Findings Of Fact At all times material hereto, Respondent Maria C. Perez has been licensed as a pharmacist under the laws of the State of Florida, having been issued license number 0018025. At all times material hereto, Respondent Perez has been the managing pharmacist at Respondent San Lazaro Pharmacy. At all times material hereto, Respondent San Lazaro Pharmacy has been the holder of a permit to operate a community pharmacy under the laws of the State of Florida, having been issued permit number 0002864. At all times material hereto, Olegario Cepro (or Cepero) was employed at Respondent pharmacy. At no time material hereto was Cepro licensed as a pharmacist or registered as a pharmacy intern in the State of Florida. On March 1, 1983, Georgina Jorge, an investigator with the Department of Professional Regulation, entered the Respondent pharmacy. Jorge asked Cepro for 30 Berocca tablets, 10 Librax capsules, and 5 Darvon Compound capsules. Cepro went into the dispensary department and thereafter delivered to Jorge 45 pills. At no time during this transaction did Jorge present Cepro with a prescription. On March 1, 1983, the pills received were taken to the Metropolitan Dade County Crime Laboratory. A subsequent chemical analysis of the pills revealed the presence of the controlled substance known as chlordiazepoxide, the active ingredient in Librax, a medicinal drug requiring a prescription for dispensing. Another sample which was analyzed revealed the presence of the controlled substance known as dextro propoxyphene, the active ingredient in Darvon Compound, a medicinal drug requiring a prescription to be dispensed. The suspected Berocca was not analyzed. On March 8, 1983, Jorge returned to the Respondent pharmacy. She asked Cepro for 10 penicillin tablets, 20 Valium tablets, and 10 Darvon Compound capsules. Cepro obtained from the pharmacy dispensary and gave to Jorge 10 tablets which appeared to be penicillin, 20 tablets which appeared to be Valium, and 20 capsules which appeared to be Darvon Compound. At that time, Respondent Perez was in the pharmacy dispensary. At no time during this transaction did Jorge present Cepro with a prescription. On March 8, 1983, the above substances were taken to the Metropolitan Dade County Crime Laboratory. A subsequent chemical analysis of the pills revealed in one sample the presence of penicillin, a medicinal drug requiring a prescription for dispensing. Analysis of another substance revealed the presence of the controlled substance diazepam, the active ingredient in Valium, a medicinal drug requiring a prescription for dispensing. On March 25, 1983, Jorge went to the Respondent pharmacy and asked Cepro for prices on bottles of Valium, Mebaral, Lomotil, Ritalin, Trofanil, and Lasix. Prices were quoted to Jorge by Cepro. Thereafter, Cepro delivered to Jorge 20 apparent Valium tablets, 36 apparent Ritalin tablets, 250 apparent Mebaral tablets, and 20 apparent Darvon Compound capsules. On this occasion, Jorge observed Respondent Perez, the licensed managing pharmacist, in the dispensary. At no time during this transaction did Jorge present Cepro with a prescription. On March 25, 1983, the substances which Jorge had received at the Respondent pharmacy were taken to the Metropolitan Dade County Crime Laboratory. A subsequent chemical analysis of the substances revealed the presence of the controlled substance known as methylphenidate, the active ingredient in Ritalin, which is a medicinal drug requiring a prescription to be dispensed. Methylphenidate is a Schedule II controlled substance pursuant to Chapter 893, Florida Statutes. Laboratory analysis of additional substances received from the March 25, 1983, transaction revealed the presence of the controlled substance known as mephobarbital, the active ingredient in Mebaral, a medicinal drug requiring a prescription for dispensing. In addition, one of the 20 capsules received was analyzed and revealed the presence of the controlled substance known as propoxyphene, the active ingredient in Darvon Compound, which is a medicinal drug requiring a prescription for dispensing. On March 28, 1903, Jorge went to the Respondent pharmacy once again. She asked Cepro for 20 Valium tablets and 20 Lomotil tablets. Jorge saw Respondent Perez in the prescription department. Cepro went into the prescription or dispensary department and returned with suspected controlled substances. At no time during this transaction did Jorge present Cepro or Respondent Perez with a prescription. On March 28, 1983, the suspected controlled substances were taken to the Metropolitan Dade County Crime Laboratory for analysis. A subsequent chemical analysis of the tablets revealed the presence of the controlled substance known as diazepam, the active ingredient in Valium, a medicinal drug requiring a prescription for dispensing. On March 28, 1983, an audit of the controlled substances was conducted at the Respondent pharmacy by Edward Bludworth, an investigator with the Department of Professional Regulation. That audit revealed that Respondents could not provide prescriptions or other documentation to show the dispensing of 41 Darvon Compound-65, 1,005 Valium 5 mg., 801 Valium 10 mg., 280 Tranxene 3.75 mg., 33,451 Talwin 50 mg., and 20 Talwin injectable vials. Darvon, Tranxene, Valium, and Talwin are all compounds containing controlled substances as defined in Chapter 893, Florida Statutes. Petitioner presented no evidence concerning the allegations of Count III [sic II; paragraphs 13, 14, 15, and 16] of the Administrative Complaint filed against Respondent Perez in DOAH Case No. 83-2918.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered dismissing Count III of the Administrative Complaint filed against Respondent Maria C. Perez, finding her guilty of Counts I and II of the Administrative Complaint filed against her, and revoking her license to practice pharmacy in the State of Florida. It is further RECOMMENDED that a Final Order be entered finding Respondent San Lazaro Pharmacy guilty of each and every count in the Administrative Complaint filed against it and revoking its permit to operate a community pharmacy in the State of Florida. DONE and RECOMMENDED this 27th day of March, 1984, in Tallahassee, Leon County, Florida. LINDA M. RIGOT 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 27th day of March, 1984. COPIES FURNISHED: Bruce D. Lamb, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 A. M. Schwitalla, Esquire 135 Almeria Avenue Coral Gables, Florida 33134 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Wanda Willis, Executive Director Board of Pharmacy 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact At all times relevant hereto, respondent, Ronald L. Askowitz, held dentist license number DN 0003884 issued by petitioner, Department of Professional Regulation, Board of Dentistry (DPR or the Board). Dr. Askowitz is a 1960 graduate of the Medical College of Virginia. Since 1965, he has practiced dentistry in the South Dade County area. Presently, he is engaged in the practice of general dentistry in Perrine, Florida. When the events herein occurred in 1984 and 1985, respondent's practice consisted of approximately forty percent Medicaid patients and sixty percent private pay patients. In order to be reimbursed for providing services to Medicaid patients, Dr. Askowitz was required to obtain a Medicaid provider number from the State of Florida and to adhere to then existing regulations. Among other things, respondent had to submit a dental remittance voucher to the Department of Health and Rehabilitative Services (HRS) as a prerequisite to reimbursement. Respondent has conceded that he completed and signed all vouchers himself. After HRS reviewed the voucher, a check would be issued to respondent reimbursing him at the fixed Medicaid rate. 2/ On average, Dr. Askowitz received around $1,000 per month for treating Medicaid patients. He did not differentiate between Medicaid and private pay patients in terms of quality of care. Because of unusually high billings for three surface amalgam restorations which exceeded the normal statewide range, the HRS computer "kicked out" respondent's name for further review by the Auditor General's Medicaid fraud unit. Thereafter, the billing records of thirty-one patients were picked at random and manually reviewed by the unit to ensure their accuracy. Eventually, this sample was reduced to seventeen files. Because of apparent irregularities in the files, an HRS dental consultant and two Medicaid special investigators visited each of the seventeen patients in the Miami area in August, 1985. The consultant performed an examination of the patients' teeth and compared the work he saw with the billings submitted by Dr. Askowitz to verify whether all billed work had actually been performed. Finding that many of the services for which respondent had been paid had not been performed, the consultant concluded that Dr. Askowitz had filed reports he knew to be false, that deceptive or untrue representations in the practice of dentistry had been made, that the patients had been financially exploited, and that respondent had engaged in fraud, deceit or misconduct in the practice of dentistry. Armed with the results of the unit's investigation, the State Attorney thereafter filed an information charging Dr. Askowitz with numerous counts of public assistance fraud. He was arrested on May 16, 1986. On October 17, 1986 respondent entered a plea of nolo contendere to seventeen counts of public assistance fraud. Adjudication was withheld and respondent was placed on five years' probation and required to provide 300 hours of community service. The probation term can be reduced to two years if all special conditions are met. In addition, Dr. Askowitz was required to make a voluntary $15,000 payment to the Medicaid Fraud Control Unit and a $20,000 payment to the Florida Medicaid Program. After the plea was entered, petitioner initiated this proceeding charging respondent with various violations of Chapter 466, Florida Statutes (1985), all of which relate to his billings on sixteen Medicaid patients. In general terms, respondent submitted Medicaid bills for various services rendered on these patients (mainly surface fillings), but in actuality all such services had not been performed. A more complete analysis of these billings is found in petitioner's exhibits 3, 4 and 5 received in evidence. As a result of these claims, Dr. Askowitz received some $3,412 in overpayments during a ten month period. He has not denied his wrongdoing. It is noted, however, that Dr. Askowitz actually saw every patient in question, and that all work actually performed was necessary. In addition, there is no allegation or evidence that Dr. Askowitz performed any work in a negligent or shoddy manner. Finally, the parties have stipulated that there is no issue regarding respondent's competency. At final hearing, respondent stated he was "frustrated" with HRS because he had not been paid for all of the services that he had rendered. Consequently, he filed these claims. He is now sorry he did so, and has paid a dear price for his misdeeds. He described the notoriety surrounding his arrest as having a devastating effect on his practice. Nonetheless, he still desires to continue his practice of dentistry. Indeed, Dr. Askowitz still operates an office, serving primarily patients from the middle and lower income classes. His Medicaid provider number has continued to remain valid, and he is the only dentist in the Perrine area who treats Medicaid patients. He has completed his community service hours by providing free dental care to residents of a drug and alcoholic treatment center. He has no prior disciplinary action against him over a career spanning some twenty-two years. Testimony by other dentists also established that respondent is highly regarded from a professional standpoint, and that he has done a creditable community service by treating numerous patients from the lower income stratum.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that respondent be found guilty of all charges, and that his license be placed on probation for three years. DONE AND ORDERED this 21st day of August, 1987, in Tallahassee, Leon County, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of August, 1987.
Findings Of Fact Based upon the entire record, the following findings of fact are determined: Background At all times relevant hereto, respondent, Obi E. Enemchukwu, was licensed as a pharmacist having been issued license number PS 0023082 by petitioner, Department of Professional Regulation, Board of Pharmacy (Board). He has been licensed as a pharmacist since 1981. There is no evidence that respondent has been the subject of disciplinary action prior to this occasion. When the events herein occurred, respondent was the designated prescription department manager and pharmacy permittee for Oviedo Drug World (ODW), a community pharmacy located at 83 Geneva Drive, Oviedo, Florida. A community pharmacy is not defined by statute or rule. However, a Board witness described such a pharmacy as being a drug store that serves customers in an outpatient or ambulatory setting. As the prescription manager for the pharmacy, respondent was responsible for maintaining all drug records, providing for the security of the prescription department, and following all other rules governing the practice of pharmacy. Count I This count alleges that respondent violated a Board rule by virtue of the ODW prescription department being "opened at 9:00 a.m. with a pharmacy technician only on duty with no pharmacist present until approximately 9:15 a.m.". In this regard, the evidence shows that on February 28, 1991, a DPR senior pharmacist, Charles C. Lewis, made a routine inspection of ODW. He entered the premises at approximately 9:00 a.m. and found the drug store open, the lights on in the pharmacy section, and only a pharmacist technician on duty. Respondent was not on the premises. Respondent eventually entered the premises around 9:10 a.m. Because the law requires that a registered pharmacist be on duty whenever a community pharmacy is open, respondent, as the designated manager, was in contravention of that requirement. Count II The second count alleges that "on one occasion in approximately August 1990, pharmacist technicians on duty were required to dispense medicinal drugs despite no pharmacist having been present". As to this charge, respondent admitted without further proof that the allegations were true. Thus, the charge in Count II has been sustained. Count III The third count alleges that "on at least two occasions refills for medicinal drugs were dispensed without authorization from the prescribing physician." As to this count, during the course of his inspection of ODW's prescription file, Lewis found copies of two original prescriptions dispensed by respondent on Saturday, February 9, 1991, and Saturday, February 16, 1991, respectively. Original prescriptions are those either handwritten by a doctor and brought in for filling by the patient or those that are telephoned in to the pharmacy by the doctor's office. If a prescription is telephoned in, it must be immediately reduced to writing by the pharmacist. Original prescriptions do not include refills. In this case, the two prescriptions were the type telephoned in by the doctor directly to the pharmacy. Because doctors are rarely in their offices on Saturday, Lewis turned the prescription records over to DPR for further investigation. The records of the prescriptions have been received in evidence as a part of petitioner's exhibits 1 and 2. The prescriptions indicate that Dr. James E. Quinn prescribed thirty Nalfon tablets (600 mg.) to patient L. C. on February 9, 1991, and Dr. Michael E. Meyer prescribed ten Tagamet tablets (300 mg.) to patient J. K. on February 16, 1991. The record does not disclose whether the drugs are scheduled legend drugs or non-scheduled legend drugs. Deposition testimony given by Drs. Quinn and Meyer established that neither doctor authorized by telephone or in writing that the two prescriptions in question be filled. Respondent concedes that he dispensed the drugs, and by doing so, he violated the law. Count IV The final count alleges that respondent, as a pharmacy permittee, violated former rule 21S-1.023 (now renumbered as rule 21S-28.112) by dispensing a medicinal drug in violation of state law. Because this charge is founded on the same set of facts set forth in findings of fact 4, 5 and 6, it is found that this charge has been sustained. Mitigation and Penalty At hearing, respondent generally offered mitigating testimony. As to Count I, he indicated he planned to arrive at the store at 9:00 a.m. but an automobile accident tied up traffic and caused him to be ten minutes late. He suspects that the store owner, who had the only other set of keys, opened up the store and pharmacy area and improperly let the technician into the pharmacy area even though respondent had not yet arrived. As to Count II, respondent acknowledged that two prescriptions were dispensed by pharmacy technicians without a pharmacist on duty but believes the store owner authorized the technician to dispense two prescriptions that he had filled the previous evening. He says appropriate instructions have been given to insure that this will not occur again. Finally, respondent gave the following explanation for dispensing the two prescriptions without authorization from a doctor. During the time period in question, respondent had a practice of partially filling prescriptions. In other words, even though a prescription might authorize a total of 100 tablets, respondent would dispense them piecemeal (e.g., 10 at a time) over the life of the prescription. Thus, at the end of the prescription period, if only 80 of 100 tablets had been previously dispensed, he would fill the remaining 20 tablets even though the prescription from a particular doctor had expired. In the case of the two prescriptions in issue, respondent believes that the customers either had a valid prescription from another doctor but he inadvertently refilled the prescription using the former doctor's name because the prescription had not been used up, or he noted that the patient had not been given the total number of tablets authorized under the original prescription. However, no documentation was submitted by respondent to support the claim that he was presented with a new valid prescription by one of the customers. Respondent apparently no longer engages in this practice. Finally, throughout the course of this proceeding, respondent has fully cooperated with the Board. Although the Board did not submit a proposed order containing a recommended penalty, at hearing counsel for the Board suggested that respondent's conduct warrants the imposition of a fine, probation and a reprimand.
Recommendation Based upon the foregoing findings of facts and conclusions of law, it is RECOMMENDED that respondent be found guilty of violating Sections 465.014, 465.015(2)(c), 465.016(1)(e)and (n), and 465.023(1)(c), Florida Statutes (1989), and that he be given a reprimand, fined $500 and his license placed on probation for one year. DONE and ENTERED this 12th day of March, 1992, 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 12th day of March, 1992. COPIES FURNISHED: Tracey S. Hartman, Esquire 1940 North Monroe Street, Suite 60 Tallahassee, FL 32399-0792 Obi E. Enemchukwu P. O. Box 32 Tavares, FL 32778-0032 Jack L. McRay, Esquire 1940 North Monroe Street, Suite 60 Tallahassee, FL 32399-0792 John Taylor, Executive Director Board of Pharmacy 1940 North Monroe Street Tallahassee, FL 32399-0792
The Issue At issue is whether Respondent committed the offenses set forth in the Administrative Complaint dated March 3, 2000, and, if so, what penalty should be imposed.
Findings Of Fact Respondent, Robert Gibson McLester, III ("McLester") is a licensed pharmacist 2 with a heretofore unblemished record. McLester graduated from the University of Florida with a degree in pharmacy in August 1977. He was licensed by the State of Florida to practice pharmacy in February 1978. He currently holds an Alabama pharmacy license, and was previously licensed in Mississippi but at some point ceased to pay the state's licensing fee; the license thus lapsed by operation of law. McLester received a Master of Science degree in hospital pharmacy from the University of Mississippi in December 1987 and a Master of Health Care Administration from the same institution the following May. McLester entered the Navy as an aviator cadet in June 1965, and was commissioned as a naval aviator in February 1967. He flew 103 missions with Attack Squadron 147 and was honorably discharged as a lieutenant in December 1970. Following a brief stint in the insurance and investment business, McLester applied unsuccessfully to medical school. McLester entered the University of Florida's pharmacy school in September 1974 and following his graduation in August 1977, has been continuously employed as a pharmacist when not pursuing advanced degrees in pharmacy and related fields. Much of McLester's pharmacy employment has been in the Navy, which he reentered in February 1978 as an ensign in the Medical Service Corps. McLester served in a variety of posts before retiring as a lieutenant commander in August 1992, including at the National Naval Medical Center in Bethesda, Maryland, where he supervised in excess of 25 pharmacists and pharmacy technicians in the preparation of an average of 1600 outpatient prescriptions per day. McLester continued the practice of pharmacy as a civilian, working briefly as a relief pharmacist for the Eckerd Drug chain in the Vero Beach area before being hired full time by Winn-Dixie in August 1992. Under McLester's supervision, Store No. 2358 enjoyed high sales volume and was used as a training site for other Winn-Dixie pharmacies. At all times during McLester's employment at Winn- Dixie, reports of annual inspections of his pharmacy conducted by the Agency for Health Care Administration ("AHCA") pursuant to law showed no deficiencies of any kind. McLester worked at the Winn-Dixie Store No. 2358 until June 17, 1998. McLester's separation from Winn-Dixie was voluntary. McLester left Winn-Dixie because he considered the hours assigned to him by his new supervisor, Steve Howard ("Howard") to be "slave hours." Following McLester's departure, sales and customer satisfaction at Store No. 2358 deteriorated. For most of the time relevant to this case, McLester was responsible for filling in the neighborhood of 150 prescriptions per day. That number placed his store at the high end of Winn- Dixie pharmacy productivity. 3 During the course of his employment at Winn-Dixie, McLester had occasion to report approximately a dozen instances of prescription drug fraud to the authorities, including St.Lucie County Detective Scott Silverman (Silverman). Following his resignation from Winn-Dixie, McLester worked briefly with various services which would find him work as a relief pharmacist. On the instructions of Howard, McLester was not permitted to work at any of the Winn-Dixie stores in the area. In October 1998, McLester found full-time employment with Doctors' Clinic Pharmacy in Vero Beach, a "closed pharmacy" which serves only the patients of that multi-specialty practice. During his term of employment at Winn-Dixie, McLester was assisted by about a half dozen pharmacy technicians. Pharmacy technicians are licensed by the state and must work under the close supervision of a registered pharmacist. Tasks which the law permits to be delegated to pharmacy technicians and which, in fact, are typically delegated to a pharmacy technician include ordering drugs, including controlled substances; receiving drugs and other inventory; counting and transferring drugs from their original containers to packages for individual prescriptions; shelf maintenance; department maintenance; and stocking shelves. Other tasks which pharmacy technicians may legally perform, and which were in fact performed by technicians at Winn-Dixie stores, include logging invoices into the computer system for payment; verifying orders shipped into the store; answering telephones; taking refills from patients or doctors provided that there is no change in any element of the prescription (i.e. instructions to the patient, dosage, etc.); requests to doctors to issue new prescriptions on behalf of a patient; preparing labels and delivering filled prescriptions to the pharmacist for final verification. Because of the nature of the tasks delegated to pharmacy technicians, the relationship between pharmacist and technician must be one of, as several witnesses testified, implicit trust. McLester trusted all of the pharmacy technicians with whom he worked at Winn-Dixie. One of the Winn-Dixie pharmacy technicians, Tonya Tipton ("Tipton") betrayed McLester's trust, along with the trust of the State of Florida which licensed her, Winn-Dixie which employed her, and several other pharmacists under whose supervision she worked. Weeks after McLester left Winn-Dixie, Tipton's betrayal of trust was discovered. Soon after, she was fired from Winn-Dixie and subsequently arrested for crimes she allegedly committed in and against the Winn-Dixie pharmacy. Tipton's arrest set in motion a chain of events which led to this Administrative Complaint. Following a work-related injury suffered in the early 1990s, Tipton developed a dependence upon prescription painkilling medication, including the narcotic nasal spray Stadol.4 Unbeknownst to anyone, Tipton devised a scheme by which she could steal Stadol from Winn-Dixie, and also obtain Stadol under a forged prescription. At all times prior to Tipton's firing from Winn-Dixie, she was a trusted employee. Tipton fell under suspicion when she stated to a co- worker that a package would be arriving the following day and that it should not be opened. Store employees opened the package nevertheless and discovered it contained Stadol. Thereafter, a fellow pharmacy technician followed Tipton into the ladies' room and discovered empty bottles of Stadol in the wastebasket. Confronted by store employees about her inappropriate instruction to the co-worker not to open the package, as well as the empty Stadol containers in the ladies' room, Tipton admitted only to taking one bottle of Stadol from the Winn-Dixie pharmacy. Abundant circumstantial evidence suggests that Tipton's dependence upon Stadol led her to commit more than the one offense to which she admitted. McLester had been the primary pharmacist on duty at Store No. 2358 during many of the shifts when Tipton was alleged to have illegally obtained Stadol. Following a criminal investigation by Detective Silverman and the arrest of Tipton, McLester's former supervisor, Howard, lodged a complaint against McLester with the Board of Pharmacy. In his letter of complaint, Howard characterized his complaint as an effort to protect the interests of Winn-Dixie "in case this problem was found out." Howard claimed that Mostafa Macida ("Macida"), who had replaced McLester as the store's primary pharmacist,"discovered" that Stadol was being stolen from the pharmacy but this testimony is rejected as inconsistent with the testimony of numerous individuals who, unlike Howard, had personal knowledge of the events surrounding Tipton's arrest. Macida suspected nothing and discovered nothing. Tipton's employment at Winn-Dixie began in February 1995 when she was hired as a pharmacy technician by McLester.5 In that capacity, Tipton worked not only with McLester, but also with then-Head Technician Ava Forsythe (Forsythe). Forsythe trained Tipton in the technicians' duties, including the various methods by which prescription drugs, both controlled and non-controlled, may be ordered. At all times relevant to this case, there are three ways in which Winn-Dixie pharmacies may procure drugs and medical supplies requiring prescriptions for resale to the public. The primary system is a computer-generated daily order. The system was referred to by many witnesses as "the PDX system" ("PDX"). Technicians, working under the supervision of the pharmacist, would review the order to verify that the required types and quantities of supplies were being ordered. When the order was deemed complete, "the button was pushed" and the order electronically transmitted to Winn-Dixie's major drug supplier, Bindley-Western.6 In theory, the computer would accurately track stock in over 2,000 line items. The computer was supposed to automatically add to the inventory based upon what was ordered, and subtract based upon records of what was actually dispensed to customers. In reality, the computer-generated inventory was corrupt on a daily basis. Because of the PDX system's unreliability, technicians often had to make adjustments by hand so that the computerized records would match what was actually in stock. Orders could also be manually keypunched into a unit called a Telxon, which also transmitted orders to Bindley- Western. The Telxon unit is portable. The size of a telephone, the Telxon unit at Store No. 2358 was generally kept in a drawer when not being used. Finally, drugs can be ordered from Bindley-Western and/or from one of two secondary suppliers used by Winn-Dixie from any telephone, whether or not the telephone is located in a Winn-Dixie store. None of the systems used by Winn-Dixie, either singly or in combination, had the ability to flag the fact that hundreds of bottles of Stadol had been ordered and paid for by Winn-Dixie, yet not placed on the shelves as pharmacy inventory in Store No. 2358, during the period of Tipton's employment. Under Winn-Dixie's system, it is possible for a pharmacy technician to order medications unbeknownst to the pharmacist, to have them paid for by Winn-Dixie, and to physically divert them to his possession before the medications were logged in to pharmacy inventory. Once drugs are properly entered into inventory, it is reasonable to expect that the pharmacist could be aware of large amounts of a drug being stolen from the inventory. Any single incident of placing unauthorized drug orders could take place in the two or three minutes the duty pharmacist might be absent to go to the restroom, or have his attention diverted for any reason. Silverman is an experienced police officer, having served for over two decades in various law enforcement positions in Florida. For nearly five years Silverman has been exclusively assigned to work with pharmacies and other law enforcement agencies in St. Lucie County. Silverman's job is to assist in the prevention and prosecution of crimes involving the misuse of prescription drugs. Silverman's involvement in this case began when Tipton sought him out. Tipton knew Silverman because her husband is a fellow St. Lucie County detective, and Tipton herself was a sworn St. Lucie officer. Tipton approached Silverman to confess that she had taken a bottle of Stadol from the Winn-Dixie store where she worked. Tipton's confession was not provoked by an attack of conscience. Rather, after she was fired by Winn-Dixie, she began damage control. As Silverman's investigation progressed, substantial effort was made to determine how Tipton had diverted Stadol and what, if any, other crimes may have been committed. Documents collected in the course of the investigation revealed that Tipton had developed a dependency on prescription painkillers dating to a back injury in 1990 in which she suffered a herniated disc. Tipton developed a dependency on Stadol in 1996, after dealing with pain related to the 1990 injury. Tipton claimed to Winn-Dixie security supervisor Robert Blakely ("Blakely") that she had told McLester of the problem, and that he referred her to her doctor for help. Ultimately, Silverman arrested Tipton on 17 counts of insurance fraud and one count of felony possession of a controlled substance. No evidence was offered regarding the disposition of Tipton's case. No evidence was presented of what, if any, effort was made to determine from Tipton if McLester had any complicity in her crimes. It was clear to Silverman that while Tipton had figured out a way to illegally divert Stadol to her unauthorized use, as of the date of the final hearing, "nobody knows how it was done." 7 There was conflicting testimony as to precisely how much Stadol was diverted by Tipton over the relevant period of time but Tipton's ability to obtain the drug through the use of fraudulent prescriptions and outright theft was audacious in scale. Stadol was a legend drug until June 1997 when the Drug Enforcement Agency upgraded its status to a Schedule IV controlled substance. Prior to October 19, 1996, Tipton had a legitimate prescription for Stadol. On that date, Les Gessley ("Gessley"), a relief pharmacist at Store No. 2358, approved a new Stadol prescription for Tipton under a legend number. Tipton used this approved prescription number subsequently when she herself prepared numerous unauthorized refills under this same number. Each of these unauthorized refills was listed on daily pharmacy logs certified mostly by McLester, but also by other duty pharmacists as well. Because these unauthorized prescriptions were refills rather than original prescriptions, the duty pharmacist was not required to personally view the original written prescription. McLester was the pharmacist on duty a majority of the days on which Tipton is believed to have diverted Stadol illegally. Somewhere between ten and twenty percent of the Stadol believed to have been unlawfully diverted by Tipton from Store No. 2358 was diverted after McLester had ceased to be employed there. Some of the Stadol obtained by Tipton under fraudulent prescription at Store No. 2358 was obtained on days when McLester was not the pharmacist on duty. In addition to Les Gessley and Mostafa Macida, other pharmacists on duty while Tipton was believed to have engaged in the criminal diversion of Stadol are Ted Kline and Al Leota. McLester admitted knowing Tipton had a problem with Stadol but did not know the extent of her problem. Forsythe told McLester that she thought there might be some Stadol missing from the shelves. When she shared her concern with McLester, he instructed Forsythe not to leave Tipton alone in the pharmacy. No evidence placed McLester's conversation[s] with Tipton and other parties about her use of Stadol in the context of when Tipton's alleged diversions occurred. According to Forsythe's unrebutted testimony, If you were that desperate you could order any medication you wanted on the Telxon machine or verbally order without knowledge of the pharmacist knowing what you were doing. And then when the medication comes in, you pay the invoice. You throw the invoice away. You throw the copy that you received from the computer away. The invoice is paid. The only person that will know about it will be the person at the headquarters that pays the payment on the invoice without knowing what is on it and the person gets the medication. Take the medication home via however and no one is the wiser. Winn-Dixie has no security procedures in place, such as searching handbags or packages, to prevent employee theft in the pharmacy. Winn-Dixie's ordering system is tailor-made to be abused by individuals who are, in Forsythe's words, "that desperate." It is not illegal for pharmacy technicians to fill their own prescriptions. It is possible for a pharmacy technician to fill or refill a prescription without the pharmacist knowing that had been done if he was absent from the pharmacy or had his attention diverted in some fashion. It appears that Tipton refilled her own fraudulent prescription on a number of occasions, but that her preferred method of diverting Stadol was outright theft. The Winn-Dixie system by which the pharmacies are stocked is flawed in a manner which allowed Tipton to divert Stadol without being detected by the duty pharmacist. The Department failed to show that McLester knew or should have known that Tipton had diverted Stadol to her unauthorized use at Store No. 2358.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the charges in the Administrative Complaint be dismissed. DONE AND ENTERED this 17th day of November, 2000, in Tallahassee, Leon County, Florida. FLORENCE SNYDER RIVAS 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 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 17th day of November, 2000.
The Issue Whether the Agency for Health Care Administration is authorized to terminate the participation of Respondent, Ronald M. Marini, D.M.D., P.A., in the Medicaid program.
Findings Of Fact AHCA is designated as the single state agency authorized to make payments for medical assistance and related services under Title XIX of the Social Security Act, otherwise known as the Medicaid program. See §§ 409.902(1) and 409.901(2) and (14), Fla. Stat. AHCA is responsible for administering and overseeing the Medicaid program in the State of Florida. See § 409.913, Fla. Stat. AHCA’s Bureau of Medicaid Program Integrity (“MPI”) is the unit within AHCA that oversees the activities of Florida Medicaid providers and recipients. MPI ensures that providers abide by Medicaid laws, policies, and rules. MPI is responsible for conducting audits, investigations, and reviews to determine possible fraud, abuse, overpayment, or neglect in the Medicaid program. See §409.913, Fla. Stat. Dr. Ronald M. Marini established his dental practice, Ronald M. Marini, DMD, PA (Respondent), in 2002. Dr. Marini’s practice focuses primarily on the treatment of children who have dental coverage through Medicaid. Respondent holds an active Medicaid provider agreement with AHCA, and is assigned Medicaid Provider No. 076031500. At all times relevant to this proceeding, Respondent was an enrolled Florida Medicaid provider authorized to provide dental care to Medicaid beneficiaries and receive reimbursement for covered services rendered to Medicaid recipients. A Medicaid provider agreement is a voluntary contract between AHCA and the provider. As an enrolled Medicaid provider, Respondent is subject to the duly-enacted federal and state statutes, regulations, rules, policy guidelines, and Medicaid handbooks incorporated by reference into rule. See § 409.907, Fla. Stat. For services rendered to Medicaid recipients, AHCA pays Medicaid providers under an honor system. AHCA is authorized to monitor the activities of Medicaid providers and to recover “overpayments.” See §§ 409.913 and 409.9131(5), Fla. Stat. An “overpayment” includes “any amount that is not authorized to be paid by the Medicaid program, whether paid as a result of inaccurate or improper cost reporting, improper claiming, unacceptable practices, fraud, abuse, or mistake.” § 409.913(1)(e), Fla. Stat. AHCA is also empowered to impose sanctions against offending Medicaid providers. § 409.9131, Fla. Stat. The dispute between AHCA and Respondent originated in 2014 when AHCA’s MPI unit initiated a review of Respondent’s claims for Medicaid reimbursement for the period of March 1, 2010, through August 31, 2012. Following the MPI unit review, AHCA issued a Final Audit Report on September 19, 2014, informing Dr. Marini that Respondent was overpaid for claims not covered by Medicaid in the amount of $590,008.15. In accordance with section 409.913 and rule 59G-9.070, AHCA notified Respondent that it intended to collect the full amount of the overpayment, plus an administrative fine. Respondent responded by requesting a formal administrative hearing to contest AHCA’s action. Respondent’s overpayment proceeding was eventually heard in DOAH as Agency for Health Care Administration v. Ronald M. Marini, D.M.D., P.A., Case No. 16-5641MPI (the “MPI Hearing”). The matter was assigned to Administrative Law Judge Linzie F. Bogan who conducted a formal administrative hearing on June 28 and 29, 2017. During the MPI Hearing, AHCA presented the testimony (via deposition) of Mark Kuhl, D.M.D. AHCA requested Judge Bogan accept Dr. Kuhl as an expert in the area of rendering dental care and dental medical necessity with respect to Medicaid overpayment. AHCA also offered Dr. Kuhl as a “peer reviewer” pursuant to section 409.9131. On August 29, 2017, Judge Bogan issued a Recommended Order in the MPI Hearing siding with AHCA. Judge Bogan specifically concluded: As determined in the Findings of Facts, [AHCA] met its burden of proof and established for those claims identified herein that Respondent was paid for claims that failed to comply with the laws, rules, and regulations governing Medicaid providers. Marini, Case No. 16-5641MPI, RO at 38. Thereafter, Judge Bogan recommended that AHCA enter a final order that: Revises the Final Audit Report consistent with the Findings of Fact and Conclusions of Law set forth herein; Recalculates the total overpayment consistent with the Findings of Fact and Conclusions of Law set forth herein; Requires Respondent to pay interest at the statutorily mandated rate on the recalculated overpayment; and Requires Respondent to pay a fine in the amount of 20 percent of the recalculated overpayment. Marini, Case No. 16-5641MPI, RO at 39. In reaching his decision, Judge Bogan specifically noted that he accepted Dr. Kuhl as an expert “in the areas of rendering dental care and dental medical necessity with respect to Medicaid overpayment cases.” Judge Bogan further accepted Dr. Kuhl “as a peer reviewer pursuant to section 409.9131, Florida Statutes.” Judge Bogan also noted that Dr. Kuhl operates a general dentistry practice where he treats pediatric patients. However, he is not board-certified in any specialty. Marini, Case No. 16-5641MPI, RO at 8. AHCA issued its Final Order on October 27, 2017. In its Final Order, AHCA adopted Judge Bogan’s findings of fact as set forth in his Recommended Order without modification. AHCA also adopted Judge Bogan’s conclusions of law without modification. Marini, Case No. 16-5641MPI, FO at 16. Per Judge Bogan’s recommendations, AHCA calculated that Respondent must repay an overpayment of $424,031.64. AHCA further imposed a fine on Respondent of $84,806.33. Marini, Case No. 16-5641MPI, FO at 16.2 Dr. Marini appealed AHCA’s Final Order to the Fifth District Court of Appeal on November 27, 2017. On April 16, 2019, the Fifth District affirmed the Final Order in a per curiam affirmed decision.3 On May 15, 2019, Dr. Marini appealed the Fifth District’s decision to the Florida Supreme Court. On May 23, 2019, the Supreme Court dismissed Dr. Marini’s appeal stating that the Court: lacks jurisdiction to review an unelaborated decision from a district court of appeal that is issued without opinion or explanation or that merely cites to an authority that is not a case pending review in, or reversed or quashed by, this Court.[4] As of the date of the final hearing, Respondent has not paid to AHCA the full amount of either the overpayment or the fine ordered by the Final 2 Pursuant to section 409.913(25)(c), Respondent was also responsible to pay interest on the overpayment amount of ten percent per year from the date of the Final Order. Marini, Case No. 16-5641MPI, FO at 16. 3 Ronald M. Marini, D.M.D., P.A. v. Ag. for Health Care Admin., 269 So. 3d 558 (5th DCA 2019), review dismissed sub nom. Ronald M. Marini, D.M.D., P.A. v. Ag. for Health Care Admin., No. SC19-843, 2019 WL 2238725 (Fla. May 23, 2019). 4 Ronald M. Marini, D.M.D., P.A. v. Ag. for Health Care Admin., No. SC19-843, 2019 WL 2238725 (Fla. May 23, 2019). Order (a total of $508,837.97). Neither has Respondent entered into an agreement with AHCA to repay the overpayment. Based on Respondent’s failure to reimburse the overpayment or enter into a repayment agreement, on or about January 29, 2020, AHCA initiated this action to terminate Respondent’s participation as a provider in the Medicaid program. AHCA pursues this action based on section 409.913(30), which directs that AHCA: [S]hall terminate a provider’s participation in the Medicaid program if the provider fails to reimburse an overpayment or pay an agency-imposed fine that has been determined by final order, not subject to further appeal, within 30 days after the date of the final order, unless the provider and the agency have entered into a repayment agreement. See also Fla. Admin. Code R. 59G-9.070(7)(s). In support of its case, AHCA called Shelby Sauls, a Management Review Specialist for AHCA’s MPI unit. As part of her responsibilities, Ms. Sauls supervises AHCA’s issuance of suspension and termination notices for Medicaid provider agreements. During the hearing, Ms. Sauls reviewed AHCA’s case financial history notes recording all Respondent’s Medicaid payment activity following the MPI Hearing in 2017. Ms. Sauls testified that Respondent still owes over $500,000 of the overpayment and fine ordered in AHCA’s Final Order. Ms. Sauls further relayed that AHCA and Dr. Marini have not entered into a repayment agreement to address the amount Respondent owes to AHCA per the 2017 Final Order. Katrina Derico-Harris also testified for AHCA. Ms. Derico-Harris is an Accounting Services Supervisor II and supervises the Medicaid Accounts Receivable Unit section of AHCA’s Bureau of Financial Services, which handles the majority of Medicaid overpayment collections. Ms. Derico-Harris stated that, as of the date of the final hearing, AHCA has received only one payment from Respondent in the amount of $24.49 on March 5, 2020. Ms. Derico-Harris declared that Respondent owes a current balance of $468,512.54 to AHCA to satisfy the full amount of the overpayment.5 Ms. Derico-Harris also confirmed that Respondent and AHCA have not entered into an agreement to repay the overpayment. Dr. Marini, in challenging AHCA’s decision to terminate Respondent from the Medicaid program, vigorously asserts that the calculation of an overpayment of $424.031.64 in AHCA’s 2017 Final Order was “spoiled fruit” from the beginning. Dr. Marini’s predominant argument is his strenuous objection to AHCA’s presentation of, and the presiding ALJ’s reliance upon, Dr. Kuhl’s testimony at the MPI Hearing. Dr. Marini asserts that the $424,031.64 overpayment amount was based on the testimony of an unqualified dental expert who used “an outrageous formula that turned a supposed overpayment of $3,500 into $590,000.” To support his position, Dr. Marini points to the fact that when Dr. Kuhl rendered his opinion, he was not a Medicaid Dental Provider, he never worked with a Medicaid Dental Provider, and he was not well versed in the use of the Florida Medicaid Dental Services Coverage and Limitations Handbook. Further, Dr. Marini contends that Dr. Kuhl should never have been considered an expert in Medicaid dentistry or children’s dentistry due to the fact that his exposure to children’s dentistry was limited to one to two children per week as compared to the 60-80 children seen per day in Dr. Marini’s practice. Finally, Dr. Marini proclaims that Dr. Kuhl’s “knowledge and use of dental materials was opinion bias and against the acceptable standards presented by the American Dental Association and the manufacturers of dental materials.” 5 Ms. Derico-Harris added that this amount does not include interest from February 10, 2020, to present, for which Dr. Marini is also obligated to pay. Consequently, Dr. Marini argues that Dr. Kuhl’s testimony could not support the finding that Respondent was overpaid by Medicaid, and the ALJ should not have accepted Dr. Kuhl as an expert to testify regarding the validity of Medicaid claims for dental services. Therefore, Dr. Marini emphatically declares that the Final Order issued in 2017 was improperly decided and invalid. In requesting an administrative hearing in the present matter, Dr. Marini hopes to have a “properly vetted and qualified dental expert” review his Medicaid claims. Dr. Marini maintains that Respondent owes nothing more to AHCA than $24.49, which is based on two errors he found in Respondent’s Medicaid claims during the audit period. Dr. Marini voluntarily paid the $24.49 to AHCA on March 5, 2020, which he considers the full amount of the overpayment. Dr. Marini admits that Respondent has not reimbursed AHCA for any amount over the $24.49. Neither has Respondent entered into a repayment agreement with AHCA. At the final hearing, Dr. Marini testified that Dr. Kuhl has never been challenged or properly vetted as an expert. However, contrary to Dr. Marini’s assertions, the record in the MPI Hearing reveals that Respondent had a full and fair opportunity to attack Dr. Kuhl’s competency to testify with respect to Medicaid overpayment claims. Indeed, Dr. Marini (through his legal counsel) frequently and purposefully questioned Dr. Kuhl’s expertise, knowledge, and training.6 More to the point, as further discussed below, Respondent cannot 6 For example, before the final hearing, Respondent and AHCA participated in two depositions of Dr. Kuhl. Prior to Dr. Kuhl’s last deposition, Respondent filed an Objection to Notice of Taking Deposition in Lieu of Live Testimony and Motion in Limine to Exclude Testimony of Mark Kuhl, D.M.D. Following the deposition, Respondent filed another Motion in Limine to Strike Testimony of [AHCA’s] Expert Witness, Mark Kuhl, D.M.D., and Supporting Memorandum of Law. Finally, nine days after the final hearing, Respondent filed a Motion in Opposition to [AHCA’s] Tendering of Mark A. Kuhl, D.M.D., as an Expert in Rendering Dental Care and Dental Medical Necessity With Respect to Medicaid Overpayment Cases. In its motions, Respondent repeatedly urged the ALJ to exclude Dr. Kuhl’s testimony. Respondent argued that Dr. Kuhl did not specialize in pediatric dentistry, therefore Dr. Kuhl did not possess the knowledge, training, or expertise to testify relitigate these issues. AHCA’s Final Order is final and is now beyond appeal. Respondent’s recourse to raise issues regarding AHCA’s overpayment determination was by appeal, which he pursued and ultimately lost. Based on the competent substantial evidence presented at the final hearing, the clear and convincing evidence in the record establishes that Respondent failed to reimburse AHCA for a Medicaid overpayment or pay a fine AHCA imposed by final order. The evidence further establishes that Respondent has not entered into an agreement with AHCA to repay the overpayment or the fine. Accordingly, AHCA met its burden of proving that section 409.913(30) authorizes the termination of Respondent’s participation in the Medicaid program.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that AHCA issue a final order terminating Respondent’s participation in the Medicaid program. In its Proposed Recommended Order, AHCA requests that, as the prevailing party, it is entitled to recover all costs incurred in this matter pursuant to section 409.913(23)(a). To the extent that section 409.913(23)(a) applies, jurisdiction is retained to determine the amount of an award of costs, if any. Within 30 days after entry of a final order, either party may file a request for a hearing to determine the amount of appropriate costs. Failure to request a hearing within 30 days after entry of the final order shall be deemed to indicate that the issue of costs has been resolved. DONE AND ENTERED this 16th day of July, 2020, in Tallahassee, Leon County, Florida. S J. BRUCE CULPEPPER 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 16th day of July, 2020. COPIES FURNISHED: Ronald Marini, D.M.D, P.A. 2921 South Orlando Drive, Suite 146 Sanford, Florida 32773 Kimberly Murray, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 (eServed) Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 (eServed) Mary C. Mayhew, Secretary Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 1 Tallahassee, Florida 32308 (eServed) Stefan Grow, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 (eServed) Shena L. Grantham, Esquire Agency for Health Care Administration Building 3, Room 3407B 2727 Mahan Drive Tallahassee, Florida 32308 (eServed) Thomas M. Hoeler, Esquire Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 (eServed)
Findings Of Fact Respondent, Norman G. Becker, Jr., is a licensed dentist having been issued license number DN 0002281 by Petitioner, Department of Professional Regulation, Board of Dentistry. He has practiced dentistry in the State since 1958. On or about September 8, 1980, Respondent furnished one William R. Northlick, 101 North Grandview, Mount Dora, Florida, a written prescription for four-ounces of dimethvl sulfoxide (DMSO). Northlick had been a patient of Respondent for approximately ten years, had complained of severe elbow pain, and inquired as to the status of DMSO and where it could be obtained. Respondent told him it was available at a local drug store and advised he could try a small amount. At an undisclosed date in 1980, Respondent was approached by a professional golfer named Gary Weintz who commlained of golfers elbow and who asked about the availability of DMSO. Respondent is active in arranging golf functions on the Professional Golf Association-(PGA) tour and presumably met Weintz, uho is a member of the PGA, in that capacity. Respondent telephoned William Kennedy, a pharmacist at Thayer's Colonial Pharmacy in Orlando, Florida, and asked whether DMSO could be legally prescribed. Kennedy replied that he believed it permissible for Becker to assist Weintz in obtaining the drug and thereafter took a prescription for the same over the telephone. Before filling the prescription, Kennedy required Weintz to sign a patient release form acknowledging that DMSO was a veterinary product and releasing anyone from liability due to its use. Other than the two occasions referred to above, Becker has not prescribed DMSO at any time. He did not charge Northlick or Weintz for his assistance nor did he provide any follow-up care or treatment to either individual. Respondent has never personally used DMSO or applied it to any other patient or friend. Respondent has been a practicing dentist in Florida since 1958, and has lived in Winter Park, Florida, for the last eighteen years. His specialty is periodontics and he was the founder and first president of the Florida Society of Periodontics. He enjoys an excellent personal and professional reputation in the community. This was attested to by Dr. Neil G. Powell, immediate past president of the Florida Dental Association. Other than the present incident, Respondent's record has been exemplary, and he has never been subject to prior disciplinary action. Although Becker wrote the prescription for Northlick on a prescription pad, he did not consider it to be a prescription item". Rather, he considered it the same as when giving customers written instructions for obtaining water piks, electric toothbrushes and other non-prescription items. For this reason, he wrote the words "use as directed" on the prescription pad in lieu of the detailed instructions typically given when writing a normal prescription.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that Respondent be found guilty of violating Subsection 466.028(1)(z), Florida Statutes, as charged in the Administrative Complaint and that the remaining charge in paragraph 11a be dismissed. It is further RECOMMENDED that Respondent be issued a private reprimand. DONE and ENTERED this 22nd day of February, 1982, in Tallahassee, Florida. DONALD R. ALEXANDER 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 22nd day of February, 1982. COPIES FURNISHED: Theodore R. Gay, Esquire 130 North Monroe Street Tallahassee, Florida 32301 James F. Page, Jr., Esquire P.O. Box 3068 Orlando, Florida 32802 Salvatore A. Carpino, Esquire 130 North Monroe Street Tallahassee, Florida 32301
