discharge summary on pages 13 and 14 of the patient records to misleading since both erroneously suggested a pre mortem physical finding. Also, Dr. Neufeld opined that the medical records did not justify the course of treatment to the patient. However, the basis for this opinion is not clearly delineated in the record.

    
    

17. Doctor Neufeld conceded that though he would have gone to the hospital at 1:20 a.m. to examine the patient, respondent did not violate the standard of care by evaluating the needs of the patient by telephone. Even so, Dr. Neufeld maintained that respondent should have ordered antibiotics after his consultation with Dr. Shaffer. The expert differed in one respect with Dr. Cohen and agreed with respondent that the records, at least at 1:20 am., did not call for a spinal tap or head scan, and respondent's failure to perform those tests at that time was acceptable. Finally, although he acknowledged that an order for a third generation antibiotic regimen at 6:05 a.m. might not have been mixed and ready for patient use by the time the patient expired, Dr. Neufeld opined that respondent still had a duty to use all available measures to keep her alive until the drugs were received.

    
    

18. According to Dr. Shaffer, she observed Dr. Bilang on a day to day basis and considered him a "caring, competent, practicing physician." However, she stated that respondent was sometimes too busy" and overextended" himself. As a consequence, she was "concerned" that he was taking care of too many patients at the same time. Although she did not consider herself qualified to

    render an opinion, she opined that respondent did not deviate from the minimally acceptable standards for Clearwater area physicians when he failed to initially order antibiotics for N.K. at 1:20 a.m. This was because, if a physician was unsure if a patient had a viral syndrome or a bacterial septic condition, he might wait "a little bit of time" to see what course of treatment was required. Further, the decision to order antibiotics is a "judgment call" by a doctor and depends in part on two "iffy" tests, a lumbar puncture and a gram stain of the blood smear. The latter test result was not available until several days after the patient expired.

    
    

19. According to Dr. Brady, respondent's course of treatment and overall conduct, with one exception, fell within the minimal acceptable standards of

    care for physicians. The exception pertained to respondent's issuance of a CMO order. After reviewing the patient's records, Dr. Brady concluded that respondent could not have known the patient was suffering from a bacterial infection since nothing in the physical examination was suggestive of meningococcemia, the organism affecting the patient. Thus, he concluded that the patient's illness was probably not diagnosable until shortly before she died. This was because the patient did not have a stiff neck (nuchal rigidity), purplish skin rash, or signs of shock, which are the normal indications of meningitis, and because the infection is extremely rare and has an incidence rate of only one case per one hundred thousand persons in a given year. Even so, he conceded that if the disease occurs, its physical signs can manifest in a very short period of time and could have begun shortly after the patient was first examined by the emergency room physician around 11:00 p.m. Once respondent recognized the severity of the patient's ailment, and prescribed mandol at 6:05 a.m., Dr. Brady agreed that mandol would not have had any beneficial effect on the patient even if administered immediately after being ordered. Instead, the witness would have ordered a third generation antibiotic which is more effective in treating gram negative rods. While he characterized respondent's choice of mandol as "not the best thing to do", he nonetheless said "it was not an unreasonable thing to do" given the circumstances. The expert next agreed with the Board experts that a CMO order is appropriate only when the patient has a terminal illness and has requested that no life-sustaining measures be used. In this case, he agreed that the patient records did not justify this action. He added, however, that the patient would probably have expired no matter what resuscitative efforts were undertaken. Finally, while Dr. Brady did not think respondent was attempting to falsify his records by copying the notes of others in preparing the post-mortem physical and patient history, he noted that respondent should have indicated on his February 3, 1986 notes that he was copying the records of others.

    
    

20. Having evaluated the testimony of the experts, the undersigned has resolved the conflicts in favor of the Board. Accordingly, it is found that respondent fell below the minimum standard of care by failing to initially recognize the patient's septic condition and prescribing a comprehensive antibiotic regimen, by failing to institute the same regimen at 6:05 a.m. after becoming aware of her critical condition, and by issuing a CMO order at 6:40

    a.m. when the patient did not have a terminal illness. Further, respondent filed reports on February 3 and 21, 1986 which he knew or should have known were misleading and false, namely, a patient history, physical examination and discharge summary prepared post mortem which suggested that such reports were based on pre mortem findings by respondent. Finally, it is found that the records maintained by respondent were inadequate to justify the issuance of a CMO order since the patient did not have a terminal illness.

    
    

21. By stipulation approved by Board order dated October 30, 1987, respondent was reprimanded by the Board, paid a $1,000 fine, was placed on monitored probation for a year, and agreed to take twenty hours of continuing medical education in the area of prescribing medicinal drugs. Official Board records indicate that respondent's license still remains on a probationary status presumably because of the pending proceeding.

    
    

    CONCLUSIONS OF LAW

    
    

22. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties thereto pursuant too Subsection 120.57(1), Florida Statutes (1987).

23. Since respondent's professional license is at risk, the agency must prove the allegations in the administrative complaint, as amended, by clear and convincing evidence. Ferris v. Turlington, 510 So.2d 292 (Fla. 1987).

    
    

24. Initially, a delineation of the specific issues to be tried in this proceeding is necessary. This is because a dispute between counsel arose at hearing concerning a so-called "understanding" as to the issues in the case. The first administrative complaint filed on November 4, 1987 alleged generally that respondent (a) failed to keep medical records to justify the course of treatment (Count I), (b) filed a report that he knew was false (Count II), and

    (c) was guilty of gross or repeated malpractice or failed to conform to the standard of care expected of area physicians (Count III). At hearing, respondent's counsel contended that Count I was no longer an issue based upon an understanding he had with Board co-counsel, as reflected in a letter sent by him to Board counsel on April 26, 1988, and received in evidence as respondent's exhibit 1. The letter stated in part that:

    
    

    this - letter will confirm our telephone conversation with reference to the presently pending matter outstanding against my client

    ... You have advised me that the only matters which will be at issue will be whether Dr. Bilang deliberately falsified records and whether his ordering comfort

    measures only and - not placing the patient in a code status was unacceptable.

    
    

    There is no evidence of any reply from Board counsel. However, on May 18, 1988 the Board filed a second amended administrative complaint containing essentially the same charges except that clarifying language was added to paragraph 19 of the factual allegations. Since respondent made no further inquiry regarding the amended complaint and did not lodge an objection until final hearing, and the "understanding" was never formalized by stipulation, the undersigned concludes that all three counts in the amended complaint are viable and should be tried.

    
    

25. The amended administrative complaint alleges first that respondent failed to keep adequate written medical records to justify the course of treatment on the patient. If proven, this would constitute a violation of Subsection 458.331(1)(m), Florida statutes, which requires, at a minimum, that a physician keep written entries of a patient's history, examination and test results. Rizzo v. Department of Professional Regulation, Board of Medical Examiners, 511 So.2d 1019 (Fla. 4th DCA 1987)(statute sets forth a legislatively mandated minimum standard of recordkeeping by physicians). Under petitioner's theory, the patient's medical records did not justify the issuance of a CMO order since the patient did not have a terminal illness. Because the records maintained by respondent did not justify his course of treatment as to the CMO order, it is concluded that this allegation has been sustained by clear and convincing evidence, and that respondent violated subsection 458.331(1)(m) as charged in Count I of the amended complaint.

    
    

26. Next, the amended complaint alleges that respondent filed a report which he knew to be false in violation of Subsection 458.331(1)(h), Florida Statutes. That subsection makes unlawful the "making or filing a report which the licensee knows to be false." It is immaterial as to whether such a report is required to be filed by state or federal law. Britt v. Department of Professional Regulation, Board of Medical Examiners, 492 So.2d 697 (Fla. 1st DCA 1986). The evidence reflects that on February 3 and 21, 1986, respondent

    prepared patient history and physical examination reports and a discharge summary without indicating that the findings of other persons had been used in preparing such reports. Because such reports were misleading and false, it is concluded that a violation of subsection 458.331(1)(h) has occurred.

    
    

27. Finally, the amended complaint alleges that respondent is guilty of gross or repeated malpractice or failing to conform with the acceptable medical standards of the community within the meaning of Subsection 458.331(1)(t), Florida Statutes. The evidence does not sustain a charge of gross or repeated malpractice. However, by clear and convincing evidence the Board has proven the charge that respondent failed to conform to minimal acceptable community medical standards by failing to recognize the serious nature of the patient's illness at 1:20 a.m. and taking appropriate steps, failing to institute aggressive antibiotic therapy at 6:05 a.m. after learning that the patient was critically ill and issuing a CMO order when the patient did not have a terminal illness and without personally performing an examination of the patient. Therefore, to this extent, the allegations in Count III have been sustained.

27. Rule 21M-20.001, Florida Administrative Code (1987) provides extensive guidelines for imposing penalties whenever disciplinary action against a licensee is warranted. Subsection (2) of the rule provides that, for a violation of subsections 458.331(1)(h)(m) and (t), a licensee may have penalties imposed upon him ranging from a reprimand to licensure revocation and a $5,000 administrative fine. However, in assessing an appropriate penalty, subsection

1. of the same rule requires that, if relevant, certain aggravating and mitigating circumstances be considered. As is relevant here, they include the number of counts established, the disciplinary history of the licensee, and the exposure of the patient to injury or death. Given the number of counts established, respondent's record of having been disciplined on one prior occasion, and the fact that the patient died (although her chances of survival were very small) suspension of respondent's license for two years is appropriate.

   
   

   RECOMMENDATION

   Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that respondent be found guilty of the violations discussed in

   the Conclusions of Law portion of this Recommended Order, and that respondent's

   medical license be suspended for two years.

   
   

   DONE and RECOMMENDED this 11th day of July, 1989, in Tallahassee, Florida.

   
   

   DONALD R. ALEXANDER

   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 11th day of July, 1989.

   ENDNOTES

   
   

   1/ The record suggests, but does not specifically reveal, that respondent had treated the patient at his office for other ailments on prior occasions.

   
   

   
   

   APPENDIX

   
   

   Petitioner:

   
   

   1. Covered in finding of fact 1.

   2. Covered in finding of fact 5.

   3. Covered in finding of fact 2.

4-5. Covered in finding of fact 5.

6. Covered in finding of fact 6.

7-8. Covered in finding of fact 9.

1. Covered in finding of fact 10.

2. Covered in finding of fact 4.

3. Covered in finding of fact 9.

4. Covered in findings of fact 13, 15, 19 and 20.

5. Covered in findings of fact 16, 19 and 20. 14-16. Covered in finding of fact 20.

17. Covered in finding of fact 21.

COPIES FURNISHED:

Bruce D. Lamb, Esquire 730 South Sterling Street Suite 313

Tampa, FL 33609-4582

Stephanie A. Daniel, Esquire

1940 North Monroe Street, Suite 60

Tallahassee, FL 32399-0792

Salvatore A. Carpino, Esquire One Urban Centre, Suite 750 4830 West Kennedy Boulevard Tampa, FL 33609

Ms. Dorothy Faircloth, Executive Director Board of Medicine

1940 North Monroe Street, Tallahassee, FL 32399-0792

Kenneth D. Easley, Esquire

1940 North Monroe Street, Suite 60

Tallahassee, FL 32399-0792

=================================================================

AGENCY FINAL ORDER

=================================================================

DEPARTMENT OF PROFESSIONAL REGULATIONS BOARD OF MEDICINE

DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF MEDICINE,

Petitioner,

vs. CASE NO. 87-5382

BERNARDO G. BILANG, 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 October 7, 1989, in Tampa, 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 Bruce Douglas Lamb, Attorney at Law. Respondent was not present, but was represented by Salvatore

A. Carpino, Attorney at Law.

At the hearing, the parties submitted a written Stipulation (attached hereto as Exhibit B) for consideration by the Board, as authorized by Section 120.57(3), Florida Statutes. Said Stipulation included an agreement by Respondent to permanently relinquish his license to practice medicine in the State of Florida and to never seek reinstatement of said license, or otherwise seek licensure as a physician in the State of Florida.

Upon review of the Recommended Order, the Stipulation, the argument of the parties, and after a review of the complete record in this case.

IT IS HEREBY ORDERED AND ADJUDGED that the Stipulation offered is hereby ACCEPTED.

This order takes ef fect upon filing with the Clerk of the Department of Professional Regulation.

DONE AND ORDERED this 11th day of October, 1989.

BOARD OF MEDICINE

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 NOTICE OF APPEAL WITH THE AGENCY CLERK OF THE DEPARTMENT OF PROFESSIONAL REGULATION AND A SECOND COPY, ACCOMPANIED BY FILING FEES PRESCRIBED BY LAW, WTTH 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 triie and correct copy of tho foregoing Order has been provided by certified mail to Bernardo G. Bilang, M.D., 1201 South Highland Avenue, Suite 11, Clearwater, Florida 34661 and Salvatore A. Carpino, Attorny at Law, One Urban Centre, Suite 750, 4830 W. Kennedy Avenue, Tampa, Florida 33609, by U.S. Mail to Donald R. Alexander, Hearing Officer, Division of Administrative Hearings, The DeSoto Building, 1230 Apalachee Parkway, Tallahassee, Florida 32399- 1550; and by interoffice delivery to Bruce D. Lamb, Attorney at Law, Department of Professional Regulation, 730 South Sterling Street, Tampa, Florida 33609-4582 at or before 5:00 P.M., this 11th day of October, 1989

Docket for Case No: 87-005382

Orders for Case No: 87-005382