The Issue Whether the Petitioner has met the requirements for licensure as a medical doctor in the State of Florida set forth in Section 458.311(1)(f), Florida Statutes (1986 Supp.), as required by Section 458.313(1), Florida Statutes (1986 Supp.)?
Findings Of Fact The Petitioner applied for licensure by endorsement as a medical doctor in Florida in September of 1986. Following notification by the Respondent that additional materials were required to complete the Petitioner's application, the Petitioner timely submitted the materials. In March of 1987, the Petitioner appeared before the Foreign Medical Graduate Committee of the Respondent. On April 5, 1987, the Respondent entered an Order titled Notice of Intent to Deny the Application for Licensure by Endorsement of Hien B. Nguyen. The stated basis for the denial of the Petitioner's application was that the Petitioner had failed to demonstrate that he graduated from a medical school. The Petitioner began medical school in 1967 at the University of Saigon, Faculty of Medicine, in Saigon, Republic of Vietnam. The Petitioner Successfully completed the six years required course work in medicine at the University of Saigon, Faculty of Medicine, in 1974. Following the completion of the course work required to earn a medical degree at the University of Saigon, Faculty of Medicine, the Petitioner was drafted into the Republic of Vietnam's military. He attended training for approximately six months immediately following the completion of his medical degree course work. The Petitioner was required to complete a thesis before being eligible for a medical degree from the University of Saigon, Faculty of Medicine. Upon completion of military training, the Petitioner commenced and completed work on his thesis. The Petitioner's thesis consisted of a translation of "Central Nervous Disease in Children," of Nelson's Pediatric Textbook, from English into Vietnamese. The Petitioner presented his thesis on April 14, 1975. Thuc R. Bach, M.D. attended the presentation of his wife's thesis on April 14, 1975, and witnessed the Petitioner's thesis presentation. The Petitioner was awarded a Certificate from the University of Saigon, Faculty of Medicine, on April 14, 1975, which indicated that the Petitioner had completed work necessary to be awarded a medical degree. The Certificate was issued temporarily. After approximately five years the Petitioner was required to return the Certificate at which time he could be issued an official diploma. On approximately April 30, 1975, the government of the Republic of Vietnam fell to the army of North Vietnam. Following the fall of the Republic of Vietnam, the Petitioner was confined to a concentration camp where the Petitioner acted as camp doctor. Following the Petitioner's release from confinement in 1976, the Petitioner worked as a physician at Saint Paul Clinic in Saigon until 1979. From 1977 until 1980 the Petitioner also attended and taught at a medical training center in Saigon. In October, 1980, the Petitioner escaped from Vietnam. He resided in Galang, Indonesia until March, 1981, when he moved to the United States. The Petitioner has completed the following since his arrival in the United States: December, 1981: Sat for the Federation Licensing Examination and was subsequently certified by the Federation of State Medical Boards; January 24, 1983: Certified by the Educational Commission for Foreign Medical Graduates; July, 1984 - June, 1985: Interned at the Cook County Hospital, Chicago, Illinois; July, 1985 - June, 1987: Residency program at Cook County Hospital, and February 19, 1986: Licensed as a physician by the State of Illinois (the license is currently active and unrestricted). The Petitioner was presented with a certificate from the Faculty- Council-in-Exile of the Faculty of Medicine of the University of Saigon dated April 20, 1981. The certificate affirms that the Petitioner "Successfully completed the course of study leading to the degree of Doctor of Medicine..." The certificate is signed by the Dean Emeritus of the University and Dao Huu Anh, M.D., Associate Dean of the University. Prior to the fall of the government of the Republic of Vietnam, graduates of the University of Saigon, Faculty of Medicine, were presented with a certificate authorizing them to practice as a physician without restriction upon completion of the required courses of study and a thesis. Graduates were not issued an Official Diploma until five years had passed since the issuance of their certificate. Although the Petitioner completed the required courses of study, presented his thesis and received a certificate authorizing him to practice as a physician, the Petitioner was not able to obtain an Official Diploma five years later because of the fall of the government of the Republic of Vietnam. In light of the fall of the government of the Republic of Vietnam, it is doubtful that the records of the University of Saigon, Faculty of Medicine are available or that the Petitioner could obtain an Official Diploma. The Petitioner is a graduate of the University of Saigon, Faculty of Medicine, a medical school.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be issued GRANTING the Petitioner's application for licensure by endorsement as a medical doctor in the State of Florida. DONE AND ORDERED this 25th day of January, 1988, in Tallahassee, Florida. LARRY J. SARTIN 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 28th day of January, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-2969 The parties have submitted proposed findings of fact. It has been noted below which proposed findings of fact have been generally accepted and the paragraph number(s) in the Recommended Order where they have been accepted, if any. Those proposed findings of fact which have been rejected and the reason for their rejection have also been noted. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in Recommended Order of Fact Number of Acceptance or Reason for Rejection 1 1. 2 2. 3 3. 4 4 and 5. 5 6. 6 7-10. 7 11-12. 13. The Petitioner worked at the training center from 1977 through 1980. 15. The Petitioner went from Vietnam to Indonesia in October of 1980. He did not travel to the United States until March of 1981. 10-12 Cummulative, summary of the evidence and unnecessary. Dr. Nghia Van Tran's letter was not accepted into evidence. 13 16. The last sentence is cummulative, a summary of evidence and unnecessary. The footnote is irrelevant. The burden of proof in this proceeding was on the Petitioner. The Respondent is not required to verify the signature of Dr. Dao. 14 10 and 17. 15 17-18. 16-18 Cummulative, summary of the evidence and unnecessary. The Respondent's Proposed Findings of Fact 1 1 and 3. 2-5 The Respondent's remaining proposed findings of fact are essentially summaries of the Respondent's inter- pretation of the evidence and argument concerning the evidence. The Respondent's interpretation of the evidence is rejected. The following is a brief discussion of why the Respondent's arguments have been rejected. The first two sentences are true and support the finding of fact that the Petitioner began medical school in 1967, completed his course work in 1974 and presented his thesis in April of 1975. See findings of fact 4-5 and 9. The third and fourth sentences are true but the Respondent has overlooked the fact that the Petitioner presented other evidence which supports his position. Therefore, even if the fifth sentence were correct, there is other evidence which supports findings of fact 4-5 and 9. The sixth sentence is irrelevant. Although the Board may have raised a question, the correct answer to that question is a matter of proof. The seventh sentence is true but irrelevant. The eighth sentence is not supported by the weight of the evidence. There was no testimony sufficient to support any finding of fact concerning Dr. Dao's signature on any document. Although the ninth sentence is correct, the weight of the evidence does not support the alleged fact set out in the tenth sentence. The eleventh sentence was taken into account in the weight given to Dr. Dao's statement. Although the twelfth sentence is correct the thirteenth and fourteenth sentences are not supported by the weight of the evidence. While it is true that the Petitioner's testimony with regard to when he completed his course work at the University of Saigon was not totally consistent, the weight of the evidence supports a conclusion that the Petitioner finished his course work in June of 1974. The Petitioner's explanation concerning the inconsistency in his testimony was credible. The first and second sentences are true. The third sentence is true but overlooks the fact that it corroborates non-hearsay evidence. The fourth sentence is law. The fifth sentence is true. The sixth and seventh sentences are true. The eight sentence is not supported by the weight of the evidence. The ninth and tenth sentences are true but they do not support the ultimate conclusion the Respondent suggests. It is possible that the Certificate in question could have been based upon other credible evidence. The first sentence is true. The second sentence is not supported by the weight of the evidence. The Petitioner testified that he completed his course work in 1974. The third sentence is true. The fourth and fifth sentences are not supported by the weight of the evidence. COPIES FURNISHED: Carolyn S. Raepple, Esquire Cheryl G. Stuart, Esquire Hopping, Boyd, Green & Sams 420 First Florida Bank Building Post Office Box 6526 Tallahassee, Florida 32314 M. Catherine Lannon, Esquire Assistant Attorney General Administrative Law Section Department of Legal Affairs Room 1601, The Capitol Tallahassee, Florida 32399-1050 Ms. Dorothy Faircloth Executive Director Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Tom Gallagher, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 William O'Neil Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact By application dated July 20, 1995, Petitioner applied to Respondent for a Clinical Laboratory Supervisor's license. Petitioner has not earned a doctoral degree in clinical laboratory science, one of the specialty areas, or one of the chemical or biological sciences. Petitioner does not have a masters degree in clinical laboratory science, one of the specialty areas, or one of the chemical or biological sciences. Petitioner does not have a baccalaureate degree in medical technology, one of the specialty areas, or one of the chemical or biological sciences. Petitioner does have a baccalaureate degree in business administration and has taken college level courses in biology, human anatomy and chemistry. Petitioner has demonstrated that she has five years of pertinent experience following receipt of the degree. Accompanying her application for licensure, Petitioner presented documentation that she completed an advanced clinical practicum as a Specialist in Blood Bank Technology in 1995 and has been certified by the national Board of Registry in Chicago, Illinois. Petitioner did submit an evaluation of her college transcript by a qualified staff member of the Board of Registry, Chicago, Illinois. Petitioner did not submit an evaluation of her college transcript by a Chairperson of a chemical or biological science department of a regionally accredited U. S. college or university. Petitioner did not file a motion for an extension of time in which to submit an evaluation of her college transcript prior to the expiration of the thirty day extension period.
Recommendation Based on the foregoing, it is hereby RECOMMENDED that a Final Order be entered denying Petitioner's application for licensure as a Clinical Laboratory Supervisor. DONE AND ENTERED this 27th day of August, 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 27th day of August, 1996. APPENDIX TO RECOMMENDED ORDER, CASE NO. 96-2187 Petitioner's proposed findings of fact. Petitioner did not submit proposed findings. Respondent's proposed findings of fact. Accepted in substance: paragraphs 1,4,5,6,7,8,9,10. Rejected as subsumed or irrelevant and immaterial: Paragraphs 2 (see Preliminary Statement) and 3 (see preliminary statement). COPIES FURNISHED: Lealand L. McCharen Assistant Attorney General Office of the Attorney General The Capitol, PL-01 Tallahassee, Florida 32399-1050 Diane Orcutt, Executive Director Board of Clinical Laboratory Personnel Agency for Health Care Administration Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-0792 Jerome W. Hoffman, General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Douglas M. Cook, Director Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Mary Donna Lee, pro se 2544 Robert Trent Jones Drive Apartment Number 816 Orlando, Florida 32835
Findings Of Fact In February, 1984 Petitioner applied to Respondent for licensure by examination under Section 458.311(2), F.S., but after review of said application at a meeting held on June 10, 1984, Respondent issued an Order dated July 21, 1984 denying said application. Petitioner received a degree which is designated Doctor of Medicine on May 2, 1983 from the Universidad Techologica de Santiago, (UTESA), Santo Domingo, Dominican Republic. He has been in residency at Orlando Regional Medical Center since June 28, 1983. Various required clerkships were performed by Petitioner between August 2, 1982 and February 28, 1983 in hematology, obstetrics and gynecology, pediatrics, dermatology and ENT/0phth., and were performed completely, or partially at osteopathic hospitals, or under the supervision of osteopathic physicians. An additional one month elective clerkship was also performed in April 1983 at Southeastern College of Osteopathy. Petitioner passed the exam given by the Educational Commission for Foreign Medical Graduates (ECFMG) on March 15, 1983, but has not been certified due to the need for additional institutional verification. Respondent informed Petitioner of the decision of ECFMG to withhold verification of certification and also informed Petitioner of its duty to approve or deny an application for licensure within ninety (90) days, unless waived by the applicant. Petitioner declined to consent to a waiver and requested Respondent to act on his application without verification of an ECFMG certificate.
Findings Of Fact STIPULATED FACTS The facts set forth below in paragraphs 1.-20. are stipulated to by the parties. The initial notarized application of Petitioner, Henry Calas, for licensure by endorsement was filed on September 29, 1993, and is known as the "September 29 Application." A second notarized application submitted by Dr. Calas on or about January 27, 1994, is known as the "January 27 Application." A third notarized applcation was submitted by Dr. Calas on or April 25, 1994, and is identified as the "April 25 Application." This third application was filed at the direction of the Credentials Committee during its March 25, 1994 meeting. On March 25, 1994, Petitioner appeared before the Credentials Committee of the Board of Medicine. At the time, the Credentials Committee had two applications before it, the September 29 Application and the January 27 Application. On May 13, 1994, Dr. Calas appeared before the Credentials Committee of the Board of Medicine. At that time, the Credentials Committee had before it all materials dated prior to that time that are presently contained in the parties' joint exhibit 1. This exhibit consists of all materials in Petitioner's application file. By order filed August 10, 1994, the Board of Medicine approved Dr. Calas' application for licensure: . . .contingent upon applicant being on probation for 2 years, 6 months of said probation shall be under indirect supervision by a licensed physician who shall review 50 percent of patient records including billing. The Board hereby states as the basis for this decision that you misrepresented your qualifi- cations on your application for licensure. See Section 458.331(1)(gg). Petitioner timely filed his Petition for Formal Hearing disputing the Board's finding that he had misrepresented his qualifications on his application and requested that he be granted an unrestricted Florida medical license. Dr. Calas obtained his Doctor of Medicine degree from Universidad Central Del Este in the Dominican Republic on February 3, 1984. Dr. Calas participated in a residency in Internal Medicine at Northwestern Ohio College of Medicine from May 15, 1989, until December 30, 1990. Throughout that time, the program director was Dr. Andre J. Ognibene, Professor of Medicine and Chairman of the Department of Medicine. Dr. Callas successfully completed a three year residency in Neurology at Albany Medical College, Albany Medical Center Hospital, Albany, New York from January 1, 1991 to December 31, 1993. During his third year, Petitioner served as Chief Resident. Dr. Calas meets all statutory educational and training qualifications required of him for licensure as a physician in Florida. THE ELLIS HOSPITAL ISSUE In his September 29, 1993 application on page 3, Dr. Calas represented that he currently had privileges at Ellis Hospital stating "Ellis Hospital 1101 Nott St. Schenectady NY 12308 I just obtained privieleges (sic), and I have not begun to work there yet." Dr. Michael SS. Jakubowski, Vice President, Medical Affairs, Ellis Hospital, wrote the Florida Board of Medicine regarding Petitioner on April 6, 1994. THE NORTHEASTERN OHIO COLLEGE OF MEDICINE ISSUE On October 18, 1990, Dr. Calas and Dr. Ognibene met regarding the Petitioner's record and performance in his Internal Medicine Residency. That meeting was memorialized by Dr. Ognibene in a document entitled, "Counseling Session/Longitudinal Evaluation" and signed by Dr. Ognibene and placed in Petitioner's file at Northeastern College of Medicine. On October 18, 1993, Dr. Andre J. Ognibene wrote the Florida Board of Medicine to return a training and evaulation form of the Board regarding Petitioner. On October 28, 1993, the Medical Board staff wrote Dr. Ognibene inquiring, in part, "Accordingly, please clarify why [Calas] left prior to completion, or if he was given credit for a complete year, on what basis(es); indicate whether he left in good standing and specify if he was (or would have been) offered a contract to continue to complete the program." On November 4, 1993, Dr. Ognibene responded by letter to the Board staff's letter of October 28, 1993. On February 11, 1994, the Medical Board staff wrote Dr. Ognibene, acknowledged receipt of his November 4, 1993 letter and inquired as follows: Please specify if he was (or would have been) offered a contract to continue to complete your program? On February 14, 1994, Dr. Ognibene responded by letter to Board staff's letter of February 11, 1994. At the request of Dr. Calas, Dr. Ognibene wrote a letter to the Board of Medicine dated April 25, 1994, which was received by the Board in time for the Credentials Committee meeting of May 13, 1994. OTHER FACTS By letter dated January 12, 1994, Petitioner represented to the Board of Medicine that he "completed PGY-1 [Post Graduate Year 1] in good standing" and "chose not to remain in medicine despite the offer of a PGY-2 contract" in the residency program at Northeastern Ohio College of Medicine's internal medicine program. By letter dated January 15, 1994, to an administrative assistant to the Board, Petitioner stated he "declined" the contract for a second year. In actuality, Petitioner had completed PGY-1 in good standing, but was counseled by Dr. Andre J. Ognibene, the program director, to seek another specialty. Petitioner was perceived as deficient in organizational skills necessary to meet the complexities of internal medicine. Petitioner elected neurology. Ognibene concurred with Petitioner's choice "because he could then focus on one organ system and not 17 organ systems which were rather difficult for him [Petitioner] to assimilate." If Petitioner were unable to secure a PGY- 2 position in neurology, Ognibene agreed that Petitioner would be permitted to stay for another year in internal medicine, although there was no expectation by Ognibene that Petitioner could complete the internal medicine residency. Petitioner, in effect, was promised a safety net in the event he did not secure a neurology position, but he was not "offered" a position for the subsequent year in internal medicine which he could have immediately accepted or declined. Petitioner's statement on the September 29 application that he currently had privileges at Ellis Hospital was also artfully inaccurate. Petitioner possessed no documentary evidence confirming any grant of privileges from the hospital to himself at the time he completed the application. Instead, if his testimony is credited, he relied upon the representation of a clerical worker at the hospital made to him in the course of a telephone conversation which he instigated wherein he was allegedly told that "all approvals had been received and he was ready to begin." This recital by Petitioner of a statement made to him on the telephone by an individual known only as "Nancy" is not corroborated by other direct evidence and is further complicated by Petitioner's almost hypertonic demeanor and behavior while testifying; consequently, Petitioner's testimony on this point is not credited. Although his application was pending, privileges are granted only when a staff vacancy ocurrs and employment begins. Petitioner knew at the time that he stated he had privileges at Ellis Hospital that a neurology position on the staff was not yet available and added the words "I have not begun to work there yet." As stated by Petitioner at the final hearing, he would have better served his own interest by not representing that he possessed privileges since the purpose of disclosure of such information is to enable the Board of Medicine to review an applicant's performance. Petitioner's action in stating that he possessed privileges at Ellis Hospital constituted misrepresentation by him, notwithstanding the addition by him on the application of the words "I have not begun to work there yet".
Recommendation Based on the foregoing, it is hereby RECOMMENDED that a Final Order be entered denying Petitioner's application, absent the legal determination of the Board of Medicine to permit the conditioned admission of Petitioner to the practice of medicine in the State of Florida. DONE AND ENTERED this 6th day of December, 1994, in Tallahassee, Leon County, Florida. DON W. DAVIS 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 6th day of December, 1994. APPENDIX The following constitutes my specific rulings, in accordance with Section 120.59, Florida Statutes, on findings of fact submitted by the parties. Petitioner's Proposed Findings. Adopted. Adopted as to first sentence, remainder rejected as redundant. 3.-12. Adopted. 13.-35. Rejected, subordinate to HO findings. Respondent's Proposed Findings. 1.-10. Adopted, but not verbatim and frankly in much more condensed form than that proposed by Respondent's counsel. COPIES FURNISHED: Wilson Jerry Foster Attorney at Law 227 E. Virginia St. Tallahassee, FL 32301 Gregory A. Chaires Assistant Attorney General Department of Legal Affairs PL-01, The Capitol Tallahassee, Florida 32399-1050 Harold D. Lewis General Counsel Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303 Dr. Marm Harris Executive Director Board of Medicine Agency for Health Care Administration The Northwood Centre 1940 N. Monroe St. Tallahassee, Florida 32399-0750
Findings Of Fact On August 7, 1984, the Petitioner, Abraham W. Chames, executed an application for examination for licensure as a medical doctor which was filed with the Florida Department of Professional Regulation on behalf of the Board of Medical Examiners, (now Board of Medicine), on August 9, 1984. Among other information required on the application was a section requesting information regarding the applicant's medical education. That question reads as follows: Be specific. Account for each year. List all universities or colleges where you attended classes and received training as a medical student. In response and on each of four lines which required the name of the medical school and location and the dates of attendance, the applicant listed the names of the appropriate universities. These were: Universidad Del Noreste/Tampico, Mexico, from August, 1978 to June 1979. Universidad Del Noreste/Tampico, Mexico, from August 1978 to June, 1979 [sic] CETEC University/Santo Domingo, Dominican Republic, from June, 1980 to June, 1981. CETEC University/ Santo Domingo, Dominican Republic, from June, 1981 to December 1981. The question immediately preceding the one just described requires the applicant to list all places of residence since initiation of medical training. In response, the applicant listed, Tampico, Tamps, Mexico, from August, 1978 to June, 1980 and on the second line, Miami Beach, Florida from June, 1980 to June, 1982. For the question that requires the applicant to account for all time from date of graduation to present, the Petitioner stated: "Started my residency in family medicine at the University of Miami: June 83 until present." Dr. Chames also indicated on his application that his Doctor of Medicine degree was obtained from CETEC University, Santo Domingo, Dominican Republic from which he graduated on December 12, 1981. As a part of the narrative reports submitted with his application and relating to the period of time spent at CETEC University from June, 1980 through December, 1981, Dr. Chames stated: "During this time, I performed all of my required and elective clinical rotations under the auspices of CETEC University and its New York City based office of C.J. Institute. I lived at 1247 West Avenue, Apt No. 1, Miami Beach, Florida." By so doing, he explained the apparent ambiguity between his place of residence and his medical education during the period, June, 1980 through December, 1981. The rotations taken and the dates thereof were thereafter listed immediately below the above-cited statement. It should be noted that all the rotations were completed at hospitals in the Miami, Florida area. It is not at all unusual for situations like this to happen and it is not improper. Along with the application submitted by Dr. Chames was a certification that he had successfully passed the examination of the Educational Commission for Foreign Medical Graduates, (ECFMG), which he took on July 21, 1982. On August 20, 1984, Dr. Chames was notified by the Board that it had been advised by the ECFMG that as of March, 1984, that body was withholding verification of its certificates for individuals with medical credentials issued in the name of CETEC University because of alleged irregularities with regard to these medical credentials. The Board requested that Dr. Chames waive the 90 days that it had for approval or denial of his application for licensure, which he did. ECFMG subsequently verified Dr. Chames' certification and this information was sent directly to the Board. On September 18, 1984, the Board advised Dr. Chames that he would be required to appear personally before the Foreign medical Graduate Committee, (FMGC), of the Board when notified. Two days later, on September 20, 1984, the Board advised him that his application was considered incomplete because he had failed to submit a copy of his medical school diploma, (notarized and certified as a true and correct copy) and a certified translation thereof. He was further advised that he had failed to submit an accounting for all of the time between December, 1981 and May, 1983, and a FLEX application with Part A completed. On August 23, 1985, Dr. Chames submitted a notarized affidavit in which he attempts to account for all time from December, 1981 through May, 1983 as requested. On August 15, 1985, Ms. Dorothy Faircloth, Executive Director of the Board, notified Petitioner that his application was still considered incomplete because of the failure to submit certain documentation including his diploma and translation thereof, an examination fee, a standard ECFMG certificate, photographs, letters of recommendation, an accounting for all of the time since graduation, and a FLEX application. By letter dated August 23, 1985, Dr. Chames' counsel, Deborah J. Miller, forwarded a notarized copy of the medical school diploma certified by the U.S. Vice-Consul, a notarized copy of the original translation thereof, a notarized copy of the ECFMG clearance, a notarized copy of the original standard ECFMG certificate, an accounting of Dr. Chames' time since graduation, and a comment that the addition application fee requested had been forwarded previously. The two photographs requested were forwarded by counsel on September 3, 1985. In her September 3, 1985 letter, Ms. Miller indicated she understood the ECFMG would contact the Board directly in the event that written verification had not been received by the time Dr. Chames was to appear before the FMGC. On September 27, 1955, the Board, by letter, advised Dr. Chames, (the salutation refers to Dr. Eaton) that he was required to appear personally before the FMGC at Sarasota on October 4, 1985. Dr. Chames appeared as required and was examined verbally by committee members, primarily Dr. Robert Katims, Chairman, on his credentials as a graduate of CETEC. His answers apparently raised some further questions and an extract of the minutes of that committee meeting reflects that Dr. Chames, a candidate for licensure by examination and a graduate of CETEC University, received a... unanimous vote to recommend unfavorably for examination based upon a total lack of credibility, deliberately failed to tell the truth in the application process. It cannot be determined in whose handwriting this notation was made. Dr. Katims, who was Chairman of the FMGC since its founding until just prior to the hearing, examined Dr. Chames from the file maintained by the Committee on foreign medical graduates. The Petitioner's testimony was not of a nature to inspire confidence in his credibility. He was hesitant in his answers and those which he gave were, if not evasive, at least not definitive. While acknowledging he made several mis-statements of fact on his application, Petitioner contended these were made through honest error rather than through design. He was obviously not believed by any committee member. No doubt this antipathy toward the applicant, manifested by the blatant hostility and outrage evidenced by Dr. Katims during his questioning and his threats to carry the matter further, even to the pressing of criminal charges if available, indicates that no matter what Dr. Chames would have said, the likelihood of his being voted upon favorably was remote. The file examined by Dr. Katims and the committee consisted of the application, letters of reference, test scores and other matters relevant to the candidate's suitability for licensure. This file documentation is knows as the Agenda Book. The Agenda Book maintained on Dr. Chames was reviewed by Dr. Katims prior to Petitioner's appearance. In his evaluation of this file, Dr. Katims looked primarily at Petitioner's application to take the ECFMG exam and his attention was drawn to the sites of medical education listed thereon. The file contained several different applications which, when reviewed, reflected that on two, Dr. Chames listed his medical schools as Del Noreste and Dominica and on a third he listed CETEC and Del Noreste. Dr. Katims also noted a different listing for undergraduate education. He did not look so much at the dates listed, though dates are important. At that time, his policy as Chairman and that of the committee, was to look closely at CETEC graduates because of that institution's reputation for fraud in the issuance of diplomas. It was his understanding that several people associated with CETEC, including some applicants, had been jailed in the United States and as a result, CETEC graduates got a lot of scrutiny. In fact, Dr. Katims threatened to "...pursue this beyond the actions of this Board, if it seems appropriate, along the lines indicated by Board Counsel...." The Board's counsel had just previously noted a change in the Florida law to make it a criminal offense to obtain or attempt to obtain a license by knowing misrepresentation. Dr. Katims categorically denies that he felt all CETEC students were trained by this "stink of corruption". In fact, he recalls many CETEC graduates have been voted upon favorably after they had been afforded an opportunity to prove their credentials and discuss their applications before the committee. As a result, Dr. Katims felt he did not prejudge the Petitioner. Dr. Katims has interviewed many applicants during his term in office and this includes many CETEC graduates. Consequently, he looked closely at Dr. Chames' application but it was the discrepancy in the applications and the applicant's failure to clarify it satisfactorily that was the problem here, not the fact that he was a CETEC graduate. Dr. Chames was called before the FMGC because it was felt necessary to have him amplify his file and give greater information on his actual scholastic residence. This was because several applicants had told Dr. Katims their only visit to the CETEC campus was to get their diploma. This is exactly what Dr. Chames stated in his interview. Though enrolled at both (Dominica) Ross and CETEC at the same time, he says he did not attend any classes at either campus, did not ever visit the (Dominica) Ross campus, and in fact visited the CETEC campus only once, in December, 1981, to get his diploma. In short, it appears that neither school required regular on-site educational activities. In substance, the Board considered that Dr. Chames' attendance at CETEC raised a question that required a more detailed examination. However, Dr. Katims, on behalf of the committee, clearly contends that CETEC graduates were held to no more strict standards of qualifications than other graduates of foreign medical schools. With regard to this Petitioner, the Board only looked at the educational discrepancies. Nothing else was looked into by the committee before it's report the next day to the full Board. Dr. Katims felt that Petitioner's story was "incredible." He could not accept Petitioner's story that he simultaneously applied to and attended both CETEC and Dominica (Ross) and concluded that Dr. Chames deliberately falsified his application. The discrepancies regarding the schools attended were not consistent with his explanation, and to this date, Dr. Katims feels the same way. He concludes that Petitioner lied in his applications and may have conspired with unknown others to do so but he has no proof of a conspiracy. The important issue to Dr. Katims was initially the caliber of education available at both (Dominica) Ross and CETEC. It was only when Petitioner testified and his testimony was felt to be "incredible" that the issue became his credibility. Dr. Chames graduated from Miami-Dade Community College with an AA degree; then from Yeshive University in New York with a BA degree and thereafter from Florida International University with a BS degree. He then entered Universidad Del Noreste medical school in Tampico, Mexico where he actually attended classes for two years. At his hearing before the FMGC, he stated that during his fourth semester there, he decided to transfer and looked into two medical schools both located in the Caribbean. They were the University of Dominica (Ross) and CETEC. He contends that he applied to both, took some entrance exams for Dominica which he passed and paid some initial fees to that school. He states, however, that it was CETEC that he stayed with and from which he got his degree. According to Dr. Chames, this was a tumultuous time for foreign medical schools. Many students of these institutions wanted to come back to do their obligatory rotations in the United States. As a result, he enrolled in both schools, though he felt affiliated with Dominica (Ross) and paid it only. CETEC indicated he could pay later. In the fall of 1981, he switched to CETEC because a number of states were determining that students of proprietary foreign medical schools could not do U.S. residencies. CETEC was considered to be a higher quality school and had a greater legitimacy in the Dominican Republic. It was a viable school in disciplines other than medicine and was not categorized as an "offshore" medical school. Dr. Chames was expelled from Dominica (Ross) on July 12, 1982, because he failed to pay for the fourth year of medical school. He had, by this time, transferred his credits to CETEC and had graduated from there in December, 1981. Neither school had a requirement for on-campus participation. Students paid their money and turned in the paperwork, and the rotations--the learning periods spent in active hospitals--which constitute the greatest part of the last two years of medical school, were done in the United States. In reality, Dr. Chames arranged his clerkships and rotations by himself. When asked by the various hospitals to which he applied where he was in school, he would say either Del Noreste, Dominica (Ross), or CETEC depending on the time in question. He claims he considered himself to be a student at both Dominica (Ross) and CETEC at the same time. He gave his clerkship evaluations, however, only to Dominica (Ross) until the end of the fourth year of training, when he also gave one to CETEC. He first started paying fees to CETEC and provided a clerkship evaluation there in the fall of 1981, even though he says he considered himself a student there from the beginning. He intended to graduate in December, 1981. This date was established in the fall of 1981 when he started sending CETEC the evaluations of clerkships he had completed almost two years previously which had already been sent to Dominica (Ross). Dominica (Ross) required the taking of a basic second examination upon starting and a final examination prior to graduation unless one took and passed the ECFMG examination. Petitioner admittedly failed the final at Dominica (Ross). CETEC required no examinations. He took and passed the ECFMG exam long after he graduated from CETEC. Petitioner applied to CJ Institute, CETEC's U.S. affiliate, in November, 1981. He contends that he had applied to CETEC previous to that time, but paid no money to CETEC until approximately two weeks prior to graduation, and he got credit from CETEC for rotations/clerkships performed while enrolled at Dominica (Ross). In reality, what appears to be the fact, and it is so found, is that Dr. Chames was enrolled for by far the greatest majority of the last two years of his medical training at Dominica (Ross). Having failed the final examination and being concerned over the ECFMG examination, he looked around and found another medical school that would grant him a diploma based on work done at his former institution, Dominica (Ross). This he found in CETEC which had no requirements and was willing to give him full credit for all work performed at or under the auspices of Dominica (Ross). It would graduate him, awarding him a medical degree upon payment of the required fees, even though no work was done either in the classroom or in rotations while enrolled at that university. When the applicant subsequently filled out the forms for admission to licensure in Florida, he unfortunately listed only CETEC and not Dominica (Ross) as his medical school, even though the application form instructed him to list all schools and omit nothing. He admits that since he did his rotations, and since CETEC granted him credit for them even though he did them while enrolled at another school, he didn't feel it necessary to list Dominica (Ross) as one of his schools. Notwithstanding the apparent lapse as defined above, Respondent's reputation for honesty is generally good. His wife for almost nine years, who has known him since he was fifteen, considers him a most honorable man who makes no distinction between his personal and business ethics which are high in both categories. Though she is an attorney and notarized at least one of the applications he filled out, she did not discuss them with him. She has no reason to believe that they were not accurate and knows no reason that Petitioner would falsify them as she knows he dearly wants to be a doctor. When he filled out his applications, he did them based on his recollection and not on files or documents. She knows he has a terrible memory for dates and numbers and this may have contributed to his mistake. Mrs. Chames' testimony is not credited highly as to her failure to discuss the applications with her husband, however. Dr. Lynn Carmichael, Chairman of the Department of Family Medicine at the University of Miami Medical School, supervised the Petitioner in the Family Practice service at Jackson Memorial Hospital when Petitioner was a resident there. Petitioner's employment file contains all materials received regarding him including evaluations, letters, applications, etc., and a review of this file reveals that all evaluations rendered on Petitioner over the three years of his residency were above average. At the time Petitioner applied for the residency program in October, 1982, he listed his medical school as CETEC University. While he was in the residency program, Petitioner consistently performed in an outstanding manner in all six criteria considered and his reputation for truth and veracity, a highly important factor in evaluation, is good. Dr. Carmichael became aware of the denial of Petitioner's application for licensure after the fact and is aware now of the reasons therefor. Based on his knowledge of the Petitioner, he does not feel that Dr. Chames is a perjurer, or a liar, or would deliberately falsify an application. He was very surprised at the result of the committee hearing because the facts discussed there did not fit in with his evaluation of Petitioner. In fact, his peers at the University Hospital thought so highly of Dr. Chames, that if he had been licensed, the hospital was going to ask him to stay on for a fellowship, for which a license is required. Dr. Carmichael does not consider the listing of the medical school on the application for as a particularly important factor in evaluating foreign medical graduates for the simple reason that these graduates are required to show ECFMG certification which, in fact, the Petitioner was able to do. Ms. Deborah Miller, an attorney specializing in administrative and governmental law, represented Petitioner in his efforts to apply for licensure in Florida. He was concerned that foreign medical graduates were being unduly scrutinized and discriminated against in the licensing process. In this case, the Board of Medicine had asked Petitioner to waive the 90 days they had to rule one way or another on his application and she looked into this for him. In doing so, she procured the Petitioner's application file and went over it item by item with a representative of the Board. It was after this that Dr. Chames was notified of his requirement to appear before the FMGC, as were most foreign medical graduates and all CETEC graduates. Ms. Miller wrote to the Board just before the meeting to see if there was anything else in Petitioner's file than that of what she had been notified and was told that there was not. However, an AMA profile on Petitioner was in the file which listed both CETEC and Dominica (Ross) medical schools and this document may not have come to her. In the past, it has been Ms. Miller's experience that the Board does not always give a "full" file upon request, at times holding matters back. Based on what she knew, Ms. Miller had no reason to believe Dr. Chames had concealed anything regarding his application. Had Petitioner told her that he had applied to both CETEC and Dominica (Ross), she would have advised him to amend his application to correctly reflect the situation which could have been done at that time. On cross examination, Ms. Miller indicated that Petitioner told her that he applied to CETEC and Dominica (Ross) because he had heard of CETEC and was impressed by its good reputation. When he was accepted at CETEC, he dropped all further dealings with Dominica (Ross). He felt the board was concerned more with the courses and rotations not with which school was listed on the application form. This third story regarding Dr. Chames' reasons for switching from Dominica (Ross) to CETEC, clearly establishes that his application forms were consciously filled out; that he knew what he was doing; that his omission was more-than mere oversight; and that he was not particularly concerned with the accuracy of his application and the requirements for forthrightness contained on the face of it. On all of the reports of rotations and clerkships submitted to Dominica (Ross) during the time he was enrolled there and performing them, Dr. Chames was always highly rated and no adverse comments about his ability, his sensitivity, his patient relationships or his integrity was ever raised. There is no doubt that Dr. Chames possesses the clinical and technical skills necessary to be an excellent physician. He also apparently possesses the sensitivity to patients which separates a healer from a technician. In substance, then, it is found that Dr. Chames was enrolled for the last two years of his medical education at Dominica (Ross) and completed the course work/rotation/clerkships satisfactorily. Unfortunately for him, Dominica (Ross) required the passing of an examination prior to the award of the medical diploma, which Dr. Chames failed once and chose not to taken again. He found another school, CETEC, that would award him his medical degree upon payment of the required fees on the basis of the work done while a student at Dominica and without any work being done under the auspices or supervision of CETEC at all. Thereafter, when he applied for licensure in Florida, notwithstanding the fact that the application form clearly required a listing of all medical schools attended, Dr. Chames neglected to list his enrollment at Dominica (Ross), choosing instead, to list only his graduation from CETEC. It is this failure to list Dominica, coupled with the apparently false listing of the true term of the CETEC enrollment which constitutes the discrepancy of such grave concern to the Board and, the ultimate basis for its denial of Petitioner's application. Notwithstanding the apparent hostility of the Chairman of the FMGC and his predisposition to vote unfavorably on this Petitioner's application, it would appear that the unfavorable vote was justified and appropriate.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law it is, therefore, RECOMMENDED that Petitioner's current application for examination as a physician in Florida be denied. RECOMMENDED this 14th day of April, 1987, in Tallahassee, Florida. ARNOLD H. POLLOCK 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 14th day of April, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-1438 The following constitutes my specific rulings pursuant to Section 120.57(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. By Petitioner Petitioner failed to number his proposed Findings of Fact. To facilitate identifying them for ruling, I have numbered them consecutively as they appear in the Proposed Recommended Order. Accepted. Accepted. Accepted. Accepted except for the reason for changing schools which is contrary to the better evidence. Accepted. Accepted. Accepted. Accepted. Accepted as to date of filing and schools listed. Rejected as to his reason for failing to list Dominica, Petitioner's different stories as to the point make it impossible to determine why he failed to list Dominica. Accepted. Accepted. Accepted. Accepted except for words "sting of corruption" which should be "stink of corruption." Accepted. Accepted. Accepted. Accepted. Sentence 1 rejected as comment and not a Finding of Fact. Sentence 2 accepted. Sentence 3 & 4 rejected as speculation. Sentence 5 accepted. Sentence 6 rejected as argument. Sentence 7 accepted. Sentence 8 rejected as argument or contrary to the weight of the evidence. Rejected as contrary to the weight of the evidence. Rejected as irrelevant except for the last sentence which is argument, not Finding of Fact. Sentences 1-3 rejected as argument. Sentence 4 et seq. accepted. By Respondent Accepted. Accepted. Accepted. Accepted. First sentence accepted, Second sentence rejected as irrelevant. Accepted. Accepted. Accepted. Sentences 1 & 2 accepted. Sentences 1 & 2 rejected as recitations of the evidence. Sentence 3 rejected as contrary to the better evidence. Sentence 4 et seq. are recitations of the evidence and not Finding of Fact. Rejected as a recitation of the evidence. Accepted. No numbered paragraph. Accepted. COPIES FURNISHED: Dorothy Faircloth, Executive Director Florida Board of Medicine 130 North Monroe Street Tallahassee, Florida 32301 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Harold M. Braxtone Esquire Suite 406, Datran Center 9100 South Dadeland Blvd. Miami, Florida 33156 Catherine Lannon, Esquire Department of Legal Affairs Room 1601, The Capitol Tallahassee, Florida 32399-1050 =================================================================
Findings Of Fact Petitioner is licensed by the State of Florida as a laboratory technologist. Petitioner applied to the Respondent for licensure as a supervisor. On February 2, 1982, Respondent denied Petitioner's application to take the supervisory examination for the stated reason that Petitioner did not have ten years of experience. Petitioner holds a Bachelor's degree in Fine Arts from Florida International University. Petitioner has supplemented his education by taking additional science courses. The science courses taken before and after Petitioner received his Bachelor's degree total 26 semester credits. The courses taken after receipt of his degree have been specifically related to his field. Petitioner has been employed by the Miami Heart Institute since July 11, 1976, except for the period between September, 1976, and August, 1977. Dr. Jerome Benson is a pathologist and is the Director of Laboratories at the Miami Heart Institute. He is also Vice Chairman of the National Accreditation for Clinical Laboratory Sciences, the organization which accredits approximately 1,000 programs in the medical technology field and which is responsible for the Committee on Higher Education and Accreditation of the United States Office of Education, which accredits laboratories. He is familiar with accreditation of medical technology programs throughout the country and locally. He serves on the Advisory Committee at Miami-Dade Community College, and he planned the curriculum for the medical technology programs at both Miami- Dade Community College and at Florida International University. He was recognized as an expert by both parties. Dr. Benson believes that Petitioner is qualified to sit for the supervisory examination in terms of education, in terms of experience time, in terms of intent of the law, and in terms of protecting the public safety. He further believes that the science courses Petitioner has taken, both pre-baccalaureate and post-baccalaureate, qualify Petitioner for a Bachelor's degree in medical technology. Norman Bass was formerly Petitioner's immediate supervisor. He evaluates Petitioner's performance in the laboratory as excellent and believes that Petitioner is qualified through experience and academic courses to sit for the supervisory examination. At the time of the formal hearing in this cause, Petitioner had a total of 12,935 hours of work time at the Miami Heart Institute. Respondent considers 37.5 hours as constituting a full work week. George S. Taylor, Jr., reviewed Petitioner's application on behalf of Respondent. The application was received on January 18, 1982, and was denied on February 2, 1982, for the reason that Petitioner did not have ten years' experience. At the time, Respondent did not have current transcripts reflecting courses taken by Petitioner. Respondent did not request any, but simply used transcripts on file with Respondent which had been filed when Petitioner applied for his technologist's license, even though Petitioner's application for licensure as a supervisor reflected that he had taken various science courses at Miami-Dade Community College. Taylor is of the opinion that an applicant with 120 college credits must have between 25 and 30 of those credits in science courses in order to have a major in science; an applicant with 90 semester hours in college is required to have 17 to 24 credits in science in order to have a science major.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered denying Petitioner's application to take the examination for a supervisor's license. DONE and RECOMMENDED this 14th day of January, 1983, in Tallahassee, Leon County, Florida. LINDA M. RIGOT, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 14th day of January, 1983. COPIES FURNISHED: Samuel S. Forman, Esquire The Counsel Building 2016 Harrison Street Hollywood, Florida 33020 Morton Laitner, Esquire Dade County Health Department 1350 North West 14th Street Miami, Florida 33125 David H. Pingree, Secretary Department of HRS 1323 Winewood Boulevard Tallahassee, Florida 32301
The Issue The issue in these two consolidated cases is whether disciplinary action should be taken against Luis J. Marti, M. D., hereinafter referred to as "Respondent Marti," and/or Jesus Escar, M.D., hereinafter referred to as "Respondent Escar," based upon the alleged violations of Chapter 458, Florida Statutes, contained in the separate Administrative Complaints filed against each of the Respondents.
Findings Of Fact Based on the stipulations of the parties; on the testimony of the witnesses, and on the exhibits received in evidence at the hearing; I make the following findings of fact. Respondent Escar is, and has been at all times material hereto, a licensed physician in the state of Florida, having been issued license number ME 0034247. Respondent Escar's last known address is 935 West 49th Street, Suite #107, Hialeah; Florida 33012. Respondent Marti is, and has been at all times material hereto, a licensed physician in the state of Florida, having been issued license number ME 0034842. Respondent Marti's last known address is 24355 West Flagler Street, Miami, Florida 33125. Respondent Marti went to medical school in Madrid, Spain. In approximately 1970, while Respondent Marti was in medical school in Madrid, Spain, Respondent Marti met Jose A. Tudela for the first time. At the time, Tudela had come to Madrid, Spain, for the purposes of starting medical school. In approximately 1975, while Respondent Marti was working as a resident at Cedars of Lebanon Hospital, Respondent Marti again saw Jose A. Tudela. At about the same time, Respondent Escar met Tudela for the first time. Tudela's father, Francisco Tudela, a physician, was an attending physician at Cedars of Lebanon Hospital. Respondents Marti and Escar saw Jose and Francisco Tudela in 1975 while on rounds at the hospital. In 1979, while Respondents Marti and Escar were working at Palm Springs General Hospital, Jose A. Tudela came to the hospital to apply for a position as a house physician and saw Respondents Escar and Marti. When Tudela applied for the position of house physician at Palm Springs General Hospital, Respondents Marti and Escar were both residents at the hospital. On the day that Jose A. Tudela came to apply for the position of house physician at Palm Springs General Hospital, Tudela came to the doctors' lounge at the hospital where he spoke with Respondents Escar and Marti. Tudela had with him a diploma which appeared to Respondents Escar and Marti to be authentic and which appeared to have been issued by the Universidad Central del Este. The diploma had on the back what appeared to be official stamps and seals and the signature of the Vice Consul of the United States. Additionally, a translation of the diploma was attached to the diploma. On the date that Tudela came to apply for the position of house physician at Palm Springs General Hospital, Tudela also showed Respondents Escar and Marti what appeared to be a transcript of his grades from the Universidad Central del Este and a letter purportedly from one Victoria Marcial de Gomez. The transcript and letter appeared to Respondents Escar and Marti to be original and authentic. The letter from Gomez, who purportedly was the medical director for the health center of Trujillo Alto Health Department, in the associated Free State of Puerto Rico, appeared to verify the fact that Dr. Jose A. Tudela had worked in the Health Center of Trujillo Alto for seven months. When Respondent Marti reviewed Tudela's documents, he knew it was important that foreign papers be certified because he had had the experience of having to leave Cuba and re-establish himself. Respondent Marti's own diplomas from Spain bear attestations of notarization of a foreign government. Respondent Escar believed that Tudela's documents were originals because of his experience in having seen similar original documents of other residents in the past. On or about August 1, 1979, Jose A. Tudela completed an application for employment as a house physician at Palm Springs General Hospital. The application contained basic personal information about Tudela and listed some of Tudela's education and work experience. According to the application, Tudela went to Belle Glade High School, in Belle Glade; Florida; Warwick High School, in Newport News, Virginia, where he graduated in 1965; and the University of Miami; in Coral Gables, Florida where he graduated in 1970. According to the application, Tudela worked in an unspecified capacity in the Centro de Salud, in Trujillo Alto, Puerto Rico, from 1978 to 1979. The application form does not contain any information about Tudela's medical education. Specifically, it does not contain any mention of University of Santo Domingo, Universidad Central del Este, or U.C.E. On or about August 8, 1979, Jose A. Tudela was employed by Palm Springs General Hospital as a house physician. Jose A. Tudela remained at Palm Springs General Hospital as a house physician until October 29, 1979. Tudela left Palm Springs General Hospital on that date to become a surgical assistant at Miami Children's Hospital. While employed a Miami Children's Hospital, Tudela received the highest score on every item on his employee evaluation form. That hospital never knew of any problem with Tudela's performance or credentials until this case occurred. Between approximately 1979 and 1983, Respondents Escar and Marti practiced medicine together as partners. In 1980, Jose A. Tudela approached Respondent Marti and asked Respondent Marti to sign an affidavit on behalf of Tudela. Therefore, on or about March 13, 1980, Respondent Marti signed a Form B-1 which was addressed to Rafael A. Penalver, M.D., Director, Office of International Medical Education, University of Miami School of Medicine; Miami; Florida. The form B-1 contained the following sworn statement: This is to certify that Jose A. Tudela born in Cuba and a graduate from the University Santo Domingo on 1978 was legally engaged in the practice of medicine from ---- to in Puerto Rico. I have known the applicant since 1975 and was acquainted with him/her during the time he practiced medicine. I was algo (sic) engaged in the practice of medicine in Miami U.S.A. during the years of 1975 and up. At some time after Respondent Marti signed the Form B-1, the abbreviation "(U.C.E.)" was added to the above-referenced sworn statement after the school name, "University Santo Domingo." Respondent Marti did not place the quoted abbreviation on the Form B-1. Prior to signing the subject Form B-1, Respondent Marti reviewed, for verification purposes, the employment application of Jose A. Tudela for Tudela's employment as a house physician at Palm Springs General Hospital. However, the employment application in question does not reflect any attendance by Tudela at any educational institution in the Dominican Republic or Santo Domingo. Furthermore, the employment application does not indicate the capacity in which Tudela worked in the Centro Salud in Trujillo Alto, Puerto Rico, and does not specifically indicate that Tudela practiced medicine in Puerto Rico. In 1980, Jose A. Tudela also approached Respondent Escar and asked Respondent Escar to sign an affidavit for him. Therefore, on or about March 13, 1980, Respondent Escar signed a Form B-1 which contained the following sworn statement: This is to certify that Jose A. Tudela born in Cuba and a graduate from the University of Santo Domingo on 1978 was legally engaged in the practice of medicine from ---- to in Puerto Rico. I have known the applicant since 1970 and was acquainted with him/her during the time he practiced medicine. I was algo (sic) engaged in the practice of medicine in Miami, Fla during the years of 1977 and up. The Form B-1 was addressed to Rafael A. Penalver, M.D., Director; Office of International Medical Education, University of Miami School of Medicine, Miami, Florida. At some time after Respondent Escar signed the Form B-1, the abbreviation "(U.C.E.)" was added to the above-referenced sworn statement after the school name, "University of Santo Domingo." Respondent Escar did not place the quoted abbreviation on the Form B-1. Respondent Escar relied upon Respondent Marti's verification of Tudela's background information in signing the Form B-1 described in the immediately preceding paragraph. Respondent Escar did not personally review Tudela's application for employment at Palm Springs General Hospital but discussed the information contained in the employment application with Respondent Marti. At the time Respondents Marti and Escar signed the Forms B-1, they did not know Tudela very well and did not know very much about his background. Although they both thought Tudela was probably a graduate of a medical school, they did not remember what school he had supposedly graduated from, as evidenced by the fact that they put the wrong school name on the Forms B- 1. Both Respondent Escar and Respondent Marti lacked personal knowledge of the information contained in the Forms B-1 which they signed for Jose A. Tudela. Neither of the Respondents saw or taught Tudela at medical school in the Dominican Republic. Furthermore, neither Respondent Escar nor Respondent Marti was in Puerto Rico at the time Jose A. Tudela allegedly practiced medicine at the Centro Salud in Trujillo Alto, Puerto Rico. Neither of the Respondents had any source of information about Tudela's alleged medical education in the Dominican Republic or his alleged practice of medicine in Puerto Rico other than statements Tudela may have made to them, statements Tudela wrote on the application form at Palm Springs General Hospital, and whatever information could be gleaned from a casual review of Tudela's forged credentials. Jose A. Tudela has never graduated from the Universidad Central del Este, which is located in the Dominican Republic, nor from any other medical school. Tudela enrolled in the Universidad Central del Este (U.C.E.) medical school in August, 1977. There is no evidence in the school records for U.C.E. that Tudela passed any of his courses. In May of 1978 Tudela was no longer at the university. Tudela was given a special concession at U.C.E. so that upon presentation of a pre-medical certificate which Tudela claimed to possess, Tudela could receive credit for the pre-medical program training. However, Tudela never presented the required proof of his pre-medical program. Tudela did not complete any of the twelve semesters at U.C.E. which make up the medical degree program including pre-medical training. Although Respondent Marti first met Tudela in 1970 and Respondent Escar met him in 1975, the Form B-1 signed by Respondent Marti states that he met Tudela in 1975, and the one signed by Respondent Escar states that he met Tudela in 1970. The reason for this error is that both of the forms were prepared by Respondent Marti and the forms were inadvertently switched at the time they were signed. The Forms B-1 signed by Respondents Marti and Escar were submitted to the Board of Medical Examiners by Jose A. Tudela as attachments to an Application for Continuing Medical Education Program, which was submitted as part of Tudela's application for licensure as a physician in Florida. Tudela applied for licensure in Florida under the provisions of a special law which provided that the Board of Medical Examiners would establish continuing education courses designed to qualify for licensure those individuals who were resident nationals of the Republic of Cuba and were residents of Florida on July 1, 1977. In order to qualify for the continuing education program set up by the Board of Medical Examiners for Cuban nationals, an applicant had to demonstrate that he was a graduate from a medical school with a medical degree and that he was a resident national of the Republic of Cuba and a resident of Florida on July 1, 1977. Upon approval of the applicant to participate in the continuing education program set up by the Board of Medical Examiners, the applicant would have to complete the continuing education program. Upon completion of the continuing education program, the applicant would be qualified to take the licensing examination. In or about March of 1980, Tudela submitted an Application for Examination, an Application for Florida State Board of Medical Examiners Continuing Education Program, and the necessary attachments, which included the Forms B-1 signed by Respondents Escar and Marti and copies of what purported to be his diploma and transcript of grades. After successfully completing the continuing medical education program and the licensure examination, Tudela became certified to practice medicine and surgery by the Board of Medical Examiners on August 23, 1982. At the time of Tudela's application for medical license, the staff of the Board of Medical Examiners conducted the initial review and made the initial determination as to whether an individual was qualified to take the continuing education course and to take the licensure examination for certification to practice medicine and surgery in Florida. In making such determinations, consideration is given to all of the information contained in an applicant's file, which includes such things as the applicant's degree or diploma, transcript of grades, and the Forms B-1. At the time Tudela applied for licensure, the staff of the Board of Medical Examiners did not verify the medical education of applicants and conducted no investigation into the school or the graduation of applicants for licensure. Prior to approving Tudela's application, neither the Board members nor the staff independently contacted the Universidad Central del Este to verify whether Tudela actually graduated from medical school. The Board members did not personally review Tudela's application. The staff reviewed the papers and presented the Board with a list of applicants who appeared to be eligible for the continuing education course and the licensure examination. The diploma and the transcript of grades which Tudela showed to the Respondents and filed with the Board of Medical Examiners are forgeries. They are very good forgeries and bear a remarkable resemblance to genuine diplomas and transcripts issued by the Universidad Central del Este. The false documents provided by Tudela to the Board as part of his application, along with the Forms B-1 signed by Respondents Marti and Escar, deceived the staff into recommending Tudela for the continuing education course, the licensure exam, and ultimately for certification to practice medicine. Tudela's application to the Board also contains several letters of recommendation from other physicians who were convinced of Tudela's competence. The Educational Commission for Foreign Medical Graduates granted Tudela a certificate despite his forged documents. In November 1984, an Administrative Complaint was filed against Jose A. Tudela which alleged that Tudela did not graduate from or obtain a degree of Doctor of Medicine from U.C.E., contrary to what Tudela had indicated in his application for licensure examination described above. In March 1985, the Board of Medical Examiners entered an order accepting the surrender for revocation of Jose A. Tudela's license to practice medicine in lieu of further prosecution of the charges contained in the Administrative Complaint which had been filed in November 1984. Tudela is not currently licensed as a physician in the state of Florida. No further action was taken against him for his having fraudulently obtained a medical license in Florida. Respondents Escar and Marti were both aware of the fact that the Forms B-1 which they signed were to be submitted as part of the application for the continuing medical education program which had been established by the Board of Medical Examiners for Cuban nationals as a prerequisite to take the licensure examination. In fact; Respondent Marti became eligible to take the medical licensure examination in Florida by completing the same continuing medical education program. When the Respondents Escar and Marti signed the subject Forms B-1, neither of them had any personal knowledge as to the truth or falsity of the statements therein regarding Tudela's medical education and experience; yet they deliberately certified, under oath, to the truthfulness of matters about which they were distinctly uninformed. When the Respondents Escar and Marti signed the subject Forms B-1, both of them knew the purpose of the forms and both knew that the Board of Medical Examiners would rely on the information in the forms.
Findings Of Fact Petitioner, Peter P. McKeown, is a graduate of the University of Queensland Medical School in Brisbane, Australia. He holds the degrees of Bachelor of Medicine and Bachelor of Surgery. Doctorates of Medicine, under the British system, are reserved for specialists. Nonetheless, the medical training Petitioner received equates to that leading up to the award of the degree of Doctor of Medicine in the United States, and he is a physician and licensed as such in several states. He has completed residencies in general and thoracic surgery in Australia and the United States and has taken advanced training in cardiovascular and thoracic surgery at Emory University. Immediately before coming to the University of South Florida, (USF), Dr. McKeown was an Assistant Professor of Surgery at the University of Washington. In mid to late 1988, Dr. McKeown responded to an advertisement USF had placed in the Journal of the American Medical Association seeking applicants qualified for appointment at the Associate Professor level "... to join the Department of Surgery at the University of South Florida College of Medicine as the Chief of Cardiothoracic Surgery." He was selected for the position and joined the faculty effective May 1, 1989. All the correspondence leading up to Petitioner's joining the University faculty referred not only to his appointment as Associate Professor but also his assignment as Chief of the Cardiothoracic Surgery Division. Only the actual state employment contract described his employment exclusively as Associate Professor and made no mention of the Chief position. Under these circumstances, Petitioner did not gain any proprietory interest in the position of Chief of the Cardiothoracic Surgery Division. Dr. McKeown held the position of Chief of the Cardiothoracic Surgery Division until April, 1994, when, as a result of a decision made by the Chairman of the school's Department of Surgery, he was replaced as Chief and that position was filled, on a temporary basis, by the Department Chair. Petitioner claims that when he arrived at USF to assume the directorship, an administrative position, he saw an opportunity to develop the position into something significant. He contends he would not have come to USF unless he was to be the Chief of the Division as there was no appeal to him in a position as a general faculty member. He wanted an opportunity to budget, hire people, and develop plans and programs, and in order to advance in academic medicine, one must, at some point, hold an administrative position. Apparently the Department of Surgery had experienced a rapid turnover in faculty. It is not clear whether this caused or was the result of a dispute with administrators and medical staff at Tampa General Hospital, (TGH), where much of the clinical medical school activity is carried on. However, the program was recognized as being weak in cardiothoracic surgery, and this condition offered Petitioner the challenge he wanted. In his five years as Chief, Petitioner increased both the number and quality of personnel and revenues considerably. He developed affiliations with several foreign universities and recruited qualified people, built up the laboratory, secured more grants, developed a program of continuing medical education and raised the examination scores of the school's graduates. He opened new clinical programs and built up both billings and collections to the point where the program revenues were increased at least 2 to 5 times. By 1992- 1993, the Division was making money and generating a surplus and still used clinic funds to support research. During his tenure as Chief of the Division, Petitioner served under two Department of Surgery chairmen. The first was Dr. Connar, the individual who recruited him; and the incumbent is Dr. Carey, the individual who removed him. Petitioner asserts that at no time during his tenure in the position of Chief of the Cardiothoracic Surgery Division was he ever told, by either Department Chairman, that his performance was unsatisfactory. All Division heads within the Department were, from time to time, counseled about personnel costs, and Petitioner admits he had some differences with Dr. Carey about that subject and some other financial aspects of the job, but nothing different than anywhere else in academia. Petitioner was removed by Dr. Carey based in part upon his alleged inability to get along with people. Though he claims this is not true, he admits to three areas of conflict. The first related to his objection to transplants being accomplished by unqualified surgeons which, he alleges, Dr. Carey permitted to further his own ends. The second related to the pediatric heart transplant program for which Petitioner supported one candidate as chair and Dr. Carey supported another. The third related to Petitioner's reluctance to hire a physician whom Dr. Carey wanted to hire but to whom Petitioner purportedly objected. Of the three areas of dispute, only the first two came before his removal, but he contends at no time was he advised his position was a problem for the Department. By the same token, none of Petitioner's annual performance ratings reflected any University dissatisfaction with his performance. At no time was he ever rated unsatisfactory in any performance area; and prior to his removal, he had no indication his position as Chief of the Division was in jeopardy. Dr. Carey indicates he did counsel with Petitioner often regarding his attitude but did not rate him down because he hoped the situation would improve. Dr. McKeown was called to meet with Dr. Carey in his office on April 12, 1994. At that meeting, Dr. Carey was very agitated. He brought up the "Norman" incident and indicated he was going to remove Petitioner as Chief of the Division. Dr. McKeown admits to having made an inappropriate comment regarding Dr. Norman, another physician, to a resident in the operating room while performing an operation. He also admits that it was wrong to do this and apologized to Dr. Norman both orally and in writing shortly thereafter. Dr. Norman accepted his apology and Petitioner asserts that after his removal, Dr. Norman called him and assured him he, Norman, had not prompted the removal action. Dr. Norman did not testify at the hearing. Dr. Carey removed Petitioner from his position as Chief because of the comments he had made regarding Dr. Norman. Almost immediately after the meeting was concluded, Dr. Carey announced in writing his assumption of the Chief's position, in which position he remained until he hired Dr. Robinson as Chief in April, 1995. Petitioner found out that Carey's threat to remove him had been carried out the following day when his nurse told him his removal had been announced at the Moffett Cancer Center. He thereafter heard other reports of his removal from other sources, and based on what had happened, concluded his removal was intended to be and constituted a disciplinary action for his comment regarding Dr. Norman. He was not advised in advance of Carey's intention to impose discipline nor given an opportunity to defend himself before the action was taken. He claims he was not given any reason for his removal before or at the time of his dismissal. It is found, however, that the removal was not disciplinary action but an administrative change in Division leadership. Dr. McKeown at first did nothing about his removal, believing it would blow over. However, after he heard his removal had been publicized, he called several University officials, including a Vice-President, the General Counsel and the Provost, to see how the matter could be handled. He claims he either got no response to his inquiries or was told it was a Medical College problem. He then met with the Dean of the College of Medicine who indicated he could do nothing. After he was removed as Division Chief, Petitioner's salary remained the same as did his supplement from his practice. He claims, however, his removal has had an adverse effect on his reputation in the medical and academic communities. It is his belief that people now feel something is wrong with him. Dr. Carey's blunt announcement of his assumption of the Chief's position, without any reasons being given for that move or credit being given to Petitioner for his past accomplishments has had an impact on his ability to work effectively. After his removal, he received calls from all over the world from people wanting to know what had happened. The removal has, he claims, also made it more difficult for him to get grants and has, thereby, adversely impacted his ability to do productive research. In addition, his removal made it difficult for him to carry out his academic duties. His specialty is still presented in student rotations, only in a different place in the medical curriculum. Dr. McKeown has sought reinstatement to the administrative position of Chief of the Division. He is of the opinion that Dr. Carey's action in removing him from his position as Division Chief was capricious and damaging to the University as well as to his career. Petitioner admits he could have been less confrontational in the performance of his duties as Division Chief, but he knows of no complaints about him from TGH, All Children's Hospital or the VA Hospital. There are, however, letters in the files of the Department Chairman which indicate some dissatisfaction with Petitioner's relationships in some quarters and, as seen below, there were signs of dissatisfaction from both TGH and All Children's Hospitals. Petitioner admits he may have been somewhat overbearing or abrasive, but neither his alleged inability to properly steward finances nor his alleged inability to get along with people were mentioned to him at the time of dismissal or before. After Dr. Carey assumed the Chairmanship of the Department of Surgery in July, 1990, he saw Dr. McKeown frequently on an official basis at first. A Chief, as Petitioner was, has many and varied functions such as administration, teaching, fiscal, research, clinic administration and the like. People skills are important because of the necessary interface with colleagues, faculty, administrators and the public. When Dr. Carey came to USF, Dr. McKeown had not been in place very long, and the Division of Cardiothoracic Surgery was not doing well financially. There were contract negotiations going on with the VA Hospital which were not going well, at least partly because, Dr. Carey asserts, Dr. McKeown had made some major unacceptable demands. As a result, Dr. Carey stepped in, along with Dr. Benke, who was very effective in dealing with the VA, and as a result, an agreement was reached which resulted in somewhere between $275,000 and $300,000 per year coming in which put the Division in the black. Dr. Carey recalls other instances indicating Dr. McKeown's inability to get along with others. One related to the relationship with TGH previously mentioned. TGH had made a decision to use a particular physician as head of its transplant program because, allegedly, Dr. McKeown had so angered private heart patients they would not let him be appointed even though Dr. McKeown was Dr. Carey's choice. As it turned out, Dr. Carey convinced the TGH Director and another physician to agree to a plan whereby Dr. McKeown would be head of the program 50 percent of the time. This would have been good for the University, but Dr. McKeown refused indicating that if he could not be in charge all of the time, he would not be in charge at all. Another incident relates to All Children's Hospital. That institution wanted to initiate a pediatric heart transplant program and a meeting was set up to which Dr. McKeown was invited. Petitioner so infuriated the community surgeons attending that meeting they would not work with him, and without his, Carey's, efforts, Dr. Carey claims the program was doomed to failure. As a result, Carey asked Dr. Nevitsky to help get the program started. This gave the USF an opportunity to participate in the program, but when Nevitsky left, they lost it. Still another example, according to Dr. Carey, is the fact that some surgeons on staff have called to complain about Dr. McKeown's attitude and unwillingness to compromise and negotiate and about his demands for service and staff, all of which creates friction among the hospital staff. A few days before Dr. Carey removed Petitioner as Chief, he spoke with the Dean of the College of Medicine, a Vice-president of the University, and others who would be impacted, about his concern regarding the Cardiothoracic Surgery Division and, in fact, he had had discussions with other officials even before that time. Long before making his decision to remove Petitioner, Carey spoke of his consideration of possibly shifting the emphasis within the Division to non-cardiac thoracic surgery in place of the cardiac program which Dr. Carey felt was not very successful. He believed the program did not do enough procedures to support the medical school affiliation. Dr. Carey chose to dismiss Dr. McKeown as Chief of the Division on April 12, 1994, after learning of McKeown's destructive attack on another surgeon before a junior physician in a public place, an operating room, (the Norman incident). He notes that over the years there was a building concern regarding Dr. McKeown's abilities as an administrator, and this incident with Dr. Norman was the last straw. Dr. Carey had received complaints about Petitioner from other physicians, all of which he discussed with Dr. McKeown. Finally, with the Norman incident, it became abundantly clear that Dr. McKeown's capabilities as a leader had diminished to the point where a change was necessary. Before he dismissed Petitioner, and during the investigation which led up to the dismissal, Dr. Carey admits, he did not give Dr. McKeown any opportunity to give any input to the decision. By the time Carey met with McKeown on April 12, 1994, his mind was made up. The Norman incident was demonstrative of what Carey perceived as McKeown's lack of supervisory ability, and it was that factor which led Carey to the ultimate decision to remove McKeown. He felt it necessary to act then and not leave Dr. McKeown in place during the search for a replacement. Petitioner cites alleged comments made by Carey to others that he would have relieved anyone for doing what Petitioner did in the Norman incident. Dr. Carey cannot recall having made such a statement. He claims he considered disciplinary action against Petitioner for the Norman comments but decided against it. However, it was the last in a series of incidents which caused him to question the propriety of McKeown's placement in the Chief's position, and which ultimately cemented his decision to replace him. Dr. Carey met with Dr. McKeown several times before the dismissal and counseled him about administrative deficiencies in his performance, but he never told Dr. McKeown that unless he improved, he would be dismissed. This is consistent with Petitioner's testimony that he was not warned of his shortcomings or of the administration's dissatisfaction with his performance. Disagreements in conversations between superior and subordinate, meant by the former to be corrective in nature, are not always taken as such by the latter. Dr. Carey did not document any of this in Dr. McKeown's personnel files but put some of the information he received by way of communications from others in the files. These are the letters submitted by the University, pursuant to agreement of the parties, subsequent to the hearing. They contributed to Carey's increasing concern about Dr. McKeown's ability to lead the Division. At no time, however, though he questioned Dr. McKeown's leadership, did Dr. Carey ever question his good faith and sincerity, nor does he do so now. When he finally decided action was necessary, on April 12, 1994, Dr. Carey wrote a memorandum to the Medical College faculty concerning his assumption of the position as Chief of the Cardiothoracic Surgery Division. He also advised Dr. McKeown of his removal. Dr. Carey remained in the Chief's position, holding that title in an administrative capacity and not from a clinical standpoint, for approximately one year, intending to stay in the position only until he could find a fully qualified thoracic surgeon to take the job. After Carey removed Petitioner, he was contacted by the Medical College Dean who asked that he get with McKeown and try to work something out. He thereafter offered Dr. McKeown the position of Chief of the cardiac section of the Division but McKeown declined. Dr. Carey also, on April 26, 1994, wrote to TGH recommending that Dr. McKeown be allowed to have more impact on the hospital's transplant program, pointing out that the change in McKeown's position at the University was occasioned by a need for a change in leadership. According to Dr. Tennyson J. Wright, Associate Provost of the University, disciplinary action against nonunion faculty members is governed by Rule 6C4-10.009, F.A.C., and requires notice of proposed action be given before such disciplinary action is taken. The contract which Dr. McKeown holds and has held since the inception of his tenure at the University, is a standard USF/State University System contract. It reflects Petitioner was hired as an Associate Professor, which is one of the three types of personnel classifications used within the system. These are faculty, administration and support. Petitioner's contract does not refer to his holding the Division Chief position and it is not supposed to. Such a position is an administrative appointment within a Department and a working title used to define the holder's duties, and service in such a position is at the pleasure of the Department Chair. Appointment to or removal from a Chief position is an administrative assignment. The position of Department Chairperson, on the other hand is a separate position and subclassification within the University classification system and is different.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore: RECOMMENDED that Petitioner, Peter P. McKeown's, grievance against the University of South Florida School of Medicine arising from his removal as Chief, Cardiothoracic Surgery Division in the Department of Surgery be denied. DONE AND ENTERED this 19th day of January, 1996, in Tallahassee, Florida. ARNOLD H. POLLOCK, 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 19th day of January, 1996. APPENDIX TO RECOMMENDED ORDER IN CASE NO. 95-1832 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. FOR THE PETITIONER: 1. - 7. Accepted and incorporated herein. Though the documents in question refer to appointment, in actuality the personnel action was an appointment to the faculty with an administrative assignment to the position of Director of the Division. & 10. Accepted. 11. & 12. Accepted and incorporated herein. 13. & 14. Accepted and incorporated herein. - 19. Accepted and incorporate herein. Accepted and incorporated herein. Accepted. Rejected as inconsistent with the better evidence of record. Accepted. Accepted and incorporated herein. Rejected as inconsistent with the better evidence of record. & 27. Accepted. & 29. Accepted and incorporated herein. Accepted. Accepted and incorporated herein. 32. - 34. First sentence accepted. Second sentence rejected as inconsistent with the better evidence of record. 35. - 37. Accepted. 38. Rejected as argument. 39. Accepted. FOR THE RESPONDENT: - 9. Accepted and incorporated herein. Accepted. - 14. Accepted and incorporated herein. 15. & 16. Accepted and incorporated herein. COPIES FURNISHED: Benjamin H. Hill, III, Esquire William C. Guerrant, Jr., Esquire Danelle Dykes, Esquire Hill, Ward & Henderson, P.A. Post Office Box 2231 Tampa, Florida 33601 Thomas M. Gonzalez, Esquire Thompson, Sizemore & Gonzalez 109 North Brush Street, Suite 200 Post Office Box 639 Tampa, Florida 33601 Olga J. Joanow, Esquire University of South Florida 4202 East Fowler Avenue, ADM 250 Tampa, Florida 33620 Noreen Segrest, Esquire General Counsel University of South Florida 4202 East Fowler Avenue, ADM 250 Tampa, Florida 33620-6250
The Issue The issues to be determined are whether Petitioner meets the requirements for licensure by endorsement pursuant to section 458.313, Florida Statutes (2013), and whether the Board’s interpretation of section 458.311(3), Florida Statutes, is an unadopted rule in violation of section 120.54(1), Florida Statutes (2013).
Findings Of Fact Based upon the stipulations of the parties and the documentary evidence presented, the following facts are found: Petitioner, Leon Rawner, M.D., is a licensed medical doctor in the state of Wisconsin and an applicant for licensure as a medical doctor by endorsement in Florida. The Florida Board of Medicine is the agency charged with the licensing and regulation of allopathic medical doctors pursuant to section 20.43 and chapters 456 and 458, Florida Statutes. Applicants for licensure by endorsement must meet the requirements specified in section 458.313. Those requirements include meeting the qualifications identified in section 458.311(1)(b)-(g) (alternative one) or section 458.311(1)(b)-(e), (g), and (3) (alternative two). Petitioner is over 21 years of age, and has submitted a set of fingerprints on a form and under procedures specified by the Department of Health, along with a payment in an amount equal to the costs incurred by the Department of Health. Petitioner has successfully passed the required criminal background screening. Petitioner’s application for licensure by endorsement demonstrates that he is licensed to practice medicine in another jurisdiction, the state of Wisconsin, and that he has been active in the practice of medicine for at least two of the four years immediately preceding the application. Petitioner has a clean record in his current medical practice in Wisconsin and is not under any investigation in any jurisdiction for an act or offense which would constitute a violation under section 458.331, and has not committed any act or offense in any jurisdiction which would constitute the basis for disciplining a physician pursuant to section 458.331. Petitioner has completed the equivalent of two academic years of pre-professional, postsecondary education, as determined by rule of the Board, which included, at a minimum, courses in anatomy, biology, and chemistry prior to entering medical school. Petitioner received a bachelor’s degree from Brandeis University, an accredited United States university. Petitioner has passed the appropriate medical licensure examinations, the United States Medical Licensing Examination, Step-1, Step-2, and Step-3. Petitioner holds an active, valid certificate issued by the Educational Commission for Foreign Medical Graduates (ECFMG) and has passed the examination used by the Commission. In 2006, Petitioner graduated with a degree of Doctor of Medicine from American University of the Caribbean School of Medicine. Petitioner graduated from an allopathic foreign medical school (American University of the Caribbean School of Medicine) which is recognized by the World Health Organization. Petitioner completed all of the formal requirements for graduation from American University of the Caribbean School of Medicine. Petitioner’s application for licensure demonstrates that he has completed the academic year of supervised medical training prior to graduation as required under section 458.311(3)(d). Petitioner did not graduate from an allopathic medical school or allopathic college recognized and approved by an accrediting agency recognized by the United States Office of Education. Petitioner did not graduate from an allopathic medical school or allopathic college within a territorial jurisdiction of the United States recognized by the accrediting agency of the governmental body of that jurisdiction. Petitioner is not a graduate of an allopathic foreign medical school registered with the World Health Organization and certified pursuant to section 458.314, Florida Statutes, as having met the standards required to accredit medical schools in the United States or reasonably comparable standards. Petitioner has not completed an approved residency or fellowship of at least two years in one specialty area. Petitioner’s application for licensure demonstrates that he does not meet the postgraduate training requirements under section 458.311(1)(f)3. Petitioner completed one year of residency training in the Internal Medicine Program at Mt. Sinai-Elmhurst Hospital Center, Queens, New York. Besides the residency training program at Mt. Sinai– Elmhurst Hospital Center, Queens, New York, Petitioner has not completed any other residency or fellowship training. Petitioner does not have two years of any residency or fellowship training which can be counted toward regular or subspecialty certification by a board recognized and certified by the American Board of Medical Specialties. Since January 24, 2011, Dr. Rawner has been practicing medicine in Wausau, Wisconsin, as a staff physician with Knee Pain Solutions Center. Accordingly, he has been in the active practice of medicine for the two years preceding his Florida application. Dr. Rawner submitted his application for licensure by endorsement on March 13, 2013. Supplemental documentation was filed with the Board by letter dated March 18, 2013. In that letter, Dr. Rawner expressly stated that he was relying on the second alternative for establishing licensure by endorsement, which does not include the requirements identified in subsection 458.311(1)(f). On April 3, 2013, the Board requested additional information, and in response, Dr. Rawner provided a copy of his undergraduate degree and information related to his one year of supervised medical training. Other information requested in the April 3, 2013, letter was sent directly to the Board office by the appropriate agencies, including an official United States medical examination transcript, indicating that Dr. Rawner passed USMLE Steps I, II, and III; a letter from the residency program director, indicating that Dr. Rawner completed one year of residency training; confirmation from the Wisconsin Medical Board confirming his current, valid medical license in the state of Wisconsin; an American Medical Association (AMA) profile letter; and Dr. Rawner’s fingerprints and clear background check. Program Operations Administrator Chandra Prine notified Dr. Rawner by letter dated June 26, 2013, that he was required to appear before the Credentials Committee of the Board. The purpose of the appearance was to discuss: Failure to meet the training requirement pursuant to section 458.313(1)(a), 458.311(1)(f)3.c., Florida Statutes. Failure to complete an academic year of supervised clinical training pursuant to section 458.311(3)(d), Florida Statutes. Dr. Rawner appeared before the credentials committee of the Board of Medicine on August 1, 2013. The committee recommended that his license be denied. On August 22, 2013, the Board of Medicine issued a Notice of Intent to Deny Licensure, stating that it intended to deny Dr. Rawner’s application because Dr. Rawner did not meet the requirements of section 458.313(1), which requires an applicant to meet the qualifications outlined in either section 458.311(1)(b)-(g) (alternative one), or in section 458.311(1)(b)- (e), (g) and (3) (alternative two). The notice stated that with respect to alternative one, Dr. Rawner did not meet the requirements of section 458.311(1)(f)3., because he had not completed an approved residency or fellowship of at least two years in one specialty area. With respect to alternative two, the Board determined that Dr. Rawner did not meet the requirements of section 458.311(3)(c) because, in the Board’s view, the section was inapplicable to Dr. Rawner because he had completed all requirements of the foreign medical school, with none outstanding, and did not meet the requirement of (3)(d) because he had not completed an academic year of supervised clinical training in a hospital affiliated with a medical school approved by the Council on Medical Education of the American Medical Association. Dr. Rawner filed a Petition for Administrative Hearing with respect to the Notice of Intent to Deny, and the matter was reconsidered at the credentials committee’s meeting on October 3, 2013. The credentials committee voted to reconsider the application based on the issues presented in the Petition. On October 22, 2013, the Board issued an Amended Notice of Intent to Deny Licensure. With respect to alternative two, in the Amended Notice, the Board stated: [t]he application file reveals that Dr. Rawner fails to meet subsection (3) for the reasons set forth below. Subsection (3) provides: Notwithstanding the provisions of subparagraph (1)(f)3., a graduate of a foreign medical school need not present the certificate issued by the Educational Commission for Foreign Medical Graduates or pass the examination utilized by that commission if the graduate: Has received a bachelor’s degree from an accredited United States college or university. Has studied at a medical school which is recognized by the World Health Organization. Has completed all of the formal requirements of the foreign medical school, except the internship or social science requirements, and has passed part I of the National Board of Medical Examiners examination or the Educations Commission for Foreign Medical Graduates examination equivalent. Has completed an academic year of supervised clinical training in a hospital affiliated with a medical school approved by the Council on Medical Education of the American Medical Association and upon completion has passed part II of the National Board of Medical Examiners examination or the Educational Commission for Foreign Medical Graduates examination equivalent. Subpart (3)(c) provides in relevant part all of the formal requirements of the foreign medical school, except the internship or social service requirements, and has passed certain examinations. A plain reading of this subpart is that the foreign medical school has an internship or social service requirement and that the internship or social service requirement has not been completed. The application file demonstrates that Dr. Rawner graduated in June, 2006, with a degree of Doctor of Medicine from the American University of the Caribbean School of Medicine. Thus, subpart (3)(c) is inapplicable to Dr. Rawner, because the application file reveals that he completed all of the formal requirements of the foreign medical school and there are no outstanding or pending internship or social service requirements. Based on the foregoing, the Board finds that the Applicant has not demonstrated that he meets the requirements for licensure by endorsement set forth in Section 458.313(1)(a), Florida Statutes. The Amended Notice no longer listed failure to complete an academic year of supervised clinical training as a basis for the denial of Dr. Rawner’s application. There is no persuasive evidence presented that Respondent’s interpretation of the requirements of section 458.311, Florida Statutes, as it applies to this case, is a statement of general applicability.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Florida Board of Medicine enter a Final Order approving Leon Rawner, M.D.’s application for licensure by endorsement. DONE AND ENTERED this 28th day of April, 2014, in Tallahassee, Leon County, Florida. S LISA SHEARER NELSON 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 28th day of April, 2014. COPIES FURNISHED: Donna C. McNulty, Esquire Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399 Amy W. Schrader, Esquire GrayRobinson, P.A. 301 South Bronough Street, Suite 600 Post Office Box 11189 Tallahassee, Florida 32302 Allison M. Dudley, Executive Director Board of Medicine Department of Health Division of Medical Quality Assurance Boards/Councils/Commissions 4052 Bald Cypress Way Tallahassee, Florida 32399 Jennifer A. Tschetter, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399 Edward A. Tellechea, Esquire Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399
The Issue Whether the petitioner has "completed undergraduate work" and is, therefore, eligible for a license by endorsement to practice medicine in Florida pursuant to Section 458.313 and 458.311.
Findings Of Fact Petitioner attended undergraduate school at the University of Puerto Rico. The University of Puerto Rico is an accredited United States university. He graduated with a medical degree from La Universidad Autonoma de Guadalajara, Mexico, and returned to the University of Puerto Rico from January 21, 1930, to December 20, 1980, to satisfactorily complete the Fifth Pathway Medical Program at the Mayaquez ;~ledical Center in Puerto Rico. Petitioner is a licensed physician in Georgia, Michigan and Puerto Rico. He successfully passed the FLEX and obtained a weighted average of 76. Petitioner attended the University of Puerto Rico from July, 1972, until December, 1975. He did not obtain any degree from the University of Puerto Rico, but he testified, and it was so stipulated, that he completed his pre-med undergraduate work. Petitioner was fifteen hours short of obtaining his degree when he withdrew from the University of Puerto Rico to attend medical school. Although petitioner had completed all the required courses in his pre-med program, he needed fifteen hours of credit in electives before he could complete his undergraduate work and obtain his degree. There was no evidence presented that the University of Puerto Rico considered the completion of the required pre-med courses as constituting the completion of undergraduate work at that institution. In her affidavit, which was entered into evidence by stipulation, the Executive Director of the Board of Medical Examiners stated that the board has consistently interpreted Section 458.311(3)(a) as requiring a diploma or official transcript showing that an undergraduate degree has been awarded as the only evidence of successful completion of undergraduate work. She further averred that, to the best of her knowledge and belief, no applicant for medical licensure pursuant to Section 458.311(3) had been licensed who had not submitted a diploma or official transcript showing that an undergraduate degree had been awarded.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered denying the petitioner's application for licensure by endorsement. DONE and ENTERED this 27th day of August, 1985, in Tallahassee, Leon County, Florida. DIANE A. GRUBBS Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, FL 32301 (904) 488-9675 FILED with the Clerk of the Divisign of Administrative Hearings this 27th day of August, 1985. COPIES FURNISHED: Frederic A. Buttner, Esq. 112 West Adams Street Barnett Bank Building Jacksonville, FL 32202 Arden M. Siegendorf, Esq. M. Catherine Lannon, Esq. Department of Legal Affairs The Capitol, Suite LL04 Tallahassee, FL 32301 Dorothy Faircloth Executive Director Department of Professional Regulation Board of Medical Examiners 130 North Monroe Street Tallahassee, FL 32301 Salvatore A. Carpino General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, FL 32301 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, FL 32301
