Findings Of Fact Petitioner, Omar J. Adams, was born in Pahokee, Florida, on July 18, 1950. He attended the University of Florida from 1968 to 1973 and was awarded the degree of Bachelor of Science in chemistry upon graduation. Immediately upon graduation, he spent one year teaching special high school students and in 1974 applied for admission to the medical school of the University of Florida but was not accepted. He also applied to other medical schools and, likewise, was not accepted. He thereafter applied for admission to the Program in Medical Sciences (PIMS) conducted jointly by Florida State University (FSU), Florida A & M University (FAMU) and the University of Florida College of Medicine (UF Med) and was accepted. This program is designed to provide to individuals not accepted to medical school a two-year course of study parallel to that given to first- and second-year medical students enrolled at UF Med, so that if a vacancy occurred in UF Med at the completion of the first two years of academics the PIMS student could step into that vacancy for the third and fourth years of clinical training. After two years in PIMS at FSU and FAMU in Tallahassee, Petitioner transferred to the University of Florida for two more semesters of science courses. UF MED was aware of his efforts to he admitted. In fact, his studies at the University of Florida after the PIMS years were courses taken at UF Med, and UF MED sponsored him for admission to a course in gross anatomy at McHarry College in Tennessee, although he was not enrolled in the medical school as a medical student. Petitioner's grade point average for the PIMS years and the additional studies at the University of Florida was 3.8 out of a possible 4. Petitioner fully expected to be admitted to UF Med in 1977 and was sponsored by that institution to take Part I of the examination of the National Board of Medical Examiners (National Boards), which he took both in June 1977 and June 1979, achieving a passing score each time. However, because an act passed by the United States Congress in 1977 gave preference for funds for admission to U.S. medical schools to U.S. students in foreign medical schools, he again was not admitted to UF MED or to any other medical school in the United States to which he had applied. In the fall of 1977, he heard that some foreign medical schools would permit their students to do their clinical training in the United States. After several months in both the Dominican Republic and Mexico studying Spanish and attempting to gain admission to medical school, he applied to medical school in the Dominican Republic and was provisionally accepted. He chose not to go there, because they would not give him transfer credit for his PIMS work and would have required him to take his third and fourth years of medical school in that country. When Petitioner left the Dominican Republic, he went to Mexico where, in early 1978, he applied for admission to and was accepted at the school of medicine of the Centro de Estudios Universitarios "Xochicalco," A.C. (CEUX), which was incorporated into the Universidad Autonoma de Guerrero (UAG). This school is approved by the World Health Organization. CEUX gave him full credit for the PIMS courses he took in 1976 and 1977 even though he did not take even one day of classes at that institution, which, coincidentally, was not established until December 18, 1977; nor did he ever see any of the institution's classrooms or laboratories. He paid a fee of approximately $5,000 per year for each of the two years work for which he was given credit and was admitted to the school's clinical program conducted out of a sparsely manned office in New York City. Under this program, Petitioner was responsible for arranging his own clinical training, which he did at teaching hospitals in the New York City area during 1978, 1979 and 1980. These hospitals and the medical schools with which they were affiliated, at which Petitioner took his externships, were: Medical, OB/GYN: New York Infirmary (NYU School of Medicine) Neurology, Pediatrics: Elmhurst City Hospital Center (Mount Sinai School of Medicine) Surgery: Beeckman Downtown Hospital (Cornell University Medical College) Cardiology: Downstate Medical Center (SUNY College of Medicine) Radiology, Pneumology: Mount Sinia Medical Center (Mount Sinai School of Medicine) Basic Medical Science Review: College of Physicians and Surgeons (Columbia University School of Medicine) Urology, Psychiatry: Beth Israel Medical Center (Mount Sinai School of Medicine) Otorhinolaryngology, Ophthalmology: Manhattan EET Hospital (Cornell University Medical College) Nephrology: VA Hospital (Bronx) (Mount Sinai School of Medicine) Forensic Medicine: Chief Medical Examiner' s Office (NYU School of Medicine) Family Practice: Brookdale Hospital (SUNY College of Medicine) Family Practice: Lutheran Medical Center (SUNY College of Medicine) Medicine, Dermatology: VA Hospital (Brooklyn)(SUNY College of Medicine) Family Practice: Halifax Hospital (Daytona Beach)(UP School of Medicine) Upon completion of these externships, Petitioner was awarded a Certificate of Completion on June 23, 1980, by the Dean of the School of Medicine at UAG. He was not awarded a diploma because, under the Mexican requirements, he would have had to complete a year of community service in Mexico as a condition precedent to the award of a diploma. He did not desire to do this and instead enrolled in the Fifth Pathway Program conducted-by the Mount Sinai Medical Center (Mount Sinai) in New York. This program, otherwise known as a supervised clinical clerkship, was established at that school in 1975 in accordance with guidelines proposed by the Council on Medical Education of the American Medical Association (AMA) to provide a year of supervised clinical training for students who completed their premedical requirements in the United States, were qualified but where unable to gain admission to a United States-medical school, and had completed the formal requirements of a foreign medical school except for internship and/or social service. The primary aim of the program is to provide an opportunity for superior students from foreign medical schools to benefit from a formal, supervised clinical training experience in an American medical school and to develop and refine their clinical abilities in preparation for obtaining the maximum benefits from internship and residency in the United States. Following completion of the program, the student is awarded a Certificate and is eligible to enter the first year of an AMA-approved graduate training program (internship and residency). Students are also eligible for licensure in those states in which the program is acceptable. Petitioner successfully completed the program in June 1981. Florida accepts this program when accompanied with passage of the ECFMG examination and completion of one year of internship or residency. Over a year prior to entering the Fifth Pathway Program in January 1979, Petitioner took and passed the written examination of the Educational Commission for Foreign Medical Graduates (ECFMG) and, in June 1981, passed the FLEX examination for certification for medical licensure in New York State. As a result, on October 13, 1981, Petitioner was issued license number 148022 to practice medicine and surgery by the State of New York. After getting his New York license, Petitioner decided he wanted a specialty in Family Practice, which requires a three-year residency. He applied to and was accepted in August 1981 into the program at Halifax Hospital in Daytona Beach, Florida, where he is currently enrolled under the supervision of Dr. Bernard Breiter, Director of the Family Practice Residency Program. In this program, Petitioner is subjected to an ongoing system of evaluation by all physicians with whom he works in the residency. Based on input from these evaluating physicians and his own observations of Petitioner, Dr. Breiter has very positive feelings about him and considers him well above average. Petitioner is comparable with all other residents at his same level of experience, all of whom are graduates of American medical schools. In May 1982, Petitioner applied to the State Board of Medical Examiners of Florida (Respondent) for licensure to practice medicine and surgery in Florida by endorsement. On the application, he listed his basis for the application as Federation Licensure Examination (FLEX). He also reflected he had attended the University of Florida from September 1968 to August 1973, which was true, and FSU from September 1975 to June 1976, which was also true. He neglected to reflect his schooling at FSU-FAMU during the 1974-1975 school year by oversight. The grades earned during that period, all As, certainly give no reason for intentional concealment. He also indicated on the application that he attended UAG from January 1976 to June 1980, and that he obtained the degree of Doctor of Medicine from that same university. Both entries are technically incorrect. Petitioner was not enrolled in UAG until 1978, at which time he was given credit for courses as if he had taken them in 1976 and 1977. A Certificate of studies issued by UAG medical school in March 1978 so indicates and was admitted into evidence as Petitioner's Exhibit 4. In addition, Petitioner was not awarded the degree of Doctor of Medicine, or its Mexican equivalent "Titulo," because he failed to perform the one-year community service requirement of the school. That this is a common situation for American graduates of foreign medical schools is recognized in the literature of the Fifth Pathway Program, introduced as Petitioner's Exhibit 10. The application form utilized by the Florida Board of Medical Examiners does not provide answer blocks appropriate to Petitioner's situation. He should have answered accurately and attached a certificate of explanation. He did not do so, however, though his entries, while technically false, are not fraudulent. Though Petitioner did not attend classes at a medical school as a full-time registered medical student, during 1978, 1979 and 1980, he was a full- time registered medical student when he attended his clinical training as outlined in paragraph 7, supra. The parties have stipulated Petitioner is of good moral character and there is no evidence to suggest he is not capable of safely engaging in the practice of medicine.
Recommendation Based on the foregoing, it is RECOMMENDED: That the Florida Board of Medical Examiners issue Petitioner a license to practice medicine in Florida by endorsement. RECOMMENDED this 22nd day of September, 1983, 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 22nd day of September, 1983. COPIES FURNISHED: Edward F. Simpson, Jr., Esquire Post Office Box 305 Ormond Beach, Florida 32075 John E. Griffin, Esquire Assistant Attorney General Department of Legal Affairs The Capitol Tallahassee, Florida 32301 Ms. Dorothy Faircloth Executive Director Board of Medical Examiners Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Mr. Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue Whether disciplinary action should be taken against Respondent's license to practice medicine and surgery based on the violations of Section 458.331(1), Florida Statutes, alleged in the Administrative Complaint filed in this proceeding.
Findings Of Fact The following paragraphs of the findings of fact submitted by the Respondent have been accepted and included in the findings of fact in this Recommended Order at least in substance and in most instances in their entirety. Editorial modifications have been made in some instances in the interests of accuracy and clarity; as well as when consolidating similar proposals submitted by both parties: 1, 2, 3, 4, 15, and 17. Paragraph 5 is rejected as constituting argument rather than proposed findings of fact. Paragraph 6 is rejected as constituting primarily argument about the credibility of witnesses rather than proposed findings of fact. To the extent findings are proposed in this paragraph, they are rejected as subordinate. The first two sentences of paragraph 7 are rejected as constituting argument about the credibility of witnesses rather than proposed findings of fact. The last sentence of paragraph 7 is accepted. The first five sentences of paragraph 8 are accepted. The last two sentences of paragraph 8 are rejected as constituting legal argument and/or subordinate facts. Paragraphs 9 and 10 are rejected as constituting argument about the credibility of witnesses rather than proposed findings of fact. The substance of the first three sentences of paragraph 11 is accepted. The last two sentences of paragraph 11 are rejected as constituting argument about the credibility of witnesses rather than proposed findings of fact. Paragraph 12 is rejected as for the most part constituting argument rather than proposed findings of fact. To the extent findings are proposed; they are rejected as subordinate. With the exception of the last sentence; all of paragraph 13 is rejected as for the most part constituting argument rather than proposed findings of fact. The substance of the last sentence of paragraph 13 is accepted. The fourth sentence of paragraph 14 is accepted with the deletion of the last clause. The remainder of paragraph 14 is rejected as constituting argument or as proposing irrelevant and/or subordinate facts. Paragraph 16 is accepted in substance, but only as to when and where the Respondent and Vicente met and as to what Vicente told the Respondent he was doing. Paragraph 18 is rejected as constituting argument about the credibility of some of the evidence rather than constituting proposed findings. Paragraph 19 is rejected as constituting argument about the credibility of some of the evidence rather than constituting proposed findings. Further, the implications of the arguments are rejected as being contrary to my resolution of credibility issues. The substance of the first two sentences of paragraph 20 is accepted. The remainder of paragraph 20 is rejected as irrelevant commentary about testimony rather than proposed findings on a material issue. Paragraphs 21, 22, and 23 are rejected as constituting argument rather than proposed findings of fact.
Recommendation For all of the foregoing reasons, it is recommended that the Board of Medical Examiners enter a Final Order in this case dismissing all charges against the Respondent, Roberto Cuesta, M.D. DONE AND ORDERED this 12th day of March, 1986, at Tallahassee, Florida. MICHAEL M. PARRISH, 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 12th day of March, 1986. COPIES FURNISHED: Leonard Sussman, Esquire 7195 S.W. 47th Street Suite #101 Miami, Florida 33155 Stephanie A. Daniel, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Dorothy Faircloth, Executive Director Board of Medical Examiners Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Salvatore A. Carpino, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 APPENDIX The following are my specific rulings on each of the proposed findings of fact submitted by each of the parties. By way of preface to the specific rulings which follow, I feel constrained to make the following observations regarding three of the principal witnesses in order that the parties may more clearly understand the basis for certain of the findings of fact. With regard to conflicts between the testimony of the Respondent and the witness Carlos Ramirez, I have generally tended to credit the testimony of the Respondent, largely on the grounds that the Respondent's version was more consistent with other evidence. Further, I found the Respondent to be sincere, candid, accurate, and honest in his testimony. Accordingly, I have given a great deal of weight to the Respondent's testimony. I found the witness Armando R. Vicente to be otherwise. Accordingly; I have given very little weight to Mr. Vicente's testimony except to the extent that it was corroborated by other reliable evidence or constituted admissions against interest.
Findings Of Fact The sole witness for the Petitioner, Dorothy J. Faircloth, established that the Respondent, Dr. Thomas K. Thomas, M.D., was licensed by endorsement by the Board on May 8, 1979. On-March 19, 1982, Witness Faircloth, as Executive Director of the Board, sent a letter to the Respondent, Dr. Thomas, indicating that the records of her office showed that he was licensed by endorsement on the above date and that he had not complied with Section 458.313, Florida Statutes, by demonstrating to the Board that he had actively engaged in the practice of medicine in Florida within a three year period after issuance of the license by endorsement, provided for in that Section, nor that he had continued that practice in Florida continuously for a minimum period of one year. That letter further informed him that if the establishment of his Florida practice was postponed due to the necessity of obtaining additional training or because of military service, then he should submit proper documentation in affidavit form or properly certified to establish that he was in an approved training program at the time of receiving his license, until a date certain, or was in the military service. The letter informed him that in order to avoid cancellation of his license by endorsement he should submit proper documentation in affidavit ford or properly certified to the effect that he had been actively engaged in the practice of medicine within the three-year period after issuance of that license and that he had continued his practice for a minimum of one year. This letter was elated March 19, 1982, and an identical letter pursuant to the Board's procedure was sent one month later on April 19, 1982, which constitute two written warnings sent to the Respondent's last known address and which indeed was shown to be the address from which the letter requesting this proceeding was posted. The doctor failed to demonstrate in the requested manner that he had complied with Florida practice requirements for his licensure by endorsement and accordingly on June 10, 1982, an order was entered by the Board of Medical Examiners declaring his licensure by endorsement void and of no force or effect. By his letter of June 21, 1982, the doctor petitioned for a formal proceeding, in which petition he acknowledged that he had not been able to come to Florida to practice medicine within the three years of acquiring his license by endorsement due to "circumstances beyond my control." This letter was admitted into evidence as a part of Exhibit One. The cause was then transmitted to the Division of Administrative Hearings for a formal proceeding, the hearing being held on the above date. Dr. Thomas failed to appear at the hearing. It was established that Dr. Thomas has not practiced in Florida since his licensure by endorsement on May 5, 1979.
Recommendation Having considered the foregoing Findings of Fact, Conclusions of Law and the evidence in the record, it is therefore RECOMMENDED: That license number ME00345I6 issued to Dr. Thomas K. Thomas, M.D., on May 5, 1979, be revoked. DONE and ENTERED this 30th day of March, 1983, in Tallahassee, Florida. P. MICHAEL RUFF, 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 30th day of March, 10983. COPIES FURNISHED: Chris D. Rolle, Esquire Department of Legal Affairs The Capitol Tallahassee, Florida 32301 Thomas K. Thomas, M.D. 842 Moorland Grosse Point Wood, MT 48236 Dorothy J. Faircloth, Executive Director Board of Medical Examiners Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issue presented is whether Petitioner's application for licensure as a physician by examination pursuant to Section 458.311(8), Florida Statutes, should be granted.
Findings Of Fact Petitioner attended medical school in Cuba from September 1978 through July 1984. In that country, the academic year commences in September and ends in July. The medical school program in Cuba is a six-year curriculum which is divided into three phases, with each phase lasting two years. Phase I involves the study of normal structures and functions of the human body (basic science courses); Phase II involves the study of pathological structures and functions (clinical rotations in hospitals); and Phase III involves integral medical care. Clinical rotations continue through the first half of Phase III, the student's fifth year in medical school. During the second half of Phase III, the medical student undertakes a rotating internship in four disciplines or a vertical internship in an individual discipline. The four disciplines are internal medicine, pediatrics, obstetrics and gynecology, and surgery. The student must pass a theoretical and practical examination in each discipline in order to proceed to the next rotation. After the medical student successfully completes each Phase, including the internship, the student is awarded the degree of Doctor en Medicina. During Phase III, instruction is given in the form of lectures, small group seminars, individual instruction, practical training, and problem-oriented instruction. Students rotate to different teaching hospitals and polyclinics. At the teaching hospitals, students review clinical records with the principal professors and discuss, as a group, patient symptoms, diagnoses, and treatment. The polyclinics are neighborhood clinics emphasizing preventative medicine. While students are working at the polyclinics, they are not members of the staff; rather, the staff doctors supervise and consult with the medical students rotating through the various polyclinics. A medical student graduates after completion of the sixth year's curriculum without the necessity of taking a written examination. To practice medicine in Cuba, however, it is necessary for the medical school graduate to obtain a license and register with the national health registry. Upon registering, the physician receives a medical card, which carries the picture and signature of the physician. Petitioner completed a rotating internship from September 1983 through July 1984 as part of her medical education. She was assigned to a physician/specialist in each field of study during her internship rotation. She examined patients in front of her fellow students and/or the professor. She participated in discussions regarding pathology or symptoms, particular diagnoses, and appropriate treatments. She interviewed patients, performed physical examinations, and ordered laboratory tests if indicated. She did not participate in surgical procedures during the surgical rotation of her internship. Although Petitioner completed her medical school curriculum in July 1984, she did not receive a diploma. She did not register with the national registry and, therefore, did not receive a medical card. In September 1984 Petitioner left Cuba and went to Venezuela. Petitioner offered no evidence as to her activities from July 1984 when she completed her medical school curriculum until September 1984 when she left Cuba. Petitioner has taken the examination offered by the Educational Commission for Foreign Medical Graduates once, but she did not receive a passing grade on that examination.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered denying Petitioner's application for licensure pursuant to Section 458.311(8), Florida Statutes. DONE and ENTERED this 22nd day of June, 1995, at Tallahassee, Florida. LINDA M. RIGOT, 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 22nd day of June, 1995. APPENDIX TO RECOMMENDED ORDER Petitioner's proposed findings of fact numbered 1, 4, 5, and 5 [sic] have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed finding of fact numbered 2 has been rejected as not constituting a finding of fact but rather as constituting a conclusion of law. Petitioner's proposed finding of fact numbered 3 has been rejected as not being supported by the evidence in this cause. Respondent's proposed findings of fact numbered 2-9 have been adopted either verbatim or in substance in this Recommended Order. Respondent's proposed findings of fact numbered 1 and 10 have been rejected as not constituting findings of fact but rather as constituting conclusions of law. COPIES FURNISHED: Frank Valladares, Esquire 2955 Southwest 8th Street Suite 204 Miami, Florida 33135 Gregory A. Chaires, Esquire Christopher E. Butler, Legal Intern Office of the Attorney General Suite PL01, The Capitol Tallahassee, Florida 32399-1050 Dr. Marm Harris, Executive Director Agency for Health Care Administration Board of Medicine 1940 North Monroe Street Tallahassee, FL 32399-0770 Tom Wallace, Assistant Director Agency for Health Care Administration 2727 Mahan Drive Fort Knox Building 3, Suite 3431 Tallahassee, Florida 32308-5403 Sam Power, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive Fort Knox Building 3, Suite 3431 Tallahassee, Florida 32308-5403
Findings Of Fact Petitioner, Immaculate Espejo Asuncion, of St. Paul, Minnesota, filed an application with Respondent, Board of Medical Examiners, on September 21, 1982, for licensure by endorsement to practice medicine. (Testimony of Petitioner, Joint Exhibit No. 1) On March 7, 1983, Respondent issued a Notice of Intent to Deny Endorsement Licensure on the grounds that Petitioner had not obtained a 75 percent FLEX weighted average on the licensure examination of the Federation of State Medical Boards of the United States, Inc., as required by Rule 21M- 29.01(2), Florida Administrative Code, and was not certified by the National Board of Medical Examiners as having completed its examination within the ten years immediately preceding the filing of the application for licensure by endorsement, as required by Section 458.313(1)(d), Florida Statutes. Petitioner thereafter requested a hearing on the proposed denial of her application. (Testimony of Faircloth, Joint Exhibit No. 1) Petitioner was licensed to practice medicine in the state of Minnesota in 1978. She obtained such licensure by satisfactorily passing the clinical science and clinical competence portions of the FLEX examination, and by successfully completing a basic sciences examination administered by the Minnesota State Board of Examiners. (Testimony of Petitioner, Joint Exhibit No. 1) Petitioner is a graduate of a foreign medical school and is therefore not eligible to take the examination of the National Board of Medical Examiners. The alternate method of obtaining licensure by endorsement is by certification through licensure examination of the Federation of State Medical Boards of the United States, Inc. (FLEX). This examination has three parts and is taken over a period of three days. The three parts of the examination are basic science, clinical science, and clinical competence. The scores on the three parts are averaged under a formula to produce a weighted average score. Respondent's Rule 21M-29.01(2), Florida Administrative Code, requires that an applicant have a FLEX weighted average of 75 percent from one complete sitting on the examination. Petitioner took only the clinical science and clinical competence portions of the examination and therefore did not obtain a certified FLEX weighted average score. The Minnesota basic sciences examination taken by Petitioner was not the same basic sciences examination administered as part of the FLEX examination. (Testimony of Faircloth, Joint Exhibit No. 1)
Recommendation That Respondent enter a Final Order denying Petitioner's application for licensure by endorsement. DONE and ENTERED this 16th day of June, 1983, in Tallahassee, Florida. THOMAS C. OLDHAM 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 16th day of June, 1983. COPIES FURNISHED: Immaculate Espejo-Asuncion, M.D. Dorothy J. Faircloth 80 Battle Creek Place Executive Director St. Paul, Minnesota 55119 Board of Medical Examiners 130 North Monroe Street John Griffin, Esquire Tallahassee, Florida 32301 Department of Legal Affairs The Capitol Tallahassee, Florida 32301 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue At issue in this proceeding is whether petitioner's application for a medical license by endorsement should be approved.
Findings Of Fact The Findings of the Facts of tbe Recommended Order are adopted by the Board of Medicine as being based on competent substantial evidence.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered certifying petitioner's application to the Department of Professional Regulation, for licensure by endorsement with, should the Board be persuaded that such is appropriate, placement of petitioner on probation for such term and subject to such conditions as the Board may reasonably specify. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 24th day of April 1991. WILLIAM J. KENDRICK 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 24th day of April 1991.
The Issue The primary issue in this case is whether Petitioner is qualified for reinstatement of his license to practice medicine in the State of Florida. There are two principal areas of concern: Petitioner's conviction of illegally dispensing a controlled substance in Dougherty County, Georgia, on March 19, 1982; and Whether Petitioner has obtained the 36 hours of Class I Continuing Medical Education (CME) credit required (12 hours for each year his license was inactive since 1979).
Findings Of Fact The Petitioner, Fred Louis Vidal, M.D., obtained licensure in Florida in 1949, holding License #4369. In 1966, Petitioner's license was suspended for nonpayment of fees. Section 458.321, Florida Statutes (1979), requires the Board of Medical Examiners to adopt a rule setting forth the type and required number of hours of Continuing Medical Education (CME) needed to reactivate a license. The Board's rule concerning this is Rule 21M-28.01, Florida Administrative Code, which requires 12 hours per year for each year the license is inactive. Therefore, Petitioner must show evidence of 36 hours of Class I, American Medical Association CME. Petitioner's request for reinstatement was denied by Order of the Board rendered March 9, 1982. The Board's Order contained a typographical error which was corrected by its Amended Order rendered on March 22, 1982. Petitioner offered no evidence at the hearing or before the record was closed on June 7, 1982, proving his attendance at any Class I, AMA approved CME courses. Petitioner testified that on March 19, 1982, he was convicted for illegally dispensing a controlled substance in Dougherty County, Georgia. The sentence ordered by the court in this case placed Petitioner on probation for five years and provided that he not practice medicine in the State of Georgia during that period of probation. Regarding his conviction, Petitioner was convicted of prescribing Percodan to a nurse who worked for the group of physicians employing the Petitioner. He prescribed Percodan for this nurse because she was suffering from severe headaches associated with tension. Petitioner stopped prescribing for the woman when he ceased to work for the group. Petitioner had warned the woman about depending upon the drug, but while working with her he saw no evidence that she was abusing it. At the time he left the group he ceased to write prescriptions for this woman.
Recommendation Having failed to show that he has the required number of Continuing Medical Education units, it is determined that the Petitioner, Fred Louis Vidal, M.D., is not qualified at this time for reinstatement of his license, and it is recommended that his application be denied. DONE and ORDERED this 22nd day of July, 1982, in Tallahassee, Leon County, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 22nd day of July, 1982. COPIES FURNISHED: Fred Louis Vidal, M. D. 20 Wayah Street Franklin, North Carolina 28734 Chris D. Rolle, Esquire Assistant Attorney General Department of Legal Affairs The Capitol, Suite 1602 Tallahassee, Florida 32301 Dorothy Faircloth, Executive Samuel Shorstein, Secretary Director Department of Professional Board of Medical Examiners Regulation 130 North Monroe Street 130 North Monroe Street Tallahassee, Florida 32301 Tallahassee, Florida 32301
Findings Of Fact The parties stipulated as follows: Raul Ivan Vila, Petitioner, applied to Respondent for licensure by endorsement after having graduated from a foreign medical school, passed the Federation Licensing Examination (FLEX) and having been certified by the Educational Commission for Foreign Medical Graduates (ECFMG). He was denied licensure on the grounds that the supervised clinical training he received in the United States was not obtained in wither a hospital affiliated with a medical school approved by the Council on Medical Education of the American Medical Association, or in a residency program approved by the Accreditation Council for Graduate Medical Education as required by Rule 21M-22.18, Florida Administrative Code, which took effect on November 28, 1984. Petitioner had completed his supervised clinical training in the United States and had received his medical degree prior to the effective date of this rule. Petitioner's application would also be denied under amended Rule 21M-22.18, Florida Administrative Code, which took effect on March 13, 1985, because the supervised clinical training he received in the United States was not obtained in either a hospital affiliated with a medical school accredited by the Liaison Committee on Medical Education, or in a residency program accredited by the Accreditation Council for Graduate Medical Education in the specialty area in which the clinical training is obtained. The following findings are based upon the evidence received and matters officially recognized: The Board adopted Rule 21M-22.18, which took effect on November 28, 1984, and it provided: Foreign Medical Graduates: Qualification Re- quirements. Before any foreign medical school graduate, except a graduate of an approved school in Canada, is admitted to take the writ- ten licensure examination or be licensed by endorsements [sic], he or she must demonstrate (in addition to other requirements set forth in Chapter 458, F.S.) that the supervised clinical training received in the United States as part of the curriculum of the foreign medi- cal school was obtained either in a hospital affiliated with a medical school approved by the Council on Medical Education of the Ameri- can Medical Association or in a residency pro- gram approved by the Accreditation Council for Graduate Medical Education. The Board subsequently amended Rule 21M-22.18, and the amendment took effect March 13, 1985, to provide: Foreign Medical Graduates: Qualification Requirements. Before any gra- duate of a medical school not accredited by the Liaison Committee on Medical Education, ex- cept a graduate of an accredited school in Canada, is admitted to take the written licen- sure examination or be licensed by endorsement, he or she must demonstrate (in addition to other requirements set forth in Chapter 458, F.S.) that the supervised clinical training re- ceived in the United States as part of the cur- riculum of the medical school was obtained either in a hospital affiliated with a medical school accredited by the Liaison Committee on Medical Education or in a residency program accredited by the Accreditation Council for Graduate Medical Education in the specialty area in which the clinical training is being obtained. This rule, as well as its amendment, were adopted to implement Sections 458.311 and 458.313(4), Florida Statutes. The Liaison Committee on Medical Education, which reviews and accredits medical schools in the United States, has adopted standards for the accreditation of medical education programs which were ratified by the Council on Medical Education of the American Medical Association on March 1, 1985, and the Executive Council of the Association of American Medical Colleges on April 4, 1985, and which state in part: The traditional required clinical subjects, which should be offered in the form of requir- ed experiences in patient care (customarily called clerkships), are internal medicine, ob- stetrics and gynecology, pediatrics, psychia- try and surgery. Additionally, many schools require a clerkship in family medicine. . . . Each required clinical clerkship must allow the student to undertake thorough study of a series of selected patients having the major and common types of disease problems represent- ed in the primary and related disciplines of the clerkship. . . . The required clerkships should be conducted in a teaching hospital or ambulatory care fa- cility where residents in accredited programs of graduate medical education, under faculty guidance, may participate in teaching the stu- dents. In an ambulatory care setting, if faculty supervision is present, resident par- ticipation may not be required. If required clerkships in a single discipline are conduct- ed in several hospitals, every effort must be made to ensure that the students receive equivalent educational experiences. No schools outside the United States are accredited by the Liaison Committee. According to Charles P. Gibbs, M.D., Assistant Dean for Curriculum at Shands Teaching Hospital, chairman of the clerkship committee at Shands, and an expert in medical education, clerkships are an essential part of a medical education because they are the first time the student is introduced to the real practice of medicine and contact with patients in a supervised setting. Clerkships occur in the third and fourth years of a medical education, after the student has had courses in the basic sciences, pathology, pharmacology and an introduction to clinical medicine. During a clerkship, the student participates as part of a team and does patient histories, physicals, participates in discussions about patient care, observes operations and attends lectures. Clerkships are usually taken in fields such as obstetrics and gynecology, pediatrics, internal medicine, surgery, community health, family medicine and psychiatry. The Liaison Committee reviews the clinical clerkship program as part of the accreditation process. Dr. Gibbs testified that written exams, such as FLEX or the National Board, are important in measureing a student's cognitive knowledge and determining minimum qualifications, but cannot measure clinical qualities of a doctor such as how he works with colleagues, and how he communicates. Clerkships are important in determining a student's performance level in these clinical qualities. Robert B. Katims, M.D., testified as a member of the Board and Chairman of the Foreign Medical Graduates Committee of the Board. As Committee Chairman he had noted problems with the clinical experience being received by graduates of certain foreign medical school that are not accredited by the Liaison Committee. All medical schools in the United States are accredited. Dr. Katims observed that problems with the clinical experience offered at these foreign medical schools arise because there are not enough teaching hospitals in some foreign countries, and therefore students must arrange their own clinical experience in the United States. There have been repeated instances of little of or no supervision in these clinical experiences, which frequently consist of a one-on-one affiliation with a practicing physician with very little structured training. Under these circumstances, the foreign medical student does not receive the kind of supervised clinical training which is a vital part of a medical education.
The Issue Whether the Petitioner meets the requirements for licensure as a medical doctor set forth in Section 458.311(1)(c), Florida Statutes (1985), as required by Section 458.313(1), Florida Statutes (1985)?
Findings Of Fact In July of 1984, the Petitioner applied for licensure as a medical doctor by endorsement. The Petitioner's application was denied by the predecessor of the Respondent on June 17, 1985, for the following reason: The applicant has not completed an approved internship of at least one year or at least five years of licensed practice as required by Section 458.311(1)(c), Florida Statutes and Section 458.313(1), Florida Statutes. The Petitioner began postgraduate training at the University of Alberta on August 1, 1960, as a "Straight Intern - Division of Internal Medicine." The training program the Petitioner participated in was part of a four year program at the University of Alberta. The portion of the program which the Petitioner began started on July 1, 1960 and ended on June 30, 1961. Most of the students in the program began on July 1, 1960. The Petitioner was not able to begin on July 1, 1960 because of visa problems. Based upon a form filed with the Respondent by Dr. L. M. Anholt, Assistant Dean, Director, Division of Postgraduate Medical Education, at the University of Alberta, the Petitioner began the program on August 1, 1980, and ". . . continued in that program until 30 June 1981 at which time he did further two months (until 31 August 1981 in Paediatrics) at his request." [Emphasis added]. According to Dr Anholt, the Petitioner requested pediatrics training "because he was leaving the Department of Medicine and desired the additional experience prior to returning to the United Kingdom and continuing training." Based upon a letter from the Petitioner to the Respondent, dated November 13, 1984, the Petitioner took the two months of pediatrics training in order to obtain a license to practice medicine in Canada where he had passed the licensing exam. The Petitioner gave the following explanation for why he took the two months of pediatrics training: For an unrestricted license to practice medicine here in Alberta I had taken to complete a second post graduation year to include at least 2 months paediatrics, 2 months surgery and 2 months obstetrics. Dr. Anholt's predecessor as Director of Post Graduate Training assisted in arranging for me 2 months paediatrics but was unable to arrange the surgery or obstetrics. The University of Alberta subsequently issued a certificate to the Petitioner indicating that the Petitioner had satisfactorily performed the duties of "Straight Intern - Division of Internal Medicine" from August 1, 1980 until July 31, 1981. Based upon the foregoing the Petitioner completed 11 months of a program as a Straight Intern in the Division of Internal Medicine and two months of training in pediatrics as part of a second year of post graduate training.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medical Examiners enter an order denying the application of James McDonald for licensure by endorsement. DONE and ORDERED this 29th day of October, 1986, in Tallahassee, Florida. LARRY J. SARTIN 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 29th day of October, 1986. APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-0811 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 were accepted. Those proposed findings of fact which have been rejected and the reasons for their rejection have also been noted. Paragraph numbers in the Recommended Order are referred to as "RO Petitioner's Proposed Findings of Fact First Sentence: First Sentence: The first sentence of the Petitioner's proposed recommended order is a final recommendation and not a finding of fact. Second Sentence: The second sentence is accepted in RO 7. Third Sentence: The alleged steps followed before issuing "Statements of Training" are not supported by the record of the hearing in this case and are therefore rejected. Fourth Sentence: The fourth sentence is not supported by the record of the hearing in this case and is therefore rejected. Fifth Sentence: The fifth sentence is not a finding of fact and is therefore rejected. Sixth Sentence: The sixth sentence is not a finding of fact and is therefore rejected. Respondent's Proposed Findings of Fact Paragraph Number: Accepted in RO 1 and 2. Accepted in RO 3 and 4. Accepted in RO 5 and 6. Accepted in RO 7. Accepted in RO 8. COPIES FURNISHED: M. Catherine Lannon, Esquire Assistant General Counsel Administrative Law Section Department of Legal Affairs Room LL-04 - The Capitol Tallahassee, Florida 32399-1050 James McDonald Box 400 Leduc T9E2Y2 Alberta, Canada Ms. Dorothy Faircloth, Executive Director Board of Medical Examiners 130 North Monroe Street Tallahassee, Florida 32301
