STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, Vv. CASE NO. 2006-36570 CHARLES H., MADSEN, JR., PH.D., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Heaith, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Psychology against the Respondent, Charles H, Madsen, Jr, Ph:D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of psychology pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 490, Florida Statutes, 2. At all times material to this Complaint, Respondent was a licensed Psychologist within the state of Florida and was issued license number PY 2886. 3, Respondent's address of record is 1254 Ocala Road, Tallahassee, Florida, 32304-1548, 4. On or about June 28, 2005, EC, the maternal grandmother of minor child, SaL, requested that the Respondent evaluate Sal, because EC believed that Sal had been sexually abused by SL, the biological father of Sal, sometime prior to June 28, 2005. J:\PSU\Allied Heaith\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compl.doc t Filed December 22, 2011 4:35 PM Division of Administrative Hearings ‘ile , ROA. 5. Prior to conducting the evaluation of SaL, the Respondent. knew Sal's maternal grandmother, EC, and Sal's maternal grandfather, JC, for almost thirty (30) years through the Mormon Church, and the Respondent had treated EC and JC's son regarding some violence by JC with his son. 6. The Respondent conducted the sexual abuse evaluation over the course of several months. 7. | On or about November 19, 2005, the Respondent at his clinic observed SL and Sal's interactions with each other. 8. The Respondent failed to obtain written informed consent from SL concerning all aspects of assessment and therapy. 9. The Respondent also arranged for Dr. L, who works with the Respondent and is the Respondent's son-in-law, to provide therapy for Sal with the restriction that -. Dr. L., not address sexual abuse issues, 10, Dr. L., who is supervised by the Respondent, has a Ph.D, in psychology, but is not licensed to practice psychology in the State of Florida. Ii. On or about February 21, 2006, the Respondent prepared a written report wherein the Respondent concluded that SL did “inappropriately touch his minor child, Sal.” 12. The Respondent also recommended that. all contact with Sal's biological father, SL, should be supervised and that , if Sal reacted to such contact negatively as identified during continued therapy sessions with Dr L, SU’s contact with SaL should be discontinued permanently. JA\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H./Jr., Ph.D\Admin Compl.doc 2 13. The Respondent did not interview any of the Sources that SL provided that could attest to SL’s parenting style or behaviors. 14. The Respondent did not appropriately weigh physical examination evidence of Sal, or the negative findings of the DCF investigations of alleged sexual abuse of SaL, or the negative polygraph results of SL. 15. The Respondent failed to conduct and document: an adequate diagnostic interview of SaL, including a history of present illness, prior psychiatric history, medical history, current medications, family psychiatric history and psychosocial history. 16. Respondent failed to maintain confidentiality of SL by disclosing SL's participation in Sal's evaluation without obtaining a release. 17, ~Respondent failed-to-maintain-the- confidentiality. of-SL-al ad Sat when he disclosed information regarding the evaluation with the head of the Mormon Church, COUNT ONE 18. Petitioner realleges and incorporates Paragraphs. one (1) through seventeen (17) as if fully set forth herein, 19, Section 490.009(1)(r), Florida Statutes (2005-2006), provides that failing to meet the minimum standards of performance in professional activities when measured against generally prevailing peer performance, including the undertaking of activities for which the licensee is not qualified by training or experience, constitutes an act for which disciplinary action may be taken. 20. Respondent violated Section 490.009(1)(r), Florida Statutes (2005- 2006), in one or more of the following ways: J:\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compl.doc 3 a. By conducting an evaluation of Sal, when the Respondent knew Sal's maternal grandmother, EC, and Sal’s maternal grandfather, JC, for almost thirty (30) years through the Mormon Church, and the Respondent had treated EC and JC's son, regarding some violence by JC with his son. b, By not interviewing any of the sources that SL Provided that could attest to SL’s parenting style or behaviors; Cc. By not appropriately weigh physical examination evidence of Sal, or the negative findings of the DCF investigations of alleged sexual abuse of Sal or the negative polygraph results of SL; or d. By failed to conduct an adequate diagnostic interview of Sak, including a history of present illness, prior psychiatric history, medical history, current medications, family psychiatric history and psychosocial history, 21, Based on the foregoing, Respondent violated Section 490.009(1)(r), Florida Statutes (2005-2006), by failing to meet the minimum standards of performance in professional activities when measured against generally prevailing peer performance, including the undertaking of activities for: which the licensee is not Qualified by training or experience, constitutes an act for which disciplinary action may be taken, COUNT TWO 22. Petitioner realleges and incorporates Paragraphs one (1) through seventeen (17) as if fully set forth herein, 23. Section 490.009(1)(u), Florida Statutes Florida Statutes (2005-2006), provides that the failure of a licensee to maintain in confidence a communication made J:\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compt.doc 4 by a patient of client in the context of such services, except as provided in Section 490.0147, Florida Statutes (2005-2006), constitutes grounds for disciplinary action by the Board of Psychology. ‘24. Section 490.0147 Florida Statutes (2005- -2006), allows for a waiver of confidentiality under the following conditions: when the person licensed under this chapter is a party defendant to a civil, criminal, or disciplinary action arising from the complaint filed by the patient or client, in which case the waiver shall be limited to that action; when the patient or client agrees to the waiver, in writing, or when more than one person in a family is receiving therapy, when each family. member agrees to the waiver, in writing; or when there is.a clear and immediate probability of physical harm ~~to-the-patient.or client, other- individuals, or to-society, and the person licensed_undler this chapter communicates the information only to the potential victim, appropriate family member, or law enforcement or other appropriate authorities, 25. None of the circumstances permitting a waiver of confidentiality were Present when the Respondent disclosed SL’s participation in Sal’s evaluation and when the Respondent disclosed information regarding SaL’s evaluation with the head of the Mormon Church, 26. Based on the foregoing, Respondent violated Section. 490, 009(1)(u), Florida Statutes (2005-2006), by failing to maintain in confidence a communication made by a patient or client in the context of such services, except as provided in Section 490.0147, Florida Statutes (2005-2006), J:\PSU\Allied Heaith\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compl.doc 5 COUNT THREE 27, Petitioner realleges and incorporates Paragraphs one (1) through seventeen (17) as if fully set forth herein. 28, Section 490.009(1)(w), Florida Statutes (2005-2006), provides that violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto, constitutes an act for which disciplinary action may be taken, 29, Rule 64B19-19.0025(2), Florida Administrative Code provides that a psychologist must obtain and document written informed consent concerning all aspects of services including assessment and therapy, 30. Respondent violated Section 490, 009(1)(w), Florida Statutes (2005-2006), through a violation of Rule 64B19-19, 0025(2), Florida Administrative Code, by failing to obtain and document written informed consent from SL prior to observing SL and Sal's interactions with each other, 31. Based on the foregoing, Respondent violated Section 490.009(1)(w), Florida Statutes (2005-2006), through a violation of Rule 64B19-19.0025(2), Florida Administrative Code, by failing to obtain and document written informed consent from SL Concerning all aspects of services including assessment and therapy. COUNT FOUR 32. Petitioner realleges and incorporates Paragraphs one (1) through seventeen (17) as if fully set forth herein. J:\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compi.doc 6 33. Section 490.009(1)(w), Florida Statutes (2005-2006), provides that violating any provision of this chapter or chapter 456, or any rules adopted. pursuant thereto, constitutes an act for which disciplinary action may be taken, 34. Rule 64B19-19,0025(1), Florida Administrative Code, provides that psychologists’ records — must meet minimum requirements for chronicling and documenting the services performed by the psychologist, including basic identification data such as name, address, telephone number, age and S€x; presenting symptoms or requests for services; dates of service and types of services provided. Additionally, as applicable, medication, especially current: what transpired during the service sessions; significant actions by the psychologist, service user, and service payer; psychologist’s eatin Slagesng pss sostve ates We thet progress notes opis of correspondent related to assessment or services provided: and notes concerning relevant psychologist’s conversation with persons significant to the service user. 35. Respondent violated Section 490.009(1)(w), Florida Statutes (2005-2006), through a. violation of Rule 64B19-19.0025(1), Florida Administrative Code, by failed to document an adequate diagnostic interview of SaL, including a history of present illness, prior psychiatric history, medical history, current Medications, family psychiatric history and psychosocial history, COUNT FIVE 36. Petitioner realleges and incorporates Paragraphs one (1) through seventeen (17) as if fully set forth herein. J\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compi.doc 7 37, Section 490.009(1)(w), Florida Statutes (2005-2006), provides that Violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto, constitutes an act for which disciplinary action may be taken. 38. Rule 64B19-11.005(2)(a), Florida Administrative Code provides that there may be no conflict of interest created by the Supervisory association and no relationship may exist between the supervisor and the psychological resident except the supervisory association, 39. Respondent violated Section 490.009(1)(w), Florida Statutes (2005-2006), through a violation of Rule 64B19-11.005(2)(a), Florida Administrative Code by supervising a psychological resident who is also his son-in-law. . ~~ MOS=Based=on--the--foregoing, -Respondent=violated Section -490.009(4)(w), Florida Statutes (2005-2006), through a violation of Rule 64B19-11,005(2)(a), Florida Administrative Code by supervising a psychological resident who is also his son-in-law. WHEREFORE, the Petitioner respectfully requests that the Board of Psychology enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the. Respondent on probation, corrective action and/or any other relief that the Board deems appropriate. J\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,3r., Ph.D\Admin Compl.doc 8 SIGNED ied fe day of Abas , 2008. DEPARTMENT OF HEALTH —DEPUTY CLERK CLERK: Peal Wwe DATE = -U-c§ PCP Date: 2-26-08 PCP Members: Rivas-Vazquez/Webster Ana M. Viamonte nel, D., M.PH, State Surgeon “mer Crpthia L. Jakeman - / tant General Cours¢! Florida Bar # 0714690 Department of Health Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399- 3265 (850) 245-4640 Ext, 8133 (850) 245-4684 FAX J:\PSU\Allied Health\Cynthia Jakeman\Board of Psychology\Cases\Madsen, Charles, H.,Jr., Ph.D\Admin Compi.doc 9

Docket for Case No: 11-006477PL