Findings Of Fact Petitioner, Dr. Winifred Chambers received a master's degree in religion and art in 1957, a second master's degree in 1968 in philosophy with a specialization in ethics and social philosophy and a Ph.D. (with honors) in 1975 in the philosophy of science, all from the University of Chicago. While working on her dissertation, she studied at the Chicago Institute of Psychoanalysis. After working around hospitals and conducting classes and workshops on medical ethics for medical personnel, Petitioner decided to attend medical school. Because her educational training did not include extensive background in certain scientific areas, Petitioner was concerned with her ability to score well on the MCATS, which are the entrance examinations required by all medical schools in the United States. In addition, Petitioner's age (she was in her mid 40's at the time) was considered a negative factor by many medical schools in the United States. As a result, she inquired about attending certain foreign medical schools. She was limited in the schools that she could consider because she did not speak Spanish. Medical Education In 1979, Petitioner applied to the American University of the Caribbean (AUC). AUC taught its medical courses in English and Petitioner was only required to make up a few undergraduate science courses (including physics) in order to enroll in the medical school. Petitioner enrolled in classes at AUC in May of 1980. She actually started classes a few days after the semester began. She completed the first two semesters from May to December 1980 and then went home during the Christmas break. During the break, Petitioner learned that she had received an F in her course in neurosciences. Petitioner met with the professor from that course to discuss the failing grade she received and also met with the President of AUC. As a result of these meetings, it was her understanding that the grade was changed to a passing grade. In January of 1981, Petitioner visited CETEC (another Caribbean medical school located in the Dominican Republic,) and met with officials of the school to discuss transferring from AUC to CETEC. Petitioner applied to CETEC during her visit and, prior to leaving, was informed of her acceptance into medical school at CETEC. Petitioner returned to AUC and completed her third semester at the school. In May of 1981, she officially enrolled at CETEC by initiating clinical rotations at Sharp Hospital in San Diego, California. Even though Petitioner had only completed three semesters at AUC, she was granted status as a fifth semester medical student. She contends that she was granted this status based upon CETEC'S evaluation of her transcript and the number of hours she took at AUC. Prior to her enrollment at CETEC, Petitioner provided CETEC with a transcript indicating she had passed neurosciences at AUC and CETEC gave her credit for the course. From May 4, 1981 to June 6, 1982, Petitioner participated in clinical rotations at Sharp Memorial Hospital in San Diego, California as part of her medical education at CETEC. During this time period, Petitioner also participated in a clinical rotation at Children's Hospital in San Diego, California (from 12/28/81 to 2/20/82). Beginning in 1983, the media and some state licensing agencies began challenging the validity and/or authenticity of the credentials and training of some CETEC medical graduates. CETEC medical school was ultimately closed in 1984. The Dominican Republic government formed an agency to verify and certify the transcripts of CETEC graduates. This agency was called the "Counsel For Superior Education" also referred to by the acronym of CONES. CONES verified and certified the legitimacy of higher education credentials from all Dominican schools submitted to other countries. As part of her pending Florida Application, Petitioner has submitted a certification from CONES dated October 15, 1987 attesting to Petitioner's graduation from medical school at CETEC on June 12, 1982. Petitioner has also submitted a second certification from CONES dated July 8, 1988 confirming her graduation on June 12, 1982. Included as part of the documents submitted by Petitioner from CONES is a Certification of Clinical Rotations dated July 14, 1987 (the "CONES Report") and an academic transcript dated July 14, 1987 (the "CONES Transcript.") The "Education Commission For Foreign Medical Graduates" ("ECFMG") provides a certification of the education of applicants from foreign medical schools who seek licensure in the various United States and offers an examination required by some state licensing boards for licensure of applicants graduating from foreign medical schools. Petitioner passed the ECFMG examination and was certified by the ECFMG in 1982. However, after the CETEC scandal began in 1983, the ECFMG started an investigation of graduates of CETEC (including Petitioner) for the purpose of reverifying their medical training. The ECFMG required clearance from CONES of Petitioner's CETEC education before reverifying her ECFMG certificate. The ECFMG reinstated Petitioner's ECFMG certification on June 26, 1987. The earliest certification from CONES that has been submitted by Petitioner is dated July 14, 1987, approximately two and a half weeks after the ECMFG certification. It is not clear what the ECFMG relied upon in reissuing a certification to Petitioner. While Petitioner contends that CONES had originally certified her CETEC transcript shortly after her graduation in June of 1982, no competent evidence was presented to establish when or if an earlier CONES certification was issued. In any event, Petitioner currently holds a valid ECFMG certificate. In certifying Petitioner's medical degree from CETEC, CONES gave Petitioner credit for courses taken and work done at non-medical schools (i.e., the University of Chicago) prior to entering medical school. These credits are discussed in more detail in Findings of Fact 17. Although the ECFMG has apparently accepted CONES' certification of Petitioner's medical education at CETEC, there are several inconsistencies on the face of the CONES Report. The CONES Report states that during the period from May 4, 1981 to June 6, 1982, Petitioner completed fifty six (56) weeks of clinical rotations. However, in reaching this total the CONES Report provides one week of credit for a rotation (from 5/24/82 to 5/28/82) in obstetrics and gynecology which overlapped with another rotation (from 5/10/82 to 6/5/82) in obstetrics and gynecology. It it also provides double credit for a single two week clinical rotation (from 5/4/81 to 5/16/81) in obstetrics and gynecology. In addition, there are two periods of time (from 2/21/82 to 3/14/82 and from 4/25/82 to 5/9/82, which total approximately five (5) weeks), during which no clinical rotations were taken. Since the period between May 4, 1981 and June 6, 1982 consisted of approximately fifty seven (57) weeks, it does not appear that Petitioner actually completed fifty six (56) weeks of rotations as listed. Deleting the double credit received for the 5/4/81 to 5/16/81 clinical rotation, the CONES Report only appears to certify completion of fifty four (54 weeks) of clinical rotations. Moreover, those fifty four (54) weeks of rotations include one week of credit for five (5) days in obstetrics and gynecology (from 5/24/82 to 5/28/82) which directly overlapped a separately listed clinical rotation in obstetrics and gynecology, and one (1) week of credit for six (6) days in obstetrics and gynecology from 6/1/82 to 6/6/82. Thus, on the face of the CONES Report it appears that Petitioner actually completed only fifty three (53) weeks of rotations at most. This conclusion is bolstered by the fact that, according to the CONES Report, there were approximately five (5) weeks of the fifty-seven (57) week period during which no clinical rotations were taken. Petitioner contends that the CONES Report fails to take into account a five (5) week clerkship in family medicine which she completed at Sharp Hospital and which was accepted by the ECFMG when Petitioner applied for licensure in California. This clerkship is reflected in the CETEC Transcript even though it is not reflected in the CONES Report. It is not clear why this rotation was not included in the CONES Report However, the evidence did establish that Petitioner completed the rotation. One of the five weeks of this family medicine rotation overlaps with an OB/GYN rotation (from 5/4/82 -5/8/82). The time frame of the family medicine rotation roughly coincides with the period of time during which no rotations are reflected in the CONES Report. Thus, this rotation would only add four more weeks to the clerkship total listed on the CONES Report. Even if this four week rotation is added to the fifty three (53) weeks certified in the CONES Report, the Report would still only indicate that Petitioner completed a total of fifty seven (57) weeks of clinical rotations. According to the boiler-plate language on the CONES Report, sixty (60) to seventy-two (72) total weeks of clinical rotations had to be completed by CETEC students who took their clinical rotations outside of the Dominican Republic. Thus, the CONES Report does not reflect completion of the required weeks of clinical rotations even though CONES has issued a certification that purports to certify successful completion of the degree requirements. This discrepancy has not been adequately explained. The CONES Report does not reflect any clinical rotations by Petitioner in psychiatry. However, the CETEC Transcript does indicate that Petitioner was granted eight hours credit for her graduate studies at the University of Chicago from 1971-1973. Petitioner contends she is entitled to at least four hours of clerkship in psychiatry for those studies. However, it appears from the CONES Transcript that the credit she received was applied towards classes in Human Conduct which were a part of the curriculum during the first two years of medical school. There is no evidence to indicate that CETEC or CONES granted or should have granted Petitioner credit for clinical rotations in psychiatry based upon her graduate studies at the University of Chicago. During a three week period (between her second and third semesters at AUC) from December 20, 1980 to January 10, 1981, Petitioner participated in an OB/GYN clinical rotation at Sharp Memorial Hospital in San Diego, California (hereinafter this rotation will be referred to as the "Unsanctioned Rotation.") This rotation is usually not done until after a student completes the third semester of medical school. Petitioner's participation in this Unsanctioned Rotation was not authorized by any medical school and was not a part of any medical school program. Petitioner contends that she satisfied the required sixty (60) clerkship weeks if the Unsanctioned Rotation at Sharp Hospital from December 20, 1980 to January 10, 1981 is added to the undisputed clinical rotations and the family medicine rotation discussed in Findings of Fact 15. However, the Unsanctioned Clerkship was not accepted by CONES and Petitioner has not provided sufficient evidence to establish that it should be counted towards her required clinical rotations. Although CETEC had previously granted Petitioner credit for the neurosciences course at AUC, CONES was not able to verify that Petitioner passed the course and CONES required Petitioner to retake the course in order to obtain the 1987 certification from CONES. Petitioner attended Northwestern University during the spring quarter of 1987 and completed a four credit hour course (based on a quarter system) in neurosciences. This neurosciences course was apparently given five hours ex post facto credit by CONES to fulfill the neurosciences requirement for Petitioner's 1982 CETEC medical diploma. From December, 1987 to March, 1988, Petitioner attended Xochicalco Medical School in Ensenada, Mexico in order to take additional coursework in partial fulfillment of a requirement by the California licensing board in a stipulated agreement for additional medical training before licensure. (Petitioner's stipulation with the State of California is discussed in more detail in Findings of Fact 47-50.) The courses taken at Xochicalco were approved by the California licensing agency and included clinical pathology, pharmacology (two courses) and physiology (two courses). Petitioner successfully passed all of the courses. However, no evidence was presented as to the accreditation status of this school. Petitioner completed a five week rotation in emergency medicine at Cruze Roja Hospital in Mexico in 1988 while she was completing the remedial science classes required by the California Licensing Board. Post-Graduate Training Petitioner completed one year of post graduate training from July 1, 1982 to June 30, 1983 in the family medicine residency program at Holston Valley Community Hospital through East Tennessee State University's Quillen-Dishner College of Medicine. Petitioner has presented a certificate verifying succcessful completion of her first post graduate year of training in this program. Petitioner performed her residency at two hospitals which are part of the East Tennessee State University Quillen-Dishner College of Medicine: Kingsport Family Practice Center and Holston Valley Community Hospital. She saw patients at the Kingsport Family Practice Center for 7 months, one afternoon each week under the supervision of various physicians. The rest of Petitioner's residency was performed at the Holston Valley Community Hospital. Dr. Lee S. Hyde was the program director of the Kingsport Family Medicine Center. Petitioner's contact with Dr. Hyde was limited, but she did have several consultations with him about patients. In an evaluation submitted to the Florida Board of Medicine in connection with Petitioner's application for licensure, Dr. Hyde evaluated Petitioner's diagnostic ability and relationships with patients as poor. He also stated that Petitioner came to the program with a "poor fund of knowledge, clinical habits, and basic medical education". Although he felt Petitioner made progress during the residency program, he did not think it was sufficient. However, his overall evaluation was to recommend with reservations. Dr. Hyde's evaluation of Petitioner to the Board was received by the Board on July 18, 1983. Dr. Hyde noted on the back of the evaluation form that Petitioner was not ready to begin a second year of unsupervised practice. Petitioner was not and would not have been offered a contract for a second year in the residency program. Dr. Hyde also commented that Petitioner demonstrated poor judgment by once going "AWOL" from the program. While Petitioner did take a three (3) day leave over a weekend while assigned to a particular rotation with another physician contrary to the rules of the program, she did so with the permission of her supervisor at the time. Prior to the negative evaluation submitted by Dr. Hyde in July of 1983, Dr. Hyde had previously written a letter dated March 24, 1983 to the Florida Board of Medicine recommending Dr. Chambers for licensure stating that she was in good standing with the program and of reasonable professional competence and excellent moral character. Leslie P. Reynolds, Jr., M.D., was a professor of Family Medicine, assistant Dean, and Director of Medical Education at the Holston Valley Hospital during Petitioner's year of residency. In a June 29, 1983 evaluation form submitted to the Florida Board, Dr. Reynolds, gave an evaluation of Petitioner's performance during the family medicine residency and recommended her as an outstanding applicant. Dr. Reynolds subsequently submitted an affidavit to the Florida Board of Medicine dated October 21, 1987 attesting that Petitioner earned the respect of both her instructors and fellow residents and that the hospital's records suggest that she performed well on all her services and that she was very helpful to other residents. Several other physicians who served as clinical supervisors during Petitioner's residency at Holston Valley have submitted letters of recommendation and virtually all other evaluations of her work were positive. Aside from the letter from Dr. Hyde, (Dr. Hyde did not testify and his letter is hearsay,) no other evidence was presented to demonstrate that Petitioner is incapable of practicing medicine with reasonable skill and safety. The weight of the evidence established that Petitioner is capable of practicing with reasonable skill and safety. Numerous letters from the physicians who have worked with Petitioner over the last several years corroborate to her ability to practice medicine with reasonable skill and safety. Petitioner was employed as a house physician at Jackson Memorial Hospital in Miami from July 11, 1983 to October 31, 1983. Her position was under the supervision of the Department of Family Medicine in the Ambulatory Care Unit of the Emergency Room Department and the Family Medicine Clinical Faculty from the University of Miami. However, the position was not an advanced residency program and the nature of the supervision and training that Petitioner received has not been fully explained. Furthermore, the evidence did not establish the exact nature of her duties and functions. From October 1984 to March 1985, Petitioner participated in a series of clinical rotations at the Wesley Medical Center which is affiliated with the University of Kansas. The exact nature of Petitioner's position is not clear. The position at the Wesley Medical Center was a non-paying position during which Petitioner completed an eight week rotation in Internal Medicine, twelve weeks in General Surgery and four weeks in psychiatry functioning in each rotation at the level of a first-year resident. Petitioner was not officially enrolled as a resident in this program. However, she did receive evaluations from the attending physicians and her evaluations by the supervising physicians in that program were acceptable. In 1988, Petitioner completed an eight month internship at Universal Medical Center in Plantation, Florida Universal Medical Center is an osteopathic teaching institution. This internship was undertaken to satisfy a requirement of the California licensing authority for eight months of "remedial" clinical work. See, Findings of Fact 50. Petitioner was evaluated as performing in a competent and professional manner in this program. At the Universal Medical Center, Petitioner completed thirty three (33) weeks of clinical rotations. The program extended from March 21, 1988 through November 3, 1988. Her duties and responsibilities were similar to other interns in the program. In sum, Petitioner has successfully completed several additional science courses and completed at least thirty eight (38) additional weeks of clinical training beyond her medical school rotations and first post-graduate year residency. Those weeks of training include thirty three (33) weeks at Universal Medical Center which is an approved osteopathic medical training program that was accepted by the California Licensing Agency for purposes of Petitioner's remedial clinical work. Licensure Applications Petitioner passed the FLEX exam in June, 1982 with a score of 78. She also passed the ECFMG exam in January, of 1982 with a score of 76. In addition, she passed an oral examination administered by the California State Licensing Board in 1988. After graduating from CETEC in June 1982, Petitioner initiated efforts to obtain licensure in several states. In her initial attempts at licensure, Petitioner submitted several misleading applications which have backfired into a morass of complications and confusion. In 1982, Petitioner knowingly submitted a fraudulent application to the State of Oregon. Petitioner filed the application with the Oregon licensing authority in order to take the Federal Licensing Examination known as the FLEX. Oregon was one of the few states which allowed applicants to take the FLEX examination prior to graduation and also granted applicants some choice in the location of the exam. Petitioner took the FLEX in the Virgin Islands in June of 1982. This was the nearest location to the Dominican Republic where she was attending graduation ceremonies at CETEC around the same time. On the application to take the FLEX exam filed with Oregon, Petitioner falsely stated that she attended AUC from May, 1979 to April, 1981. She actually attended AUC from May, 1980 through April, 1981. In the early part of 1983, Petitioner submitted applications for licensure to South Carolina, California, Georgia, New Mexico, and Florida. South Carolina determined that Petitioner was not eligible for licensure in that state because she had not completed the required post-graduate training. Her application for licensure in that state was returned without action. In her applications to Georgia, California and Florida in 1983, Petitioner misrepresented her attendance at CETEC as having commenced in May, 1979 rather than reporting attendance at AUC starting in May, 1980 and ending in May, 1981 when she transferred to CETEC. Petitioner admits that she falsely stated that she began her medical education in May, 1979 on the Oregon FLEX application, as well as the California, Georgia and 1983 Florida applications. In an attempt to justify these false statements, Petitioner points out that the Dean from CETEC had issued a letter to these licensing agencies stating that Petitioner had completed eight (8) semesters at CETEC from 1979 to 1982. Petitioner claims she completed the misleading applications because she wanted her statements to be consistent with the CETEC Dean's certification of attendance. It would appear that an additional motivation for falsifying the applications was to avoid having to explain that she had received medical education credit for some of her non-medical course work at the University of Chicago approximately ten years earlier. It is unclear why the Dean's certification letters were not accurate. While no evidence was presented to directly link Petitioner to the issuance of these incorrect Dean's letters, the shady circumstances surrounding her involvement with Pedro de Mesones around this same time period (discussed in Findings of Fact 87-95 below) leads to an inference that Petitioner was at least indirectly responsible for these misleading letters. In her February 1983 application to New Mexico, Petitioner accurately stated the dates and locations of her medical school education. No adequate explanation was given as to why the correct dates were listed on this 1983 application but not the other applications filed around the same time in Georgia, Florida and California. Petitioner listed the correct dates of attendance at AUC and CETEC on her 1984 Florida application and the 1988 filing which are discussed in more detail in Findings of Fact 69-72 below. Georgia and New Mexico granted Petitioner licensure based upon the 1983 applications. California initially denied her licensure. However, as described in Findings of Fact 47-51 below, Petitioner challenged that decision. Florida permitted Petitioner to withdraw her 1983 Application rather than go to hearing on the Board's intent to deny licensure. See Findings of Fact 67-68. Petitioner's application for licensure in California was filed in the Spring of 1983. Petitioner received a letter in April of 1983 returning her application without action. Petitioner requested reconsideration of her application which, eventually, resulted in a proposed order of denial dated June 9, 1986. Petitioner requested a hearing on that proposed denial. The proposed denial was resolved without hearing by a stipulation between Petitioner and the California licensing agency in an order dated November 5, 1987 (the "California Stipulation"). The stipulated findings of fact in the November 5, 1987 California Stipulation recognize that the application filed by Petitioner in March, 1983 remained pending without action until the 1987 California Stipulation was entered. The California Stipulation notes that the proposed denial of her application in 1986 was based on the grounds that: (a) Petitioner had not listed on her application her attendance at AUC; (b) she had falsely stated under oath that she began her medical education at CETEC beginning in May, 1979; and (c) her medical education did not conform to California requirements. The California Stipulation provides that it supersedes the reasons set forth in the 1986 proposed denial so long as Dr. Chambers abides by the terms of the Stipulation. The California Stipulation makes no findings of fact or conclusions of law regarding wrongdoing on the part of the Petitioner. The California Stipulation provides that Petitioner would be issued a license to practice medicine in California upon completion of remedial medical education specified in the Stipulation, completion of an additional academic year of clinical training before September, 1990, satisfactory proof of certification by CONES, and passage of an oral examination. The California Stipulation also provides that Petitioner shall take forty (40) hours of continuing medical education within the first two (2) years of licensure in addition to the continuing education classes statutorily required for licensure in California. Petitioner was issued her license to practice medicine in California on November 11, 1988 demonstrating that she satisfied the requirements of the November 1987 California Stipulation. In her application to the State of Georgia in June of 1983, the Petitioner specifically represented that she attended CETEC from May of 1979 to April 1980, attended AUC from April, 1980 to May, 1981 and CETEC again from April 1981 through June, 1982. The Dean of CETEC certified to the Georgia licensing agency that Petitioner enrolled in the school of medicine in May, 1979 and attended eight semesters of 4.2 months each. As discussed in Findings of Fact 43, the basis for this certification by the Dean is unclear. Petitioner obtained a license to practice medicine in Georgia based on her 1983 application and did in fact practice medicine in that state from January, 1984 to August, 1984. On August 17, 1984 the Georgia State Board of Medical Examiners issued a Notice of Hearing to Petitioner setting forth charges against her including failure to meet the standards for licensure and/or intentionally making false statements in obtaining a license to practice medicine. The charges also included an allegation that Petitioner "was denied a license by the Board of Medical Quality Assurance of the State of California based on evidence of making false statements on a sworn application and submitting false and/or inaccurate certificates of education to obtain a license to practice in that state." In fact, in 1984 the California licensing authority had not formally denied Petitioner's application for licensure. The proposed denial of Petitioner's California application was pending, but not acted upon. Indeed, a formal denial of her California application was never finalized. Instead, the issues were resolved by the California Stipulation in November, 1987. On September 22, 1984, Petitioner executed a "Voluntary Surrender" which was approved by the Georgia State Board of Medical Examiners and served as the final order of that agency with respect to the Notice of Hearing discussed in Findings of Fact 54. By voluntarily surrendering her license to practice medicine in Georgia, Petitioner waived her right to a hearing on the charges contained in the Notice of Hearing. The first paragraph of the "Voluntary Surrender" states: "I hereby acknowledge that this surrender shall have the same effect as revocation of my license, and I knowingly forfeit and relinquish all right, title and privilege of practicing medicine in the State of Georgia, unless and until such time as my license may be reinstated, in the sole discretion of the Board." Notwithstanding this language, Petitioner contends the "Voluntary Surrender" should be distinguished from a revocation because she did not admit to any wrongdoing and because she was allowed to seek reinstatement upon application and demonstration of the ability to safely practice medicine. The Voluntary Surrender of the Georgia license contains no specific findings of fact or conclusions of law that establish any wrongdoing on the part of the Petitioner. The "Voluntary Surrender" states that Petitioner did not admit to any wrongdoing and it allows Petitioner to seek reinstatement. The Executive Director of the Composite State Board of Medical Examiners of Georgia certified to the Florida Board of Medicine on August 2, 1988, that Petitioner's Georgia license had been issued in 8/83, surrendered in 9/84 and that license had not been "suspended or revoked." Thus, while disciplinary action was clearly initiated against Respondent in Georgia, her license was not revoked. Petitioner was licensed to practice medicine in the State of New Mexico in November, 1983. On January 10, 1985, the New Mexico Board of Medical Examiners served on Petitioner a Notice of Contemplated Action notifying her of charges including having made misrepresentations in applying for and procuring a license to practice medicine in New Mexico and having her license in Georgia revoked. The New Mexico case was referred to a hearing officer who considered argument and briefs by the parties regarding the nature and effect of Petitioner's surrender of her Georgia license. By an order of the New Mexico State Board of Medical Examiners, Petitioner's New Mexico medical license was revoked in January, 1986. The New Mexico order of revocation treated Petitioner's voluntary surrender of her Georgia medical license as the functional equivalent of a revocation for purposes of the New Mexico licensing statute. In reaching this determination, the New Mexico Board relied upon the wording of the Voluntary Surrender and the Georgia Statutes which both indicate that a voluntary surrender shall have the same effect as revocation. No other specific grounds were cited by the New Mexico Board in its Findings of Fact and Conclusions of Law, Decision and Order. As indicated above, Petitioner's initial application to the Florida Board of Medicine (the "Board") for licensure was filed March, 1983. When the Board proposed denial, Petitioner requested a formal hearing. Prior to hearing, the Board obtained leave from the hearing officer to amend the basis for denial to include grounds relating to information presented to the Board by U.S. Postal Service investigators regarding Petitioner's truthfulness on her application form and the validity of certain documents she utilized in her attempt to obtain a Florida medical license. The Board was granted leave to amend as requested by order dated February 20, 1984. Shortly thereafter, Petitioner filed with the hearing officer a motion to withdraw her application because of the new information presented from the "federal investigation." The Board granted the request to withdraw the 1983 Application in an order rendered May 29, 1984. The Board's proposed denial of Petitioner's 1983 Application was on the basis that the Board had reason to believe that Petitioner, "as a graduate of CETEC, was not capable of safely engaging in the practice of medicine as a result of a report of the California Board of Medical Quality Assurance which indicated gross irregularities in the degree granting process of CETEC University and which raised serious doubts about the adequacy of medical education certified by CETEC." Petitioner filed with the Board a second application for licensure in Florida in December of 1984 (hereinafter referred to as the 1984 Application.) In response to a request for additional information from the Board regarding this second application, Petitioner executed a waiver of the requirement that the Board act upon the application within 90 days. As a result, the 1984 Application was left pending. The 1984 Application was for licensure by endorsement based upon Petitioner's license in New Mexico. As discussed in Findings of Fact 62-66, action was initiated against that New Mexico license in January, 1985 ultimately leading to the revocation of the license in January, 1986. After her New Mexico license was revoked, Petitioner did not hold a valid license to practice medicine in any other state until California issued her a license in November, 1988. On August 1, 1988, Petitioner filed another application with the Board as an update to the 1984 Application. (This August 1988 application is referred to as the "1988 Filing.") In her 1988 Filing, Petitioner included a recertification from ECFMG. At the time she filed her 1984 Florida application, Petitioner's original ECFMG certification had been placed on hold because of the CETEC scandal. Petitioner was required to provide a revalidation of her medical education by ECFMG in order to obtain consideration of her application in Florida. This revalidation was not provided until the 1988 Filing. On September 12, 1988, Petitioner filed a supplement to the 1988 Filing. On November 2, 1988 the Board requested additional information relating to the application. On December 12, 1988 Petitioner filed a response to this request. The Board issued an Order of Intent to Deny on March 3, 1989 stating as grounds for denial in Paragraph 2: You have had licenses in Georgia, New Mexico and California acted against by the licensing bodies of those states. See, Subsections 458.331(1)(b) and 458.311(1)(d), Florida Statutes (1988). The only year of training you received was in 1982-1983 at Holston Valley Community Hospital and the Kingsport Family Practice Center through the auspices of East Tennessee State University Quillen-Dishner College of Medicine. You were recommended less than favorably by both hospitals and you were not permitted to return for a second year of residency training by the College of Medicine. Your poor performance in your only year of medical training evidences your inability to practice medicine with reasonable skill and safety. See, Sections 458.301 and 458.331(4), Florida Statutes (1988). There are material discrepancies between answers and information provided in your 3 different applications and supporting documents submitted to the Board; and you have provided fraudulent information and misrepresented or concealed information regarding your medical education. See Subsections 458.311(1)(c) and 458.331(1)(a) and (hh), Florida Statutes (1988). Inconsistencies in the Application There are several discrepancies between Petitioner's 1983 Florida Application, her 1984 Application, and her 1988 Filing. On the 1984 Application, Petitioner reported her participation in the Unsanctioned Rotation at Sharp Memorial Hospital from December 20, 1980 to January 10, 1981 as part of her clinical clerkships. The Unsanctioned Rotation is not listed on the 1988 Filing. Petitioner contends that it was not until after submission of the 1984 Application that she found out that CONES refused to recognize the clerkships taken in 1980 because Petitioner was not enrolled as a student at CETEC at the time. Therefore, Petitioner deleted those unapproved clerkship weeks from the 1988 Filing. However, while specific reference to the clerkship was deleted in 1988, Petitioner admitted at the hearing that she counted the Unsanctioned Rotation as part of sixty (60) weeks of clerkships claimed in the 1988 Filing. The 1988 Filing states Petitioner completed sixty (60) weeks of clinical clerkships as part of her medical education at CETEC. However, as discussed in Findings of Fact 13 through 18, Petitioner's submitted a CONES verification of clinical rotations that only details fifty six (56) weeks (including duplicate and overlapping credit) of clinical clerkships. In the 1988 Filing, Petitioner did report the actions taken against her medical licenses in Georgia and New Mexico and mentioned her problems obtaining licensure in California. On the 1984 Application, Petitioner responded to the question "Have you ever been notified to appear before any licensing agency for a hearing on a complaint of any nature, including, but not limited to, a charge or violation of the medical practice act, unprofessional or unethical conduct?" by stating "after my voluntary surrender, notice of hearing in Georgia, [sic] charging denial and Flafalse documents re licensure (both false)." Both the Notice of Hearing and the Voluntary Surrender in Georgia were issued prior to the completion of Petitioner's 1984 Florida Application. Thus, while Petitioner did disclose the voluntary surrender, she only provided a brief and somewhat misleading explaination. The 1984 Application does not mention Petitioner's application in South Carolina (which was returned without action) nor does it discuss Petitioner's licensure difficulties in California other than to say she had been denied a license because of "informal deficiencies." The 1984 Application also omits Petitioner's licensure problems in New Mexico which is understandable since the Notice of Contemplated Action in that case was not filed until January, 1985. The application form requires the applicant to list all universities or colleges where the applicant "took classes/received training." Petitioner listed her training at the University of Kansas, Wesley Medical Center under the medical education section of her 1984 Application. In the 1984 application, she refers to it as a "externship". That position is also listed in the medical education section of the 1988 Filing with an explanation indicating that she was not actually a resident. As discussed in Findings of Fact 30, her position at the Wesley Medical Center is not easily described due to the unusual circumstances that led to her participating in the program. She was repeating clerkships in certain areas in accordance with the stipulation reached with the California licensing agency. Although Petitioner was not officially enrolled in classes or a residency program in that position, she considers it as part of her medical education and training and, therefore, listed it as such. In her 1984 Application, Petitioner listed time spent at Jackson Memorial Hospital (University of Miami) and Wesley Medical Center (Unversity of Kansas) on a sheet entitled graduate and post-graduate education. On her 1988 Filing, she listed both positions as post-graduate training. Both of these positions were actually house staff positions rather than part of the training programs of the affiliated medical schools. In the 1984 Application, Petitioner listed her dates of training at the Wesley Medical Center as October, 1984 to April 1985 (which was her projected completion date.) The 1984 Application was filled out and filed with the Board in December 1984, four months prior to the projected completion date of the Wesley position. In the 1988 Filing, Petitioner listed her actual completion date of March, 1985, which was approximately two weeks earlier than the projected completion date referred to in the 1984 Application. From January 1984 to August 1984, Petitioner worked for Spectrum Emergency Care in emergency rooms and free-standing clinics in Georgia. Petitioner listed different dates of service with Spectrum on the 1984 Application and the 1988 Filing. Petitioner contends the differences are due in part because the 1988 Filing included employment at Spectrum in New Mexico in December 1984 and January 1985 after submission of the 1984 Application. However, the 1988 Filing states that Petitioner was continuously employed by Spectrum from January 1984 - January 1985. In fact, she was not employed during the months of August, September, October and November, 1984. Moreover, her employment with Spectrum in New Mexico in December, 1984 and January, 1985 overlaps with her "externship" at the Wesley Medical Center/University of Kansas which took place from October, 1984 through March, 1985. Apparently, this overlap was possible because her work for Spectrum in December, 1984 consisted of one weekend and a holiday and in January, 1985 consisted of one weekend. In sum, the 1988 Filing significantly overstates her actual experience with Spectrum. The 1988 Filing contains several inconsistent statements regarding Petitioner's employment as a ship's physician. Under the practice/employment section of that Filing, she states she was a ship's physician for SeaEscape from April, 1985 to September, 1985 and a ship's physician for Commodore Cruise Lines from February, 1986 to September, 1986. Later in the application, under postgraduate medical training and work experience, she states she was a Chief Medical Officer for cruise ships from April, 1985, through September, 1986. However, according to the previously cited information, for at least a four month period during that time frame, she was not employed. In another portion of her application, Petitioner lists under clinical medicine that she worked on the two ships from April, 1985 through September, 1987. Even assuming that there is a typographical error and Petitioner meant September, 1986 as indicated in the other listings, by deleting any reference to the four months that she was not employed, an impression is created that Petitioner has more clinical experience than was actually true. There is a conflict between the AUC transcript that Petitioner submitted with the 1988 Filing and earlier versions of the transcript that appear in her records. The course titles are consistent in the transcripts, but the numbers of some of the courses are different. Only the last digit of the course numbers are different. Whether a course is listed in the 100 series, 200 series and 300 series is consistent in all of the transcripts. The series numbers reflect first semester, second semester and third semester courses respectively. The AUC transcript submitted with the 1988 Filing was the most recent one obtained by Petitioner from AUC. That transcript was prepared in June, 1986 and reflects a failing grade in the neurosciences course. However, as discussed in Finding of Fact 4, that grade was changed to a passing grade as reflected in a 1981 transcript from AUC which was submitted to CETEC when Petitioner transferred to that school. No adequate explanation has been given to explain why the 1986 AUC transcript is not consistent with the earlier one. Postal Investigation The confusing circumstances surrounding Petitioner's medical education are further complicated by her involvement with Pedro de Mesones. The circumstances surrounding her involvement with Pedro de Mesones have not been fully explained. While Pedro de Mesones' exact status or position is unclear, Petitioner believed him to be a representative of CETEC. He has subsequently been convicted of mail fraud in connection with selling medical diplomas and has been sentenced to a federal prison term. Between July, 1981 and January, 1982, while Petitioner was conducting her clinical rotations in San Diego, she attempted to get information and documentation from CETEC, but she had trouble getting responses to her repeated telephone calls, letters and telegrams. Petitioner sought the help of Pedro de Mesones in getting cooperation and/or responses from CETEC regarding transcripts and other documents necessary for the loan applications and residency applications which she had to file prior to her anticipated medical school graduation date of June, 1982. Another reason Petitioner hired Pedro de Mesones was to get confirmation that CETEC would give her credit towards her medical degree for her prior work on her Ph.D. at the University of Chicago. These credits were necessary for Petitioner to graduate in June of 1982 as she anticiapted. Petitioner was advised by others familiar with the school that Pedro de Mesones could help her in her dealings with CETEC. She first contacted Pedro de Mesones by telephone in February, 1982. She agreed to pay him a total of more than $8,000 for his services. Petitioner explains her payments to Pedro de Mesones as a $3000 fee, plus the next two (2) semester's tuition payments totaling an additional $5000.00 plus a $100.00 graduation fee. Pedro de Mesones advised Petitioner that she had to pay CETEC's tuition totalling $5,000 for two (2) additional semesters even though she did not have to take any classes at CETEC because she was given credit for her work at the University of Chicago. At one point during her dealings with Pedro de Mesones, Petitioner signed a false transcript from a Mexican medical school at Pedro de Mesones' request. This transcript reflected work which Petitioner never completed. No adequate explanation was given as to why these false transcripts were ever prepared. While Petitioner contends that she asked Pedro de Mesones not to use the false Mexican transcript for any purpose, it appears that these transcripts were prepared in the event that Petitioner could not secure two semesters credit from CETEC for her Ph.D. work at the University of Chicago. Ultimately, CETEC decided to give her credit for some of the Ph.D. course work she completed at the University of Chicago. As a result, Petitioner was able to graduate in June of 1982 from CETEC without having to use the false Mexican transcripts. It does not appear that the fraudulent Mexican transcript were ever used by Petitioner in any of her applications. Petitioner provided Pedro de Mesones with two false transcripts regarding her AUC medical education. It is clear that she intended for him to use those transcripts, if necessary, to get a dean's certification from CETEC. One of the false AUC transcripts she prepared made its way into the records of CETEC. It is not clear how CETEC obtained that transcript. Because Petitioner was given credit for her graduate work at the University of Chicago, she did not need the extra credits reflected on the false AUC transcripts. Petitioner subsequently wrote the Dean of CETEC requesting removal of the false AUC transcript after she saw it in her CETEC records during a visit to CETEC to obtain a letter from the Dean showing her to be in good standing. Petitioner asked Pedro de Mesones to provide her with letters signed by the CETEC Dean showing her to be in good standing and on track for graduation in June, 1982. She intended to use these letters in applying for licensure for residency programs. Petitioner felt that she was on track to graduate and indicated to Pedro de Mesones that because of time pressures, she felt it would be acceptable for him to forge the signature of the Dean on the letters required by the various state licensing agencies. However, there is no indication that he did so. While none of the false transcripts prepared by Petitioner were directly submitted by her in any of the applications for licensure filed with any state licensing authorities, it is clear the Dean's certification letters included in Petitioner's 1983 Applications in some of the states were false. See Findings of Fact 39-44. No direct connection has been drawn between the false Dean's certification letters submitted with Petitioner's applications in Georgia and California and Pedro de Mesones. However, the circumstances surrounding Petitioner's dealings with Pedro de Mesones raise a question as to how the certifications were obtained. More importantly, it is clear that Petitioner was aware that the representations contained in the Dean's certifications and the dates of attendance at medical school listed on her 1983 Applications were false. Nevertheless, she still submitted the applications. Petitioner's dealings with Pedro de Mesones ended on June 14, 1982, two days after her graduation ceremonies at CETEC. Practice Experience Petitioner has at various times practiced medicine in Georgia and New Mexico prior to surrendering or losing her license in those states. She has also worked on cruise ships as a ship's doctor for several months. She is currently licensed and practicing in California. She has been licensed in that state since November, 1988. She has practiced emergency medicine at various hospitals and has been practicing as a primary care physician for Castle Air Force Base in California since December 1988. There is no indication that she has been deficient in carrying our her professional duties in any of these positions.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Board of Medical Examiners enter a Final Order granting Petitioner's application for licensure as a physician in the State of Florida subject to a probationary period of two years upon such terms and conditions as the Board deems appropriate. DONE AND ORDERED in Tallahassee, Leon County, Florida, this 2nd day of July, 1990. J. STEPHEN MENTON 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 2nd day of July, 1990. APPENDIX Both parties have submitted Proposed Recommended Orders. To the extent that the proposed findings of fact can be isolated, they are addressed below. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in the Findings of Fact of Fact Number in the Recommended Order Where Accepted or Reason for Rejection. 1. Adopted in substance in Findings of Fact 37, 46-50 and 67. 2. Aubored in substance in Findings of Fact 67 and 68. 3. Adopted in substance in Findings of Fact 69. 4. Adopted in substance in Findings of Fact 70. 5. Adopted in substance in Findings of Fact 71. 6. Adopted in substance in Findings of Fact 72. Adopted in substance in the preliminary statement. Adopted in substance in Findings of Fact 73. Adopted in substance in Findings of Fact 73. Adopted in substance in Findings of Fact 1. Subordinate to Findings of Fact 2-4 and 6. Adopted in substance in Findings of Fact 5. Subordinate to Findings of Fact 6. Suborindate to Findings of Fact 6 and 8. Adopted in substance in Findings of Fact 20. Adopted in substance in Findings of Fact 96. Adopted in substance in Findings of Fact 9. Subordinate to Findings of Fact 9. Adopted in substance in Findings of Fact 10. Adopted in substance in Findings of Fact 11 and 33. Subordinate to Findings of Fact 87. Subordinate to Findings of Fact 87 and 88. Subordinate to Findings of Fact 88. Subordinate to Findings of Fact 89. Subordinate to Findings of Fact 90-94. The first sentence is rejected as constituting argument. The second sentence is subordinate to Findings of Fact 94. Adopted in substance in Findings of Fact 95. Subordinate to Findings of Fact 35. Subordinate to Findings of Fact 35. Subordinate to Findings of Fact 35. Adopted in substance in Findings of Fact 36. Subordinate to Findings of Fact 36 and 39- 42. Adopted in substance in Findings of Fact 45. The first sentence is adopted in Findings of Fact 87. The remainder is rejected as irrelevant. Rejected as irrelevant. Rejected as irrelevant. Adopted in substance in Findings of Fact 73. Subordinate to Findings of Fact 47-66. Adopted in substance in Findings of Fact 47. Adopted in substance in Findings of Fact 48. Adopted in substance in Findings of Fact 50. Adopted in substance in Findings of Fact 51. Adopted in substance in Findings of Fact 49. Subordinate to Findings of Fact 54. Adopted in substance in Findings of Fact 55. Subordinate to Findings of Fact 57, 59-60. Subordinate to Findings of Fact 58. Suborindate to Findings of Fact 61. Adopted in substance in Findings of Fact 59. Subordinate to Findings of Fact 62-66. Subordinate to Findings of Fact 66. Subordinate to Findings of Fact 66. Adopted in substance in Findings of Fact 73. Adopted in substance in Findings of Fact 73. Subordinate to Findings of Fact 20-30. Adopted in substance in Findings of Fact 73. Adopted in substance in Findings of Fact 22 and 27. Adopted in substance in Findings of Fact 23. Subordinate to Findings of Fact 24. Adopted in substance in Findings of Fact 23. Subordinate to Findings of Fact 25-26. Adopted in substance in Findings of Fact 27. Subordinate to Findings of Fact 24 and 25. Adopted in substance in Findings of Fact 73. Subordinate to Findings of Fact 27. Adopted in substance in Findings of Fact 73. Subordinate to Findings of Fact 74. See proposed findings 26-30 above. Subordinate to Findings of Fact 79-80. Subordinate to Findings of Fact 81. Subordinate to Findings of Fact 82-83. Subordinate to Findings of Fact 38. Subordinate to Findings of Fact 78. Subordinate to Findings of Fact 83. Subordinate to Findings of Fact 77. Rejected as irrelevant. Rejected as irrelevant. Rejected as irrelevant. Rejected as irrelevant. Subordinate to Findings of Fact 78. Subordinate to Findings of Fact 84. Addressed in Findings of Fact 12-18. Rejected as irrelevant. Subordinate to Findings of Fact 12-19. The Respondent's Proposed Findings of Fact Proposed Finding Paragraph Number in the Findings of Fact of Fact Number in the Recommended Order Where Accepted or Reason for Rejection. Adopted in substance in Findings of Fact 1. Subordinate to Findings of Fact 2. Subordinate to Findings of Fact 3. Subordinate to Findings of Fact 4. Adopted in substance in Findings of Fact 5. Adopted in substance in Findings of Fact 6. Adopted in substance in Findings of Fact 7. Subordinate to Findings of Fact 9 and 13. Subordinate to Findings of Fact 13 and 14. Subordinate to Findings of Fact 16. Subordinate to Findings of Fact 18. Subordinate to indings of Fact 35. Adopted in substance in Findings of Fact 37. Adopted in substance in Findings of Fact 48. Adopted in substance in Findings of Fact 39. Adopted in substance in Findings of Fact 44. Subordinate to Fndings of Fact 46-52 and 67- 68. Adopted in substance in Findings of Fact 69. Subordinate to Findings of Fact 78. Subordinate to Findings of 78. Subordinate to Findings of Fact 76. Adopted in substance in Findings of Fact 70. Subordinate to Findings of Fact 76, 77 and 78. Adopted in substance in Findings of Fact 71. Adopted in substance in Findings of 72. 26. Adopted in substance in the preliminary statement. 27. Adopted in substance in Findings of Fact 73. 28. Adopted in substance in Findings of Fact 73. 29. Adopted in substance in Findings of Fact 54. 30. Adopted in substance in Findings of Fact 56. 31. Adopted in substance in Findings of Fact 78. 32. Adopted in substance in Findings of Fact 63. 33. Adopted in substance in Findings of Fact 65. Subordinate to Findings of Fact 47-51. Adopted in substance in Findings of Fact 22. Subordinate to Findings of Fact 24-26. Adopted in substance in Findings of Fact 27. Adopted in substance in Findings of Fact 25. Subordinate to Findings of Fact 31 and 79- 81. Subordinate to Findings of Fact 29. Adopted in substance in Findings of Fact 12 and 17. Adopted in substance in Findings of Fact 19. Subordinate to Findings of Fact 87-95. Adopted in substance in Findings of Fact 20. Adopted in substance in Findings of Fact 97. Subordinate to Findings of Fact 87-95. Rejected as not supported by competent substantial evidence. Adopted in substance in Findings of Fact 40. Rejected as not supported by competent substantial evidence. Subordinate to Findings of Fact 47-68. Rejected as constituting argument. Rejected as constituting argument. Copies furnished: Paul Watson Lambert, Esquire Attorney at Law 1355 Mahan Drive P. O. Box 31 Tallahassee, Florida 32308 Allen R. Grossman, Esquire Assistant Attorney General Suite 1602 - The Capitol Tallahassee, Florida 32399-1050 Dorothy Faircloth Executive Director Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, Florida 32399-0792 Kenneth E. Easley General Counsel Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, Florida 32399-0792
Findings Of Fact On February 7, 1977, while still in school, Mitchell Abrams, Petitioner, applied to take the technologist examination. At the time he applied for this examination he was not qualified to take the examination but expected to be qualified when the examination was given. Abrams thought the next examination would be after his completion of his qualifying curriculum in May, 1977. The examination for which Petitioner applied was given on April 20, 1977. On May 5, 1977 Petitioner completed his curriculum at Miami-Dade Community College and became eligible to qualify for the next examination which will be given in October, 1977. Following the completion of Petitioner's case Respondent acknowledged that subsequent to May 5, 1977, and upon submission by the registrar of Miami- Dade Community College of Petitioner's Permanent Academic Record verified by said registrar, Petitioner would be qualified to sit for the next examination for technologist if application therefor is submitted. Petitioner was further advised that, upon receipt of his application and Academic Record he would be issued a temporary license pending the results of the October examination.
Findings Of Fact The Petitioner Mario Alberto Almeida applied to the Respondent Board of Medical Examiners to sit for the medical licensure examination and paid his application fee in September, 1985. At that time, the Petitioner Almeida was interning in New York and his wife, concerned that a prior application had been untimely filed, assisted the Petitioner in filling out the subject application. When filling out the application, Mrs. Almeida erroneously wrote on the application form that her husband had a "B.S. 1979, University of Miami," which error arose from the fact that she was unaware that the Petitioner had not completed his University of Miami undergraduate degree work despite completing 137 credit hours of courses and being eligible for graduation. Mrs. Almeida believed that her husband graduated from the University of Miami because he had not informed her that he had left prior to graduating and Mrs. Almeida had seen solicitations for funds addressed to her husband as a 1979 University of Miami graduate. Also omitted by the Almeida's was the Petitioner's race (which is caucasian), that he had successfully attended a junior college and that he was a United States citizen who had legally changed his name to reflect his father's name, Alberto. Other than these erroneous statements and omissions, the Petitioner Almeida supplied the Respondent with all information requested, including additional information requested by letter dated November 4, 1985. Thereafter, the Respondent Board issued to the Petitioner Almeida an authorization to sit for the December, 1985, examination which card was inadvertently issued to and returned by the Respondent. In support of his application, the Petitioner was issued a letter which requested that he personally appear in Tampa, Florida, at 4:15 p.m. on November 22, 1985, at a meeting before the Foreign Medical Graduate Committee of the Board of Medical Examiners. Although the Petitioner was put under oath and was questioned at that meeting, he was not represented by legal counsel. The Committee referred his application to the full Board with no recommendation regarding approval. On November 23, 1985, the Board voted to deny the Petitioner's application. The Petitioner did not receive notice of this second meeting and, therefore, did not attend. By order dated September 9, 1986, the Petitioner was notified of the Respondent's denial of his application based upon "material discrepancies between the information stated on the application and the testimony given with regard to the applicant's education," citing Section 458.331(1)(a) and (2), Florida Statutes. The Petitioner's application did misstate his undergraduate, pre- medical school data. He failed to disclose his successful completion of Miami- Dade Community College and his 137 credit hours when he left the University of Miami before attaining the "B.S. 1979, University of Miami." He did however, accurately testify concerning these discrepancies under oath at the November 22, 1985, committee meeting. These discrepancies were unintentional and resulted from the Petitioner's preoccupation with his medical duties and his wife's concern that another application deadline not be missed. No evidence was submitted which would support a finding that fraud or deceit was intended by either of the Almeida's or that any advantage would be gained as a result of any errors or omissions in completing the form. The Respondent's order of September 9, 1986, finds that the Petitioner either has been found guilty of attempting to obtain a license to practice medicine by fraudulent misrepresentation or adjudicates him guilty of attempting to obtain a license to practice medicine by fraudulent misrepresentation. The Petitioner is presently a duly licensed physician in the State of New York.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That a final order be entered by the Board of Medical Examiners approving the application of the Petitioner Mario Alberto Almeida Suarez, to sit for the next scheduled medical license examination. DONE and ENTERED this 26th day of May, 1987 in Tallahassee, Florida. SHARYN L. SMITH 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 26th day of May, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-3996 Petitioner's Proposed Findings of Fact Accepted. Accepted. Accepted. Accepted, but not in issue. Accepted. Accepted, but not in issue. Accepted. Rejected, not relevant to this proceeding. Accepted in part, rejected in part. Accepted. Accepted. Accepted. Rejected, not relevant. Accepted. Accepted. Accepted. Accepted. Accepted. Rejected. Respondent's Proposed Findings of Fact Accepted. Accepted. Accepted, but relevant only insofar as educational background is concerned. Accepted. Accepted. Accepted. Accepted, but not relevant. Accepted. Accepted. Accepted, but not relevant. Accepted, but not relevant. Accepted insofar as the information is characterized as incomplete. Accepted. Accepted. Accepted. Accepted insofar as this concerns Mrs. Alemeida's knowledge subsequent to completing the application. Accepted insofar as this concerns Mrs. Alemeida's knowledge subsequent to completing the application. Accepted. COPIES FURNISHED: Stephen Marc Slepin, Esquire SLEPIN & SLEPIN 1114 East Park Avenue Tallahassee, Florida 32301 Allen Grossman, Esquire Assistant Attorney General Department of Legal Affairs 1601 - The Capitol Tallahassee, Florida 32399-1050 Joseph A. Sole, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Van B. Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Dorothy Faircloth, Executive Director Board of Medical Examiners Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 =================================================================
The Issue The sole issue, as reflected in the Joint Stipulation, is whether the Petitioner fraudulently misrepresented his places of residence (where lived) since the initiation of medical training or his medical education as called for on his application for licensure.
Findings Of Fact Raymond Francis Caron was licensed as a physician in the State of Minnesota in November 1986. He currently lives in Orlando, Florida, and is employed as a pediatric resident at Orlando Regional Medical Center. He is seeking licensure by endorsement to practice medicine in the State of Florida. On his application submitted to the Board of Medical Examiners, Dr. Caron responded in the following manner regarding his places of residence: LIST ALL PLACES OF RESIDENCE (WHERE LIVED) SINCE INITIATION OF MEDICAL TRAINING: FROM: 1 , 1982 TO 3 , 1983 FROM: 3 , 1983 TO 6 , 1984 55434 FROM: 6 , 1984 TO 6 , 1986 Siervas de Maria #10 Plaza Naco Santa Domingo Dominican Rep. (city, state or county) 1800 Senate #109 Columbia, S.C. (city, state or county) 349-96th Lane NE, Minneapolis MN Minneapolis MN (city, state or county) 4604 Middlebrook, Unit J Orlando, Fla FROM: 6 , 1986 TO PRESENT 19 (city, state or county) Carretera La Romeno #79, San Pedro Dom Rep From 3-78 to Jan 1982 The following response was provided on the application with regard to his medical education: MEDICAL EDUCATION: BE SPECIFIC. ACCOUNT FOR EACH YEAR. LIST ALL UNIVERSITIES/COLLEGES WHERE ATTENDED CLASSES/RECEIVED TRAINING AS A MEDICAL STUDENT. May, 1978 TO May, 1981 May, 1981 TO May, 1982 May, 1982 TO May, 1983 UNIVERSIDAD CENTRAL DEL ESTE FROM: (name of medical school/location) SAN PEDRO DEMACORIS DOMINICAN REPUBLIC CENTRO DE ESTUDIOS TECHNOLOGICOS FROM: (name of medical school/location) SANTA DOMINGO DOMINICAN REPUBLIC UNIV. TECHNOLOGICA DE SANTIAGO FROM: (name of medical school/location) SANTA DOMINGO DOMINICAN REPUBLIC FROM: , 19 TO , 19 (name of medical school/location) At his appearance before the Board's Foreign Graduate Committee in March 1987, Dr. Caron disclosed that he left the Dominican Republic in December 1979, and lived in Columbia, South Carolina until January 1981. During this time he tried to get into a medical school in the United States, but after the attempt proved unsuccessful he returned to the Dominican Republic. He also lived in Columbia, South Carolina from approximately June 1982 until December 1982, while he fulfilled some elective credit requirements for his degree from the University Technologica de Santiago. (UTESA) Those electives were taken under the sponsorship and tutelage of two physicians associated with the University of South Carolina, Department of Medicine in Columbia, S.C. Given the choice of fulfilling elective requirements in the Dominican Republic or in Columbia, South Carolina, Dr. Caron preferred the training in the United States. He was not enrolled at the University of South Carolina, but rather at UTESA. These electives are reflected on his UTESA transcript as clerkships, for which he received passing grades and twenty-eight (28) credit hours. The disclosures to the Committee regarding time spent in the United States in 1980 and 1982, as well as the elective credits taken under the aegis of the University of South Carolina created an obvious conflict with the information provided on the application. The application provides, as stated in paragraph 2, above, that Dr. Caron resided in the Dominican Republic from March 1978 to March 1983, with no breaks. The application, as stated in paragraph 3, above, does not reflect any training at the University of South Carolina Medical School. At the end of the application form is an affidavit from the applicant including, in part, this statement: I have carefully read the questions in the foregoing application and have answered them completely, without reservations of any kind, and I declare under penalty of perjury that my answers and all statements made by me herein are true and correct. Should I furnish any false information is [sic] this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice medicine/surgery in the State of Florida. Dr. Caron filled out the application at various times while he was between duties at the Orlando Regional Medical Center. It took several weeks, as he took the papers to the hospital when he was on call and worked on them at all times of the day or night. He was in a hurry as he felt it preferable to have a license going into his third year of residency at the Orlando Regional Medical School. He consulted with his wife regarding the places of residence and she counselled him based on her recent experience with a mortgage application. In that situation she had put detailed information regarding a pregnancy leave from school. The lending institution questioned this because her transcript apparently indicated that she was still enrolled. The mortgage company told her she was being too specific. Dr. Caron also talked to his brother-in-law, a pediatric neurologist licensed as a Florida physician. The brother-in-law, himself a foreign medical graduate, suggested that the Board was probably interested in the different places he had resided and the details would be elicited when he appeared before the Foreign Medical Graduate Committee. Dr. Caron's discussion with the members of the Committee in March 1987, lends credibility to that explanation. He appeared before the Committee with his box of documents, prepared and expecting to show them to the Committee; he became frustrated and chagrined when they concentrated on the discrepancies between the information on his application and the verbal information he was providing them. He ultimately agreed that the accuracy of the application was relevant. Besides being in a hurry and relying on the advice of his wife and brother-in-law, Dr. Caron sincerely believed that he provided the Board with he information they sought. While the dates were clearly off, he provided the four places he has lived since starting Medical School: the Dominican Republic; Columbia, South Carolina; Minneapolis, Minnesota; and Orlando, Florida. He did not put the University of South Carolina as a place of medical training because he was never enrolled there. Nothing in the record of this proceeding suggests that Dr. Caron was deliberately misleading or attempting to defraud the Board. He gained nothing by omitting certain information from his application; nothing whatsoever suggests that he was involved in misdeeds or had any motive for disguising his true whereabouts in 1980 and 1982. He has explained the discrepancies and conceded his error in judgment. Two competent physician witnesses who are familiar with his work testified as to his ability to practice medicine with reasonable skill and safety, including the ability to maintain proper medical records.
Recommendation For the foregoing reasons, it is hereby, RECOMMENDED: That a Final Order be issued granting licensure by endorsement to Raymond Francis Caron. DONE and RECOMMENDED this 12th day of October, 1987 in Tallahassee, Florida. MARY CLARK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 12th day of October, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-2483 The following constitute my rulings on the findings of fact proposed by Petitioner: 1-5. Addressed in "Background" of this order. 6-7. Addressed in the statement of issue. Adopted in paragraph 3, Conclusions of Law. Adopted in Findings of Fact, paragraph 2. Adopted in Findings of Fact, paragraph 4. Adopted in Findings of Fact, paragraph 2. Adopted in Findings of Fact, paragraph 4. Rejected as unnecessary. Adopted in Findings of Fact, paragraph 2. Adopted in substance in Findings of Fact, paragraphs 4 and 6. 16-17. Adopted in Findings of Fact, paragraph 8. 18. Adopted in substance in Findings of Fact, paragraph 9. 19-20. Adopted in Findings of Fact, paragraph 10. Rejected as unnecessary. Adopted in Findings of Fact, paragraph 3. Adopted in Findings of Fact, paragraphs 5 and 6. Adopted in Findings of Fact, paragraph 5. Adopted in Findings of Fact, paragraph 5, except that Dr. Caron's testimony was that the electives were under the aegis of the University of South Carolina. (Transcript of meeting of FMGC, p. 25.) Adopted in Findings of Fact, paragraphs 9 and 10. Adopted in Findings of Fact, paragraph 10. Adopted in substance in Findings of Fact, paragraph 10. Adopted in Findings of Fact, paragraph 1 30-31. Rejected as unnecessary. The following constitute my rulings on the Findings of Fact proposed by the Respondent. Addressed in "Background" and Findings of Fact, paragraph 1. Adopted in Findings of Fact, paragraph 2. Adopted in Findings of Fact, paragraph 7. Adopted in Findings of Fact, paragraphs 4 and 5. Adopted in Findings of Fact, paragraph 3. Rejected as cumulative. Adopted in substance in Findings of Fact, paragraph 6. Rejected as unnecessary. Rejected as cumulative. Addressed in the "Background". Adopted in substance in Findings of Fact, paragraph 8. 12-13. Rejected as unnecessary. Adopted in Findings of Fact, paragraph 8. Rejected as unnecessary. COPIES FURNISHED: Charles L. Curtis, Esquire Allsworth, Doumar, Cazel & Curtis 1177 S. E. Third Avenue Fort Lauderdale, Florida 33316 Basil E. Dalack, Esquire 350 South Country Road Palm Beach, Florida 33480 M. Catherine Lannon, Esquire Assistant Attorney General Department of Legal Affairs 1601 The Capitol Tallahassee, Florida 32399-1050 Dorothy Faircloth, Executive Director Board of Medicine 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, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue Whether Petitioner's application for medical licensure by endorsement has expired and Respondent is therefore without authority to act on the application, as Petitioner claims? If not, whether the application should be denied on the grounds that Petitioner is guilty of violating Section 458.331(1)(a) and (gg), Florida Statutes,1 as Respondent has preliminarily determined.
Findings Of Fact Based on the evidence adduced at hearing, and the record as a whole, the following findings of fact are made to supplement and clarify the factual stipulations set forth in the parties' December 8, 2005, Prehearing Stipulation3: Petitioner is now, and has been since 1998, a Napperville, Illinois anesthesiologist licensed to practice medicine in the State of Illinois. At no time has she resided in Florida or used a Florida mailing address. "[A]t the end of 2002," Petitioner hired US Medical Licensing (USML) to help her obtain licenses to practice medicine in Florida, California, and Nevada, including "put[ting] together the application[s for such licensure] for [her]." In making these arrangements with USML, Petitioner dealt with USML's Melinda Hilterbrand, with whom she spoke over the telephone. Petitioner paid USML by credit card. USML first "charged [Petitioner's] credit card in January" of 2003 (using the credit card number Petitioner had given Ms. Hilterbrand during their telephone conversation). Petitioner provided USML, at USML's request, information and documentation (including a "standard credentialing application [she used in] Illinois") for USML to utilize in "put[ing] together [her Florida, California, and Nevada] application[s]." None of the information and documentation Petitioner provided was, to her knowledge, false or inaccurate. USML "put together the application[s]," as it had agreed to do. It then submitted them to the Florida, California, and Nevada medical licensing agencies without Petitioner's review, approval, or signature, notwithstanding that Petitioner had not given USML authorization to make such submissions. On June 16, 2003, Respondent received the Florida application that USML had "put together" for Petitioner (Petitioner's Florida Application) using the appropriate Respondent-developed form . Petitioner's Florida Application gave Petitioner's mailing address as "5631 Ballybunion Drive, Pace, Florida" (Pace, Florida Address). This was actually USML's mailing address, not Petitioner's. Petitioner's Florida Application gave Petitioner's telephone number as "(850) 994-4646." This was actually USML's telephone number, not Petitioner's. 10. Items 12, 12a., 12b., 15a., and 19b. on the application form on which Petitioner's Florida Application was submitted (Florida Application Form) asked the following questions: 12. Was attendance in Medical school for a period other then the normal curriculum? (If "yes," explain on a separate sheet providing accurate details.) 12a. Did you take a leave of absence during medical school? (If "yes," explain on a separate sheet providing accurate details.) 12b. Were you required to repeat any of your medical education? (If "yes," explain on a separate sheet providing accurate details.) 15a. Have you ever been dropped, suspended, placed on probation, expelled or requested to resign from a postgraduate training program? (If "yes," explain on a separate sheet providing accurate details.) 19b. Have you ever applied for, taken an examination for, or failed to receive specialty board certification or recertification for any reason?" (If "yes," explain on a separate sheet, providing full details). Each of these questions was incorrectly answered "no" on Petitioner's Florida Application. Item 15 on the Florida Application Form asked the applicant to "[l]ist in chronological order from date of graduation from Medical school, to present, all professional/postgraduate training (Internship/Residency/ Fellowship)." In response to this request, Petitioner's Florida Application listed her participation (following graduation from medical school) in programs at the University Medical Center in Las Vegas, Nevada, at the Medical College of Ohio in Toledo, Ohio, at the Advocate Illinois Masonic Medical Center in Chicago, Illinois, and at St. Anthony's Hospital in Chicago, Illinois. No other post-graduate programs were listed, notwithstanding that Petitioner had also received post-graduate training at the Vanderbilt University Medical Center. At the time, Petitioner did not even know that her Florida Application had been submitted, much less that it contained any erroneous information, inasmuch as she had not seen it or been made aware of its contents. As will be discussed in more detail below, it was not until approximately three months later that she first learned of her Florida Application’s submission, and it was even later, at her July 24, 2004, appearance before Respondent’s Credentials Committee, that she first became aware "that there was any incorrect information on [her] application." No one from USML had ever contacted Petitioner and asked her for her responses to items 12, 12a., 12b., 15, 15a., 19b. or any other item on the Florida Application Form. Item 18 on the Florida Application Form was an Affidavit of Applicant, which read, in pertinent part, as follows: I affirm that these statements are true and correct and recognize that providing false information [ma]y result in disciplinary action against my license or criminal penalties pursuant to Sections 456.067, 775.083 and 775.084, Florida Statutes. I hereby authorize all hospitals, institutions, my references, personal physicians, employers (past and present) and all governmental agencies and instrumentalities (local, state, federal or foreign) to release to the Florida Board of Medicine information which is material to my application for licensure. I have carefully read the questions in the foregoing application and have answered them completely, without reservations of any kind, and I declare under penalty of perjury that my answers and all statements made by me herein are true and correct. Should I furnish any false information in this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice Medicine in the State of Florida. * * * Date of Expiration (Signature of Applicant required) 4 (Date Signed required) The Affidavit of Applicant in Petitioner's Florida Application contained what purported to be, but was not, Petitioner's signature. It was dated May 30, 2003. Petitioner had not authorized USML to sign her Florida Application on her behalf or otherwise "submit documents using [her] signature," nor was she "aware that [USML was] going to do [so]." On July 14, 2003, Respondent prepared and sent to the Pace, Florida Address (which, as noted above, was USML’s, not Petitioner’s, mailing address) a notice advising that Petitioner's Florida Application was "deficient" and explaining what needed to be done in order for the application to be considered "complete" (July 14, 2003, Deficiency Notice). The July 14, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). A letter has been sent to St. George's University to confirm you left the medical school in good standing. Your file has been submitted in for advisement regarding your examination score reports submitted to the board office. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? A letter has been sent to the Medical College of Ohio to retrieve[] further information on your performance. Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit two current letters of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). We await licensure verification from the Illinois State Medical Board. The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800)767-6732. The AMA Physician Profile sheet has not been received. You may contact the AMA at (312) 484-5199. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -University Medical Center, regarding your Internship, from 6/92 to 6/93 -Medical College of Ohio, regarding your Residency, from 4/94 to 5/96 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 -Valley Ambulatory Surgery Center, verifying your staff privileges and good standing. * * * On August 15, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (August 15, 2003, Deficiency Notice). The August 15, 2003 Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). We are in receipt of the evaluation form submitted by Valley Ambulatory Surgery Center. They indicate you did not perform competently and you were not regularly appointed. Please submit a written explanation. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit two current letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile sheet has not been received. You may contact the AMA at (312) 484-5199. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -University Medical Center, regarding your Internship, from 6/92 to 6/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * It was not until sometime in or around September of 2003, during a telephone conversation (she had initiated) with USML's Ken Carroll, that Petitioner first learned that her Florida Application had been submitted to Respondent. Petitioner was "very surprised" when Mr. Carroll told her about the application's submission because she had thought that she was "going to get to look at the application" and "go over it" before it was sent to Respondent and she had not been given this opportunity. Nonetheless, she did not voice any objections to Mr. Carroll during her telephone conversation with him. Rather, "[she merely] asked him if there were any problems with [the application], and he said that everything was okay." Petitioner assumed, erroneously, that USML had completed the application accurately. She did not, at that time, request a copy of the application to verify the application's accuracy, nor did she do anything to indicate that she did not want Respondent to treat the application as hers. Indeed, until becoming aware of the actual contents of the application, it was her desire that Respondent act on the application and grant her licensure, and her actions were consistent with such a desire. On September 17, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application remained "deficient" and explaining what needed to be done in order for the application to be considered "complete" (September 17, 2003, Deficiency Notice). The September 17, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). We are in receipt of the evaluation form submitted by Valley Ambulatory Surgery Center. They indicate you did not perform competently and you were not regularly appointed. Please submit a written explanation. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit one current letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 464-5199. The AMA Physician Profile submitted to the board office indicates you had training with Vanderbilt University in Anesthesiology from 7/93 to 11/93. However, this training is not listed on question 15 of your licensure application. Please submit a written explanation. Also, a training evaluation form will have to be completed. A letter has been sent to the training program to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board office indicates your training with Medical College of Ohio is incomplete. Please provide a written explanation. A letter has been sent to the program to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to . . . our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On September 26, 2003, Respondent received a letter, dated September 23, 2003, that was addressed to one of its employees, Lakeisha Henderson, and purported to be, but was not, from Petitioner and signed by her (September 26, 2003, Letter). The September 26, Letter, of which Petitioner had no knowledge, read as follows: In answer to your questions in the letter you sent me 9/17/03 [sic], I am providing these answers: I left St. George's because of the war in Grenada. I waited till I was sure the situation was stable and I also took a leave to study for my ECFMG. I was not satisfied with the situation at the school so I transferred/moved to Ross. One course prior to the start of my clinicals was required at Ross before I could start there in the clinical phase. This was a repeat from St. George[']s, but the only one. During this period, I had numerous child care and child health issues with my children which caused me to not be available for work and surgery. Page one is attached. Page three is attached. Page 4 is attached. In answer to question #7, there was a change at Medical College of Ohio. The Program Director left due to illness and subsequently the program started changing, so I finished my second year and then did my third year at another program. I left in good standing, getting credit for everything. I could have continued if I had elected to do so but I declined. In question 8, I started my third year based on what was needed to complete and where the class was. I was having a child and was allowed to start off cycle. Non-Employment Dates: 01/89-6/92-Child Birth and child care, studied for tests. 05/96-01/97-Unemployed 11/98-02/99-Moving and vacation 11/02-04/03-Unemployed 05/03-Present @ Surgical Center of Downers Grove, IL I thought the fingerprint card had been sent to your office (Question #9) Item #11 has been requested. Question #12. I was married for a short period of time and while married took the last name of husband Prochazka. When we divorced I retained my maiden name. Question #18- The program was overfilled with Residents and I elected to leave with no credit as I only attended for a short period of time. Question #19- I was given full credit for my training there, so I do not understand the question. I have attached my diploma. All other items have been requested and will be sent directly to you. On September 30, 2003, Respondent received another letter, also dated September 23, 2003, that was addressed to Ms. Henderson and purported to be, but was not, from Petitioner and signed by her (September 30, 2003, Letter). The September 30, 2003, Letter, of which Petitioner had no knowledge, read as follows: I am sorry I forgot to include the fact that I was arrested for disturbing the peace. I have included all those documents. I forgot till Ken Carroll asked. I thought it was not needed as it was over 10 years ago, sorry to cause any issues. I have also included my divorce papers. Among the documents that were "included" with the September 30, 2003, Letter to Ms. Henderson was a statement in Petitioner’s handwriting, dated June 10, 1996, which provided an explanation of the circumstances surrounding Petitioner’s arrest. This handwritten statement was among the materials that Petitioner had furnished USML for use in the application preparation process. On October 16, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (October 16, 2003, Deficiency Notice). The October 16, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the letter dated September 23, 2003, [in which] you indicate employment with Surgical Center of Downers [Grove]. Do you hold staff privileges with this hospital? If so, an evaluation form will have to be completed. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. Submit a written account of your employment/non-employment activities from 6/93 to 4/94. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. We are in receipt of the letter of recommendation from Dr. Kianoosh Jafari. Please submit an additional letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. 19. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * Respondent received, in response to the October 16, 2003, Deficiency Notice, a letter that purported to be, but was not, from Petitioner and signed by her. The letter, of which Petitioner had no knowledge, read as follows: Question #5 from letter of 10/13/03 [sic] I left [the] program after one year to move closer to my husband at the time wh[o] was in the Midwest. I spent the time from 7-93 till 4-94 looking for a program and applying to programs. Petitioner was not married during the time period referenced in the letter. To the extent that the letter suggests otherwise, it is inaccurate. In or around the end of October of 2003, Petitioner received a letter from the Nevada State Board of Medical Examiners (Nevada Board) concerning an application for licensure that USML had submitted to the Nevada Board on her behalf. The letter, which was dated October 28, 2003, read as follows: Dear Dr. Sawan: Please find enclosed a new application for medical licensure for the State of Nevada. You will be required to complete this application without the assistance of a credentialing service. The Nevada State Board of Medical Examiners does not accept any documentation from the credentialing company U.S. Medical Licensing and Credentialing. After receiving this letter, Petitioner telephoned Mr. Carroll and asked him why "this Nevada licensure application . . . was not accepted." Mr. Carroll, in response to Petitioner’s inquiry, explained that "there were some other doctors that did not get their licenses and they were upset with [USML]" and had complained to the Nevada Board. Having received this response to her inquiry, Petitioner "did not dig anymore" into the matter. Petitioner subsequently completed the application form she had been sent by the Nevada Board and then returned it. Approximately, four and a-half months later she received her Nevada medical license On November 17, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (November 17, 2003, Deficiency Notice). The November 17, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the letter dated September 23, 2003, [in which] you indicate employment with Surgical Center of Downers [Grove]. Do you hold staff privileges with this hospital? If so, an evaluation form will have to be completed. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * Respondent received, in response to the November 17, 2003, Deficiency Notice, a letter that purported to be, but was not, from Petitioner and signed by her. The letter, of which Petitioner had no knowledge, read as follows: Question #2 from letter of 11/14/03 [sic] Downers Grover Surgical Center is an out patient center. Not a hospital. Question #5 A copy of my ECFMG is enclosed. On December 19, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (December 19, 2003, Deficiency Notice). The December 19, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * The December 19, 2003, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (December 19, 2003, Deficiency Letter), which read as follows: Your application remains incomplete. Please review the attached update [the December 19, 2003, Deficiency Notice] outlining the remaining deficiencies. Please be advised previous malpractice, criminal charges, discipline, addictions/impairment, unfavorable evaluations, etc. may require that you appear before the Credentials Committee for determination of eligibility for licensure. If your appearance is required, you will be notified in writing once your file is complete. Any information received by this office may require additional explanation and/or documentation to be requested in order to further determine licensure eligibility. After all requested documentation is received, your file will be submitted for a standard supervisory review. Should additional information be required, you will be notified. Once your file is determined complete, it will be presented to the Board for consideration at the next scheduled meeting. As documentation is received in our office, an updated list of deficiencies will be mailed to you. Your application will remain incomplete until all deficiencies are completed. In addition, notify the Board office immediately in writing of any occurrence(s) that would in any way change or affect any answer given in the application or an answer provided in response to any of our direct questions to you. If I can be of any assistance, please contact me at (850) 245-4131 extension 3512 or e-mail me at Lakeisha_Henderson @doah.state.fl.us. On January 22, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (January 22, 2004, Deficiency Notice). The January 22, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On February 24, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (February 24, 2004, Deficiency Notice). The February 24, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On March 24, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (March 24, 2004, Deficiency Notice). The March 24, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * The March 24, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (March 24, 2004, Deficiency Letter). The body of the March 24, 2004, Deficiency Letter was identical to the body of the December 19, 2003, Deficiency Letter. On March 31, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (March 31, 2004, Deficiency Notice). The March 31, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the training evaluation form from Valley Ambulatory Surgery Center. The evaluation form indicates you resigned and your staff privileges were terminated. It appears you should have answered yes to question 18c. Please submit a written explanation as well [as] explain the no answer given for question 18c. A letter has been sent to Valley Ambulatory Surgery Center to retrieve[] further information. Enclosed for your review is a copy of the evaluation form. A letter will be sent to each training program requesting a copy of your training file. A letter has been sent to the Medical College of Ohio requesting further clarification on the letter submitted from them dated July 22, 2003. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 * * * The March 31, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (March 31, 2004, Deficiency Letter). The body of the March 31, 2004, Deficiency Letter was identical to the bodies of the December 19, 2003, and March 24, 2004, Deficiency Letters. In or around March of 2004, during a telephone conversation with Mr. Carroll, Petitioner inquired as to whether her "talk[ing]" to Respondent "could help expedite" the processing of her Florida Application. Mr. Carroll, in turn, gave Petitioner Ms. Henderson’s name and telephone number and suggested Petitioner call Ms. Henderson. Petitioner followed Mr. Carroll’s suggestion and spoke with Ms. Henderson. Petitioner asked Ms. Henderson "if there [was] any problem with the application" and offered to provide "anything extra that [Ms. Henderson] may need." Ms. Henderson "did not say that there were any problems," but she did indicate "that she would like additional information," which she described for Petitioner. After speaking with Ms. Henderson, Petitioner prepared a handwritten letter, which she sent to Ms. Henderson by facsimile transmission on April 9, 2004. The letter read as follows: You requested an explanation for why staff privileges at Valley Ambulatory Surgery Center were terminated. It has been my understanding from their contract agreement that once I stop working there (resign), the staff privileges are automatically terminated. The following day, April 10, 2004, Petitioner sent to Ms. Henderson by facsimile transmission a handwritten list of references, as well as letters of recommendation (from others about her). Ms. Henderson had not asked Petitioner to provide these materials, but Petitioner sent them anyway, thinking that Ms. Henderson "might like to have them." On May 4, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (May 4, 2004, Deficiency Notice). The May 4, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION EXPIRATION DATE IS: June 15, 2004. APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation form from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter will be sent to each training program requesting a copy of your training file. A letter has been sent to Medical College of Ohio requesting further clarification on the letter submitted from them dated July 22, 2003. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. * * * The May 4, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson addressed to Petitioner at the Pace, Florida Address (May 4, 2004, Deficiency Letter). The body of the May 4, 2004, Deficiency Letter was identical to the bodies of the December 19, 2003, March 24, 2004, and March 31, 2004, Deficiency Letters. Petitioner never received the May 4, 2004, Deficiency Notice or the May 4, 2004, Deficiency Letter; nor had she ever received any of the previous deficiency notices and letters. On June 15, 2004, Petitioner’s Florida Application was still incomplete inasmuch as Respondent had not received all of the information it had requested in the May 4, 2004, Deficiency Notice (including the letter from Petitioner requested in item 1 of the notice, the training files from University Medical Center in Las Vegas, Nevada, and Vanderbilt University Medical Center requested in item 2 of the notice, and the "license verification letter" requested in item 4 of the notice, which were all materials that were reasonable for Respondent to have asked for as part of the application review process). On June 28, 2004, Chandra Prine, Respondent’s Program Operations Administrator (and Ms. Henderson’s supervisor), prepared and sent to the Pace, Florida Address a letter addressed to Petitioner (June 28, 2004, Letter) advising her that she was required to make a personal appearance before the Credentials Committee on July 24, 2004, to discuss: Your medical education and your failure to answer yes to questions numbers 12, 12a & 12b on the licensure application. Failure to list your training at Vanderbilt from 7/93-11/93 and your failure to answer yes to question number 15a on the licensure application. In addition, the Committee may inquire into any other issues relating to your application and eligibility for licensure. Petitioner did not receive this letter. In July of 2004, Petitioner telephoned Ms. Henderson to inquire about the status of Petitioner’s Florida Application. She was unable to speak with Ms. Henderson, so she left a message asking Ms. Henderson to return the call. Petitioner subsequently received a telephone message from Ms. Henderson. In her message, Ms. Henderson stated that she thought Petitioner "was going to be going to a hearing" on her Florida Application, but suggested that Petitioner telephone Ms. Prine "just to be sure." Ms. Henderson did not say anything about there being "questions that were answered incorrectly on [the] application." After receiving Ms. Henderson’s message, Petitioner telephoned Ms. Prine and spoke with her. Petitioner told Ms. Prine that Ms. Henderson had left a message about an upcoming hearing concerning Petitioner’s Florida Application and had suggested that Petitioner contact Ms. Prine regarding the matter. Ms. Prine responded, "Yes, we sent you a letter saying you have to show up for this hearing," referring to the June 28, 2004, Letter. Petitioner replied that she had "not received any letter" from Respondent. Ms. Prine then "gave [Petitioner] the address" to which the June 28, Letter had been mailed. Petitioner informed Ms. Prine that this address (the Pace, Florida Address) was not hers. She then "gave [Ms. Prine] her home address for [Ms. Prine] to send [her] another letter." Petitioner asked Ms. Prine during their telephone conversation "what the hearing was going to be about." Ms. Prine's response was that Petitioner should be prepared to answer questions at the hearing regarding certain specific items on her Florida Application, which Ms. Prine identified by number. Petitioner told Ms. Prine that she "had never seen the application," to which Ms. Prine retorted, "Oh, but you signed it." Petitioner insisted that she "didn’t remember signing anything" and asked Ms. Prine to send her, along with the letter concerning the hearing, "a copy of whatever [she supposedly] signed." At no time during the telephone conversation did Ms. Prine tell Petitioner that her Florida Application contained any incorrect information, nor did she reveal to Petitioner anything about those items on the application that Petitioner would be questioned on at the hearing other than what their numbers were and that they pertained to her "schooling and training." It did not come as surprise to Petitioner that the Credentials Committee "wanted to hear from [her]" about her "schooling and training" given the difficulties she had encountered in these areas. Petitioner did not ask Ms. Prine to elaborate any further on what the Credentials Committee would inquire about at the hearing. Two days after her telephone conversation with Ms. Prine, Petitioner received a letter dated July 14, 2004, from Ms. Prine (July 14, 2004, Letter). The July 14, 2004, Letter was addressed to Petitioner at her Naperville, Illinois address and read as follows: This is in further reference to your application for licensure by endorsement. Please be advised that you are required to make a personal appearance before the Credentials Committee of the Board of Medicine to discuss the following: Your medical education and your failure to answer yes to questions numbers 12, 12a & 12b on the licensure application. Failure to list your training at Vanderbilt from 7/93-11/93 and your failure to answer yes to question number 15a on the licensure application. In addition, the Committee may inquire into any other issues relating to your application and eligibility for licensure. Date: Saturday, July 24, 2004 Time: 8:00 a.m. Location: Radisson Hotel 415 N. Monroe St. Tallahassee, FL 32301 (850) 224-6000 The meeting room will be posted in the lobby of the Hotel. Additionally, the Committee's recommendation on your application will be presented to the Board of Medicine, August 6-7, 2004 for final action. Thank you for your continued cooperation. Should you have any question regarding this matter, please feel free to contact me. Along with the July 14, 2004, Letter, Petitioner received from Ms. Prine the signature page of the September 26, 2003, Letter. After reviewing the latter, Petitioner telephoned Ms. Prine and left a message advising Ms. Prine that the signature on that document was not hers. The July 14, 2004, Letter was not accompanied by a copy of Petitioner’s Florida Application. Petitioner made a "personal appearance" before the Credentials Committee on July 24, 2004, as scheduled. As noted above, it was during this appearance that she first learned that her Florida Application contained information that was incorrect. In response to questioning, Petitioner truthfully told the Credentials Committee that she had not "even seen the application" and that it was "not [her] signature" that was on the application in that she did not sign it. The Credentials Committee voted to recommend the denial of Petitioner’s Florida Application, a recommendation that Respondent subsequently followed. On August 2, 2004, following her appearance before the Credentials Committee, Petitioner prepared and sent a letter to Ms. Prine formally requesting, for the first time, a "complete copy of [her] application for the Florida medical license [be] mailed to [her]" at her Napperville, Illinois address. On August 10, 2004, Petitioner prepared and sent to Ms. Prine another letter, which read as follows: I am writing to ask that you do not accept any communication from the USML agency regarding my application. I am not working through them anymore. Please call me directly at (773) 405-3718, or send all mail to: RANDA SAWAN M.D. 1304 Dunrabin Road Naperville, IL 60540 Your assistance with this matter will be greatly appreciated. Thank you. After Petitioner had made several post-Credential Committee hearing requests to Mr. Carroll that he send her copies of "anything [he had] involving [her] application," Petitioner received the following letter, dated September 23, 2004, from Mr. Carroll: I am sorry to inform you but your files along with several hundred other physicians' files were destroyed while in our storage area due to Hurricane Ivan which made a direct hit on Pensacola. Our Pensacola office is operating but has limited phone and no internet or cable. Again I apologize for this inconvenience. Petitioner never received any of the documents she had requested from Mr. Carroll.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that Respondent issue a final order finding that Petitioner's Florida Application expired, without being acted on, one year after it was filed and that it is therefore too late for Respondent to either approve or deny the application. DONE AND ENTERED this 7th day of March, 2006, in Tallahassee, Leon County, Florida. S STUART M. LERNER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 7th day of March, 2006.
Findings Of Fact Respondent graduated from the University of Havana Medical School in 1951 and practiced medicine in Cuba from that time until he immigrated to the United States in 1960. In Cuba his practice was primarily in the fields of obstetrics and gynecology. In his application dated 9 February 1975 to take the Florida Medical Examination, Respondent listed work at Hudson County Hospital for Mental Diseases (New Jersey) in 1960, work for the American Plasma Company (Miami) from 1965 to 1968, work at the Opa Locka General Hospital from 1967 to 1970, and that he was presently working as assistant doctor at 620 Southwest 1st Street, Miami. Prior to commencing this work at the Southwest Medical Clinic he contacted Physicians's Association of Clinics, Hospitals and Annex (PACHA), an organization which helps Cuban doctors obtain Florida licenses, and was told he could work at the clinic under Dr. Tomas and should register with the Board of Medical Examiners. Respondent registered with the Florida State Board of Medical Examiners as an unlicensed physician in two undated registrations, copies of which were admitted into evidence as Exhibit 5. In the earlier registration he states he is not a naturalized citizen and in the later application he states he is a naturalized citizen, although the year of naturalization is not shown. Anne West, who was apparently running an abortion referral service, called the State's Attorneys office in Miami on behalf of Respondent and was told Respondent could work at the clinic under a licensed doctor. She subsequently became Mrs. Bulas. Respondent testified he commenced doing medical work in the Miami area in 1975 when he became associated with and worked under the supervision of Kamel Tomas, M.D. in a clinic located at 620 Southwest 1st Street, Miami. He subsequently worked at this clinic under the supervision of two other licensed doctors whose names are Hernandez and Martin. In 1976 Respondent successfully passed the Florida Medical Examination and was licensed in July 1976. While working at the clinic on Southwest 1st Street Respondent performed several abortions. In an 18-count Information filed 23 March 1978 (Exhibit 1) for the period 1 May 1975 through 5 March 1976 Respondent was charged with 11 counts of unlawful practice of medicine, 6 counts of larceny and one count of unlawful termination of pregnancy. At his trial and upon the advice of counsel he pleaded nolo contendere, was found guilty of 10 counts of unlawful practice of medicine, six counts of grand larceny and one count of unlawful termination of pregnancy, and Adjudication of Guilt was withheld (Exhibit 2). Most of these charges alleged felonies. In Exhibit 3 the court stayed imposition of sentence and placed Respondent on probation for 5 years with a condition of probation that he be confined in the Dade County Jail for a term of one year. From reading the counts of the Information, as well as from the testimony of Respondent, it is clear that the larcenies alleged resulted from the fees charged by the clinic to those patients treated by Respondent, which formed the bases for the unlawful practice of medicine counts. The information alleging unlawful termination of pregnancy was based upon the performance of an abortion by Respondent while not licensed in Florida. The testimony was unrebutted that numerous clinics in Miami employ Cuban doctors who are unlicensed in Florida. In a class conducted at Jackson Memorial Hospital to prepare former Cuban doctors for the Florida examination there were about 460 in the class attended by Respondent, most of whom worked in clinics in Miami. At the time Respondent worked at the clinic he believed that so long as he was under a licensed doctor the medical work he performed was lawful. However, Respondent was not under the direct supervision of the licensed doctor as each was working on a different patient in separate examining rooms at the same time. No evidence was presented to indicate Respondent was not fully qualified by training and experience to perform the medical practices that he performed prior to receipt of his Florida license.
The Issue The issues in this case are: (1) whether Petitioner’s application pursuant to Section 458.315, Florida Statutes, for a temporary certificate to practice in an area of critical need should be granted or denied; and (2) whether Petitioner is entitled to withdraw his application prior to action by the Board of Medicine on the merits of the application.
Findings Of Fact Petitioner is a medical doctor, presently licensed to practice medicine in the State of New York. Petitioner signed a Florida Department of Health Board of Medicine Application for Temporary Certificate to Practice in an Area of Critical Need on June 19, 2003. Question number 13 on that application form asked, “Have you ever had any Medical/professional license revoked, suspended, placed on probation, received a citation, or other disciplinary action taken in any state territory or country?” Petitioner answered “yes” to question number 13. The Notice of Intent to Deny issued by the Florida Board of Medicine cited as the only reason for denial “[t]he applicant had action taken against the license by the New York and the Utah Medical Licensing Boards.” It has since been confirmed that the Utah Division of Occupational & Professional Licensing did not take any action against Petitioner’s medical license in Utah. The New York Department of Health, Monitoring Unit, Office of Professional Medical Conduct, did take action against Petitioner’s medical license in New York. The New York Department of Health described its action as follows: Dr. Jacoby currently holds a valid NYS medical license, and is permitted to practice in this State, however the sanctions imposed by the enclosed Order are still in effect, and have not yet been fully satisfied. The suspension was lifted in January 2003, however the three years probation remains ‘tolled’ at this time, to be imposed when Dr. Jacoby returns to the practice of medicine in this State. [Emphasis added.] The underlying reason for Petitioner’s discipline in New York is for failing to repay a student loan guaranteed by the federal government. Petitioner had secured a health education assistance loan guaranteed by the federal government for approximately $51,000.00 between 1982 and 1983. The loan came due nine months after Petitioner graduated from medical school in June or July of 1984. Petitioner did not make any payments toward the loan for approximately 18 years. In September of 2002, Petitioner finally settled his long past-due student loan debt. Petitioner requested to withdraw his Application for Temporary Certificate to Practice in an Area of Critical Need after the Credentials Committee voted to recommend denial of his application to the full Board of Medicine. Petitioner promptly made a similar written request addressed to the full Board of Medicine. The full Board of Medicine denied Petitioner’s request to withdraw his application. The Board of Medicine then considered the merits of Petitioner’s application and voted to deny the application. The Board’s action was memorialized in a Notice of Intent to Deny Licensure by Area of Critical Need, which reads as follows in pertinent part: This matter came before the Credentials Committee of the Florida Board of Medicine at a duly-noticed public meeting on September 13, 2003, in Tampa, Florida and the full Board on October 3-4, 2003, in Ft. Lauderdale, Florida. The applicant appeared before the Credentials Committee on September 13, 2003, and presented testimony regarding the application file. The application file shows: The applicant had action taken against the license by the New York and the Utah Medical Licensing Boards. Additionally, the Board considered applicant’s Motion to Withdraw his application during the full Board meeting and voted to deny applicant’s motion. The applicant is guilty of violating Section 458.331(1)(b), Florida Statutes, for having a license acted upon by another jurisdiction. Based on the foregoing, the Board may refuse to certify an applicant for licensure, or restrict the practice of the licensee, or impose a penalty, pursuant to Sections 458.331(2) and 456.072(2), Florida Statutes. It is therefore ORDERED that the application for licensure by area of critical need by DENIED. If a final order is issued denying Petitioner’s license, the denial will be reported to the Federation of State Medical Boards, which is a depository of all disciplinary actions and license application denials by state boards in the United States. In recent years, it has been the consistent practice of the Florida Board of Medicine to deny applications for licenses to practice medicine if the applicant’s medical license is on probation in another state. Such practice is not required by either rule or statute. The Board of Medicine does not make any effort to advise applicants or prospective applicants of its consistent practice of denying applications from physicians who are on probation elsewhere. At the time he filed the subject application, as well as at the time of his appearance before the Credentials Committee, Petitioner was not aware of the Board of Medicine’s history of not granting applications submitted by physicians on probation elsewhere. Had Petitioner been aware of the Board’s history in that regard, he would not have filed an application.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be issued in this case granting Petitioner’s application for a temporary certificate to practice medicine in communities of Florida where there is a critical need for physicians. DONE AND ENTERED this 22nd day of April, 2004, in Tallahassee, Leon County, Florida. S MICHAEL M. PARRISH Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 22nd day of April, 2004.
The Issue By a three Count Administrative Complaint filed August 22, 1987, Petitioner sought to discipline Respondent's medical license. Counts II and III were voluntarily dismissed ore tenus at the commencement of formal hearing and they are therefore dismissed as a matter of law. The remaining Count I alleges violations of Section 458.327(1)(c), Florida Statutes, attempting to obtain or obtaining a license to practice by a knowing misrepresentation and of Section 458.331(1)(a), Florida Statutes, by attempting to obtain, obtaining or renewing a license to practice medicine by bribery, fraudulent misrepresentations or through an error of the Board of Medicine. BACKGROUND AND PROCEDURE Petitioner presented the oral testimony of Respondent as an adverse witness and introduced deposition testimony of 5 other witnesses. Petitioner had 5 exhibits (including depositions) admitted in evidence. Respondent testified on his own behalf and presented the oral testimony of 4 other witnesses, John C. McCloskey, Dr. John K. Robinson, Dr. William M. Straight, and Hilda Bengochea and the deposition testimony of 1 other witness. Respondent had 5 exhibits (including one deposition) admitted in evidence. The Joint Prehearing Stipulation was admitted as Hearing Officer Exhibit A. The transcript in this cause was duly filed and the parties timely filed their respective proposed findings of fact and conclusions of law, the findings of fact of which have been ruled on in the Appendix to this Recommended Order, pursuant to Section 120.59(2), Florida Statutes.
Findings Of Fact Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.30, Florida Statutes, Chapter 455, Florida Statutes, and Chapter 458, Florida Statutes. Respondent is, and has been at all times material hereto, a licensed physician in the State of Florida, having been issued license number 0040981. Respondent's last known address is 555 Biltmore Way, Suite 201, Coral Gables, Florida 33134. On or about May 11, 1982, Respondent submitted an application to the Florida Board of Medical Examiners for licensure to practice medicine in the State of Florida. Based on the application, Respondent was granted licensure by endorsement and was issued Florida Medical License ME 0040981 from the Board of Medicine in September, 1982. On the above-mentioned application Respondent represented that he had attended Universidad Nacional Pedro Henriguez Urena (UNPHU) from January 1975 to January 1979 and that he had attended Universidad Centro de Estudios Technicos Medical School (CETEC) between January 1979 and December 1980. Respondent further failed to include his attendance at Instituto Technologico de Santo Domingo Medical School (INTEC) between approximately October 1979 and June 1980 (approximately 8 or 9 months). Respondent's actual attendance at UNPHU was from January 1975 to June 1979. From June 1979 to October 1979 Respondent was to all intents and purposes on summer vacation. He was in attendance at INTEC from October 1979 to June 1980 and at CETEC from June 1980 to December 1980. All of these medical schools are physically located in the Dominican Republic. In September, 1979 Respondent had applied for a transfer from UNPHU to INTEC. He was accepted in September, 1979 and began his course of study at INTEC in 0ctober, 1979. INTEC required that, in order for Respondent to graduate from that institution, he must repeat a number of courses that he had previously taken and passed at UNPHU. As a consequence, Respondent took approximately six courses (during two academic quarters) at INTEC, which courses he had previously taken and passed at UNPHU. Under the auspices of INTEC, after completing two quarters, Respondent was required for three months, until June, 1980, to do field medical work to assist those in the Dominican Republic countryside who needed medical assistance as a result of hurricanes Frederick and David. Respondent also did clinical rotations at one or two local hospitals in the city of Santo Domingo. He did well at INTEC and was not asked to leave that university. In June 1980, Respondent applied and was accepted at CETEC. CETEC's school of medicine first began its admission process in December 1979 but CETEC did not start its first classes until January, 1980. Respondent was admitted into the M.D. program in June 1980. Respondent never lived on any campus in the Dominican Republic but lived independently in town. He does not recall if he switched residences between institutions. CETEC gave Respondent credit ("convalidated") for the courses he had taken at both UNPHU and INTEC. Petitioner has pointed to no evidence that his convalidation was inappropriate under the circumstances. Respondent's motivation when he transferred to CETEC was that CETEC allowed him to participate in a rare opportunity--an externship program at the University of Miami School of Medicine at Jackson Memorial Hospital in Miami, Florida. Respondent changed his Santo Domingo residence to one in his hometown of Miami when he moved there. He completed his rotations in the United States under the auspices of CETEC. The evaluations from the University of Miami School of Medicine indicated that Respondent did extremely well during these rotations. Respondent graduated from CETEC and was granted a diploma in December, 1980. Subsequently, Respondent applied for, and was accepted and worked in a residency training program in Pensacola, Florida, for three years. The evaluations from his residency indicate that Respondent's performance was well above average and he was appointed as chief resident in his last year of this residency. The application for Florida licensure containing the inaccuracies stated in Finding of Fact 5, supra, was filed during Respondent's year of internship, when he was on call every other night. The application form requested him to list his medical education and to "be specific" and "account for each year". He did not have his records with him in his physical location in Pensacola at the time he discovered that the Florida Board only accepted applications once a year and he had little time in which to meet the time limit for his only possible application for 1982. The inaccuracies of Respondent amount to a wrong date for departure from UNPHU; a wrong date (18 months early) for beginning at CETEC, which date predates CETEC's first medical school class, and complete omission of his INTEC experience. In addition to the speed and stress of the application period and the absence of accurate backup records, Respondent explains the application's inaccuracies by pointing to his contemporaneous belief that he was being accurate and his incorrect perception at that time, based on prior experience, that the question was only seeking the name of the medical school from which he graduated and his date of graduation. He also never considered his INTEC attendance as part of his medical education since it was short term and largely repetitive of previous course work he had successfully completed. Apparently recognizing that the question was ambiguous or at least could be better worded, the Board has since revised its application form to specifically require listing of all schools, clerkships, etc. by date. Dr. John Robinson, M.D., Associate Dean for Student Affairs at the University of Miami Medical School for twenty-one years testified on Respondent's behalf. As part of his duties at the medical school, Dr. Robinson acts as the Registrar who keeps students records and certifies their education. It is common within Dr. Robinson's education, training, and experience that students and physicians alike frequently but unintentionally mistake the dates and places they attend medical school. Based on his personal good opinion of Respondent's past medical background and practice and Respondent's reputation for truth and veracity, it was Dr. Robinson's opinion that the application inaccuracies represented human error of Respondent and common error within Respondent' s experience. Respondent presented testimony of other prominent physicians and lay witnesses in the community who attested to his good character, reputation for truth and veracity, excellent patient care, and community service through his medical practice. Generally, Petitioner did not affirmatively demonstrate any improper motive or establish that Respondent had any intent to conceal or misrepresent his medical education on his application. Nor did Petitioner establish that Respondent had anything to gain by the inaccurate information on his application. The dates given by Respondent were correct to the extent that they indicate the date he began his medical education, the date he ended his medical education, and the medical school (CETEC) from which he graduated and which gave him credit for his work at the two previous schools (UNPHU and INTEC). Dorothy Faircloth, Medical Board Executive Director, confirmed that in 1982 the Board's process was to verify the education of an applicant only from the school which issued his medical degree. Specifically, it was not affirmatively demonstrated that Respondent would not have been licensed had he disclosed his attendance at INTEC and noted the correct dates of his interim medical education. At the time of Respondent's application, the Board had no rule or policy relating to the number of schools an applicant had attended and nothing in the transcripts and official documents of any of the three universities attended by Respondent reflect unfavorably on Respondent. The Board has licensed a number of medical physicians who graduated from CETEC but who previously attended one or more medical schools prior to attending CETEC. Respondent was a bona fide student in attendance at CETEC and graduated in good standing. Except for alleging misrepresentation and fraud in the application, Petitioner has not attacked the thoroughness, efficiency, or efficacy of Respondent's actual education, nor his ability to practice medicine safely. Respondent is presently in private practice with two other medical physicians in Coral Gables, Florida. He has staff privileges at six area hospitals, he has never been charged or accused of malpractice, and he has not, until this case, been investigated by the Board of Medicine or had any action taken against his license. He is also currently licensed in Georgia.
Recommendation Upon consideration of the foregoing, it is, RECOMMENDED that the Board of Medicine enter a Final Order dismissing Count I against Respondent. DONE and RECOMMENDED this 28th day of January, 1988, at Tallahassee, Florida. ELLA JANE P. DAVIS, 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 Divisionf Administrative Hearings this 28th day of January, 1988. APPENDIX TO RECOMMENDED ORDER DOAH Case No. 87-0401 The parties' proposed findings of fact (PFOF) are ruled on pursuant to Section 120.59(2), Florida Statutes, as follows: Petitioner's PFOF A. 1. Covered in FOF 1. 2. Covered in FOF 2. 3. Covered in FOF 3. 4. Covered in FOF 4. 5-6. Covered in FOF 5. 7-8. Covered in FOF 11. B. 1-2. Covered in FOF 5. 3-4. Covered in FOF 19. 5. Covered in FOF 9. 6-8. Covered in FOF 10. 9. Rejected as not supported by the record, taken in context. SeeTR 35-36. 10-11. Accepted but unnecessary. Accepted but out of context and not dispositive of any issue at bar. Accepted but unnecessary and not dispositive of any issue at bar. Unnecessary. Unnecessary and not dispositive of any issue at bar. Rejected as stated because it is misleading as to the competent substantial record evidence as a whole and it is not an ultimate FOF. See FOF 19 and 22. Covered in FOF 4. Respondent's PFOF 1. Covered in Substance in FOF 2. 2-3. Covered in FOF 23. 4. Covered in FOF 3-4. 5-6. Covered in FOF 6. Covered in FOF 6-7. Covered in FOF 6-8. Covered in FOF 9. Subordinate, and also not clear from the record. The Respondent could just as easily mean that several different professors and not a single professor taught him at INTEC. 11-12. Covered in FOF 10. Covered in FOF 11. Covered in FOF 13. Covered in FOF 14. Covered in FOF 15. Covered in FOF 16. 18. Covered in FOF 17. 19. Covered in FOF 18. 22-23. Covered in FOF 19. 24. Covered in substance in FOF 19. 25-27. Cumulative. 28-29. Covered in FOF 19. 30. Covered in Substance in FOF 19. 31. Except as cumulative or subordinate, covered in FOF 19. 32. Covered as a conclusion of law. 33. Covered in FOF 19. 34. Unnecessary and not dispositive of the single count of the Administrative Complaint remaining at issue. 35. Rejected as argument of counsel. 36-39. Covered in FOF 20. 40. Covered in substance in FOF 20. 41-46. Except as subordinate, covered in FOF 21. 47-49. Unnecessary, but see FOF 21. 50-51. Except as subordinate, covered in FOF 21. 52. Unnecessary. 53-56. Covered in FOF 22. 57-58. Unnecessary and subordinate. 59 . Covered in FOF 22. 60. Covered in substance in FOF 19. 61-69. Unnecessary. COPIES FURNISHED: Dorothy Faircloth, Executive Director Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Peter S. Fleitman, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Robert S. Turk, Esquire Suite 3400, One Biscayne Tower 2 South Biscayne Boulevard Miami, Florida 33131 William O'Neil, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue Whether Petitioner is qualified to be licensed as a medical doctor in Florida by endorsement.
Findings Of Fact Petitioner Jeffrey Jad Gaier applied for licensure by endorsement in Florida by filing a written application in November of 1983 with the Board of Medical Examiners, which is within the Department of Professional Regulation. He made a personal appearance before the Foreign Graduate Committee of the Board of Medical Examiners in April 1984. After Petitioner's appearance before the Foreign Graduate Committee, the Foreign Graduate Committee made a favorable recommendation regarding Petitioner's application for licensure to the Board of Medical Examiners. However, the full Board of Medical Examiners voted to deny Petitioner's application for licensure. On May 21, 1984, the Board of Medical Examiners rendered an Order denying Petitioner's application for licensure as a physician by endorsement, stating as the grounds: Your application and supporting documentation does not provide sufficient information to demonstrate that you can practice medicine with reasonable skill and safety. See Section 458.331(3), F.S. More specifically, the clinical training you received while attending the American University of the Caribbean as disclosed within your documentation was determined to be insufficient insofar as the clinical training was not received at a hospital affiliated with a medical school approved by the Counsel [sic] on Medical Education of the American Medical Association. The denial of Petitioner's application for licensure by endorsement was taken before the Board of Medical Examiners for reconsideration on February 3, 1985. Counsel for Petitioner was present at the hearing. At that hearing, the discussion by the Board of Medical Examiners of the request for reconsideration clarified the basis for the denial of the medical license as being the overall inadequacy of the clinical training and not specifically because the clinical training was not obtained at teaching hospitals. Except for the purposes of clarifying the issue(s) herein the collegial actions of the board are irrelevant to the instant de novo proceedings. Petitioner received a B.S. degree from Clark University, Massachusetts and a Masters degree in science education from Florida Institute of Technology, August 1978. Petitioner was granted a medical degree by the American University of the Caribbean after being enrolled at that school for less than three years. During that time, Petitioner was on the campus of the American University in Montserrat, British West Indies for only eight months. There the class used prepared slides instead of gross tissue samples. Before that, Petitioner studied at the campus in Cincinnati, Ohio, where the class used rubber cadavers instead of human cadavers. All of the clinical training received by Petitioner as part of the requirements for the completion of the medical degree consisted of preceptorships at hospitals in south Florida which included Florida Medical Center, Plantation General Hospital, University Community Hospital, and Bennett Community Hospital. Dr. Neil Katz, Petitioner's principal expert medical witness, supervised Petitioner for six weeks in a preceptorship in Family Practice. Dr. Katz is a board-certified Family Physician and a fellow of the American Academy of Family Practice. He has been Chairman of the Emergency Room Department, a member of the Credentials and Qualifications Committee, and a member of the Intensive Care Unit Committee at University Hospital, Tamarac, Florida. He has taught both foreign medical students in a clinical setting and has briefly qualified as a preceptor for the University of Florida College of Medicine. Dr. Katz actually supervised Petitioner only for the six-week period at the very beginning of Petitioner's rotations. After that six-week period of time, he only "touched base" with Petitioner, seeing him on an informal basis in the cafeteria or at meetings. During the six weeks formal observation period, Petitioner accompanied Dr. Katz in his work in his office, during hospital rounds, at the emergency room, and for most other activities that Dr. Katz participated in, including committee meetings at the hospital. Petitioner took histories and did physicals on patients under direct supervision. Petitioner displayed enthusiasm and energy in his association with Dr. Katz and the rest of the program. Dr. Katz found Petitioner "barely acceptable" in three of the nine categories for which he was to evaluate Petitioner during the preceptorship. These categories were diagnostic acumen, therapeutics and management, and medical knowledge. In explaining that evaluation, Dr. Katz testified that although Petitioner was able to take a history and a physical examination, he was not able to make a diagnosis. In fact, Dr. Katz testified that Petitioner did not have truly acceptable knowledge at the time as to the various therapeutic modalities available to a physician. He encouraged Petitioner to do more reading. During his preceptorship with the University of Florida Medical School students in their first clinical semester, Dr. Katz also saw problems similar to those exhibited by Petitioner, specifically that the University of Florida students were not "super ready," so to speak, on diagnosing and doing differential diagnoses and therapeutics at that particular stage in medical school because they were still learning. I accept Dr. Katz' opinion that Petitioner had adequate exposure to the major diseases and injuries which are common to Family Medicine, sufficient for Petitioner to go into an internship, but in light of his lack of involvement with Respondent's other preceptorships in several different hospitals after the first six weeks, and in light of his specific testimony that in his professional opinion, American-trained students were far superior to the Caribbean-trained students at the same level in terms of general knowledge (TR-65-66), Dr. Katz' opinion that Petitioner did "quite good" at the end of the year and a half period is without adequate predicate and is not persuasive. Dr. Isidoro Dunn was the primary force in the arrangements for preceptorships. Dr. Dunn talked with each preceptor to work out areas which should be covered in their respective rotations. Each preceptor had a "fair amount of latitude" in deciding how to supervise the students. Petitioner was assigned by his school to do his clinical rotations in Florida. He did 14 weeks in internal medicine, 14 weeks in surgery, 10 weeks in pediatrics, 10 weeks in obstetrics/gynecology, 4 weeks in psychiatry, and 10 weeks in electives. This totals 62 weeks, not even close to two years which is the norm in medical schools in the United States. Petitioner was required to follow patients from admission to discharge in each specialty within each of these clinical rotations. Petitioner had didactic teaching on a daily basis, weekdays. Petitioner represents that he had specific didactic courses in hematology, EKG readings, pathology, orthopedics, cardiology, radiology, and gastrointestinal invasive procedures. In each subspecialty, he had a written examination after completion of the rotation, didactic teachings in each rotation, and was required to read medical journals. On Saturdays, Petitioner was required to participate in case conferences, make case presentations, and complete assigned reading from current medical journals. The case presentations necessitated review of patient records, laboratory tests, x-rays, and pathology slides. On "patient management reviews," the Petitioner was "exposed to" or "spent time in" the dialysis unit, pathology laboratory, intensive care unit, emergency room, gastrointestinal unit, blood lab, catherization department, radiology department, EKG unit, and cardiac surgery unit. Petitioner testified, and Dr. Katz confirmed, that there was an entity called the "Doctors' Club," which had a considerable amount of audiovisual equipment available for use 7 days a week, 24 hours each day. Practicing physicians used this media to obtain continuing medical education approved for credit by the American Medical Association. Petitioner represented that "on several days" he signed out equipment or reading material. There is no precise language in his testimony that he used the equipment or that he read the reading material, but drawing any other inference is straining the clear meaning of Petitioner's unrebutted testimony. Petitioner and the other students were required to use various materials from this service, but there is no evidence that Petitioner or other students were objectively checked by Dr. Dunn or their preceptors to verify that they had actually read or viewed the material assigned. Petitioner specifically testified that there was not necessarily any follow-up by the preceptors. Dr. Katz did talk with Petitioner about the reading assignments he gave. Petitioner was required to pass a competency examination for each rotation. Petitioner's clinical studies evaluation forms in his school records indicate no overall evaluation grades below "Good." Petitioner was required to attend and pass both a written and practical examination for a two-day Advanced Cardiac Life Support Course. This course is required even of board certified emergency room (ER) physicians. In Petitioner's opinion, this course was imperative for medical doctors who might work in an emergency room because they need to be very familiar with how to handle a patient presenting with a cardiac arrest, including the administration of drugs, "cardioversion" and "intubation." To the best of Petitioner's knowledge, Dr. Dunn was to report the students' progress to the dean of the American University of the Caribbean. However, the predicate for that testimony is hearsay, uncorroborated by any direct, credible evidence. As for the relationship with the university, Dr. Katz had no knowledge as to any arrangement between Dr. Dunn and the American University of the Caribbean or any counterpart-sponsoring organization in the United States. He did not know if there was any arrangement whatsoever. Dr. Katims was accepted as an expert physician witness, as an expert teaching fellow witness, and as an expert witness in medical applications and licensure. He testified that in the normal course of medical education in the United States, part of a student's medical education is clinical training, and that experience consists of bedside outpatient treatment and supervised training under the supervision of a faculty selected particularly for their knowledge, background, and interest in education and teaching. Dr. Katz testified unequivocally that a preceptorship is very different from a clinical rotation or a clerkship. A clerkship takes place in a teaching hospital, which is a very structured environment, wherein students make rounds in a very large hospital and are given instruction in an approved clinical structure. In contrast, a preceptorship gives students more knowledge about what private practice is like and it gives students a view of direct patient care, but does not replace a formal teaching setting in clinical medicine. As recognized above, in Dr. Katz' opinion, American-trained students were far superior to the Caribbean-trained students at the same level in terms of general knowledge. In Dr. Katims' opinion, Petitioner's clinical studies consisting of only four semesters were not sufficient for him to practice medicine with reasonable skill and safety. Dr. Katims testified concerning the importance of clinical training in medical education, commenting that clinical training is the sine qua non of the practice of medicine. In the usual clinical rotation, medical students are assigned to a particular area of a hospital and perform under the full-time supervision of attending physicians. In teaching hospitals, faculties are selected for their ability, interest, and dedication to education, as well as to the practice of medicine. The attending staff at a teaching hospital include house physicians, interns, and residents. Dr. Katims himself has served as a preceptor and testified that a preceptorship is one method of obtaining a minor portion of clinical training, but is very unstructured and unsupervised. Dr. Katims testified that preceptorship training is an inferior method of training because the quality of training depends totally on the quality of the physician to whom the student is assigned and the program is unstructured. There was no testimony that any of the preceptors that supervised, or purportedly supervised, Petitioner were faculty members of any medical school, let alone the American University of the Caribbean. Upon the Requests for Admissions and the Joint Pre-Trial Stipulation of the parties, it is found that: the State of Florida Board of Medical Examiners has granted a medical license to a Dr. Flugsrud-Breckenridge and a Dr. Cobb, both having non-teaching clerkships. Three doctors, Adela Fernandez, Andrew Gonzalez, and Manuel E Garcia, did their clerkships principally at the International Hospital (Miami), a non-teaching/non-medical school-associated hospital, and obtained Florida medical licenses. At least 25 foreign graduates received Florida medical licenses within the years 1981-1984 and did their clerkships principally in non-teaching/non-medical school associated hospitals. No further information appears of record by which the undersigned may determine any other similarities or dissimilarities of these licensees to each other and/or to Petitioner. Nor does the record divulge what, if any, other facts may have been considered in these cases. Petitioner is licensed to practice medicine in Georgia and is a resident of Florida. Petitioner passed the first time his Educational Commission for Foreign Medical Graduates' (ECFMG) examination was given in June, 1981. The examination is a prerequisite to acceptance in a medical residency program. The Federation of State Medical Boards of the United States, Inc.'s (FLEX) examination is recognized by all 50 states, including Florida. Petitioner took this examination after completing his rotations in Florida. Petitioner passed the June 1982 FLEX examination with an 84 percentile ranking. Fifty percent of this test is on patient management. This clinical competence examination was taken before Petitioner started his first year of residency. Petitioner had passed the FLEX examination, completed one year of residency, and obtained a medical license in another state, Georgia, by the time of the April 1984 application hearing. In Dr. Katims' opinion, Petitioner's successful passage of the FLEX examination in the 84 percentile does not show Petitioner to have had good clinical rotations, even though the FLEX test consisted of 50 percent on patient management. Dr. Katims did not feel that by the time Petitioner was in his fourth year of residency, this would be curative of deficiencies in the clinical semesters at a non-teaching hospital, but expressed the opinion that if Petitioner passes his internal medicine board examination and becomes board certified, his clinical deficiencies would be cured and Petitioner should then be granted a Florida medical license by endorsement. Dr. Katz opined that Petitioner presently possesses the medical knowledge, judgment and competency to act with reasonable skill and safety in the practice of medicine in Florida. Affidavits of Ira Spiler, M.D. and John R. Middleton, M.D. support similar opinions of these New Jersey medical physicians. Petitioner has completed three years (July 1, 1982 to June 30, 1985) of Internal Medicine residency at Raritan Bay Medical Center, Perth Amboy General Hospital, New Jersey. Petitioner is presently enrolled in a Nephrology Fellowship program, Medical College of Georgia, a teaching hospital located at, and affiliated with, the University of Georgia Medical School. Petitioner is currently eligible for board certification in internal medicine and will be certified in the event he passes the board examination taken September 10-11, 1985. Petitioner has submitted letters of Ira Spiler, M.D. and Salvatore Chiaramida, M.D., both of New Jersey attesting to Petitioner's good moral character, and no contrary evidence was turned up by the Board's investigation. The parties have stipulated that Rule 21M-22.18, Florida Administrative Code, is not applicable to Petitioner's situation.
Recommendation That the Florida Board of Medical Examiners enter a final order denying Petitioner a medical license by endorsement. DONE and ORDERED this 16th day of January, 1986, in Tallahassee Florida. ELLA JANE P. DAVIS 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 16th day of January, 1986.
