Findings Of Fact At all pertinent times, respondent Margie V. Gray Denomme worked the 3- to-11 shift as a licensed practical nurse on the orthopedic floor, 3 North, of West Florida Hospital, in Pensacola. On or about September 9, 1980, respondent was counseled for failing to record the administration of Stadol and Demerol, controlled substances, "on MAR." Petitioner's Exhibit No. 2. CHART NO. 670613 On December 19, 1980, Dr. Hooper ordered, inter alia, 10 to 12 milligrams of morphine sulfate for a patient (Chart No. 670613) "q 3-4 hrs prn pain." Petitioner's Exhibit No. 1. According to a Narcotics and Controlled Drug Administration Record, Petitioner's Exhibit No. 2, respondent administered 10 milligrams of a 15-milligram tubex of morphine (sulfate) to the patient at five o'clock on the afternoon of December 26, 1980, and wasted the other five milligrams, the wastage being witnessed by another licensed practical nurse, Ms. Grant. The December 26, 1980, patient progress notes for the patient, Petitioner's Exhibit No. 1, contain an entry reflecting administration of medication at five o'clock in the afternoon: [complaining] o[f] pain, medicated [with] M[orphine] S[ulfate] 10 mg IM . . . as stated by M. Denomme LPN." The entry is signed, "G. Grant LPN." The PRN medication administration record for this patient was signed by "G. Grant LPN" for the 3-to-11 shift on December 26, 1980. Petitioner's Exhibit No. 1. CHART NO. 667312 On December 17, 1980, Dr. Batson ordered morphine sulfate for this patient "1/4 to 1/6 IM q 34 PRN Pain." Petitioner's Exhibit No. 1. At quarter of seven on the evening of December 17, 1980, respondent administered 15 milligrams of morphine sulfate to the patient, using one 10-milligram tubex and half of another, the wastage being witnessed by another licensed practical nurse, Ms. Grant, all according to the Narcotics and Controlled Drug Administration Record. Petitioner's Exhibit No. 2. "v. Robertson, GPN" signed the patient's PRN medication administration record for the 3-to-11 shift on December 17, 1980. Petitioner's Exhibit No. 1. The nurses' notes contain this entry for 6:45 (pm.): "c/o pain-Medicated E MS 15 mg IM as stated by V. Robertson GPN-G. Grant GPN." CHART NO. 67194-3 For this patient, Dr. Batson ordered, among other things, "Morphine gr 1/6-gr 1/4 IM q 3-4 h prn pain. or Demerol 50-75-100 mg q 3-4 h IM prn pain. Tylenol #3 po T-TT q 3-4 h prn pain" on December 17, 1980, the date of his admission to West Florida Hospital's orthopedic ward. At half past six on the evening of December 17, 1980, the patient was given two tablets of Tylenol #3. Petitioner's Exhibit No. 1. He got another two tablets of Tylenol #3 about noon the following day. Petitioner's Exhibit No. 1. On December 19, 1980, Randy Godwin, a licensed practical nurse at West Florida Hospital, signed a Narcotics and Controlled Drug Administration Record indicating he had administered 15 milligrams of morphine to the patient at 6:20 p.m. Petitioner's Exhibit No. 2. Attached to this Narcotics and Controlled Drug Administration Record is an interoffice memorandum to the hospital pharmacy from Cynthia Ayres, R.N., Assistant Director of Nursing. Ms. Ayres wrote, "I have met with Randy Godwin, LPN and discussed his specific narcotic errors. He was terminated from employment at WFH. I did not allow him to correct these errors." Petitioner's Exhibit No. 2. There is no indication on this patient's PRN medication administration record that he was given any morphine on December 19, 1980. Petitioner's Exhibit No. 1. No administration of morphine on December 19, 1980, was charted in the patient's progress notes. Petitioner's Exhibit No. 1. Respondent administered 75 milligrams of Demerol, the entire contents of a tubex, to this patient at half past seven on the evening of December 19, 1980, according to a Narcotics and Controlled Drug Administration Record. Petitioner's Exhibit No. 2. (Count II) At nine o'clock that night, the patient was watching television, and had no complaint of pain. JANUARY 24, 1981 As she administered narcotics to patients during the 3-to-11 shift on January 24, 1981, respondent dropped waste paper and other debris in the narcotics drawer of the medication cart she had charge of. Toward the end of the shift, she was in the process of cleaning out the narcotics drawer when she felt something wet. Exclaiming something like, "Oh God, look at this," (T. 156; Testimony of Peat), she retrieved a cardboard container soaked to the point of disintegration with a solution of morphine sulfate, in the presence of Sandra Jean Peat, Randy Godwin, and other nurses who were in the medical room on the orthopedic floor at the time. Respondent recorded these events in an incident report and took the five-tubex plastic sleeve to the hospital pharmacy, about quarter of eleven. She asked the hospital pharmacist, James Thomas Allred, "to swap them out for five good ones." (T. 88.) At Mr. Allred's request, respondent prepared a second incident report in which she stated: When I was cleaning the Narcotics drawer, I picked up some of the packages and felt moisture on my hands. I then took the cartridges out of the PCK & found solution in bottom of Plastic Jacket. Two cartridges had the stopper out & 1 cartridge was broken. The tabs were intact as wit- nessed by R. Godwin LPN. Petitioner's Exhibit No. 3. After the wet plastic sleeve had been exchanged for a new one, respondent returned to the floor to catch up on charting. By this time, Randy Godwin had left the hospital. Mr. Allred jotted down his own contemporaneous account on the Narcotics and Controlled Drug Administration Record: Replaced a packet of five morphine sulfate 15 mgs. for a packet of five returned by M. Denomme LPN. The packet returned had two syringes with their rubber plungers out. One of these two syringes was broken. All tabs were intact except for the broken syringe. The cart count will remain the same. Petitioner's Exhibit No. 2. When respondent noticed broken glass in the five-tubex plastic sleeve, after another nurse had seen the sleeve with all tabs intact but before respondent took it to the pharmacy, she opened a tab to fish out syringe shards. The evidence clearly and convincingly established that somebody tampered with more than one of the disposable syringes or tubexes inside the plastic sleeve. Although factory defects . . . do occur, this was not a case of defective manufacture; a needle had punctured the sleeve. As the medication nurse for the 3-to-11 shift, respondent had signed for the narcotics and controlled drugs in the medication cart and taken the keys at three o'clock on the afternoon of January 24, 1981. Petitioner's Exhibit No. When she counted narcotics, before assuming responsibility for them, respondent did not pick up each item. Looking down into the narcotics drawer, she would not necessarily have known whether the bottom of the cardboard container holding two plastic sleeves, each of which contained five 15-milligram tubexes of morphine sulfate, was wet. Respondent was the third person to sign the Narcotics and Controlled Drug Administration Record as "oncoming nurse." Petitioner's Exhibit No. 2. She had the keys to the medication cart during the entire 3-to-11 shift except when she went to supper or took a break. No patient on the orthopedic floor received any morphine sulfate during the whole 24-hour-period. CHART NO. 682231 Also on January 24, 1981, respondent administered two tablets of Tylenol #3 to this patient at 5:30 and another two tablets of Tylenol #3 at 9:35, according to a Narcotics and Controlled Drug Administration Record. Petitioner's Exhibit No. 2. This "patient had been medicated with Tylenol #3 since January 20th, and this medication had held her . . . for a period of at least four hours." (T. 55.) Respondent signed out for 75 milligrams of Demerol for this patient but wasted it, in the presence of Randy Godwin. Randy Godwin did not sign the Narcotics and Controlled Drug Administration Record as a witness, however. OTHER MATTERS There was absolutely no evidence that respondent acted strangely or as if under the influence of a controlled substance at any time between September, 1980, and February, 1981. No evidence was adduced regarding anything that happened on or about February 8, 1981. On or about January 30, 1981, Altha Steen Chandler, then a ward clerk on the 3-to-11 shift for the orthopedic floor, told Gail Price that, two weeks earlier, while cleaning in the conference room, she had knocked respondent's purse off a table; that the purse opened when it fell; and that she saw containers of codeine, Demerol, and Benadryl. On hearing this, Ms. Price promptly relayed it to Bonnie Ellen Ripstein, then departmental nursing supervisor over surgical floors. The truth of this allegation, repeated under oath at the hearing (T. 5), was not clearly and convincingly established, considering all the evidence. There was no proof that any codeine was ever missing or unaccounted for at West Florida Hospital at any time between September of 1980 and February of 1981. The only record keeping irregularity with which respondent has been charged regarding Demerol has to do with records kept on January 24, 1981, after the ward clerk claims to have seen a vial of Demerol in her purse. The substances themselves were not in evidence. Ms. Chandler's testimony about their packaging was contradictory: "The demerol and the codeine was in a plastic like container and had red writing on it. The benadryl was in a brown container, and it had yellow writing on it . . . . The benadryl was a glass vial, but the other two vials, seemed like they were plastic to me." (T. 16.) Respondent admits that she regularly carries a vial of Benadryl in her purse; she testified that she is allergic to bee stings. She denied that there was codeine or Demerol in her purse on or about January 16, 1981, and claimed to be allergic both to codeine and to Demerol. At some point,, Ms. Ripstein was given the assignment of auditing narcotics records with which respondent, Randy Godwin, Nancy Torch, and Debra Mann, now Rezzarday, had been involved. None of the four is now employed at West Florida Hospital. This audit turned up most of the charges made against respondent in these proceedings. STANDARDS AND CONDITIONS The nurses at West Florida Hospital were strongly encouraged to finish their duties before shift's end to avoid their employer's having to pay overtime wages. Once, when respondent stayed late to finish her charting, she was reprimanded even though she had clocked out. On the orthopedic floor, a nurse who was "caught up" with her work would chart for other nurses who were busy, indicating on the records that she was relying on oral representations of another nurse. This practice was against hospital policy and does not conform to minimal standards of acceptable and prevailing nursing practice. It is also a departure from minimal standards to waste a controlled substance like Demerol without a witness's signing the control sheet at the time the drug is wasted. It was not shown that any patient suffered any injury at respondent's hands or on her account. The written closing argument of respondent and petitioner's proposed recommended order have been considered in preparation of the foregoing findings of fact. Petitioner's proposed findings of fact have been adopted in substance, except where unsupported by clear and convincing evidence.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED: That petitioner suspend respondent's license for thirty days. DONE AND ENTERED this 28th day of June, 1982, in Tallahassee, Florida. ROBERT T. BENTON, II Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 28th day of June, 1982. COPIES FURNISHED: W. Douglas Moody, Jr., Esquire Samuel R. Shorstein, Secretary 119 North Monroe Street Department of Professional Tallahassee, Florida 32301 Regulation 130 North Monroe Street Allen W. Lindsay, Jr., Esquire Tallahassee, Florida 32301 Post Office Box 586 Milton, Florida 32570 Helen P. Keefe Executive Director Board of Nursing 111 East Coastline Drive Jacksonville, Florida 32202
Findings Of Fact The Respondent, Natalie Patton, is a licensed pharmacist and has been licensed since 1959. She is a graduate of Sanford University, Birmingham, Alabama, and was initially licensed in Alabama as a pharmacist. She has worked as a licensed pharmacist for twelve years in Highlands County in the vicinity of Sebring. She is licensed as a pharmacy consultant as well and has been employed at several hospitals and pharmacies in that geographical area. She opened her present pharmacy' business in November, 1978, in a rural area southwest of Sebring at the community of Spring Lake. Her's is the only pharmacy in seventeen miles and her business volume reflects the rural nature of her business location and clientele in that she fills an average of thirty-five to fifty prescriptions a day. On "Race Friday," the day prior to the Sports Car Race at Sebring, a man entered her pharmacy complaining of severe headache and allergy to fumes associated with the infield and pits at the racetrack. He asked for Darvon, explaining that this was the only medication successful in treating his headaches. He explained he was from another part of the State and had no way to contact his physician. She sold him a non-prescription drug. He came back the next day, the day in question, March 22, and explained that her suggestion that he go to the emergency room the day before was impractical because a newspaper ad he had seen described the emergency room as overloaded and turning patients away. He complained of a worsening headache. She testified that she felt sympathy for him and ultimately and reluctantly sold him, at her cost, four Darvon to be used that Saturday and four for that Sunday. The individual requesting the medication then revealed himself to be a Deputy Sheriff of Highlands County, who arrested her on the spot, charging her with dispensing the Darvon without a prescription in violation of the above authority. She ultimately was tried on the charges and convicted, but adjudication was withheld and she was placed on three years probation by the Circuit Judge. A second related criminal charge was ultimately dismissed. She has been under the direction of a probation officer since that time and must report all her activities and receive permission before traveling out of her county. She also has been required to pay fifty dollars a month to reimburse the public defender for his services on her behalf. She is still operating her business and her customers have professed loyalty to her and her business is still increasing in volume. She has never had any altercation with law enforcement authorities of any type in her past and has never been convicted of any felony or misdemeanor. With the agreement of counsel for the Petitioner, certain testimonial letters on her behalf from persons who were not in attendance at the hearing were admitted as composite exhibit 1. These letters attest to and establish the fact, in corroboration of her testimony, that she is a decent and useful citizen and that she was totally unaware that she was committing a felonious act. These letters corroborate her testimony and establish that she is a crucial asset to her rural community. She is depended upon by numerous citizens, many of whom are of advanced years and who require frequent medication and are unable to travel any great distance. She has obviously gone to great lengths to operate her business in a professional and compassionate manner even to the extent of delivering medications to senior citizens and others long after the closing hours of her pharmacy. These letters in support of her position also are replete with instances described where she adheres strictly to the dictates of the various physicians' prescriptions and refused on a number of occasions to prescribe medication without a prescription. There is no question that the evidence in this record establishes that the Respondent is clothed with the highest personal integrity and moral character and that the isolated incident when she dispensed medication in violation of the above authority is not characteristic of the regular and otherwise consistent manner in which she practices pharmacy and conducts her business. The Respondent's probation officer sent a letter which is incorporated in Respondent's Exhibit 1 attesting to her conscientious efforts to obey the law and her usefulness as a citizen. He expressed the belief that she was unaware that she was actually committing a crime when the subject violation occurred and that she was simply and compassionately attempting to help a customer in trouble. He is convinced that revoking her pharmacy license would serve no useful purpose and would indeed impose a hardship on the rural customers she serves. He firmly believes she would not consciously violate the law or purposefully commit an illegal act. The Respondent was authorized by the Circuit Judge in the Respondent's criminal proceeding to make the following statement on the record in this proceeding: In re Natalie Patton: In open Court, in disposing of this case, and putting Natalie Patton on probation without adjudication, I made note of the numerous letters I received from people in the community, urging the Court to be lenient. The Respondent then noted that there were a hundred and forty signatures on those testimonial letters. At the conclusion of the Respondent's case the Respondent requested that the penalty herein be limited to a letter of reprimand. The Petitioner introduced no evidence and otherwise took no position with regard to the question of an appropriate penalty.
Recommendation Having considered the foregoing findings of fact, conclusions of law, the candor and demeanor of the witness and the evidence in the record, it is RECOMMENDED: That Natalie N. Patton and Spring Lake Pharmacy remain licensed and that Natalie Patton be accorded a written reprimand by the Board regarding the subject violation and that she be placed on probation by the Board for a period of time coextensive with the probation imposed in the criminal proceeding related hereto during which time her conduct of the practice of pharmacy be subjected to periodic monitoring by the Board. DONE AND ENTERED this 2nd day of November, 1981, in Tallahassee, Florida. COPIES FURNISHED: William M. Furlow, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Michael J. Trombley, Esquire 329 South Commerce Avenue Sebring, Florida 33870 P. MICHAEL RUFF, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 904/488-9675 Filed with the Clerk of the Division of Administrative Hearings this 4th day of November, 1981.
The Issue At issue is whether Respondent committed the offenses set forth in the Administrative Complaint and, if so, what penalty should be imposed.
Findings Of Fact Respondent's license and employment Respondent, Patrick O. Ojo, is now, and was at all times material hereto, licensed as a pharmacist by the State of Florida, having been issued license number PS 0032023. At all times pertinent hereto, Respondent was under contract with Healthcare Consultants of Central Florida, Inc., d/b/a Healthcare Consultants Pharmacy Staffing (Healthcare Consultants) , a corporation engaged in "the business of placing licensed pharmacists on a temporary and permanent basis" with businesses in need of their services. Pursuant to the agreement, Healthcare Consultants would "from time to time during the term of . . . [the] agreement offer [the] pharmacist the right to perform pharmaceutical services at the location of various clients, " which the pharmacist had the option to accept or reject. If accepted, for temporary services provided under the agreement, Healthcare Consultants would pay the pharmacist $25.50 per hour, except for legal holidays when the rate would be $41.25 per hour. Pursuant to a referral from Healthcare Consultants, Respondent accepted a position, on a temporary basis, as pharmacy manager for A & N Discount Pharmacy on June 2, 1997. A & N Discount Pharmacy is a community pharmacy licensed by Petitioner pursuant to Section 465.018, Florida Statutes, and located at 900 Alton Road, Miami Beach, Florida. The pharmacy inspection On June 24, 1997, Harold Gluck, a senior pharmacist employed by the Agency for Health Care Administration (AHCA), entered A & N Discount Pharmacy to conduct a routine community pharmacy inspection. Pertinent to this case, that inspection noted three deficiencies or violations against the pharmacy business, to wit: (1) there was a 2:1 technician to pharmacist ratio, without prior approval of the Board of Pharmacy (a perceived violation of Rule 64B16-27.410, Florida Administrative Code); (2) the two technicians were not wearing identification badges ( a perceived violation of Rule 64B16-27.410, Florida Administrative Code); and (3) the prescription department was only open 24 hours per week, as opposed to 40 hours per week (a perceived violation of Rule 64B16-28.404, Florida Administrative Code). Mr. Gluck's visual observations are supported by compelling proof, and are credited.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered which dismisses Counts I and IV of the Administrative Complaint; finds Respondent guilty of violating Section 465.016(1)(n), Florida Statutes, by failing to comply with Rule 64B16-27.410, Florida Administrative Code, as alleged in Counts II and III of the Administrative Complaint; and, which imposes, as a penalty for such violations, the issuance of a letter of guidance. DONE AND ENTERED this 15th day of September, 1998, in Tallahassee, Leon County, Florida. WILLIAM J. KENDRICK Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 15th day of September, 1998.
The Issue Whether Sandra Ann Lindstrom (“Ms. Lindstrom” or “Respondent”), a licensed physician assistant, prescribed Lorcet, a medication containing a controlled substance (hydrocodone), in violation of the Florida Statutes and the Florida Administrative Code as charged in the Amended Administrative Complaint filed at the Department of Health in DOH Case No. 2006-36542 on October 27, 2014. If so, what is the appropriate discipline?
Findings Of Fact The Parties The Department of Health is the state agency responsible for regulating the practice of physician assistants in the State of Florida. The regulation is pursuant to both chapter 456 (“Health Professions and Occupations, General Provisions”) and chapter 458 (“Medical Practice”), Florida Statutes. Respondent is licensed as a physician assistant by the Board of Medicine. Her license number is PA 9103823. The license was effective on August 3, 2006, with an expiration date of March 31, 2008. Her license has been continuously renewed since its effective date. See Pet’r’s Ex. A. Ms. Lindstrom is not licensed to practice medicine as a physician. Id. Physician Assistants Physician assistants are governed by section 458.347, a section within the chapter of the Florida Statutes that governs Medical Practice. Physician assistant licensure is provided for in section 458.347(7), and the Board of Medicine is authorized to “impose any of the penalties authorized under ss. 456.072 and 458.331(2) upon a physician assistant if the physician assistant or the supervising physician has been found guilty of or is being investigated for any act that constitutes a violation of this chapter [Ch. 458] or chapter 456.” § 456.347(7)(g), Fla. Stat. A physician assistant’s supervisory physician may delegate authority to conduct aspects of medical practice to a physician assistant under circumstances expressed in the statutes. The limited medical practice that may be delegated to a physician assistant includes certain practices at county health departments. Whether conducting the delegated practice of medicine at a county health department, or not, physician assistants may be delegated authority to prescribe medications provided they are not listed on a formulary created pursuant to section 458.347(7)(f). See § 458.347(7)(d) and (e), Fla. Stat. The formulary must include “controlled substances as defined in chapter 893.” § 458.347(7)(f)1., Fla. Stat. In sum, physicians may not delegate to physician assistants the prescription of medications which are controlled substances as defined in chapter 893, Florida Statutes. The Department’s Investigative Office The Department has an investigative office charged with looking into regulatory complaints. In a typical regulatory investigation, the investigator discloses his identity to any party interviewed, whether the party is the source of the complaint, a witness, or, if amenable to an interview, the licensee who is the subject of the complaint. Aside from interviews, the investigations include record reviews, the obtaining of evidence, and the preparation of an investigative report. In addition to investigating complaints of regulatory violations by licensed health care practitioners, the investigative office looks into cases of unauthorized practice by unlicensed individuals. Investigations of unlicensed activity are conducted by what is known as the “ULA” section of the office. Commonly, ULA investigations are done by investigators who are “undercover,” that is, the investigators hide their identity as investigators and use pseudonyms rather than their actual names. Typically, undercover ULA investigators present at the offices of the subjects of investigation. If the unlicensed subject of the investigation offers to perform services that require a license or engages in practice that requires a license, the Department pursues remedies, including an order that the subject cease and desist from the unlawful, unlicensed activity. Investigations of a licensee for practicing outside the scope of the licensed activity may be viewed as something of a hybrid of a typical regulatory investigation and a ULA investigation. It is regulatory since the subject is a licensee, but it is usually done undercover in the same manner in which a ULA investigation is conducted. One such investigation was conducted by Ryan Heal, an employee of the Department between August and December of 2006. Mr. Heal conducted the investigation undercover using a pseudonym referred to in Department documents as “RJ.” RJ and the 2006 Investigation of JHS Mr. Heal has been a medical malpractice investigator for the Department since November 2000. During the course of his more than 15 years as a Department investigator, Mr. Heal has investigated both regulatory violations and unauthorized practice violations. In 2006, allegations reached the Department that prescriptions were being written at Jacksonville Health Systems (“JHS”), a clinic located on Baymeadows Road in Jacksonville, Florida, by a physician assistant without the supervision of a physician. In response, the Department launched an investigation. The investigation was conducted undercover by Mr. Heal using his pseudonym RJ. Commenced in August of 2006, the investigation lasted until the following December. August 10, 2006 On August 10, 2006, Mr. Heal, using his fictitious name, presented at JHS. A woman behind the counter in the reception area accepted a cash payment for the visit. She took RJ’s blood pressure and requested the name of the pharmacy for any medicine prescribed. To the best of Mr. Heal’s recollection, the receptionist recorded some of the information. After the interaction with staff in the reception room, Mr. Heal took a seat and waited to be called back to the examination room. Shortly thereafter, Ms. Lindstrom emerged and asked for RJ. Mr. Heal “stood up and went over to her.” Hr’g Tr. 19. Ms. Lindstrom identified herself by her first name and said, “I’m the provider here.” Id. Ms. Lindstrom accompanied Mr. Heal to the examination room where only she and Mr. Heal were present. After Mr. Heal complained of back pain, Ms. Lindstrom asked where in his back the pain was located and what caused it, but she did not conduct a physical examination. As Mr. Heal testified at hearing, “[t]here was no examination. She never touched my back. Never took vitals or anything.” Hr’g Tr. 20. Ms. Lindstrom suggested that Mr. Heal use a chair with lumbar support, try stretching, lose weight, and have an MRI. Ms. Lindstrom then stated that she would prescribe medication to treat the pain: Lorcet, Flexeril, and Motrin. With the visit in the examination room concluded, Ms. Lindstrom took Mr. Heal back to the receptionist. The meeting in the examination room and his first visit to the JHS offices being over, Mr. Heal departed the JHS facility. He did not return until the following October. October 31, 2006 Mr. Heal returned to the JHS facility on October 31, 2006. The process during the second visit was similar to the one followed during the visit the previous August. He presented as “RJ.” A staff member took his blood pressure in the reception area and he paid her $90 in cash. Mr. Heal sat down and waited to be called. Again, Ms. Lindstrom appeared in the reception area and took him to the examination room in the back. The visit was shorter than it had been in August. Ms. Lindstrom asked if his pain had improved and if an MRI had been done. With the intention of calling in his prescriptions, Ms. Lindstrom showed Mr. Heal a list of five pharmacies from which to choose. Mr. Heal, however, took a tack that was different from Ms. Lindstrom’s intention and from his first visit: I explained to her that I did not have reliable transportation and asked [for] . . . handwritten prescriptions . . . so that I could take them to whatever pharmacy was convenient . . . . She agreed that she could write them that time, but that on the next visit, I would have to arrange for proper transportation to get to the pharmacy or wherever they needed to be called into. Hr’g Tr. 23. Ms. Lindstrom wrote out three prescriptions: Two of them were for “Flexeril 10mg (ten) #30 (thirty)” and “Ibprofen (sic) [Ibuprofen] 800mg #120 (one twenty).” Pet’r’s Ex. B. The third prescription was for “Lorcet 10/650 #90 (Ninety).” Id. Ms. Lindstrom explained to Mr. Heal that he should use one of the five pharmacies on her list because “several [of the Clinic’s patients] had been kicked out of pharmacies . . . [that] were refusing to fill the prescriptions.” Hr’g Tr. 25. Ms. Lindstrom also “mentioned that a couple of her patients had been arrested for forging prescriptions.” Hr’g Tr. 25-6. At no time during his visit to JHS on October 31, 2006, did Mr. Heal see a physician. No one entered the examination room where Ms. Lindstrom met with Mr. Heal that day. Nor did Ms. Lindstrom leave the examination room while Mr. Heal was present in the room. Like the first visit the previous August, Ms. Lindstrom recommended that Mr. Heal have an MRI. She explained that results from an MRI were needed “in case the DEA wanted to look at the file, to show that [she and JHS] were actually treating [Mr. Heal] for something.” Hr’g Tr. 28. December 1, 2006 Little more than a month later on December 1, Mr. Heal made a third visit to JHS. The reception process was the same. The receptionist took his blood pressure, he paid $90 in cash, and waited in the reception area for Ms. Lindstrom to call him back. While waiting, he was informed that the number of pharmacies that would accept JHS prescriptions had been drastically reduced. Only one pharmacy would now accept JHS prescriptions: a pharmacy called New Horizon. Subsequent to the third visit, Mr. Heal presented to the pharmacy identified as New Horizon. In the company of law enforcement and with its supervision, Mr. Heal had the prescriptions filled for three medications: Flexeril, Ibuprofen at a prescription-strength dosage, and Lorcet. Supervising Physician and Other Claims At hearing under oath, Ms. Lindstrom admitted that she treated Mr. Heal once at the JHS facility and admitted that she prescribed Flexeril and Ibuprofen for him. She claimed under oath that the supervising physician for the 2006 visit in which she prescribed the two medications was James Hendrick, M.D. The Department produced documentation in the Department’s official business records that shows that Dr. Hendrick cancelled his Professional Liability Insurance Policy effective October 1, 2005, the year before Ms. Lindstrom claims to have seen Mr. Heal at the JHS facility under Dr. Hendrick’s supervision. The reason for the cancellation of the policy is listed on the letter from the insurer to the Department as “Retired.” Pet’r’s Ex. F, letter dated October 17, 2005, from FPIC, First Professionals Insurance Company. Department records also include an “Address Change” form that contains a section entitled “Financial Responsibility” dated November 21, 2005, the year before the incidents in this case. No boxes are checked in the section that shows “Financial Responsibility Coverage.” Under a section on the form entitled, “Category II: Financial Responsibility Exemptions,” Dr. Hendrick checked a box that indicated he was “retired or maintain[ed] part-time practice,” id., at least as of late November 2005, 11 months or more before the October 31, 2006, visit by Mr. Heal. Ms. Lindstrom made other claims with regard to RJ’s visit that she asserted occurred on October 3, 2006, rather than October 31, 2006, as charged. Among them was that she left the examination room after completing the prescriptions for Flexeril and Ibuprofen and partially completing a third prescription by inserting all the information, including her signature, except for the medicine to be prescribed and how often it should be taken. Ms. Lindstrom claimed that she intended to write a prescription for Lodine, but failed to write down “Lodine” on the third prescription form because she was distracted by a discussion with Mr. Heal about the need for RJ to have an MRI. She says she left the room to make arrangements for an MRI and when she returned, RJ was gone, together with the two filled out prescriptions, the third incomplete prescription, and her prescription pad. Ms. Lindstrom’s testimony about the theft of the pad and other details about the event, including when it occurred, is not credible. In contrast, Mr. Heal’s testimony about the visits he made to the JHS facility, seeing Ms. Lindstrom, and her prescription of Lorcet, is credited as truthful. Lorcet Lorcet contains hydrocodone, which is a controlled substance.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medicine enter a final order: Finding that Respondent Sandra A. Lindstrom, P.A., violated section 458.331(1)(nn), Florida Statutes (2006), by violating Florida Administrative Code Rule 64B8-30.008 (2006), as charged in the Amended Administrative Complaint; Imposing a $2,500 fine; and Revoking Respondent’s license as a physician assistant. DONE AND ENTERED this 30th day of March, 2016, in Tallahassee, Leon County, Florida. S DAVID M. MALONEY Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 30th day of March, 2016. COPIES FURNISHED: Sandra Ann Lindstrom 6726 Pomeroy Circle Orlando, Florida 32810 Yolonda Y. Green, Esquire Maciej Lewandowski, Esquire Department of Health 4052 Bald Cypress Way, Bin C65 Tallahassee, Florida 32399-3265 (eServed) Andre Ourso, Executive Director Board of Medicine Department of Health 4052 Bald Cypress Way, Bin C03 Tallahassee, Florida 32399-3253 (eServed) Nichole C. Geary, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 (eServed)
