Findings Of Fact Respondent is now and at all relevant times has been a licensed registered nurse in Florida under license number 1074052. She is currently on active status. Her latest license renewal expires on March 31, 1989. Respondent was hired in April, 1986, as a charge nurse at John Knox Village Medical Center in Tampa. John Knox Village Medical Center is a long- term care facility divided into two wings. The wing to which Respondent was assigned houses between 24 and 32 patients requiring skilled nursing care. For the first three weeks on the job, Respondent performed her duties quite well. She learned the names of all of the long-term patients. She was a good manager and motivator of her employees. She was not absent from work. After about three weeks on the job, Respondent began to exhibit minor lapses of memory. Her hands began shaking. Her face became puffy and pale. She often became withdrawn and subject to mood swings. Occasionally, she could not be located for short periods of time by her nurse's aides, who required her supervision. A coworker smelled what was clearly alcohol on Respondent's breath one evening while Respondent was on duty. Shortly thereafter, on or about May 21, 1987, Respondent admitted to the Director of Nursing, Cary Boylan, that Respondent was an alcoholic. Respondent agreed, at Ms. Boylan's urging, to enter an alcohol treatment program sponsored by Alcohol Community Treatment Services, Inc. ("ACTS"). Respondent had been working at John Knox Village Medical Center for about six weeks at the time of her departure to enter the ACTS Program. Respondent underwent extensive residential treatment in the ACTS program from June 9, 1986 through July 7, 1986. She received counseling seven days a week. On July 14, 1986, Respondent successfully completed the intensive phase of the ACTS program and returned to work. She was rehired on that date, but was no longer the charge nurse. For the first few weeks after her return, Respondent was compliant, exhibited no signs of alcohol consumption, and generally performed her duties quite well. Respondent subsequently began a pattern of absenteeism starting at the end of August, 1986. At first, Respondent would notify her supervisors in advance of her absence. By September, it was "no call, no show." At one point, she missed six working days during a two-week period. About ten absences were unexplained. Others were accompanied by a doctor's excuse. By this time, the hand tremors had returned. Respondent's failure to show up for work or even alert her supervisor in advance of her absence left the floor short-handed. Other nurses were suddenly required to work overtime or report to work early. Sometimes a temporary nurse had to be called in. Respondent evaded Ms. Boylan's attempts to discuss Respondent's behavior. Generally, she avoided Ms. Boylan's telephone calls. When Ms. Boylan terminated Respondent from employment, Respondent's face had the pale and puffy look that it had prior to her entering the ACTS program. There were no charting or care problems with Respondent while she was employed at John Knox Village Medical Center. Ms. Barbara Burhop, a nurse responsible for the orientation of new employees at John Knox Village Medical Center, testified affirmatively to this fact. Also, Respondent was preoccupied at the time with the hospitalization of her father who was suffering from an illness that later claimed his life on November 14, 1986. However, Ms. Boylan and Rosemary Myers, a licensed practical nurse who worked with Respondent at John Knox Village Medical Center, both opined that Respondent could not practice nursing safely while at John Knox Village Medical Center, before and after the ACTS treatment, due to alcohol use. After leaving John Knox Village Medical Center, Respondent worked for six or seven months for a temporary nurse pool. On November 2, 1987, Respondent was hired to work as a staff curse at Centro Espanol Memorial Hospital in Tampa. She was assigned to the med-surg unit, but was first required to undertake two weeks of orientation and employee training. Respondent never completed the orientation training program. On the first day, she fell asleep while another nurse was training Respondent in a one- on-one session. Other times, Respondent appeared to be nodding off while on duty; often, she appeared to be trying hard to stay awake. Other nurses detected the odor of alcohol on Respondent's breath. Respondent frequently left her nurse's station for short periods of time for no apparent reason and during which she could not be found. There was no competent evidence of any charting or care problems during Respondent's short term of employment at Centro Espanol Memorial Hospital. In one instance, Respondent failed to release an in-going catheter, but Respondent's unrebutted testimony was that she told the nurse who followed her on the next shift about the unreleased catheter. Her chart entries were difficult to read, but "made sense" and were not illegible in the strict sense of the word. However, Ms. Gloria Carper, who is Assistant Director of Nursing at Centro Espanol Memorial Hospital, opined that Respondent was impaired due to alcoholism. Respondent admits that she is an alcoholic and has been for 2 1/2 to 3 years. She admits that she does not abstain from alcohol consumption. She testified that she did not drink while on duty. On days that she felt that she could not adequately care for a patient, Respondent stated that she would not report to work. She has attended various alcoholic treatment groups, including Alcoholics Anonymous, but has not successfully completed her recent treatment programs. On February 19, 1987, the Impaired Nurses Program ("INP") found Respondent noncompliant in her treatment program. On March 17, 1987, her noncompliance necessitated an extension of her INP two-year monitoring to February 4, 1989. Respondent was again found noncompliant by INP by letter dated May 11, 1987. Respondent was dismissed for noncompliance from Petitioner's Intervention Project by letter dated May 22, 1987. By letter dated June 25, 1987, Respondent was also unfavorably terminated from the post- residential, out-patient counseling phase of the ACTS program. Her ACTS counselor noted Respondent's sporadic attendance, closed attitude, and insistence upon her alcohol and drug-free status, which insistence was belied upon her uncooperative behavior. Although there is no direct, clear and convincing evidence of alcohol intoxication or even consumption while on duty, the evidence is clear and convincing that Respondent consumed alcohol during the terms of her employment at John Knox Village Medical Center and Centro Espanol Memorial Hospital. The most reasonable inference is that she consumed alcohol excessively the night before work. As a result, Respondent was either so tired and sick the next morning that she was unable to work or, if not quite so tired and sick, she would report to work and doze off.
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part Il, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The Election of Rights form advised of the right to an administrative hearing. 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED: 1. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 2. The Respondent shall pay the Agency $2,500.00. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the “Agency for Health Care Administration” and containing the AHCA ten-digit case number should be sent to: Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS 14 Tallahassee, Florida 32308 1 Filed February 23, 2015 2:41 PM Division of Administrative Hearings 3. Conditional licensure status is imposed on the Respondent beginning on May 15, 2014 and ending on June 15, 2014. ORDERED at Tallahassee, Florida, on this I day of Boren, , 2015. NOTICE OF RIGHT TO JUDICIAL REVIEW. A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct of this Final Order was served on the below-named persons by the method designated on this Veen } Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Finance & Accounting | Facilities Intake Unit Revenue Management Unit (Electronic Mail) (Electronic Mail) John E. Bradley Brian Kelly, Esquire Office of the General Counsel Law Offices of Brian Kelly, PC Agency for Health Care Administration 7316 Wisconsin Avenue, Suite 200 (Electronic Mail) Bethesda, Maryland 20814 (U.S. Mail)
Findings Of Fact Jane Ruth Burch Harrison, the Licensee, is a registered nurse in this state and holds license no. 18473-2. On or about October 15, 1976, Elsie McGuigan, an L.P.N. employed by Division Hospital in Lake City, Florida observed the Licensee on duty and appearing to be intoxicated to the extent that she was unable to carry out her duties as a registered nurse. Specifically, Ms. McGuigan observed the Respondent attempting to chart while she was in a daze. She attempted to get some assistance from the Licensee due to the heavy patient load on the three to eleven shift but the Licensee was unable to assist her due to her condition. Ms. McGuigan thereafter summoned Mary E. DePew, the Director of Nursing for the Division Hospital, and advised her of the Licensee's inability to function and the concern she had of the patient's well being. In so doing, she observed one patient who was receiving cardiac treatment and felt that the services of a doctor were necessary to check the patient's condition. Mrs. Ann Gurtler, an R.N. for approximately 34 years and an employee at Division Hospital, was also summoned on October 15, 1976 to assist with the patient load due to the Licensee's inability to function. She testified that one patient, Elsie Hilliard was suffering from asthma and breathing difficulties and required oxygen treatment to stabilize her condition. Trixie Mitchell, a nurses aide, while on duty on October 15, 1976 spoke to Respondent who was seen crying. She attempted to calm the Licensee down and told her that her problems should not be regarded as insurmountable. Mrs. DePew summoned a taxi to the hospital to take the Licensee home inasmuch as she was under the influence of alcohol. Shortly thereafter, the Respondent admitted herself for treatment at an alcoholic rehabilitation center at the Lake City Alcoholic Center and was confined for a period of one week. Upon her release, she was put on antabuse by Dr. John Philpot and returned to work at the Division Hospital. On May 10, 1977, while on duty, Respondent became intoxicated to the extent that she was unable to function as a nurse and was terminated from her employment by Ms. Depew. The Respondent admitted that she reported to work while under the influence of alcohol and/or drugs. She testified that she did so based on the numerous matrimonial problems that she was having. She testified that her divorce had recently become final and that she had suffered a traumatic episode shortly after her divorce became final. She testified that her son recently became addicted to drugs and while driving in her car had an accident and critically injured a passenger. Licensee acknowledge the seriousness of the problems and the conduct in which she engaged in by reporting to work on October 15 and on May 10, 1977 in an intoxicated state. She testified that these were isolated incidents which should not overshadow her total performance which had been adequate and resulted in no injury to patients. She is presently undergoing alcoholic treatment at the local alcoholic rehabilitation center and feels that she has put her alcoholic and drug problems behind her. Based on the foregoing facts, the undersigned concludes that the Licensee has engaged in conduct violative of Chapter 464.21, Florida Statutes, as alleged. In view of the creditable testimony that the Licensee has submitted to treatment to cure her problems which she admitted, I shall recommend that the Licensee be placed on probation for a period of two years. In so doing, consideration was given to the fact that the Licensee recognized the seriousness of the problem which she is now suffering from and her voluntary submission to treatment at the local alcoholic rehabilitation center.
Recommendation Based on the foregoing findings of fact and conclusions of law, I hereby recommend that the Licensee be placed on probation for a period of two years. RECOMMENDED THIS 3rd day of August, 1977, in Tallahassee Florida. JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32201 Jane Ruth Burch Harrison 2620 South Marion Street M4 Lake City, Florida 32055
Findings Of Fact Based on the record evidence and the admissions made by Sandbank at hearing, the Hearing Officer makes the following findings of fact: Stanley Sandbank has been a licensed pharmacist in the State of Florida since 1975 and has actively engaged in the practice of pharmacy in this state since 1982. During the Fall of 1987, Sandbank was employed as a pharmacist at Rite- Aid Discount Pharmacy 2165 in Miami Beach, Florida. Toward the latter part of November of that year, Rite-Aid management received a telephone call from a Drug Enforcement Administration (DEA) agent, who stated that she had obtained a tip from a reliable informant that Sandbank "was selling drugs on the street." The DEA agent suggested that a controlled audit be conducted to ascertain whether these drugs were being misappropriated from the pharmacy at which Sandbank worked. Rite-Aid management followed the DEA agent's suggestion and performed such a controlled audit. The audit was completed on November 25, 1987. It revealed that 154 dosage units of Percocet and 201 dosage units of Percodan were unaccounted for and missing from the pharmacy's inventory of controlled substances. Percocet is a brand name of a "medicinal drug," as defined in Section 456.003(7), Florida Statutes, which contains Oxycodone, a controlled substance listed in Schedule II of Chapter 893, Florida Statutes. Percodan is a brand name of a "medicinal drug," as defined in Section 465.003(7), Florida Statutes, which also contains Oxycodone. Because Sandbank was the only pharmacist on duty during the time the audit was conducted, Rite Aid management believed that he was responsible for the shortages that had been discovered. Sandbank initially denied knowing anything about the matter, but later admitted his transgression. As Sandbank freely admitted, he had removed from the pharmacy and delivered to relatives and neighbors the following approximate quantities of controlled substances without first having been presented with a valid prescription and without Rite-Aid having received payment in full for these controlled substances: CONTROLLED SUBSTANCE QUANTITY Valium 10 mg. 300 Diazepam 10 mg. 400 Percodan 375 Percocet 360 Dilaudid 100 Hycodan Syrup 240 Placidyl 750 mg. 30 Valium, Dilaudid, Hycodan Syrup, and Placidyl are brand names of "medicinal drugs," within the meaning of Section 465.003(7). Valium contains Diazepam, which is a controlled substance listed in Schedule IV of Chapter 893, Florida Statutes. Dialudid contains Hydromorphone, which is a controlled substance listed in Schedule II of Chapter 893, Florida Statutes. Hycodan Syrup contains Hydrocodone, which is a controlled substance listed in Schedule III of Chapter 893, Florida Statutes. Placidyl contains Ethchlorvynol, which is a controlled substance listed in Schecdule IV of Chapter 893, Florida Statutes. Sandbank kept at least a portion of the money he had been given by this neighbors and relatives for having delivered to them the above-described controlled substances. He therefore reaped a financial gain as a result of his unauthorized and surreptitious diversion of these controlled substances from Rite-Aid Discount Pharmacy #2165.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Pharmacy enter a Final Order finding that Stanley Sandbank violated Section 465.016(1)(e), Florida Statutes, as alleged in the Administrative Complaint, and imposing the above-described disciplinary action which the Department of Professional Regulation has proposed. DONE and ENTERED this 25th day of April, 1989, in Tallahassee, Florida. STUART M. LERNER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 25th day of November, 1989. COPIES FURNISHED: Michael A. Mone', Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Stanley Sandbank 4300 Sheridan Street Hollywood, Florida 32399-0750 Rod Presnell, Executive Director Board of Pharmacy Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Kenneth D. Easley, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue Whether Respondent's license to practice nursing should be disciplined on the grounds that by reason of her use of drugs and alcohol, she is unable to practice nursing with reasonable skill and safety.
Findings Of Fact Based on the evidence presented at hearing, the following facts are determined: Respondent, Ms. Fischi, a 26-year-old practical nurse, holds License No. 0517521 issued by the Department. Prior to July 29, 1980, she worked as a practical nurse at the Plantation General Hospital, Plantation, Florida. (Testimony of Fischi, Markowitz) On July 29, 1980, she was admitted to the emergency room of Cypress Community Hospital, Pompano Beach, Florida, in a comatose state from a drug and alcohol overdose; she had drunk a pint of vodka and injected herself with a drug known as Talwin. (Testimony of Fischi, Markowitz; P-3) This was the latest incident in a two to three year history of drug and alcohol abuse. She was an alcoholic who began to experiment with drugs which she obtained at Plantation General Hospital. In February, 1980, she was hospitalized for a drug overdose. She had been in and out of drug and alcoholic rehabilitation programs and a participant in Alcoholics Anonymous for over a year. Her abuse of drugs and alcohol rendered her unable to practice nursing with reasonable skill and safety. (P-3) On August 2, 1980, Ms. Fischi was discharged from Cypress Community Hospital with the recommendation that she participate in the Alcoholics Anonymous program. Subsequently, she was admitted to the Coral Ridge Psychiatric Hospital where she continued to receive treatment. When visited by a Department investigator, she candidly admitted to her alcohol and drug abuse but refused to surrender her nursing license stating that she "loved nursing too much." She premised to again participate in Alcoholics Anonymous and vowed to overcome her drug abuse problems. (Testimony of Fischi, Markowitz) She has striven to fulfill her promise. From November 18, 1980, to February 23, 1881, she received rehabilitative treatment as a resident of Bethesda Manor, a halfway home for recovering alcoholics operated by the Catholic Archdiocese of Miami. The Director of Bethesda Manor writes that "During her stay . . . Debbie worked diligently on her treatment tasks, [and] made significant forward movement in implementing behavioral and attitude changes . . . Debbie has maintained ongoing contact with the Bethesda staff and appears to be progressing very satisfactorily in her current modality." (R-2) Since leaving Bethesda, Ms. Fischi has participated in a residential Metro-Dade County alcoholic treatment program at the New Opportunity Home, 777 N.W. 30th Street, Miami. This is a 3/4 way house which offers individual and group therapy. Its counselors write that: "Ms. Fischi attends all therapeutic functions. [She] . . . presently is working on her alcohol and drug addictions and presently seems to be making good progress for herself. I feel her prognosis for recovery is good." (R-1) Ms. Fischi plans to remain at New Opportunity Home for another few months--until approximately August 21, 1981. She believes that by the end of that period, she will be able to fully resume the competent practice of nursing. In the meantime, she plans to continue working at a community blood bank. (Testimony of Fischi) Since July 29, 1980, she has refrained from all use of drugs and alcohol. Given the courage and determination of this woman, it is likely that she can succeed in her struggle to return to the nursing profession. The Department recommends that her license be suspended with provision for reinstatement after four months upon submittal of a health care professional's statement that she is capable of resuming the competent practice of nursing. Ms. Fischi is agreeable to the imposition of this penalty. (Testimony of Fischi, Stipulation of Department and Counsel)
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Florida Board of Nursing enter a final order finding Respondent guilty of violating Section 464.018(i)(h), Florida Statutes, and suspending her nursing license with specific provision for reinstatement as described above. DONE and RECOMMENDED this 1st day of May, 1981, in Tallahassee, Florida. R. L. CALEEN, JR. Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 1st day of May, 1981.
The Issue The amended Administrative complaint, forwarded to the Division of Administrative Hearings on January 20, 1987, alleges that Respondent is unable to practice medicine with reasonable skill and safety to patients by reason of alcohol and substance abuse; that Respondent attempted to treat patients while under the influence of alcohol, constituting gross or repeated malpractice or failure to practice medicine with the level of care recognized by a reasonably prudent similar physician as acceptable under similar conditions and circumstances; and that Respondent failed to fulfill a statutory or legal obligation placed upon a licensed physician. After lengthy discovery and negotiations and Respondent's submittal to an inpatient mental and physical examination, the parties filed a stipulation substantially limiting the issue to the conditions under which Respondent should be allowed to return to the practice of medicine and appropriate monitoring once he returns to practice. At the final hearing, DPR presented the testimony of two witnesses: Lynn Hankes, M. D., qualified as expert in addictionology without objection, treated Dr. Pigg for alcoholism in 1985 and examined him as an inpatient in January, 1988. Robert A. Goetz, M. D., qualified without objection as an expert in the field of impaired physicians, has been the director of Florida's Physicians' Recovery Network since February 1988, and has known Dr. Pigg since shortly after that time. Respondent's sole witness was Milton R. Burglass, M.D., qualified without objection as an expert in psychiatry and in addiction treatment. Dr. Burglass reviewed Dr. Pigg's records and files and interviewed him on April 7, 1988, in anticipation of this hearing. After the hearing the transcript was filed and both parties submitted proposed recommended orders. Specific rulings on the proposed findings of fact are found in the attached appendix.
Findings Of Fact William Larry Pigg is, and has been at all time material, a licensed physician in the State of Florida, having been issued license number ME 0040625. The parties in their prehearing stipulation filed on February 15, 1988, agree to the following: Peitioner, the Department of Professional Regulation, is the state agency charged with regulating the practice of medicine pursuant to Section 20.30, Florida Statutes; Chapter 455, Florida Statutes; and Chapter 458, Florida Statutes. Since at least the summer of 1984, Respondent has had a problem with alcohol abuse. On or about June 13, 1985, Respondent entered the Impaired Physician's Program. Respondent completed an alcohol treatment program in Miami, Florida. Thereafter, Respondent also completed an extended program in Mississippi. On or about December 17, 1985, Respondent was granted staff privileges at Holmes Regional Medical Center in Melbourne, Florida. In order to obtain staff privileges, Respondent signed a statement agreeing to do the following: to abide by the Aftercare Con- tract of the Mississippi State Medical Association Impaired Physician's Program; and to submit to blood alcohol levels [sic] at any time at the request of any physician on the staff of Holmes Regional Medical Center. In or about April 1986, Respondent began to abuse alcohol again. On or about April 12, 1986, Respondent was attempting to perform a right hip reduction on a patient at Holmes Regional Medical Center. The patient in question was legally intoxicated and a large muscular man. Respondent, in attempting to relax the patient, ordered a large dose of narcotics, including Demerol and Nubain, as well as Phenergan and Valium. On or about the evening of April 12, 1986 or the morning of April 13, 1986, Respondent left the emergency room, took a Phenergan tablet and went home. Phenergan is the brand name for prometnazine Hydrochloride. Phenergan can cause drowsiness or impair the mental and/or physical abilities of the individual taking the drug. Later on the same evening, the Emergency Department Physician, Dr. Wagner, spoke with Dr. Pigg by telephone in reference to two patients with fractures that required orthopedic intervention. Respondent agreed to come and resume care for the patients. However, Respondent never came to the medical center and could not be located by police. On or about April 16, 1986, Respondent's wife contacted the Melbourne Police Department because her husband had come home intoxicated. On or about June 7, 1986, Respondent was arrested for driving while under the influence of alcohol and reckless driving. On or about June 30, 1986, the Director of the Florida Medical Foundation Committee on Impaired Physicians, Roger A. Goetz, M.D., advised the Petitioner, by letter, that Respondent was not progressing satisfactorily with the program and had not complied with all aspects of his aftercare contract. Respondent is and has been at all times alleged in the above stipulated facts, unable to practice medicine with reasonable skill and safety to patients by reason of alcohol abuse. No evidence was presented as to substance abuse, other than alcohol. Nor was there evidence that Dr. Pigg suffers from a mental condition. Although his records reflect some prior diagnosis of a passive/aggressive personality disorder, the prevailing thought in the addictionology community is that psychiatric diagnoses are invalid until an individual has been sober long enough to assure that the problem is not solely the alcohol's effect on the individual. There is no evidence that Dr. Pigg has had this requisite period of sobriety since 1984, and particularly the time that he was examined by Dr. Burglass, the only psychiatrist to testify in this proceeding. Of the experts who testified, Dr. Hankes is most familiar with Dr. Pigg, having been his primary treating physician in the past, and having examined him recently over several days as an inpatient. Dr. Hankes found that Dr. Pigg progressed from the mid stage of alcoholism to the early late stage of this disease between 1985 and 1988. In addition to Dr. Hankes' program at South Miami Hospital, Dr. Pigg has undergone primary treatment at a series of facilities in Georgia, Mississippi and Florida, all of which have an excellent reputation. At this point, in Dr. Hankes' opinion, he is a treatment failure. He has, at various times in his treatment experience also undergone detoxification at a Myers Act facility, attempted Antabuse therapy, and tried and rejected Alcoholics Anonymous. In spite of the past failures, the experts concurred that Dr. Pigg, like other alcoholics, is capable of recovery and that once recovered, Dr. Pigg would be capable of practicing medicine safely. All concurred that the recovery must be verified prior to Dr. Pigg's return to practice, and that thereafter the recovery must be monitored for an unforeseeable period of time. Dr. Hankes' advice, based on his concern as Dr. Pigg's treatment provider and primary therapist, is a six-part program: that addiction therapy continue on an outpatient basis, at least weekly, by a certified alcohol or addiction professional; that Dr. Pigg engage in psychotherapy with a qualified psychiatrist knowledgeable about addictive disease, the frequency to be determined by the psychiatrist; that a primary internist or family general practitioner monitor his physical well-being, especially his liver dysfunction; that Dr. Pigg participate in Alcoholics Anonymous, with a lay individual sponsor, as well as engage in International Doctors in Alcoholics Anonymous with a recovering physician sponsor; that Dr. Pigg be assigned a monitoring physician, knowledgeable in addictive disease, who has the authority to require random, unannounced surprise testing of blood or urine and that personal contact be made every two weeks and telephone contact in the alternate weeks; that the treating and monitoring individuals report on a quarterly basis to Dr. Roger Goetz, the Recovery Network director and that at the end of a two-year period Dr. Pigg be examined again by Dr. Hankes who would make his recommendation to Dr. Goetz. Dr. Pigg would also have the right to go to another AMA approved treatment provider for a second opinion. Dr. Hankes distinguishes between the state of being "dry" or free from alcohol use for a period, and recovery from alcoholism which requires a personal transformation with some undefined indicators. Dr. Hankes is convinced that the latter state is essential for real recovery and that Alcoholics Anonymous is the most effective, though not exclusive, route to that state. Although Dr. Hankes recommends a two year period during which Dr. Pigg would not be permitted to practice, he concedes that recovery could be effective in less time and that he would readily endorse his return to practice if the recovery were completed sooner. He describes Dr. Pigg as a "very competent physician", a "very bright guy", a "multi-talented individual, who flies airplanes and does wonderful things in his life." None can predict the time required for recovery, but each of the three experts recommends a period of one to two years of verified sobriety prior to the return to practice. Dr. Burglass recommends neither Alcoholics Anonymous participation nor the multi-part program outlined by Dr. Hankes. Since Alcoholics Anonymous and the other treatment/recovery models have been unsuccessful, Dr. Burglass suggests that Dr. Pigg be allowed to devise his own method of achieving recovery; he emphasizes that the goal, and not the route to that goal, is the concern here. He recommends that sobriety be verified for a period of one year and thereafter Dr. Pigg be allowed to return to practice with monitoring for approximately three years. The evidence, weighed and considered as a whole, fails to establish that an absolute two-year suspension from medical practice is necessary or that involvement in Alcoholics Anonymous is essential.
Recommendation Based on the foregoing, it is, hereby RECOMMENDED: That William Larry Pigg, M.D. be suspended from the practice of medicine for an indefinite period, provided that he be given an opportunity to appear before the Board at twelve month intervals to demonstrate that he can resume the competent practice of medicine with reasonable skill and safety to patients. That demonstration should include, as a minimum: a ) That he has totally abstained from the use of alcohol for a period of twelve months, as evidenced by frequent unannounced random collection of blood samples by an agent designated by the Board. That he has been under the continuous care and supervision of a physician qualified to provide addiction therapy and that, if recommended by that individual after a necessary period of sobriety, he has also undergone a psychiatric evaluation to determine the existence of mental disease or disorder. If detected, the disease or disorder must be treated. That he has been evaluated successfully participated in Alcoholics Anonymous or other similar peer support group program. Successful participation means frequent regular attendance at meetings and the association with a qualified sponsor from the program. That he has been evaluated and recommended for return to practice by Dr. Hankes or other treatment professional designated by the Board. However, if the recommendation is negative, Dr. Pigg should be permitted to obtain a second opinion independent of the Board's designated evaluator, from an individual other than that described in b), above, who is also qualified in the field of addictionology. The length and type of monitoring necessary once Dr. Pigg returns to practice should be determined at that time, based on recommendations of the professionals responsible for assisting in his recovery. DONE and RECOMMENDED this 4th day of August, 1988, in Tallahassee, Florida. MARY CLARK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 4th day of August, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-0225 The following constitute specific rulings on the findings of fact proposed by the parties. Petitioner's Proposed Findings Adopted in paragraph 2. Adopted in paragraph 1. 3-13. Adopted in paragraph 2, incorporating the parties pre-hearing stipulation. 14. Adopted in paragraph 7. Respondent's Proposed Findings 1-4. Incorporated in Issues and Background statement. 5. Adopted in paragraph 2, incorporating the parties' prehearing stipulation. 6-8. Included in Background Statement. 9-12. Rejected as unnecessary restatement of the witnesses' testimony. Adopted in substance in paragraph 3. Included in Background Statement. 15-16. Adopted in substance in paragraph 4. Adopted in paragraph 6. Adopted in paragraph 9. 19-20. Adopted in paragraph 7. Adopted in paragraph 8. Adopted in paragraph 9. 23-24. Incorporated in substance in the Background statement. 25-28. Adopted in substance in paragraph 11, otherwise rejected as cumulative and unnecessary. 29. Adopted by implication in paragraph 12. 30-31. Rejected as cumulative and unnecessary. Adopted in paragraph 12. Rejected as a conclusion of law. Rejected as contrary to the evidence. Abstinence alone is insufficient. Adopted in substance in paragraphs 3, 11, and 12. Rejected as unnecessary. COPIES FURNISHED: John Namey, Esquire 22 East Pine Street Orlando, Florida 32801 Deborah J. Miller, Esquire One Biscayne Tower, Suite 2400 Two South Biscayne Boulevard Miami, Florida 33131 Dorothy Faircloth Executive Director Board of Medicine Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 William O'Neil, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
