Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: On or about July 3, 1962, respondent was issued Osteopathic Physician and Surgeon license No. 20A-2834 by the Board of Osteopathic Examiners in the State of California. On July 14, 1962, respondent elected to use the designation "M.D." rather than "D.O.", and thereby submitted himself to the jurisdiction of the Board of Medical Quality Assurance in the State of California. On August 10, 1978, the Board of Medical Quality Assurance in the State of California revoked respondent's California license No. 20A-2834 effective September 11, 1978. By Order dated August 18, 1982, the effective date of that decision providing for revocation was changed to September 17, 1982. A Complaint Analyst with the Department of Professional Regulation, State of Florida, received documentation from the Board of Medical Quality Assurance, State of California, indicating that respondent's license No. 20A- 2834 had been revoked in California. She thereupon forwarded such documents to the legal section of the Department of Professional Regulation. On December 29, 1982, the Department of Professional Regulation filed an Administrative Complaint seeking to "revoke, suspend or take other disciplinary action against the Respondent as licensee and against his license as an osteopathic physician under the laws of the State of Florida." It is alleged that respondent is guilty of having a license to practice osteopathic medicine revoked, suspended or otherwise acted against by the licensing authority of another state, in violation of Section 459.015(1)(b), Florida Statutes (1981). No evidence was presented in this proceeding as to whether the Department of Professional Regulation (DPR) submitted an investigative report to the probable cause panel of a regulatory board. No evidence was presented as to whether a probable cause panel of a regulatory board or the DPR found probable cause to exist. The Board of Osteopathic Medical Examiners is not named as a petitioner in the Administrative Complaint. No evidence was presented in this proceeding as to whether the respondent is licensed to practice osteopathic medicine in the State of Florida. Petitioner made no attempt to introduce evidence of any character to demonstrate whether respondent is licensed by the State of Florida to practice osteopathic medicine or any other profession falling within the purview of the Department of Professional Regulation.
Recommendation Based upon the findings of fact and conclusions of law recited above, it is RECOMMENDED that the Administrative Complaint against the respondent dated December 29, 1982, be DISMISSED. Respectfully submitted and entered this 31st day of August, 1983. DIANE D. TREMOR Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 31st day of August, 1983. COPIES FURNISHED: James H. Gillis, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Bertram Morris Rettner 998 Via Palo Alto Aptos, California 95003 Ms. Dorothy Faircloth Executive Director Board of Osteopathic Medical Examiners 130 North Monroe Street Tallahassee, Florida 32301 Fred M. Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact Following a review of the complete record, the Board of Medical Examiners hereby adopts and incorporates by reference the Findings of Fact of the hearing officer, those facts alleged in the Amended Administrative Complaint, and admitted to by the Respondent.
The Issue The central issue in this case is whether the Respondent violated Chapter 458 Florida Statutes as alleged in the Administrative Complaint dated July 11, 1986; and, if so, what penalty should be imposed.
Findings Of Fact Based upon the testimony of the witness and the documentary evidence received at the hearing, I make the following findings of fact: The Respondent, Maria I, Andrakovich, M.D., is a licensed physician in the State of Florida, having been issued license number MEOO2I436. On or about May 1, 1983, Respondent entered into a Service agreement with "The Doctor's Office, Inc." wherein Dr. Andrakovich agreed to provide medical services for the patients at 330 South Dixie Highway, Lake Worth, Florida. Respondent's employment with "The Doctor's Office, Inc." ended in March, 1984. On or about July 12, 1983, Respondent filed with the Board of Medical Examiners an Application for Certification for Physician's Assistant for Jean Eugene Raymond. On August 15, 1983, Mr. Raymond was certified to work under the supervision of Respondent pursuant to Chapter 458 Florida Statutes. On November 22, 1983, Mr. Raymond filed his Biennial Physician's Assistant Certification and reported a change of office address to 1177 Hypo1uxo Road, Lantana, Florida. Respondent executed the affidavit for this certification before a notary public. Respondent never worked at the Hypo1uxo, Road facility. Dr. Andrakovich remained at the prior office location which was approximately five miles from the Hypoluxo site. Prior to his move to the Hypoluxo facility, Mr. Raymond would confer, in person, with Dr. Andrakovich regarding each patient. After moving to the Hypoluxo facility, Mr. Raymond would confer with Dr. Andrakovich by telephone. Respondent relied on Mr. Raymond's judgment that this telephonic system of conferring about patients complied with any legal requirements of their relationship. Respondent did not know the regulations which govern physician's assistants. Many of the patients seen at the facilities on Hypoluxo and Dixie were elderly and suffered heart problems. Respondent's schedule required her to see one patient every fifteen minutes. This patient scheduling rate later increased to one patient every ten minutes. It was difficult for Respondent to confer with Mr. Raymond by telephone and meet the schedule. Respondent assumed Mr. Raymond would confer with the physicians at the Hypoluxo facility. No specific arrangement was made to require physicians at Hypoluxo to supervise Mr. Raymond nor did any physician there assume responsibility for Mr. Raymond's activities. During her employment with "The Doctor's Office, Inc." Respondent treated Norman Shapiro. Mr. Shapiro had a history of heart trouble, diabetes, and hypertension. During the fall of 1983, Mr. Shapiro had complained of increased pain which had resulted in Respondent doubling the strength of Mr. Shapiro's heart medication. Mr. Shapiro's medical record for this period suggested a deterioration in his heart condition. On November 21, 1983, Norman Shapiro went to the Hypoluxo facility and was seen by Mr. Raymond. Mr. Shapiro complained that he was constantly having to take his heart medication by handful amounts. Mr. Raymond recommended no coffee, tea, chocolates or smoking and that the patient should elevate his head 4-6 inches for sleeping. The only additional medication suggested was Maalox. The treatment recommended by Mr. Raymond was consistent with the diagnosis of a hiatal hernia but was inappropriate given the patient's history of heart disease. The minimally acceptable care within the medical community where "The Doctors' Office" was located would have required the patient Shapiro to be hospitalized. Mr. Raymond did not confer with Dr. Andrakovich regarding Mr. Shapiro's visit on November 21, 1983, until after the treatment had been recommended. Had Dr. Andrakovich seen Mr. Shapiro on that day, she would have put him in the hospital. Dr. Andrakovich believed Dr. Conti had treated Mr. Shapiro on November 21, 1983. On November 21, 1983, the electrocardiogram (EKG) for Mr. Shapiro was within normal limits. Despite the EKG, Mr. Shapiro's symptoms were cardiac- related and had a significant potential for morbidity and mortality. In fact, Mr. Shapiro died on November 22, 1983. Frank Colavecchio was president of the "The Doctor's Office Inc." and made all administrative decisions regarding the facilities on Dixie and Hypoluxo. Mr. Colavecchio administratively moved Mr. Raymond to the Hypoluxo office. On March 15, 1984, Dr. Andrahovich terminated employment with the "The Doctor's Office, Inc". Respondent did not notify the Board of Medical Examiners of this change and at no time advised the Board that she would no longer be supervising Mr. Raymond. It is inappropriate and contrary to standards of good medical practice for a physician's assistant to treat heart patients. Dr. Andrakovich knew or should have known that Mr. Raymond was treating heart patients.
The Issue The issue for determination in this proceeding is whether Respondent committed the acts alleged in the administrative complaint and, if so, what, if any, disciplinary action should be taken against Respondent's license.
Findings Of Fact Petitioner is the state licensing and regulatory agency charged with the responsibility to prosecute administrative complaints pursuant to the laws of the State of Florida. Respondent is now and has been at all times material to this proceeding a licensed physician in the state, holding license number ME 0028480. A Final Order was filed against Respondent in Department of Professional Regulation v. Roger Lopez, M.D., Department of Professional Regulation Case No. 0070692 on August 26, 1988. The Final Order was entered in accordance with the terms of a stipulation executed by Petitioner and Respondent. Respondent's license was suspended for six months, and Respondent was placed on probation from March 5, 1989, through March 4, 1994. Respondent was properly served a copy of the Final Order. Respondent was required by the terms of the Final Order to practice under the direct supervision of a physician approved by the Board of Medicine (the "Board") and to appear before the Probation Committee whenever requested to do so. Respondent violated the terms of the Final Order by failing to appear before the Probation Committee and by failing to name a monitoring physician to supervise him during his probation. By letter dated August 29, 1989, Respondent was requested by the Board to appear before the Probation Committee at its regularly scheduled meeting on September 20, 1989, and to submit a curriculum vitae for a proposed supervising physician. Respondent acknowledged the Board's request in a letter to Petitioner dated August 31, 1989. Respondent failed to appear before the Probation Committee and failed to designate a monitoring physician.
Recommendation Based upon the foregoing Findings of Facts and Conclusions of Law, it is RECOMMENDED that Petitioner should enter a Final Order finding Respondent guilty of the allegations in the Administrative Complaint, issuing a reprimand, imposing an administrative fine in the amount of $5,000, suspending Respondent's license until March 4, 1994, and requiring Respondent to demonstrate to the Board no later than March 4, 1994, his ability to practice medicine with the skill and safety required under applicable statutes and rules. DONE and ENTERED this 23rd day of October 1991, in Tallahassee, Leon County, Florida DANIEL MANRY Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 23rd day of October, 1991.
