The Issue Whether, during the course of the random drug testing program, it was appropriately determined that Petitioner Jeffrey Jones reported for work while under the influence of cocaine on or about September 27, 1995. If so, whether Petitioner Jones should be terminated as an employee of the Seminole County School Board. Whether, during the course of the random drug testing program, it was appropriately determined that Petitioner Sylvia Foster reported for work while under the influence of cocaine on or about January 8, 1996. If so, whether Petitioner Foster should be terminated as an employee of the Seminole County School Board.
Findings Of Fact Facts Common to Both Respondents Petitioner, Seminole County School Board, is a political subdivision and an administrative agency of the State of Florida charged with the duty to operate control and supervise all public schools and personnel in the Seminole County School District. Paul J. Hagerty is the Superintendent of Public Schools for Seminole County, Florida. Respondent, Jeffrey Jones, at all relevant times, was an employee in the Transportation Department of the Seminole County School District, including September 27, 1995. His position is bus driver/courier. Respondent, Sylvia Foster, at all relevant times, was an employee in the Transportation Department of the Seminole County School Board, including January 8, 1996. Her position is bus driver. Respondents, Jeffrey Jones and Sylvia Foster, are members of the bargaining unit, the Bus Driver Association, who entered into a collective bargaining agreement with their employer, the Seminole County School Board. Article XXXIII of the collective bargaining agreement provides that Seminole County School Board will implement and abide by all aspects of the Federal Omnibus Transportation and Employee Testing Act. The Federal Omnibus Transportation and Employee Testing Act was applicable to bargaining unit members who hold a Commercial Driver's License (hereinafter CDL). Corning MetPath has a contract with Seminole County School Board to conduct urine sampling. In addition to taking urine samples from school bus drivers, Corning MetPath collects hundreds of other types of sampling at its facility in Longwood, Florida, for other clients. Prior and following entering into a contract with Corning MetPath, the Seminole County School Board did not provide blind test samples for quality control before contracting with Corning MetPath to perform federally required drug testing. John Richert, the director of Petitioner's "Anti-Drug and Alcohol Program", initiated the sampling designated by receipt of a list of persons who were to take the sample for the quarter. Once every three months, John Richert sent a packet of materials containing names of individuals who were to submit to urine testing by the week to Jean Crampton, Director of Transportation. Upon receipt of that list, Jean Crampton, who supervised the bus drivers, selected each person to be tested that week and provided them with a time and date to report for testing. That information was not provided by John Richert, but was left up to Mrs. Crampton. The Director of Transportation was responsible for passing on the list of sample providers, and ultimately for recommending termination of an employee whose test result was verified as positive. Anita Callahan operates the Corning MetPath facility in Longwood, Florida, and is an employee of Corning Clinical Laboratories. During most times of operation, Anita Callahan operates the collection facility by herself, without assistance. Each month, this facility conducts or takes between 500 and 760 samples. Prior to the relevant time, Anita Callahan received training in urine collection from her employer, and she relied on two Corning MetPath office manuals provided for use by personnel for reference. Neither manual contained copies of the Federal Regulations that apply to the specific procedures required under the federal testing act. The regulations call for the collection of urine samples, as follows: An employee is to report to the testing facility with a notice for testing and a collection form (Federal Drug Testing Custody and Control Form). The employee must be identified to the technician by photo identification. The employee selects a sealed box containing a urine sample collection cup and two sample bottles from a large box. The employee is directed to wash his/her hands. The employee is directed to a bathroom to give a urine sample. The collection room is to have no other water source operating and the toilet is to contain a bluing agent. The sample is brought to the technician and the temperature is checked. To initiate the chain of custody, a portion of the urine sample is then poured into each of the collection bottles. The employee then dates and initials the seals and places them on each sample bottle. The technician then places the specimen bottles in a separate plastic bags and places them into the box from which they were originally packed, along with the original and three copies of the completed and signed Federal Drug Testing and Control Form. The box, which becomes the shipping box to transmit specimens to the laboratory in New Jersey, is sealed. The specimens are sent by courier to the Corning Clinical Laboratory in Teterboro, New Jersey for analysis. Anita Callahan did not always strictly follow this procedure because she did not want to be touching the hands, paper or pen of people who had not washed their hands after obtaining the sample. Anita Callahan did not wear gloves when collecting and handling samples. In other respects the practices and procedures used at the Corning MetPath facility varied from the procedures its personnel were to follow: At times, there was other water sources in the collection area and collection closet, including running water in the bathroom sink and a water fountain in the hall. The sample containers that were used were sometimes unsealed and opened before the sample providers arrived. At times, the toilet in the collection closet did not contain a bluing agent. The sample containers were, at times, themselves visibly contaminated. Some drivers were not given a choice as to the sample container that was to be used. At times, if she was busy, Anita Callahan directed drivers to leave samples on the counter to be split and sealed outside the presence of the driver, at a later time. More than one person providing a sample was allowed in the sampling area during collection. Unless sample containers are clean and then sealed, all hands are washed and surfaces are kept clean, contamination is possible. Unless the sample containers are split in front of the sample provider, signed by both the technician and the provider, and sealed in front of the provider, a proper chain of custody has not been initiated and the possibility of mislabeling exists. If a collection site does not strictly follow those procedures set out in the Federal Regulations as to collection, chain of custody and testing, the test result is not scientifically reliable. Facts Relating to Case No. 95-5532 Respondent, Jeffrey Jones, was directed to report to the Corning Clinical Laboratory/MetPath facility in Longwood, Florida on September 27, 1995, prior to beginning work, for the purpose of providing a urine sample for analysis for the presence of drugs/controlled substances. The process followed by Anita Callahan, in the collection of the urine sample of Jeffrey Jones was as follows: The Respondent came to the facility with a notice for testing and a collection form (Federal Drug Testing Custody and Control Form.) The Respondent was identified. The Respondent selected a box containing the urine sample collection cup and the two samples bottles from a box. The Respondent washed his hands. The Respondent went to the bathroom as directed and returned with a urine sample. The temperature of the samples was checked. A portion of the urine sample was poured into each of the collection bottles. The Respondent then dated and initialed the seals which were to be placed on the specimen bottles, referred to as split samples. The specimen bottles were then placed in separate plastic bags and placed into the box from which they were originally packed along with the original and three copies of the Federal Drug Testing and Control Form. The box, which becomes the shipping box in which the specimens are shipped to the laboratory in New Jersey, was sealed. The Respondent then signed the copy of the Federal Drug Testing and Control Form which acknowledges that the urine sample is his urine sample. j. The specimens were then sent by courier to the Corning Clinical Laboratory in Teterboro, New Jersey for analysis. At the time Jeffrey Jones was obtaining his urine sample he dropped his key chain in the toilet and then retrieved it. He did not inform the technician of this event. The first sample bottle remained sealed until it was opened for the purpose of testing at Corning Clinical Laboratories in Teterboro, New Jersey by Shilpa Joshi. The urine sample of Jeffrey Jones (second bottle) was sealed upon collection at the Corning Clinical facility at Longwood, Florida and remained sealed until it was opened for confirmation testing at LabOne in Overland Park, Kansas. Laboratory analysis of urine for the presence of drugs/controlled substance, as prescribed by 49 C.F.R. Subsection 40.29 is to be done in two phases. The initial test (screening) shall employ immunoassay and the second phase (confirmation testing) shall employ gas chromatography/mass spectrometry (GC/MS). The analysis, by Corning Clinical Laboratories, of the urine sample submitted by Jeffrey Jones was conducted in two phases. The first phase was screening employing an enzyme multiplied immunoassay test (EMIT) followed by confirmatory testing employing analysis by gas chromatograph/mass spectrometry (GC/MS). The GC/MS process for analysis of urine for the presence of controlled substances is generally accepted in the scientific community. Laboratory analysis of the urine sample submitted by Jeffrey Jones, by Corning Clinical Laboratories, determined that the urine sample tested positive for the presence of a cocaine metabolite, benzoylecgonine. The second sample was then sent to LabOne for confirmation testing. Laboratory analysis of the urine sample submitted by Jeffrey Jones to LabOne of Overland Park, Kansas, determined that the urine sample tested positive for the presence of a cocaine metabolite, benzoylecgonine. There is no substance that will cause a person's urine to test positive for benzoylecgonine, a metabolite of cocaine, other than cocaine. Both Corning Clinical Laboratories and LabOne were properly certified as required by 49 C.F.R. Subsection 40.39. Murray Lappe, M. D., was the designated medical review officer (MRO) for the drug testing of Jeffrey Jones. The MRO did not contact Jeffrey Jones or otherwise communicate with Mr. Jones after the putative positive test result. Jean Crampton, Director of Transportation was informed by telephone from Corning Labs that Jeffrey Jones had tested positive for cocaine in his urine. Neither Jean Crampton, nor anyone else in the School Board, contacted Respondent Jones about his result to inquire into possible alternative medical explanations for the result. Jean Crampton believed that alternate medical explanations was the province of the MRO and should have already happened. False positive test results can occur for cocaine either in certain prescription medications, creams, and certain consumer goods, such as teas and drinks, although such teas and drinks have been banned for sale in the U. S. Respondent Jones, prior to and at the time of taking the urine screening, was a care-giver for his two elderly parents, both of whom lived with him, were bedridden, and required extensive medications. There were times that Respondent Jones' father provided headache and toothache medicine to him. The supervisors of Jeffrey Jones were trained to recognize signs of drug or alcohol abuse. The supervisors of Jones, who saw him daily, saw no evidence of drug or substance abuse in his work performance. Facts Relating to Case No. 96-0506 Respondent Sylvia Foster was directed to report to the Corning Clinical Laboratory/MetPath facility in Longwood, Florida, after her first run, on January 8, 1996, for the purpose of providing a urine sample for analysis for the presence of drugs/controlled substances. The process followed by Anita Callahan, in the collection of the urine sample of Sylvia Foster was as follows: The Respondent came to the facility with a notice for testing and a collection form (Federal Drug Testing Custody and Control Form). The Respondent was identified by her School Board Badge. The technician selected a box containing the urine sample collection cup and the two sample bottles from a box and gave it to the Respondent. The Respondent washed her hands. The Respondent went to the bathroom, as directed, and returned with an empty urine sample. She was not able to urinate. The Respondent drank some water and returned to the bathroom. She returned with a urine sample. The technician was across the hall with another person on whom she was conducting a diabetic time test. Respondent was directed to leave her urine sample on the counter and leave; Respondent had previously signed and initialed the documents and labels. Respondent left the sample and departed. The technician later split the sample, sealed them and placed them into the box with the documentation for shipping to the laboratory in New Jersey. The specimens were then sent by courier to the Corning lab in Teterboro, New Jersey for analysis. The urine sample shipped under the name of Sylvia Foster from the Corning Clinical facility at Longwood, Florida, remained sealed until the first sample bottle was opened for the purpose of testing at Corning Clinical Laboratories in Teterboro, New Jersey by Isidoro Lomotan. The analysis, by Corning Clinical Laboratories, of the urine sample submitted by Sylvia Foster was conducted in two phases. The first phase was screening employing an enzyme multiplied immunoassay test (EMIT) followed by confirmatory testing employing analysis by gas chromatograph/mass spectrometry (GC/MS). The laboratory analysis of the urine sample submitted under the name of Sylvia Foster, by Corning MetPath, determined that the urine sample tested positive for the presence of a cocaine metabolite, benzoylecgonine. Sylvia Foster, on January 9, 1996, the day after submitting her urine sample at the Corning MetPath facility, complained to her supervisors that she was taking a lot of different prescription medications and was worried about the result. Murray Lappe, M. D. was the designated MRO for the drug testing of Sylvia Foster. Someone who identified himself as working with the MRO contacted Sylvia Foster, by telephone, after the putative positive test result. The person on the telephone informed Sylvia Foster that she had a drug problem and needed help. The person on the telephone did not make any inquiry into Respondent Foster's medical condition or history, nor that she would be able to produce information and medical records to substantiate an alternate medical explanation. Jean Crampton, Director of Transportation, was informed by telephone from Corning MetPath that Sylvia Foster had tested positive for cocaine in her urine. Neither Mrs. Crampton, nor anyone else in the School Board, contacted Respondent Foster about possible alternative medical explanations for the result. The supervisors of Sylvia Foster, who saw her daily, did not see any evidence of drug or substance abuse in her work performance. Respondent Foster's testimony as to sequence of events is credible.
Recommendation Based on the foregoing Finding of Fact and Conclusions of Law, it is RECOMMENDED tht the School Board dismiss the Superintendent's request to terminate the employment of Jeffrey Jones and Sylvia Foster, and the Respondents should be reinstated to their former positions. DONE and ENTERED this 29th day of July, 1996, in Tallahassee, Florida. DANIEL M. KILBRIDE, 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 29th day of July, 1996. APPENDIX TO RECOMMENDED ORDER, CASE NOS. 95-5532 and 96-0506 To comply with the requirements of Section 120.59(2), Florida Statutes (1995), the following rulings are made on the parties' proposed findings of fact: Petitioner's Proposed Findings of Fact. Accepted in substance: paragraphs 1, 2, 3, 4, 5, 6 (except as to the year), 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22 (as to Jeffrey Jones only), 24, 25, and 27. Rejected as against the greater weight of the evidence: paragraphs 23 and 26. Respondent's Proposed Findings of Fact. Accepted in substance: paragraphs 1, 2, 3, 4 (except as to the year), 5, 6, 7, 8, 9, 10, 11, 12, 16, 17 (except for the year), 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 (in part), 30, 31, 32, 33, 34, 35, 37, 38, 39, 40, 41, 42, 43, 44, 46, 47, 48, 49, 50, 51, 52, 53, 54 (in part), 55 (in part), 56, 53 [No. 3], 54 [No. 2], 55 [No. 2], 56 [No. 2]. Rejected as irrelevant and immaterial: paragraphs 13, 14, 15, 45. Rejected as against the greater weight of the evidence: paragraphs 29 (in part), 54 (in part), 55 (in part). COPIES FURNISHED: Ned N. Julian, Jr., Esquire Seminole County School Board 400 East Lake Mary Boulevard Lake Mary, Florida 32773 Thomas F. Egan, Esquire 56 East Pine Street, Suite 300 Orlando, Florida 32801 Dr. Paul Hagerty, Superintendent 1211 South Mellonville Sanford, Florida 32771 Frank T. Brogan Commissioner of Education The Capitol Tallahassee, Florida 32399-0400
The Issue The issues in this case are whether the allegations of the Administrative Complaint are correct, and, if so, what penalty should be imposed.
Findings Of Fact The Respondent is a licensed medical doctor, holding license number 44726. At all times material to this case, the Respondent was a physician holding board certifications in internal medicine, hematology, and oncology. Patient 1 was a patient of another hematologist, Dr. Thomas Katta. On March 17, 2003, Dr. Katta had Patient 1 admitted via the patient's internist (Dr. Frank Leiva) to Sand Lake Hospital in Orlando. The patient was anemic and thrombocytopenic and had been previously diagnosed with autoimmune hemolytic anemia, the treatment for which was transfusion. Failure to transfuse a person suffering from autoimmune hemolytic anemia can lead to death, and such a transfusion had been ordered for the patient. Dr. Katta apparently had personal obligations for the evening of March 17, 2003, and for the following day, and, in the late afternoon of March 17, 2003, he asked the Respondent to "cover" his hospitalized patients. The Respondent agreed to do so. Dr. Katta's office transmitted a list of the patients by fax to the Respondent's office. The list contained the full names and locations of Dr. Katta's other hospitalized patients, but identified Patient 1 only by last name and diagnosis ("AIHA"). The fax did not indicate the patient's first name or gender and did not specifically identify the patient's location. The Respondent made no attempt to obtain additional information from Dr. Katta or his staff. The lab work performed upon admission to the hospital indicated that the patient was severely anemic and had a critically low platelet count. At approximately 6:30 p.m. on March 17, 2003, the Respondent received a telephone call through her answering service from a hospital nurse who reported that the patient was severely anemic and that there were problems obtaining a proper blood match for the transfusion. The Respondent advised the nurse to call the blood bank and tell them to find the least incompatible blood and get the transfusion done. The Respondent did not inquire as to the patient's name or location. At about 10:19 p.m. on March 17, 2003, the Respondent was again contacted by a hospital nurse, who advised that the patient was short of breath and had tachycardia at 133 beats per minute. The nurse also advised that the blood bank had been unable to find an appropriate match for the previously ordered transfusion and that the transfusion remained uncompleted. The Respondent directed the nurse to contact the patient's primary care physician or the cardiologist on call, but did not ask the identity of either practitioner. The nursing notes indicate that the Respondent stated that she did not provide treatment for tachycardia and did not believe that Dr. Katta did either. The Respondent also advised the nurse to call the blood bank and direct them to find the least incompatible blood and perform the transfusion. The Respondent did not inquire as to the patient's name or location and provided no other direction to the reporting nurse. On the next day, March 18, 2003, at about 6:15 a.m., the Respondent was contacted by a hospital nurse, who advised that the transfusion had still not taken place. The Respondent took no action and provided no direction to the reporting nurse. The Respondent did not inquire as to the patient's name or location. Later during the morning of March 18, 2003, the Respondent attempted to locate the patient while making her rounds but was unsuccessful. In attempting to locate the patient, the Respondent talked with various hospital personnel, but had no information other than the patient's last name and diagnosis. Based on her inability to obtain any additional information, the Respondent assumed that the patient had been transfused and discharged. The patient had not been discharged, but had been transferred to an intensive care unit in the hospital. The transfusion had not yet occurred. Patient 1 died on March 20, 2003. The Respondent was unaware of the patient's death until she saw Dr. Katta at the hospital, at which time he questioned her about the patient and informed her that the patient was dead. The Petitioner presented the testimony of Dr. Howard Abel, M.D., regarding whether the Respondent met the standard of care in her treatment of the patient. Dr. Abel's testimony regarding the standard of care issues is credited and is accepted. As to the issue of the uncompleted transfusion, the evidence establishes that the transfusion did not occur while the Respondent provided hematological care for Patient 1. The Respondent should have personally contacted the blood bank to identify the cause of the inability to provide blood for the transfusion and determine whether another option was available. The Respondent should have responded to the 10:19 p.m. call on March 17 by personally examining the patient and reviewing the history and lab test results. While the Respondent's directive to contact a cardiologist was not inappropriate, breathing difficulties and tachycardia are symptomatic of severe anemia for which hematological care was required. If the Respondent determined that the symptoms were cardiac-related, the Respondent should have personally made the cardiology referral and provided the information to the cardiologist. The Respondent did not do so and was unaware of the cardiologist's identity. A review of additional lab test results including observation and evaluation of blood smears would have provided useful information as to whether the patient's condition was deteriorating and to whether the patient was developing thrombotic thrombocytopenic purpura ("TTP"), a serious condition which, left untreated, is fatal in not less than 90 percent of cases. The blood smears had been performed by the time of the phone call, but the Respondent reviewed no lab test results and made no inquiries related to the results. The failure to review lab test results may have delayed a diagnosis of TTP. While there was some disagreement between testifying witnesses as to whether or not the patient had TTP, Dr. Katta ordered that the patient be treated for TTP immediately upon his return on March 19, 2003, and there is no evidence that Dr. Katta treated the patient for TTP without reasonable cause to do so. The evidence clearly establishes that the Respondent failed to review the patient's test results that could have provided timely and useful information regarding the patient's condition. As to the Respondent's failure to locate the patient on March 18, 2003, the Respondent testified that the patient's last name was common, but the Respondent had not called Dr. Katta at the time she received the faxed list of his hospitalized patients to obtain additional identifying information. The Respondent did not request the information from the nursing staff during any of the telephone calls and made no effort to obtain the information prior to arriving at the hospital to make her rounds. The Respondent would have become aware of the patient's location had she attended to the patient's breathing difficulties and tachycardia on the night of March 17. She would have also likely reviewed the medical records and would have become aware of the admitting physician as well as other information regarding the patient's condition. The Respondent consulted with hospital personnel on March 18, 2003, in attempting to identify those patients admitted by Dr. Katta. There were approximately ten to 12 other hospitalized patients with the same last name, none of which had been admitted by Dr. Katta. The Respondent was unaware that the patient had been admitted under Dr. Leiva's name. The Respondent did not visit the ten to 12 patients with the same last name to locate the one for which she was responsible. The Respondent did not contact the blood bank, which had been having difficulty providing transfusion blood to the patient. It is reasonable to assume that the blood bank, charged with the responsibility to provide the appropriate blood supplies to the patient, would have been aware of the patient's location, and could have provided it to the Respondent. The Respondent made no effort to identify patients located in the hospital's intensive care units, despite the critical nature of the patient's condition at last report. Had she done so, she would have located the patient. The Respondent presented testimony that it was not uncommon for a physician, unable to locate a hospitalized patient, to routinely assume that the patient has been appropriately treated and has been discharged, or is deceased. However, the Respondent testified that it was unusual for her not to be able to identify and locate a patient. Even assuming that such practice is routine, it is unlikely that such an assumption could reasonably be made in the case at issue here, where the Respondent did not know the patient's name, had never seen the patient, had personally reviewed no medical records, was unable to find anyone in the hospital who could provide her with any information, and at last communication with the nursing staff had been told that a critically-needed transfusion had not occurred. The testimony is not credited and is rejected.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health enter a final order finding Vasundhara Iyengar, M.D., in violation of Subsection 458.331(1)(t), Florida Statutes (2002), and imposing a penalty as follows: a three-year period of probation; a fine of $10,000; and such additional community service and continuing education requirements as the Department of Health determines necessary. DONE AND ENTERED this 31st day of January, 2008, in Tallahassee, Leon County, Florida. S WILLIAM F. QUATTLEBAUM 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 31st day of January, 2008. COPIES FURNISHED: Jennifer Forshey, Esquire Dorys H. Penton, Esquire Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 H. Gregory McNeill, Esquire Lowndes, Drosdick, Doster Kantor & Reed, P.A. Post Office Box 2809 Orlando, Florida 32802-2809 H. Roger Lutz, Esquire Lutz, Bobo & Telfair, P.A. 2 North Tamiami Trail, Suite 500 Sarasota, Florida 34236 Josefina M. Tamayo, General Counsel Department of Health 4052 Bald Cypress Way, Bin A-02 Tallahassee, Florida 32399-1701 Larry McPherson, Executive Director Board of Medicine 4052 Bald Cypress Way Tallahassee, Florida 32399-1701
The Issue Whether Respondent acted contrary to its governing statutes, rules, policies, or project specifications in selecting the winning response to the subject Request for Proposals and, if so, whether any such act was clearly erroneous, arbitrary, capricious, or contrary to competition within the meaning of Section 120.57(3)(f), Florida Statutes.
Findings Of Fact At all times material to this proceeding, Respondent was a duly-constituted School Board with the duty to operate, control, and supervise all free public schools within the School District of Miami-Dade County, Florida, pursuant to Article IX, Florida Constitution, and Section 230.03, Florida Statutes. For over 25 years Respondent has used school facilities to conduct blood collection drives from students over the age of 17 years and adults. Intervenor conducted the blood drives for Respondent in the past and, at the time of the RFP at issue in this proceeding, was the incumbent provider. The only previous request for proposal (the 1998 RFP) issued by Respondent for the blood collection drive occurred in 1998. Petitioner and Intervenor were the only two entities submitting responses to the 1998 RFP. Intervenor was selected as the winning proposer in 1998. At times pertinent to this proceeding, Elda Martinez was Respondent's Coordinator of Special Projects for the Bureau of Community Services, Linda Brown was the supervisor for Ms. Martinez, and Alex Bromir was the supervisor for Ms. Brown. Ms. Martinez, under the supervision of Ms. Brown and Mr. Bromir, had the primary responsibility of preparing the 1998 RFP and the RFP. Barbara Jones, Director of Procurement Management and Material Testing for Respondent, assisted Ms. Martinez in the preparation of the RFP. On May 21, 2001, Respondent mailed the RFP to potential proposers to solicit proposals for the administration of its blood collection drive program. Respondent received timely responses to the RFP from Petitioner and from Intervenor. No timely protest to the RFP specifications was filed.2 Article II of the RFP provides that the purpose of the RFP is ". . . to designate one blood center to collect blood donations from students and staff at Miami-Dade County Public Schools [sic] facilities." Article IV of the RFP provides general information about the school district and a general description of the blood collection drive program. Article IV(K) provides that the blood center must have donor and individual school recognition programs acceptable to Respondent. Article IV(L) provides that a scholarship incentive program through the College Assistance Program (CAP) is desirable. Article V of the RFP sets forth certain technical requirements. Responders to the RFP were required by Article V(A) to provide the following documentation and information: Documentation of its status as a not- for-profit organization. The last two years of audited financial records. The blood center must agree to complete and open access by appropriate Miami-Dade School Board representatives and by the media, to the details of these financial records, if requested. The past three years of the Federal Drug Administration (FDA) and the American Association of Blood Banks (AABB) inspection reports, including 483 forms, warning letters, or intent to revoke license correspondence with the FDA. * * * Documentation that the blood center is active in the educational efforts of the school system they serve. (i.e., provide educational programs for teachers, staff, and students) [sic] Documentation that the blood center can develop, implement, and actually execute a school-based scholarship program within a school district at no cost to the school district. Description of existing programs in the school districts currently served. . . . Article V(B) is as follows: The organization shall provide an adequate number of mobile units, personnel, materials, equipment, and supervision to carry out the estimated number of blood units to be collected in the blood drive. Article V(C) is as follows: The blood center must provide sufficient trained and skilled personnel to screen the donors to insure that they will not be placed at risk by donating blood. Article VII of the RFP, which pertains to evaluation of proposals, provides as follows: Proposals will be evaluated by representatives of the school district in order to ascertain which proposal best meets the needs of the School Board. The Selection Committee will consist of the following or their designees: -Chief Administrator, Bureau of Community Services -Executive Director, Community Participation -Representative from Risk and Benefits - Management and Services -Principal, Senior High -Principal, Adult Center -Coordinator of Special Projects, Bureau of Community Services -A school based Activities Director -A representative from PTSA Council -A representative from Student Services -A representative from the Student Government -A representative from Comprehensive Health/Health Education -A representative from the Division of Business Development and Assistance -A representative from the Division of Procurement Management and Materials Testing Evaluation considerations will include but not [be] limited to the following: Responsiveness of the proposal clearly stating an understanding of the work to be performed meeting all guidelines. Documentation of present certification; qualification of laboratory staff members; past experience and record of performance; verification of references. Primary emphasis in the selection process will be placed on the background, experience, and service of staff to be assigned to the project. Expertise in the areas addressed in the RFP, and the ability to respond in a timely, accurate manner to the district's requirements is essential. An important consideration is the methodology of blood collection which takes into consideration not only expediency but the safest and least painful procedures. The blood center must demonstrate commitment to the continuing education of the students and faculty. The generosity of the scholarship program to be distributed by the College Assistance Program (CAP) will be another factor to be taken into account. The availability of sufficient mobile units to cover all high schools, adult centers, and vocational/technical schools so that all the students have an equal opportunity to participate in the program. The school district reserves the right to reject any and all proposals submitted. When the final selection is made, a contract acceptable to the Attorney of the Board [sic] will be entered into with the successful proposer. No debriefing or discussions will be held with unsuccessful vendors. Proposals from Petitioner and Intervenor were opened on June 14, 2001. On June 18, 2001, a Selection Committee, formed in accordance with the requirements of the RFP, met to evaluate the proposals. There was no issue at the First Meeting as to whether both proposals had satisfied the technical specifications of the RFP. At the beginning of the First Meeting the Selection Committee members were given an agenda of the meeting, a chart comparing the scholarship programs being offered by the two proposals (the chart), and evaluations of the Intervenor's performance as the present provider. There were 14 members of the Selection Committee. Mr. Bromir was the chairman and a voting member of the First Meeting. Ms. Martinez and Ms. Brown were also voting members of the Selection Committee. Ms. Martinez had worked with Intervenor's staff for several years and thought they did a good job directing the blood drive. She believed that Intervenor's contract with Respondent (as a result of the 1998 RFP) should have been renewed without the necessity of a new RFP. Intervenor honored Ms. Martinez, who was about to retire, at an awards luncheon shortly before the First Meeting. Ms. Martinez clearly favored Intervenor throughout the selection process and greeted representatives of Intervenor with embraces prior to the start of the First Meeting. Both proposals responded to the evaluation criteria set forth in Article VII(F) pertaining to the generosity of the scholarship program. Ms. Martinez prepared the chart that was distributed at the beginning of the meeting. The chart purported to compare the two scholarship proposals and was the focus of considerable attention at the final hearing. The evaluation included a determination as to what could not be included in Petitioner's proposal and estimates as to what would likely be included in Intervenor's proposal. Petitioner's response to the RFP committed to contribute $225,000 in direct donations to the CAP. In addition, the response reflected that participating schools would earn a minimum of $217,000 in recognition payments during the contract's initial, three-year term. A direct donation to participating schools is prohibited by School Board rule, and, consequently, a participating school could not earn such a donation. However, the RFP contained the following savings clause: "Any surplus funds not earned, as part of this guaranteed minimum funding to participating schools, will become an added donation to the College Assistance Program (CAP)." Because of the savings clause, Ms. Martinez correctly determined that the minimum guarantee to the CAP over the initial three- year term was $442,000 ($225,000 + $217,000). In addition to the foregoing, Petitioner's proposal contains a bonus program that could be earned by participating schools. Because these are the type payments that are prohibited (and were not requested by the RFP) and because there was no savings clause pertaining to these funds, Ms. Martinez correctly determined that the bonus program could not be considered in evaluating Petitioner's proposal. The printed agenda for the First Meeting, prepared by Ms. Martinez, included the following item: Before starting the discussion, explain that the RFP did not request for [sic] direct donations to the schools and that therefore the monies earmarked for this purpose will not be considered (as part of a scholarship or incentive program). However, since the agency (Petitioner) that offered it (direct donations to the schools) had a clause whereby "surplus funds that are not earned from the guaranteed minimum funding will become an added donation to the CAP", the minimum funding may be added to the CAP guaranteed donation. However, the bonus program should not be considered. Ms. Martinez spent considerable time in preparing the chart and attempted to present a fair comparison between the two proposals. Unfortunately, Ms. Martinez was required to make certain assumptions as to Intervenor's proposal because it contained a bonus plan that depended on the success of future blood drives. The Intervenor's bonus plans, which neither contains a minimum nor a maximum, required Ms. Martinez to estimate the success of future blood drives.3 Ms. Martinez' chart set forth that Intervenor's guaranteed scholarship contribution over the initial three-year term would be $124,800 and the estimated contribution from bonuses during that period would be $325,145.00, so that the total scholarship contribution would equal $449,945.00 for the initial three-year term (compared with $442,000.00 for Petitioner). The evidence presented at the final hearing failed to establish that her estimates were reliable. Because of her estimates, Ms. Martinez' chart did not provide an accurate comparison of the two proposals. In weighing the impact of the misleading chart, the undersigned has considered Ms. Martinez' leadership role in securing the procurement, the absence of specific evaluation criteria in the RFP, and the lack of instruction as to how the Selection Committee was to evaluate the scholarship proposals. Those considerations establish that the misleading chart was not a de minimis error. Prior to the decision to issue the RFP, Ms. Martinez attempted to evaluate Intervenor's performance as the provider pursuant to the 1998 RFP. She solicited evaluations from personnel at the various schools at which blood drives had been conducted. In addition to distributing the misleading chart, Ms. Martinez distributed to the Selection Committee at the First Meeting summaries of the positive evaluations of Intervenor that she had solicited from school personnel and added her own positive comments as to Intervenor's performance. Further, Ms. Martinez asked other persons on the Committee to attest to their own good experiences with Intervenor. The testimonials on behalf of Intervenor came from a nurse instructor, an activities director, principals, a student, and a PTA representative. The testimonials made the following points: Intervenor stresses education; Intervenor encourages student-run blood drives; blood unit giving greatly increased during Intervenor's contract; there was excellent cooperation from all of Intervenor's staff; and the program runs smoothly in schools. Ms. Martinez' acts of distributing the positive evaluation summaries and of soliciting testimonials on behalf of Intervenor tainted the Selection Committee's evaluation process at the First Meeting because it moved the focus of the evaluation from the evaluation criteria set forth in the RFP to the issues of whether the existing provider for the blood drive had been doing a good job and whether there was a need for change. Such acts were contrary to the evaluation criteria set forth in the RFP. Petitioner was not given an equal opportunity to supply positive recommendations from its clients nor was it allowed to have its clients address the Selection Committee to attest to their positive experiences with Petitioner. Intervenor was accorded an unfair competitive advantage by Ms. Martinez' acts of distributing positive evaluation summaries and soliciting testimonials on behalf of Intervenor. In addition to the foregoing, the minutes of the First Meeting reflect that the Selection Committee found the following to be of significance: number of mobile units available (25 for Intervenor and 17 for Petitioner), bad donor letter (attachment 7 to its proposal),4 personnel available (150 for Intervenor and 84 for Petitioner), the scholarships being offered, and the cash and cash equivalents at the end of the year as reflected by the financial statements ($1,800,000 for Intervenor and $26,200 for Petitioner). Article V(B) of the RFP requires the proposer to provide an adequate number of mobile units, personnel, materials, equipment, and supervision to carry out the estimated number of blood units to be collected in each blood drive. The Selection Committee had not determined the number of mobile units and personnel needed to perform the contract. Because that determination had not been made, there was no basis to judge what constituted an adequate number of mobile units and personnel. It was a material error for the Selection Committee to base its decision on the relative number of mobile units and personnel each proposer had available without first determining what constituted an adequate number of mobile units and personnel. It was not error for the Selection Committee to consider attachment 7 to Petitioner's proposal. The referenced material includes negative findings and comments from regulatory authorities following inspections of Petitioner's laboratories. Petitioner's complaint that it had to submit information as to its in-house laboratories while Intervenor did not have to submit similar information as to the independent laboratories it used is a collateral attack on the specifications of the RFP that is rejected as being untimely and without merit. The RFP required each proposer to submit audited financial statements as part of its response. Petitioner's assertion that it was error for the Selection Committee to consider the relative financial strengths of the two proposers is without merit. At the First Meeting the committee voted 14 to 0 in favor of awarding the contract to Intervenor. Thereafter Petitioner timely filed a challenge to the proposed award and the matter was referred to DOAH for formal proceedings and assigned DOAH Case No. 01-3047BID. Prior to a formal hearing before an Administrative Law Judge, Petitioner and Respondent filed a Joint Motion for Withdrawal of Petition and Dismissal Without Prejudice on the grounds that the proceeding was not ripe for hearing because the five-day public notice requirement for the First Meeting was not observed. Pursuant to the Joint Motion, DOAH Case No. 01-3047BID was closed and jurisdiction of the matter was relinquished to Respondent for further proceedings. Thereafter, Respondent invalidated the actions taken at the First Meeting and scheduled the Second Meeting. Mr. Bromir and Ms. Martinez retired between the First Meeting and the Second Meeting, which occurred August 29, 2001. Ms. Brown chaired the Second Meeting, which consisted of 11 voting members. Eight of the 11 voting members at the Second Meeting had participated as voting members at the First Meeting. No new instructions were given the members at the Second Meeting, other than they were to disregard the actions of the First Meeting. No financial analysis of the two proposals was distributed or discussed at the Second Meeting. Accordingly, the only analysis any of the committee considered or discussed regarding a comparison of the financial benefits offered by the two proposals was the misleading chart prepared by Ms. Martinez. In addition, no instructions were given at the Second Meeting to ensure that members who were present at the First Meeting would not be improperly swayed by the positive evaluations and testimonials presented on behalf of Intervenor. It is clear that the Selection Committee at both the First Meeting and the Second Meeting selected Intervenor in large part because it was doing a good job as the incumbent provider. The eight members of the Selection Committee who had been at the First Meeting and improperly selected Intervenor based in part on its incumbency were not advised that they could not make their selection on that improper basis. The failure of Respondent to cure the defects of the First Meeting tainted the Second Meeting. The minutes of the Second Meeting contain an incorrect fact that was a factor in the Selection Committee's evaluation of the two proposals. The minutes reflect that Petitioner had only two mobile units available to serve the school system. That reference is clearly an error because Petitioner's proposal represents that it had 17 mobile units available. According to the minutes, the number of available mobile units was a factor favoring the selection of Intervenor.5 Consequently, the reference to the two mobile units is a material error that tainted the Second Meeting. At the Second Meeting, Ms. Jones, a non-voting staff member who assisted in conducting the meeting, raised the issue as to whether Petitioner's proposal was unresponsive to one of the technical criteria, namely, the requirement of presenting “documentation” of its educational efforts in the school systems in which it serves. There was no determination by the Selection Committee that Petitioner was not a responsive proposer, and there was no evidence that Ms. Jones raised that issue for improper motives. Since the actions of the First Meeting had been invalidated, the issue as to whether the proposals met the technical criteria was an appropriate issue for the Second Meeting. Petitioner's argument to the contrary is rejected. Respondent's procurement rules require that minutes be kept of each Selection Committee meeting and that the minutes document the reasons for the recommendation coming out of the meeting. The minutes kept for the First Meeting and the Second Meeting do not accurately reflect what was discussed. For example, according to Ms. Jones, there was a discussion of the relative financial terms being offered by the proposals at the First Meeting. No such discussion is reflected in the minutes of that meeting. Additionally, there was limited discussion about financial benefits at the Second Meeting, yet minutes of the Second Meeting do not reflect that the Committee discussed or considered the relative financial merits of each proposal. There was no other written statement by either the First or Second Selection Committee of the reasons for its decisions. Intervenor represented that it and the labs it use are considered by the Food and Drug Administration to be among the best in the United States. That statement is at most a minor, waivable defect that should be considered puffery. The statement is not a material misrepresentation. Intervenor represented in its response that it was the only blood bank in South Florida that had the endorsement of the Red Cross. That statement is at most a minor, waivable defect that should be considered puffery. The statement is not a material misrepresentation.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Miami-Dade County School Board invalidate the award of the contract to Intervenor and conduct a new selection process. DONE AND ENTERED this 14th day of August, 2002, in Tallahassee, Leon County, Florida. CLAUDE B. ARRINGTON 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 14th day of August, 2002.
The Issue The issue for determination is whether Petitioner should discipline Respondent's pari-mutuel wagering occupational license for allegedly preventing authorized personnel from taking a urine sample from a greyhound after a race in violation of Florida Administrative Code Rule 61D-6.005(9).
Findings Of Fact Petitioner is the agency responsible for regulating pari-mutuel wagering in the state. Respondent holds pari-mutuel wagering occupational license number 467790-1021. On August 4, 2004, Respondent was the trainer of record of two racing greyhounds named "Vonda Easy" and "Zito Easy." Both dogs competed in the fourth race of the matinee performance at Sanford-Orlando Kennel Club (the race). Vonda Easy finished first in the race. As the winner of a race, Vonda Easy was subject to mandatory drug testing pursuant to Florida Administrative Code Rule 61D-6.005(1). Veterinary Assistant Mr. Anthony Manfredi met Respondent at the detention enclosure in the finish area for the purpose of walking Vonda Easy and collecting a post-race urine sample. Respondent brought Vonda Easy and Zito Easy to the detention area and refused to walk Vonda Easy without Zito Easy. Respondent effectively interfered with the required urine collection from Vonda Easy by brining two dogs to the detention area and insisting that both dogs walk during the urine collection process in violation of Florida Administrative Code Rule 61D-6.005(9). Mr. Manfredi asked Respondent to give Zito Easy to someone else while Mr. Manfredi attempted to get a urine sample from Vonda Easy. Respondent told Mr. Manfredi that she was going to walk both dogs together since they were from the same kennel. Another person was not available at the detention area to hold Zito Easy during the urine collection from Vonda Easy. Mr. Manfredi asked Respondent a second time to only bring one dog with her during the urine sample collection process. He informed Respondent that having more than one dog in the urine sample collection area would interfere with his ability to collect a urine sample. Respondent refused to bring only one dog into the urine sample collection area. Rather, Respondent brought two greyhounds with her into the urine sample collection area and effectively prevented the collection of the required urine sample. The purpose of collecting a urine sample from a racing greyhound is to protect the health and welfare of the racing greyhound by testing to see if any impermissible substances are present in the body of the racing greyhound. The collection of a post-race urine sample from a racing greyhound also ensures that the medication rules of the state are being followed. Trainers, including Respondent, must comply with procedures and policies designed to ensure that the correct animal has been sampled and that there is little or no opportunity for any kind of contamination to occur at the test site. Trainer compliance ensures the integrity of the testing process. The procedures and policies for testing animals are set forth in the Greyhound Veterinary Assistant Handbook (Handbook). In relevant part, the Handbook prohibits an owner/trainer from walking two dogs at once in the finish area after a race. The urine sample collection area at the track is limited and does not easily accommodate two dogs. Walking two greyhounds at the same time may cause a sample to go uncollected due to having the presence of the other greyhound. The presence of two dogs increases the likelihood of contaminating a post- race urine sample. The presence of Vonda Easy and Zito Easy in fact prevented the collection of the mandatory urine sample.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law it is RECOMMENDED that the Petitioner enter a final order finding that Respondent violated Florida Administrative Code Rule 61D-6.005(9), and impose an administrative fine of $1,000 pursuant to Subsection 550.105(5)(d), Florida Statutes (2004). DONE AND ENTERED this 29th day of June, 2005, in Tallahassee, Leon County, Florida. S DANIEL MANRY 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 29th day of June, 2005. COPIES FURNISHED: Stefan Thomas Hoffer, Esquire Division of Pari-Mutuel Wagering Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-2202 Kimberly A. Hudson 5622 Tangerine Avenue, South Gulfport, Florida 33711 David J. Roberts, Director Division of Pari-Mutuel Wagering Department of Business and Professional Regulation Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-0792 Leon Biegalski, General Counsel Department of Business and Professional Regulation Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-2202
Findings Of Fact Valaria Alsina has been licensed as a medical physician in Florida since 1976 and was so licensed at all times here relevant. On August 19, 1980, Elsa Trujillo and her daughter Nancy, age 12, visited the office of Respondent for treatment. This was the initial visit to Respondent by these patients. Patient histories in Exhibit 3 for Elsa show the first entry to be October 7, 1980; however, the language used in this history clearly shows this to be not Elsa's first visit. Respondent's testimony and reports submitted by Respondent to Petitioner, Exhibit 3, reveal initial complaints by this patient to be dizziness, urinary tract infection, vomiting, vaginal discharge, headache, depression, burning sensation while voiding, and dark urine. Respondent did a urinalysis, took blood for testing, did a PAP smear and vaginal irrigation. Other treatment rendered this patient was not disclosed. The skin and blood tests performed constitute the gravamen of the charges here involved. In Exhibit 1 Respondent billed the insurance carrier for Elsa $359.50 for this visit of August 19, 1980. Those blood tests, the necessity for some of which is questioned by Petitioner, are for glucose, BUN, creatinine, calcium, phosphorus, uric acid, electrolytes (including sodium, potassium, chlorides, and carbon dioxide) total protein, bilirubin, and albumin. The reason the need for these tests is questioned is because they were billed to Prudential Insurance Company as individual tests for each of which Respondent billed from $10.00 to $20.00. These tests are normally performed by medical laboratories in groups, automatically, in which testing machines are programmed to do certain tests on one blood sample introduced into the testing machine. These automatic testing procedures are generically designated "SMA" and are known as SMAC-6, SMAC-16, SMAC-26, etc., with the number denoting the number of tests performed. Those blood tests performed on the Trujillos are all included in the SMAC-22 program for which a laboratory normally charges the doctor $10-$12. Had these tests been charged as SMAC-22, the fact that several were unnecessary would have been accepted because, as a SMAC-22 neither physical nor financial harm resulted to the patient from the unnecessary blood tests conducted. The SMAC-22 could have been performed as cheaply as or cheaper than two manual and individual tests. Since Petitioner's expert witnesses both agreed that some of the tests conducted on this patient were indicated from the symptoms presented, the only fault they found was in Respondent's performing, and charging the patient for, individual and manual blood tests for which there was no medical justification. Nancy Trujillo was seen by Respondent on August 19, 1980. For this visit Respondent billed Prudential Insurance Company $262.50. Clinical data prepared by Respondent for Nancy shows usual childhood diseases, tonsillectomy, adenoid-ectomy, fever, sore throat accompanied by ear pains and swelling, patient complaining of weakness, history of anemia, poor appetite, burning sensation when voiding, dark urine, and a skin rash on right leg. Patient's weight was recorded as 70 pounds, but neither height nor temperature was recorded. In addition to a complete physical examination, a urinalysis, skin culture, and sensitivity test were done, and blood chemistry tests included complete blood count, calcium, glucose, BUN, creatinine, albumin, bilirubin, total protein, and SGPT. These blood tests, all of which (except the cbc) are included in a SMAC-22, were billed as having been performed as individual tests at costs ranging from $10.00 to $17.50 each. Treatment prescribed for Nancy consisted of aspirin suppositories. Respondent testified that Nancy was under weight, although her height was not measured, and that she took Nancy's temperature but failed to record it. Jose Trujillo was seen by Respondent on February 4, 1981, as a patient. Clinical data recorded by Respondent on this visit (Exhibit 3) include ". . . history of diverticulitis of colon, states that have diet but feels like some abdominal discomfort accompanied by diarrhea and feels weak. Patient with history of admission in the hospital, admission Palmetto General Hospital. Some lower discomfort abdomen and dark urine." For this visit prudential Insurance Company was billed $340 for complete physical examination (genital exam omitted) complete blood count; urinalysis; blood tests including glucose, BUN, creatinine, calcium, phosphorus, uric acid, electrolytes (including calcium, potassium, chlorides, and carbon dioxide) total protein, cholesterol, triglycerides, SGOT, SGPT, and alkaline phosphates; urine culture; sensitivity test; and collection and handling. The blood tests were all included in a SMAC- 22 but were billed as individual and manually performed tests with costs ranging from $10.00 to $20.00 each. Petitioner's expert witnesses both testified that some of the tests performed on these three patients were indicated by the symptoms and complaints described. Other tests conducted were not appropriate for the symptoms given. They also agreed that had these tests been conducted and billed as a SMAC-22 they would not consider that that could be a violation of the Medical Practices Act because, even though some of these tests were not medically indicated, they "come with the package" and would not increase the cost to the patient. However, when conducted manually and individually and so billed, the practice of conducting blood tests for which there is no medical justification does not conform to the generally prevailing standards in the medical community. Because of the findings below, it is unnecessary to denote those tests performed on each of the Trujillos for which there was no medical justification. Although billed to Prudential Insurance Company as manually and individually performed, the blood tests on the three patients above-named were conducted as a SMAC-22 and were not performed manually and individually as testified to by Respondent. This determination is based on the following facts, circumstances, and rationalizations: Respondent sent the blood samples from these three patients to Central Medical Laboratory, Inc., for a SMAC-22 test. Respondent testified that she performed each of the series of 10 to 15 tests on the blood samples of these patients in 20 to 30 minutes; however, other medical witnesses testified it took a trained technician 20 minutes to perform one of these blood tests manually. The latter testimony is deemed more credible. Many of these tests have subjective characteristics, such as color comparisons, and identical results from the same blood sample tested by two technicians or run through the same automated process would be rare. The odds against a technician performing individual and manual tests on 16 blood samples and obtaining the identical result on all tests that is obtained from a commercial laboratory SMA test is astronomical. Yet, the one report obtained from Central Medical Laboratory for the SMAC-22 conducted on the blood sample from Jose Trujillo (Exhibit 7) is identical to the "manual and individual" test report maintained by Respondent for the same blood sample in Exhibit 3--with one exception. The laboratory found the triglyceride test to be 254 MG/DL, well outside the 30-175 range for this test. On Exhibit 3 Respondent recorded 175 for this test. She testified she sent blood samples from the three Trujillos to the laboratory to have a check on her tests but did not ask the laboratory to do a recheck on the triglycerides test on Jose or recheck her test for triglycerides after receiving the laboratory report. Only a small amount of blood (5 or 10 cc) is required for an automated procedure for up to 40 different tests, whereas at least three times this amount of serum would be required for 10 tests conducted manually or individually. Accordingly, manual testing would require the drawing of a lot more blood than would be required for automated testing in a commercial lab. Respondent testified that she sent one-half of the blood sample taken on each Trujillo to the laboratory and kept the other one-half to test in her office. Commercial medical laboratories are licensed by the state; are checked for compliance with proper procedures; equipment used is checked for proper calibration at frequent intervals; reagents used in the testing is frequently replaced; and, when compared to the equipment, procedures, calibration, and reagents used in a physician's office which are subject to no regulation, the former should provide the more reliable test in a much shorter time. The equipment in Respondent's office is capable of being used to conduct all of the tests on these three patients for which Respondent billed Prudential Insurance Company. No rational explanation was provided to justify having a SMAC-22 performed and duplicating these tests manually. Respondent's testimony that the SMAC-22 was ordered to check the results of the manual tests she performed is not credible. If a check on the manual tests conducted on blood samples of Nancy and Elsa Trujillo for the August 17, 1980, visit was desired, it would appear appropriate to check the office procedures by doing a SMAC-22 on only one of those blood samples, rather than have both of these samples checked as was done here. Repeating this "check" on the sample taken from Jose Trujillo on February 4, 1981, does not make sense. Either the laboratory test is trusted or it is not. The same applies to the individual tests conducted manually in the office. If confident of the procedures, there would be no reason for Respondent to check the manual tests conducted in the office by sending one-half of the serum to a commercial laboratory. Respondent testified that Central Medical Laboratory picks up blood samples at her office daily. This suggests that some tests are routinely ordered by Respondent and conducted by the laboratory, and no evidence was presented to rebut such a conclusion. On the other hand, Petitioner presented no evidence of the volume of tests conducted by Central Medical Laboratory for Respondent which would solidify this conclusion. Nor did Petitioner submit the SMAC-22 results obtained by Central Medical Laboratory for the blood test conducted on the serum taken from Elsa and Nancy Trujillo on August 17, 1980, to see if they too were identical to the results shown in Exhibit 3. The only rational explanation for having SMAC-22 tests performed in a commercial laboratory and reporting these tests as done individually and manually in Respondent's office is the amount the insurance company will pay for the latter is nearly ten times what they will pay for the former. Laboratory tests billed for Jose Trujillo for the February 4, 1981, visit amount to nearly $250. Charges submitted for these tests reported on the SMAC-22 (Exhibit 7) amount to $187. Respondent testified she paid for the SMAC-22 tests she ordered and did not bill the insurance company for these tests because "they won't pay for both" SMAC and manual tests performed on the same sample. Since the lab charged Respondent only $10-$12 for the SMAC-22 tests conducted, the insurance company would not pay $187 if these tests were charged as automated tests. Considerable evidence was submitted that there was no medical justification for certain of the tests performed on Nancy, Elsa, and Jose Trujillo. For Nancy, these unnecessary tests included tests for calcium, glucose, BUN, creatinine, albumin, bilirubin, total protein, and SGPT. For Elsa, these unnecessary tests were calcium, phosphorus, uric acid, total protein, bilirubin, with either BUN or creatinine justified, but not both. For Jose, no medical justification was shown for manually performed tests for glucose, calcium, phosphorus, electrolytes, SGDT and SGNT. In view of the finding above, that these tests were not manually done but were performed as a SMAC-22, the fact that they are not medically justified if done manually becomes immaterial.
The Issue The issues in this case are whether Respondent, Robin L. Cannizzaro, D.V.M. (Respondent), committed the violations alleged in the Administrative Complaint dated July 13, 2009, and, if so, what penalty should be imposed.
Findings Of Fact Petitioner is the state agency with the duty to regulate the practice of veterinary medicine in Florida pursuant to Chapters 455 and 474, Florida Statutes. At all times material to the allegations of this case, Respondent was a licensed veterinarian in Florida fully authorized to practice veterinary medicine. Respondent has been licensed since 1991 and holds license number VM 5903. At all times material to the allegations of this case, Respondent’s address has been 26139 Halsey Road, Brooksville, Florida. At all times material to the allegations of this case, Diane Weigandt was the owner of the cat known in this record as “Maddie.” Maddie was a young cat, and Ms. Weigandt took her to Respondent’s office on or about April 7, 2008. Ms. Weigandt wanted to have Maddie spayed, but another veterinarian had declined to do so because the preoperative blood work indicated an elevated liver enzyme (ALT). During the course of the visit with Respondent, it was determined that Maddie should have a blood draw to test, among other things, Maddie’s ALT. It was expected that, if the enzyme were within or close to a normal range, Maddie could have the procedure. Respondent decided a draw from Maddie’s jugular vein was needed based upon the volume of the sample required to perform the tests. The selected site of the blood draw is not in dispute. The site of the draw did, however, cause Maddie to react uncooperatively. In order to make the blood draw, Respondent determined that Maddie would have to be restrained. It is not uncommon for cats to resist this procedure. Most pets, in fact, are not cooperative with jugular blood draws. During the first attempt to draw the blood, Respondent’s assistant held Maddie by the scruff of her neck on her side with her legs pinned. This position did not contain the struggling feline. As Maddie struggled to avoid the blood draw, Respondent made several attempts, using four different syringes, to acquire the sample. Approximately half-way through the procedure, Respondent’s assistant taped Maddie’s legs together so that they were further restrained. Between each attempt to draw blood, Maddie was afforded a break. “Break” meaning a brief intermission from the struggle that ensued each time Respondent attempted to draw blood. After approximately 20 minutes, Respondent obtained a small sample, but Maddie collapsed at the end of the blood draw. Respondent quickly performed CPR and was able to revive Maddie and get her stabilized within a short period of time. At the conclusion of the visit, Respondent referred Ms. Weigandt to a specialist to deal with Maddie. Respondent advised Ms. Weigandt that another doctor needed to rule out a pulmonary or cardiac medical condition for Maddie’s collapse. Had Maddie not appeared stable, Respondent would not have sent the cat on her way. When Ms. Weigandt presented at the second veterinarian’s office, Respondent faxed the results of the blood draw taken earlier to the second veterinarian. Ms. Weigandt was advised that another blood draw would be necessary as the specimen from Respondent’s office was compromised. It is not disputed that the second veterinarian advised Ms. Weigandt that Respondent’s blood draw was inadequate for the purposes needed. Respondent acknowledged that the blood draw was hemolyzed, but averred that most of the tests were nevertheless valid. The compromised blood draw could have resulted from a number of conditions. First, due to the numerous attempts to draw blood, a hematoma appeared at the draw site. A hematoma is a collection of blood outside the blood vessel, either in the subcutaneous tissue or in the muscle surrounding the vein. When blood is drawn through a hematoma, there can be a breakdown of the red blood cells. Additionally, myoglobin or muscle fluid from the muscle surrounding the vein may also contaminate the sample. Finally, if the draw is done after the animal has eaten (a non-fasting draw), the sample may be lipemic. Lipemic refers to fat appearing in the blood that will show up anywhere from two to six hours after eating. Any of the conditions noted can adversely affect a blood draw and leave the sample compromised. In the instant case, approximately half of the tests performed on Maddie’s sample drawn by Respondent were deemed inaccurate or insufficient for medical purposes. After consideration of the circumstances and effectiveness of Respondent’s blood draw for Maddie, Ms. Weigandt challenged the credit card payment she made to Respondent for the blood testing. Admitting no error in treatment or procedure, Respondent allowed the challenge and voluntarily withdrew the charge. Respondent believed this was a gesture of goodwill and not an admission of any wrong-doing. Subsequently, Ms. Weigandt requested that Respondent provide her copies of Maddie’s medical records. To that end, Respondent gave Ms. Weigandt the option of having the records faxed to her new veterinarian at no charge or picking up a copy of the records for which she would be expected to pay a fee. Ms. Weigandt chose the latter option, as she wanted to keep a personal copy of her pets’ records. As it turned out, Ms. Weigandt was, in effect, seeking the records for all of her pets/patients for whom Respondent had provided services. The seven pets’ records were maintained under Ms. Weigandt’s name and were copied and provided to the owner/client. Respondent charged Ms. Weigandt $55.00 for 55 pages of records. The form verification of completeness executed by Respondent’s assistant provided that the records for Maddie constituted 32 pages. In this case, Respondent kept a file for Ms. Weigandt’s pets based upon the owner’s name and information. Within the single file, Respondent maintained pet data identified by pet name with treatment notes, medications, and other pertinent information. Respondent maintained the record for the seven pets owned by Ms. Weigandt and kept notes for office visits, telephone consultations, and other matters identified by pet name. Pertinent to this case, Respondent’s notation for Maddie for the date of the blood draw indicated “WNL.” The specifics of Maddie’s temperature, heart rate or respiration were not stated. “WNL” is short-hand for “within normal limits.” Data for Maddie’s weight, considered a basic “vital,” was not provided. Instead, Respondent’s note provided, “seems undersized for age.” The process Respondent used to attempt a blood draw from Maddie’s jugular vein is within the standard of care for such procedures. As to both the site of the draw and the restraint used to obtain a sample, Respondent’s conduct was within a standard of care to be expected given the combative nature of the patient. In all likelihood, given the totality of the situation, Maddie experienced a vagal bradycardia that was quickly and appropriately addressed by Respondent. Maddie was resuscitated in an appropriate manner and stabilized before being released. As to the medical records retained by Respondent, it is determined that such records did not contain the data and information expected and required by the standard in Florida. Pertinent information concerning Maddie’s pre-procedure condition was not noted. Finally, as to the charges imposed for the copying of Maddie’s medical record, it is determined that, pursuant to the rule, Respondent was allowed to charge $26.75 for Maddie’s record. Ms. Weigandt requested and obtained records for six other animals. Presumably, the $55.00 charged for such records covered not fewer than 23 pages of records. Assuming Respondent was entitled to charge $1.00 for each of those pages, Respondent would have been authorized to charge $49.75 for the records.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Veterinary Medicine enter a final order finding that Respondent failed to keep appropriate records as alleged in Count Two of the Administrative Complaint, imposing a penalty of reprimand and the costs of investigation, and dismissing all other counts of the Administrative Complaint as unfounded. DONE AND ENTERED this 13th day of October, 2010, in Tallahassee, Leon County, Florida. S J. D. PARRISH 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 13th day of October, 2010.
Findings Of Fact Respondent is a licensed chiropractor in the State of Florida and was so licensed at the time of the alleged violations. He holds License No 2167 issued by the State Board of Chiropractic Examiners. On December 24, 1975, pursuant to a request of Randy Spector for a blood test, Respondent extracted a blood sample from Spector. At this time, Respondent informed Spector that he would send the blood sample to MET-PATH laboratories for testing and that the results would be back in approximately a week or ten days. A few days later Spector visited Respondent's office and was informed by him that the tests were fine and that he was in good health, but he did not have the results back from the laboratory. Respondent's wife, who was present, told Spector that the laboratories do not always send the test back unless they are asked for or unless something was wrong. This sounded like "double talk" to Spector and he asked Respondent for the test results. Respondent said that he would call the lab on the phone and obtain the results. On January 2, 1976, Spector again visited Respondent's office and was provided the report of blood analysis. Respondent explained some of the entries on the report and after so doing, Spector asked him to sign the report. Respondent did so. Thereupon Spector gave him a check for $15.00 in payment for the test and was provided a receipt. (Testimony of Spector, Petitioner's Exhibits 1,2 & 3) Spector was now convinced that the analysis of his blood had not been made by MET-PATH laboratories and therefore called that company several times during the next week or so. Each time he was informed by that concern that they had not received any of his blood for testing from Respondent. On January 5, 1976, Spector's legal counsel wrote a letter to Respondent advising him that Spector believed that the test results were fabricated and asserted a claim for malpractice and fraud. Respondent's counsel responded by letter of January 19 denying the allegations and stating that "if there was any error, it was simply an error in transposition of any test results and there was no resulting damage of any nature whatsoever to your client". (Testimony of Spector, Respondent's Exhibits 1 & 2). Spector contacted Dr. George Fica, a chiropractor who had been treating him and his wife. He told him of his complaint against Respondent and indicated that the matter was going "to be blown sky high" and that the press would be involved. However, Spector told Fica that if Respondent apologized, he would drop the matter. He showed Fica the blood test results and Fica told him that they were in normal limits but that some of the tests would have required the use of a laboratory. Fica talked to the Respondent about Spector's complaints and his claim that MET-PATH Laboratories had not done the work. Respondent stated that he had done it with a machine in his office. Fica then questioned him about certain tests such as triglycerides, which required laboratory analysis. Respondent then informed him that he didn't do the work in his office, but that he was using many labs for blood work and that his secretary had typed the wrong information on Spector's report. (Testimony of Fica) About January 12th or 13th, Spector went to Respondent's office and told him that the matter had gotten out of hand and that he wanted to straighten it out. Spector checked Respondent's tape recorder to make sure it was not running and also looked up and down the hallway outside his office and then closed the door. During the course of the conversation, Respondent apologized for not sending Spector's blood sample to MET-PATH and told him that he had run the tests in his own office and that they had been transposed in error. Spector told Respondent it would cost him a lot of money to go to court and indicated that the matter should be settled. (Testimony of Spector; Respondent) It was stipulated that Respondent had not sent Spector's blood sample to any laboratory for analysis. Respondent testified that he had originally planned to send Spector's blood to MET-PATH but due to a previous fire that destroyed much of his office, he had no usable mailing cartons for this purpose. Therefore, he did those tests that he could perform on a machine in his office. A number of the tests could not be done on the machine and he was unaware that his secretary had typed entries for such tests on the report given to Spector. Respondent speculated that the secretary must have mistakenly used figures from another patient's blood test when preparing the report. This explanation is not deemed credible in view of Respondent's contradictory statements in this regard to Spector and Fica as set forth in the foregoing findings. The laboratory cost for preparing a blood analysis is approximately $10.00. (Testimony of Resp., Pet.'s Exh. 4) Respondent has been a chiropractor for approximately 13 years and enjoys an excellent reputation for competence in his field. An associate, who has been in his office for the past several months, has never observed him engage in an unethical practice. (Testimony of Respondent, Fica, Gordon)
Recommendation That the Florida Board of Chiropractic Examiners issue a reprimand to Respondent, R.H. Grant, for violation of Section 460.13(3)(h), Florida Statutes. DONE and ENTERED this 25th day of October, 1976, in Tallahassee, Florida. THOMAS C. OLDHAM Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 COPIES FURNISHED: Ronald C. LaFace, Esquire Post Office Box 1752 Tallahassee, Florida Charles A. Sullivan 1245 20th Street Post Office Box 3 Vero Beach, Florida 32960
