Findings Of Fact At all times pertinent to this proceeding, the Respondent Jose Raul Suarez, held a Medical license to practice medicine from the State of Florida, Board of Medical Examiners. The Respondent Suarez was born in Tampa, Florida, in 1928 and attended the University of Florida from 1945 through February 1950, receiving a Bachelor of Science degree on February 5, 1950. Respondent Suarez then attended the University of Havana, Cuba, from September 13, 1950 until February 15, 1956. From April 5, 1956 through October 23, 1958, the Respondent attended the Madrid Medical School, Spain, and then completed an internship' in Miami Beach, Florida, from January, 1959 through January, 1960. According to her application for Medical licensure filed with the Florida Board of Medical Examiners, Olga Lourdes Romani attended the Havana University from September, 1947 to September, 1954, and worked at the Hospital- Caliato Garcia-Havana from 1953 through 1954. Romani stated in her application that following a three year absence from the practice of medicine, she resumed practice in several hospitals and clinics from 1957 through 1961. Romani subsequently applied for Medical licensure with the Florida Board of Medical Examiners, attaching to her application an affidavit of Respondent Suarez dated February 5, 1975, which states as follows: STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL AND OCCUPATIONAL REGULATION BOARD OF MEDICAL EXAMINERS 305 South Andrews Avenue, Suite 801 Fort Lauderdale, Florida 33301 AFFIDAVIT APPLICANT: ROMANI, OLGA LOURDES I, JOSE RAUL SUAREZ,. . . do hereby swear and affirm by my personal knowledge, that OLGA LOURDES ROMANI, attended and graduated from SCHOOL OF MEDICINE - HAVANA - CUBA and did lawfully practice the profession of medicine in Havana Cuba during the years 1954-1961. The affidavit went on to set forth the fact that Dr. Suarez was licensed to practice medicine in the State of Florida, stating his Medical license number. (See Petitioner's Exhibit No. 3) Based upon the application for Medical licensure with attachments, Olga Lourdes Romani became licensed as a Medical doctor in the State of Florida in 1976. Respondent provided an affidavit on April 17, 1981 to Department of Professional Regulation investigators during the course of the 1981 investigation of the Medical credentials of Olga Lourdes Romani. In the affidavit he stated as follows: I am supplying this affidavit at the request of J.P. McDougald investigator for the Dept. of Professional Regulation. I have no personal knowledge when or if she graduated from the University of Havana Medical School (she being Olga Lourdes Romani). I signed affidavit 1-29-75 for Olga L. Romani at her request because she told me that she had graduated from the University of Havana Medical School and had practiced medicine previously in Cuba. I think it's possible (at this time) that she may have practiced medicine 1954-1961 but I do not recall for sure that she had her license or graduated from the above University. To my present knowledge the above Affidavit was not notarized in my presence, it was apparently notarized February 5, 1975 which was several days after my affidavit. The above statement I have read and is true to the best of my knowledge at this moment. (See Petitioner's Exhibit No. 5) In response to the Administrative Complaint, Respondent sent another affidavit dated February 5, 1982, to the prosecutor for the Department of Professional Regulation, stating as follows: This will certify, consistent with my Affidavit of 1975, that to my personal knowledge Dr. Olga L. Romani attended and graduated from the University of Havana School of Medicine and practiced medicine in Havana during 1954 to 1961. The above statement appeared in my Affidavit of 1975 and is hereby reiterated based on my personal knowledge that Dr. Romani worked at the Havana University Hospital as a physician during the years, 1954, 1955 and 1956; was addressed as a physician during that time, and was regarded in the University Hospital by everyone, including me, as a doctor. I wish to make absolutely clear that on making this sworn statement with regard to Dr. Romani, as when I made the 1975 affidavit, the words "to my personal knowledge" refer to that personal knowledge which I had of Dr. Romani's activities in the Medical profession in Havana during the time that I knew her, and under no concept did I intent to imply that I had actually seen her diploma. In 1956 I left Cuba to continue my studies in Spain which I completed in 1958, returning to Cuba. Since Dr. Romani, to my personal knowledge, was practicing medicine in Havana in 1954, 1955, and 1956 up to the time that I left for Spain, I had no information that her professional status varied, it was certainly logical to assume that she would have continued practicing medicine until the time that she came to this country. Therefore, based on personal knowledge, Dr. Romani practiced medicine until she came to this country. In 1981, appearing before the Department of Professional Regulation in Miami, as part of a customary investigation into my activities while under suspension (October 1980 to October 1981), a private investigator for the Department, Mr. J.P. McDougald, showed me the Affidavit which I had signed for Dr. Romani in 1975. He then proceeded to question me to determine whether I had ever seen her diploma or graduation from the University of Havana Medical School. To this I replied "No" but that I had personal knowledge that she was practicing medicine as previously stated. Mr. McDougald stated that this did not constitute personal knowledge since I had not seen her diploma and that I would have to clarify the previously written Affidavit (1975). Then Mr. McDougald together with Mr. Harley, an attorney proceeded to dictate a statement which they said would qualify more specifically my aforementioned Affidavit. Despite my repeated requests, Messrs. McDougald and Harley did not allow me to insert into their dictated verbatim statement certain important personal remarks, as contained herein, which would have clearly demonstrated my nonmalicious intent at the time I signed the 1975 Affidavit, sworn by me in good faith on the basis of the true knowledge available to me at that time. I again wish to emphasize that in giving Dr. Romani my 1975 Affidavit, I acted on my true conviction that she was a physician, based on my personal knowledge that she had worked as a physician in Havana, and at no time was it my intention to misrepresent, deceive or in any way offer false information. (See Respondent's Exhibit No. 1) At the final hearing the Respondent Suarez stated that all the affidavits which he executed were true. (Transcript p. 89) In his opening statement, counsel for Respondent admitted to the erroneous signing of the affidavit as to the graduation from Medical school of Olga Lourdes Romani by Dr. Suarez. (See Transcript p. 12) Dr. Suarez first met Romani in 1954, seeing her on campus of the University Medical School dressed in a white smock and he testified that he saw her several times on campus until 1956. He did not see Ms. Romani again or hear from her until 1975 when he signed the affidavit on her behalf. The Respondent believed Romani to be a doctor since he had seen her at the hospital, believed that she was practicing in a ward at the hospital and recalled that Romani was referred to as "doctor". Mr. Suarez had no personal knowledge of the practice of medicine by Romani from 1956 through 1961 due to his not seeing her during this period of time, she being possibly in Cuba while he was in Spain and the United States. However, he executed the affidavit which stated Romani was practicing medicine during this period in Cuba on his assumption that since Romani was practicing prior to 1956, she must have been practicing subsequent to that date. No evidence was presented by the Petitioner that Romani had not graduated from Medical school and practiced medicine for five years in Cuba. Respondent's license as a physician in the State of Florida is presently on probation for a period of two years following a one year suspension of. his license to practice medicine. Said suspension and probation resulted from an Administrative Complaint and formal proceeding wherein it was established that Respondent fraudulently prescribed scheduled controlled substances in return for stolen property and monies.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Petitioner Department of Professional Regulation, Board of Medical Examiners enter a Final Order dismissing the Administrative Complaint against Respondent Suarez. DONE and ORDERED this 5th day of October, 1982, in Tallahassee, Florida. SHARYN L. SMITH, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 5th day of October, 1982. COPIES FURNISHED: Joseph W. Lawrence II, Esquire Chief Attorney Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 W. K. Chester, Esquire 810 Northeast 80th Street Miami, Florida 33138 Dorothy Faircloth, Executive Director Florida Board of Medical Examiners 130 North Monroe Street Tallahassee, Florida 32301 Samuel R. Shorstein, Secretary Department of Professional Regulation Old Courthouse Square Building 130 North Monroe Street Tallahassee, Florida 32301 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF MEDICAL EXAMINERS, Petitioner, vs. CASE NO. 82-540 JOSE R. SUAREZ, M. D., Respondent. /
Findings Of Fact At all times relevant hereto, Respondent was a licensed physician in Florida having been issued License No. ME 0010862. He completed his residency in radiology at Emory University in 1964 and has practiced as a radiologist since that time. Following his arrest on a charge of intoxication, resisting arrest, etc., and the publicity resulting therefrom, Respondent was approached by representatives of the Impaired Physicians Program in Florida to look into his situation to learn if he had a problem with alcohol or drugs. At this time Respondent concurred that his drinking had gotten out of hand and that he should enter a clinic in Miami for treatment for his alcoholism. During the year or more leading up to this admission, Respondent had gone through a bitter divorce and the resultant strain increased his ethanol consumption; he had been fired from his job at Sun Bay Hospital because of his excess use of alcohol; he had entered into a financially improvident business decision to purchase expensive radiology equipment and open his own office; he had a severe heart condition requiring bypass surgery; and he had entered into a disastrous second marriage which had foundered. Additionally, Respondent has a primary mood disorder which manifested itself in at least two hypomanic episodes before he came under the treatment in 1983 of Dr. John S. O'Brien, a psychiatrist. Dr. O'Brien quickly recognized this bipolar mood disorder and started Respondent on lithium which Respondent takes on a continuous basis to maintain the proper level of lithium which controls the mood swings. Respondent acknowledged to the group from the Impaired Physicans Program that he had an alcohol problem and agreed to follow their recommendation that he enter the South Miami General Hospital for a four-week treatment program to help overcome his alcohol dependence. Because of the improvident and financially disastrous opening of his office and no permanent job, Respondent had to borrow about half of the $7,000 needed to defray the expense of his four week treatment program in South Miami. Respondent participated in all of the activities, discussion groups and other forms of therapy at South Miami. As the program drew to a close, the staff concluded that Respondent had not completely surrendered to the concept that he was an alcoholic and powerless to overcome the problem without outside support. Accordingly, it was recommended that he enroll in a three month course at a rehabilitation center in Mississippi. Respondent refused to follow this recommendation but agreed to attend AA meetings on a daily basis for the next 90 days. Upon leaving the South Miami Center, Respondent returned to the Orlando area where his mother resides, commenced looking for a job and attending AA meetings. In his job hunting, Respondent met with little success in either the Orlando or Tampa areas, but subsequently learned of a part-time job in Georgia. Respondent went for an interview and was employed part-time with other radiologists serving several small hospitals in Georgia and South Carolina. Respondent moved to Seneca, South Carolina, applied for and received a South Carolina license but spent most of his time at the Georgia hospitals. He did not notify the Department of Professional Regulation of his new address. While working in Georgia, Respondent met, and subsequently married, a woman associated with a fundamentalist religion group who does not drink alcohol. Respondent's testimony that he has not had a drink since entering the South Miami General Hospital in July 1985 was not rebutted. Respondent is now employed as the contract radiologist at a hospital in Sandersville, Georgia, a town with a population of about 7500. He has moved to Sandersville, the pace there is slower than in larger, busier hospitals, and Respondent is happy in this less stressful environment. Respondent contends that he attends AA meetings on a weekly basis in Sandersville but he was unable to recall the name of that AA group. Each AA group has a name. After learning Respondent's address in Georgia, the Florida Impaired Physicians Committee contacted Respondent to request he present some documentation regarding his progress in remaining rehabilitated. It was suggested that he attend Ridgeview, the primary dependency facility in Georgia, located near Atlanta, for an evaluation. Respondent's testimony, partly corroborated by his wife, is that he paid $3,000 for the three day in-patient evaluation at Ridgeview starting in January 1987; that upon arrival he was put through various psychologic tests as well as being given blood tests; that these evaluations and tests were so good that they told Respondent they believed his story that he was not drinking and to save him several hundred dollars they put him in a motel rather than keep him in the hospital overnight; that the following morning he awoke to a ten inch snowfall which paralyzed Atlanta; that no one came to the motel to pick him up as planned; that his wife drove him to the hospital and upon arrival the parking lots were covered with snow but empty of cars; that everything at the hospital was shut down, the abuse evaluation cancelled and he was told to go home; and when he called Ridgeview a week later he was told he would have to start the evaluation over again, be admitted to the hospital, and pay the costs ($3,000) for the evaluation. Respondent did not go back. This scenario as testified to by Respondent and his wife is not credible in the following particulars: The evaluation requires three days as an inpatient to accomplish and it is inconceivable that one being so evaluated would be sent to a motel; Although Respondent was allegedly sent to the motel to save him "several hundred dollars" and he had paid the $3,000 up front, nevertheless he was told the full fee ($3,000) would again be required; Snowstorms and other natural disasters which do not destroy the physical integrity of the hospital, do not result in a hospital closing its doors although such storms could make the hospital inaccessible so as to preclude staff from entering or leaving. Here Respondent allegedly drove to the hospital after (or during) the snowstorm only to find it closed. Both Florida and Georgia members of their respective impaired physicians program were involved in suggesting that Respondent go to Ridgeview for an evaluation. Normally Ridgeview sends the results of such an evaluation to the state in which the evaluate is licensed. No such report was received by the Florida Impaired Physicians Committee. The depositions of physicians with whom Respondent has worked for the past two years all agree that Respondent has performed as a radiologist in a very satisfactory manner and that they have seen no evidence to indicate Respondent has ingested alcohol during this period.
The Issue Whether Respondent committed the offenses alleged in the respective administrative complaints and the penalties, if any, that should be imposed.
Findings Of Fact At all times pertinent to this proceeding, Respondent has been a physician, licensed to practice medicine in the State of Florida. Respondent practiced in the specialty of internal medicine, but he was not board certified. RESPONDENT'S TREATMENT OF D. S. Patient D. S. was admitted as an in-patient at Humana Hospital Cypress in Pompano Beach, Florida, on November 30, 1989, at approximately 5:50 p.m. Respondent was on call and became the treating physician for D. S. Respondent first saw the patient at approximately 7:25 p.m. on the date of admission. Respondent did an admission history, physical examination, and wrote the admitting orders. The admitting diagnosis for D. S. was chronic renal failure. The patient's history reflected that he was a 67-year- old black male who had a long history of diabetes and hypertension. Respondent discussed the patient's condition by telephone with Robert Coquis, M.D., who specializes in nephrology. Dr. Coquis was of the opinion that the patient was in chronic renal failure, but that he did not have an emergency need for dialysis during the evening of his admission. The patient rested comfortably through the night of November 30, 1989. At 7:45 a.m., on December 1, 1989, nurses assisted the patient get in and out of bed. The patient's pulse and blood pressure readings establish that he was in stable condition at that time. At approximately 7:56 a.m. on December 1, 1989, Respondent was on the sixth floor of the hospital in the ICU/CCU attending another critically ill patient when he was contacted by the nurse attending D. S. Respondent was told that D. S. had gone into a seizure and that he was incontinent and unresponsive. Respondent ordered that 300 milligrams of Dilantin be administered to the patient to be followed by 100 milligrams of Dilantin every eight hours. A Physician's Order sheet (Exhibit 1, Page 6/30) reflects that at 0756 hours (7:56 a.m.) on December 1, 1989, Respondent gave the nurse a telephone order for "Dilantin 300 mg IVPB now then Dilantin 100 mg IVPB 'q 8o.'" IVPB means that the Dilantin was to be administered intravenously piggyback. The reference to piggyback (PB) means that the Dilantin was to be administered along with the other fluids, such as saline or water with sugar in it, that were being administered intravenously. The Dilantin would be in a separate bag that was to be connected to the IV line that was already attached to the patient's arm. The notation Dilantin 100 mg IVPB "q 8o" instructed the nurse to administer 100 milligrams of Dilantin every eight hours thereafter. Respondent testified that he initially ordered Dilantin, 300 milligrams IV, slow push, but that the nurse to whom he gave the order complained that they were short-staffed and that she did not have time to stand there and administer the Dilantin over a 15-minute period of time as ordered. In response, Respondent told her to administer the 300 milligrams of Dilantin "IV piggyback." Respondent viewed this to be an appropriate method of administering Dilantin since he understood the nursing protocol to be that the Dilantin would be administered at a rate of no more than 20 milligrams per minute. At that rate, it would take a total of 15 minutes to administer the 300 milligrams that had been prescribed. Although Respondent relied on this nursing protocol, he did not have a copy of the protocol, and there was no other evidence as to that protocol. An entry in the medical records (Exhibit 1, page 6/58) reflects that 300 milligrams of Dilantin was administered the patient at 0800 (8:00 a.m.) on December 1, 1989, and describes the manner in which it was administered as "IVP loading dose." This reference to IVP reflects that the IV was administered in "push" fashion, which means that the nurse physically remained with the patient and slowly injected the dose into the patient. If the nurse administered the dose IVP as indicated by the notation, the Dilantin would have been administered over a period of 15 minutes, which would have been appropriate. An entry in the medical records (Exhibit 1, Page 6/64) shows the following entry: 0800 hours: patient appears to have seizure, voided unintentionally, non-responsive; . . . Acucheck 87. Dr. Hays notified - Stat. Dilantin given. Reading this entry with other entries, it is found that the administration of Dilantin noted for 0800 hours (8:00 a.m.) is the same dosage that Respondent ordered by telephone at 0756 hours (7:56 a.m.) and the same dosage that was administered IVP. The use of the term "stat" means that the nurses immediately began administering the prescribed amount of Dilantin, but it does not refer to how much time lapsed between the time the nurses started the injection and the time they completed the injection. From the records, it cannot be determined with certainty how long it took the nurse to administer the 300 milligrams of Dilantin that began at 8:00 a.m. The records reflect that the patient's condition had improved as of 8:15 a.m. The patient was responsive and requested that the Posey restraint, which had been applied when had his first seizure, be removed. Approximately five minutes later, the patient was found to be non-responsive. CPR was begun by the nurses and an emergency room doctor was summoned. Respondent went from the sixth floor where he had been attending another patient in ICU to the patient's room on the fourth floor. When Respondent came into the room, efforts to resuscitate the patient by the emergency room physician and the CPR team were underway. Respondent remained in the room a few feet from the patient's bed while these efforts were being made. Respondent did not actively participate in efforts to resuscitate the patient. The patient was pronounced dead at 8:42 a.m. on December 1, 1989. Petitioner is not contending that Respondent's treatment caused or contributed to the patient's death. Dilantin should be given carefully and slowly to elderly patients with multiple medical problems such as D. S. because of side effects that can result in cardiac problems or hypertension. If it is to be administered rapidly, the patient should be closely monitored. Dr. Mark Multach testified by deposition as an expert witness on behalf of the Petitioner. Dr. Multach was of the opinion that Respondent fell below the acceptable standard of care when he ordered that the Dilantin be administered intravenously piggy back (IVP). Dr. Multach testified that the use of the term piggy back isn't specific enough to inform a nurse the period of time over which the Dilantin is to be administered. In Dr. Multach's opinion, administering Dilantin piggy back can take anywhere from five to sixty minutes. There is no dispute that Dilantin should have been slowly and carefully administered to D. S. Respondent asserts that he did order the Dilantin to be administered slowly since his order should be read in the context of the nursing protocol. Dr. Multach was not questioned about the nursing protocol upon which Respondent relied, nor was he questioned about similar protocols. RESPONDENT'S APPLICATION WITH PALMS OF PASADENA On November 5, 1993, Respondent completed an application for appointment to the medical staff at Palms of Pasadena Hospital in St. Petersburg, Florida. Question 6 of the application form pertained to the applicant's affiliations. Included was the following item: List all present and previous hospital affiliations in chronological order, starting with most current. Attach separate sheet if necessary. Thereafter, the application form had spaces for the applicant to provide the following: the name and address of the hospital, the status of the affiliation, the type privileges, and the dates of the affiliation. In response to this item, Respondent listed the following hospitals: Bayfront Medical Center, Northside Hospital, and St. Anthony's Hospital. All three hospitals are in St. Petersburg, Florida. In the space in which the applicant was to describe the status of the affiliation, the Respondent inserted the word "pending" for each of the three hospitals. In the space in which the applicant was to describe the type privileges, Respondent inserted "Int. Medicine" or "Internal Medicine." Respondent left blank the spaces in which the applicant was to provide the dates of the affiliation. Palms of Pasadena Hospital asked Respondent for further information regarding his hospital affiliations with Bayfront Medical Center and St. Anthony's Hospital by letter dated February 4, 1994. Respondent responded by letter dated February 15, 1994, as follows: I do not have privileges or affiliations with either of the institutions listed, however, I have just recently been approved for privileges at St. Petersburg General Hospital. I do not intend to apply for privileges at Bayfront or St. Anthony's Hospitals at this time. Please remove them from my application. I apologize for the confusion. On November 5, 1993, Respondent went to work for Dr. Fernando Larach. Dr. Larach wanted Respondent to apply for privileges at various hospitals in St. Petersburg. On that date, Respondent filed the Palms of Pasadena Hospital application and an application for privileges at Northside Hospital. Respondent had not completed an application for St. Anthony's Hospital or Bayfront Hospital on November 5, 1993. Respondent explained his rationale for putting "pending" as the status for the affiliations he listed on the Palms of Pasadena Hospital application as follows: Well that I knew that if I put down the hospitals that my boss told me to, that it would look better if I had applied to other hospitals besides Palms of Pasadena. And I didn't want to mislead anyone. So I specifically told my boss that I had better put "pending" beside each one to be absolutely truthful. And I was trying to fill out an application to Bayfront Medical Center, but I found out later they did not accept even an application. And then I was allowed to fill out an application to St. Anthony's. Respondent testified, credibly, that he intended to file applications for St. Anthony's and Bayfront when he completed the Palms of Pasadena application on November 5, 1993. Respondent filed a pre-application with Bayfront a few days after November 5, 1993, but did not pursue the formal application because he did not meet Bayfront's criteria of being board certified in the area of his specialty. Respondent's use of the term "pending" in describing his affiliations with St. Anthony's and Bayfront when he signed the Palms of Pasadena Hospital application, was an untrue representation related to the practice of medicine.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Petitioner enter a Final Order that finds Respondent not guilty of violating Section 458.331(1)(t), Florida Statutes, as alleged in DOAH Case No. 97-5910. It is further RECOMMENDED that the Final Order find Respondent guilty of having violated the provisions of Section 458.331(1)(k), Florida Statutes, as alleged in DOAH Case No. 97-5911. The Final Order should impose an administrative fine against Respondent in the amount of $500.00 for that violation. DONE AND ENTERED this 12th day of November, 1998, in Tallahassee, Leon County, Florida. CLAUDE B. ARRINGTON Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 12th day of November, 1998
Findings Of Fact Petitioner is licensed by the State of Florida as a Clinical Laboratory Technician. Petitioner applied to the Respondent for licensure as a Clinical Laboratory Technologist with specialties in microbiology, serology, clinical chemistry, hematology, immunohematology and chemistry. On February 11, 1980, Respondent denied Petitioner's application for a technologist's license for the reason that Petitioner does not have the sixty semester hours or HEW exam required under Section 10D-41.25(9) or (10), Florida Administrative Code. Petitioner holds a high school equivalency diploma. Petitioner attended the Manhattan Medical Assistants' School in 1960-1961 and graduated from that school, receiving a diploma as a Laboratory Technologist. When Petitioner attempted to obtain a transcript of his studies at that school, he discovered that the school is no longer in business; and, accordingly, he is unable to obtain a transcript reflecting his studies there. Petitioner does not have a bachelor's degree from an a"credited college or university. Through the years, Petitioner has taken a number of continuing education courses, but these courses have not been affiliated with an accredited college or university. Prior to moving to Florida, petitioner was employed for seventeen years as a Laboratory Technologist at the New Rochelle Hospital Medical Center and was a supervisor of the evening and night shifts at that Center. Petitioner's witnesses testified as to the quality of Petitioner's work as an employee of the Department of Pathology at South Miami Hospital. Petitioner has taken the U. S. Public Health Service proficiency examination in clinical laboratory technology. A satisfactory score on all sections of that examination must be obtained in order to Pass the examination. Petitioner passed each section of the examination except for the hematology section. He attempted to retake the examination but was advised that the March 30, 1979, examination was the last test scheduled by HEW. That examination has been administered on five different occasions between the years 1975 and 1979. There is no information available as to whether the HEW examination will or will not ever be administered again. That examination is not the same as the licensure examination given by the Respondent but can act as a prerequisite, if satisfactorily completed, to the state licensure examination. An approved course of study is available to Petitioner at Miami-Dade Community College. Personnel at that school have advised him that he would receive thirty-two credits for his life's work and that he would be required to take six or seven examinations plus approximately a year's worth of courses. Petitioner does not desire to attend that college even on a part-time basis several times a week, since he is employed at two full-time jobs at this time.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED: That a Final Order be entered denying Petitioner's application for a technologist's license pursuant to the provisions of The Florida Clinical Laboratory Law. RECOMMENDED this 10th day of October, 1980, in Tallahassee, Florida. LINDA M. RIGOT Hearing Officer Division of Administrative Hearings The Collins Building Room 101 Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 10th day of October, 1980. COPIES FURNISHED: Richard N. Krinzian, Esquire 8585 Sunset Drive, Suite 190 Miami, Florida 33143 Morton Laitner, Esquire Dade County Department of Public Health 1350 N.W. 14th Street Miami, Florida 33125 Mr. Alvin J. Taylor, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Findings Of Fact On August 7, 1984, the Petitioner, Abraham W. Chames, executed an application for examination for licensure as a medical doctor which was filed with the Florida Department of Professional Regulation on behalf of the Board of Medical Examiners, (now Board of Medicine), on August 9, 1984. Among other information required on the application was a section requesting information regarding the applicant's medical education. That question reads as follows: Be specific. Account for each year. List all universities or colleges where you attended classes and received training as a medical student. In response and on each of four lines which required the name of the medical school and location and the dates of attendance, the applicant listed the names of the appropriate universities. These were: Universidad Del Noreste/Tampico, Mexico, from August, 1978 to June 1979. Universidad Del Noreste/Tampico, Mexico, from August 1978 to June, 1979 [sic] CETEC University/Santo Domingo, Dominican Republic, from June, 1980 to June, 1981. CETEC University/ Santo Domingo, Dominican Republic, from June, 1981 to December 1981. The question immediately preceding the one just described requires the applicant to list all places of residence since initiation of medical training. In response, the applicant listed, Tampico, Tamps, Mexico, from August, 1978 to June, 1980 and on the second line, Miami Beach, Florida from June, 1980 to June, 1982. For the question that requires the applicant to account for all time from date of graduation to present, the Petitioner stated: "Started my residency in family medicine at the University of Miami: June 83 until present." Dr. Chames also indicated on his application that his Doctor of Medicine degree was obtained from CETEC University, Santo Domingo, Dominican Republic from which he graduated on December 12, 1981. As a part of the narrative reports submitted with his application and relating to the period of time spent at CETEC University from June, 1980 through December, 1981, Dr. Chames stated: "During this time, I performed all of my required and elective clinical rotations under the auspices of CETEC University and its New York City based office of C.J. Institute. I lived at 1247 West Avenue, Apt No. 1, Miami Beach, Florida." By so doing, he explained the apparent ambiguity between his place of residence and his medical education during the period, June, 1980 through December, 1981. The rotations taken and the dates thereof were thereafter listed immediately below the above-cited statement. It should be noted that all the rotations were completed at hospitals in the Miami, Florida area. It is not at all unusual for situations like this to happen and it is not improper. Along with the application submitted by Dr. Chames was a certification that he had successfully passed the examination of the Educational Commission for Foreign Medical Graduates, (ECFMG), which he took on July 21, 1982. On August 20, 1984, Dr. Chames was notified by the Board that it had been advised by the ECFMG that as of March, 1984, that body was withholding verification of its certificates for individuals with medical credentials issued in the name of CETEC University because of alleged irregularities with regard to these medical credentials. The Board requested that Dr. Chames waive the 90 days that it had for approval or denial of his application for licensure, which he did. ECFMG subsequently verified Dr. Chames' certification and this information was sent directly to the Board. On September 18, 1984, the Board advised Dr. Chames that he would be required to appear personally before the Foreign medical Graduate Committee, (FMGC), of the Board when notified. Two days later, on September 20, 1984, the Board advised him that his application was considered incomplete because he had failed to submit a copy of his medical school diploma, (notarized and certified as a true and correct copy) and a certified translation thereof. He was further advised that he had failed to submit an accounting for all of the time between December, 1981 and May, 1983, and a FLEX application with Part A completed. On August 23, 1985, Dr. Chames submitted a notarized affidavit in which he attempts to account for all time from December, 1981 through May, 1983 as requested. On August 15, 1985, Ms. Dorothy Faircloth, Executive Director of the Board, notified Petitioner that his application was still considered incomplete because of the failure to submit certain documentation including his diploma and translation thereof, an examination fee, a standard ECFMG certificate, photographs, letters of recommendation, an accounting for all of the time since graduation, and a FLEX application. By letter dated August 23, 1985, Dr. Chames' counsel, Deborah J. Miller, forwarded a notarized copy of the medical school diploma certified by the U.S. Vice-Consul, a notarized copy of the original translation thereof, a notarized copy of the ECFMG clearance, a notarized copy of the original standard ECFMG certificate, an accounting of Dr. Chames' time since graduation, and a comment that the addition application fee requested had been forwarded previously. The two photographs requested were forwarded by counsel on September 3, 1985. In her September 3, 1985 letter, Ms. Miller indicated she understood the ECFMG would contact the Board directly in the event that written verification had not been received by the time Dr. Chames was to appear before the FMGC. On September 27, 1955, the Board, by letter, advised Dr. Chames, (the salutation refers to Dr. Eaton) that he was required to appear personally before the FMGC at Sarasota on October 4, 1985. Dr. Chames appeared as required and was examined verbally by committee members, primarily Dr. Robert Katims, Chairman, on his credentials as a graduate of CETEC. His answers apparently raised some further questions and an extract of the minutes of that committee meeting reflects that Dr. Chames, a candidate for licensure by examination and a graduate of CETEC University, received a... unanimous vote to recommend unfavorably for examination based upon a total lack of credibility, deliberately failed to tell the truth in the application process. It cannot be determined in whose handwriting this notation was made. Dr. Katims, who was Chairman of the FMGC since its founding until just prior to the hearing, examined Dr. Chames from the file maintained by the Committee on foreign medical graduates. The Petitioner's testimony was not of a nature to inspire confidence in his credibility. He was hesitant in his answers and those which he gave were, if not evasive, at least not definitive. While acknowledging he made several mis-statements of fact on his application, Petitioner contended these were made through honest error rather than through design. He was obviously not believed by any committee member. No doubt this antipathy toward the applicant, manifested by the blatant hostility and outrage evidenced by Dr. Katims during his questioning and his threats to carry the matter further, even to the pressing of criminal charges if available, indicates that no matter what Dr. Chames would have said, the likelihood of his being voted upon favorably was remote. The file examined by Dr. Katims and the committee consisted of the application, letters of reference, test scores and other matters relevant to the candidate's suitability for licensure. This file documentation is knows as the Agenda Book. The Agenda Book maintained on Dr. Chames was reviewed by Dr. Katims prior to Petitioner's appearance. In his evaluation of this file, Dr. Katims looked primarily at Petitioner's application to take the ECFMG exam and his attention was drawn to the sites of medical education listed thereon. The file contained several different applications which, when reviewed, reflected that on two, Dr. Chames listed his medical schools as Del Noreste and Dominica and on a third he listed CETEC and Del Noreste. Dr. Katims also noted a different listing for undergraduate education. He did not look so much at the dates listed, though dates are important. At that time, his policy as Chairman and that of the committee, was to look closely at CETEC graduates because of that institution's reputation for fraud in the issuance of diplomas. It was his understanding that several people associated with CETEC, including some applicants, had been jailed in the United States and as a result, CETEC graduates got a lot of scrutiny. In fact, Dr. Katims threatened to "...pursue this beyond the actions of this Board, if it seems appropriate, along the lines indicated by Board Counsel...." The Board's counsel had just previously noted a change in the Florida law to make it a criminal offense to obtain or attempt to obtain a license by knowing misrepresentation. Dr. Katims categorically denies that he felt all CETEC students were trained by this "stink of corruption". In fact, he recalls many CETEC graduates have been voted upon favorably after they had been afforded an opportunity to prove their credentials and discuss their applications before the committee. As a result, Dr. Katims felt he did not prejudge the Petitioner. Dr. Katims has interviewed many applicants during his term in office and this includes many CETEC graduates. Consequently, he looked closely at Dr. Chames' application but it was the discrepancy in the applications and the applicant's failure to clarify it satisfactorily that was the problem here, not the fact that he was a CETEC graduate. Dr. Chames was called before the FMGC because it was felt necessary to have him amplify his file and give greater information on his actual scholastic residence. This was because several applicants had told Dr. Katims their only visit to the CETEC campus was to get their diploma. This is exactly what Dr. Chames stated in his interview. Though enrolled at both (Dominica) Ross and CETEC at the same time, he says he did not attend any classes at either campus, did not ever visit the (Dominica) Ross campus, and in fact visited the CETEC campus only once, in December, 1981, to get his diploma. In short, it appears that neither school required regular on-site educational activities. In substance, the Board considered that Dr. Chames' attendance at CETEC raised a question that required a more detailed examination. However, Dr. Katims, on behalf of the committee, clearly contends that CETEC graduates were held to no more strict standards of qualifications than other graduates of foreign medical schools. With regard to this Petitioner, the Board only looked at the educational discrepancies. Nothing else was looked into by the committee before it's report the next day to the full Board. Dr. Katims felt that Petitioner's story was "incredible." He could not accept Petitioner's story that he simultaneously applied to and attended both CETEC and Dominica (Ross) and concluded that Dr. Chames deliberately falsified his application. The discrepancies regarding the schools attended were not consistent with his explanation, and to this date, Dr. Katims feels the same way. He concludes that Petitioner lied in his applications and may have conspired with unknown others to do so but he has no proof of a conspiracy. The important issue to Dr. Katims was initially the caliber of education available at both (Dominica) Ross and CETEC. It was only when Petitioner testified and his testimony was felt to be "incredible" that the issue became his credibility. Dr. Chames graduated from Miami-Dade Community College with an AA degree; then from Yeshive University in New York with a BA degree and thereafter from Florida International University with a BS degree. He then entered Universidad Del Noreste medical school in Tampico, Mexico where he actually attended classes for two years. At his hearing before the FMGC, he stated that during his fourth semester there, he decided to transfer and looked into two medical schools both located in the Caribbean. They were the University of Dominica (Ross) and CETEC. He contends that he applied to both, took some entrance exams for Dominica which he passed and paid some initial fees to that school. He states, however, that it was CETEC that he stayed with and from which he got his degree. According to Dr. Chames, this was a tumultuous time for foreign medical schools. Many students of these institutions wanted to come back to do their obligatory rotations in the United States. As a result, he enrolled in both schools, though he felt affiliated with Dominica (Ross) and paid it only. CETEC indicated he could pay later. In the fall of 1981, he switched to CETEC because a number of states were determining that students of proprietary foreign medical schools could not do U.S. residencies. CETEC was considered to be a higher quality school and had a greater legitimacy in the Dominican Republic. It was a viable school in disciplines other than medicine and was not categorized as an "offshore" medical school. Dr. Chames was expelled from Dominica (Ross) on July 12, 1982, because he failed to pay for the fourth year of medical school. He had, by this time, transferred his credits to CETEC and had graduated from there in December, 1981. Neither school had a requirement for on-campus participation. Students paid their money and turned in the paperwork, and the rotations--the learning periods spent in active hospitals--which constitute the greatest part of the last two years of medical school, were done in the United States. In reality, Dr. Chames arranged his clerkships and rotations by himself. When asked by the various hospitals to which he applied where he was in school, he would say either Del Noreste, Dominica (Ross), or CETEC depending on the time in question. He claims he considered himself to be a student at both Dominica (Ross) and CETEC at the same time. He gave his clerkship evaluations, however, only to Dominica (Ross) until the end of the fourth year of training, when he also gave one to CETEC. He first started paying fees to CETEC and provided a clerkship evaluation there in the fall of 1981, even though he says he considered himself a student there from the beginning. He intended to graduate in December, 1981. This date was established in the fall of 1981 when he started sending CETEC the evaluations of clerkships he had completed almost two years previously which had already been sent to Dominica (Ross). Dominica (Ross) required the taking of a basic second examination upon starting and a final examination prior to graduation unless one took and passed the ECFMG examination. Petitioner admittedly failed the final at Dominica (Ross). CETEC required no examinations. He took and passed the ECFMG exam long after he graduated from CETEC. Petitioner applied to CJ Institute, CETEC's U.S. affiliate, in November, 1981. He contends that he had applied to CETEC previous to that time, but paid no money to CETEC until approximately two weeks prior to graduation, and he got credit from CETEC for rotations/clerkships performed while enrolled at Dominica (Ross). In reality, what appears to be the fact, and it is so found, is that Dr. Chames was enrolled for by far the greatest majority of the last two years of his medical training at Dominica (Ross). Having failed the final examination and being concerned over the ECFMG examination, he looked around and found another medical school that would grant him a diploma based on work done at his former institution, Dominica (Ross). This he found in CETEC which had no requirements and was willing to give him full credit for all work performed at or under the auspices of Dominica (Ross). It would graduate him, awarding him a medical degree upon payment of the required fees, even though no work was done either in the classroom or in rotations while enrolled at that university. When the applicant subsequently filled out the forms for admission to licensure in Florida, he unfortunately listed only CETEC and not Dominica (Ross) as his medical school, even though the application form instructed him to list all schools and omit nothing. He admits that since he did his rotations, and since CETEC granted him credit for them even though he did them while enrolled at another school, he didn't feel it necessary to list Dominica (Ross) as one of his schools. Notwithstanding the apparent lapse as defined above, Respondent's reputation for honesty is generally good. His wife for almost nine years, who has known him since he was fifteen, considers him a most honorable man who makes no distinction between his personal and business ethics which are high in both categories. Though she is an attorney and notarized at least one of the applications he filled out, she did not discuss them with him. She has no reason to believe that they were not accurate and knows no reason that Petitioner would falsify them as she knows he dearly wants to be a doctor. When he filled out his applications, he did them based on his recollection and not on files or documents. She knows he has a terrible memory for dates and numbers and this may have contributed to his mistake. Mrs. Chames' testimony is not credited highly as to her failure to discuss the applications with her husband, however. Dr. Lynn Carmichael, Chairman of the Department of Family Medicine at the University of Miami Medical School, supervised the Petitioner in the Family Practice service at Jackson Memorial Hospital when Petitioner was a resident there. Petitioner's employment file contains all materials received regarding him including evaluations, letters, applications, etc., and a review of this file reveals that all evaluations rendered on Petitioner over the three years of his residency were above average. At the time Petitioner applied for the residency program in October, 1982, he listed his medical school as CETEC University. While he was in the residency program, Petitioner consistently performed in an outstanding manner in all six criteria considered and his reputation for truth and veracity, a highly important factor in evaluation, is good. Dr. Carmichael became aware of the denial of Petitioner's application for licensure after the fact and is aware now of the reasons therefor. Based on his knowledge of the Petitioner, he does not feel that Dr. Chames is a perjurer, or a liar, or would deliberately falsify an application. He was very surprised at the result of the committee hearing because the facts discussed there did not fit in with his evaluation of Petitioner. In fact, his peers at the University Hospital thought so highly of Dr. Chames, that if he had been licensed, the hospital was going to ask him to stay on for a fellowship, for which a license is required. Dr. Carmichael does not consider the listing of the medical school on the application for as a particularly important factor in evaluating foreign medical graduates for the simple reason that these graduates are required to show ECFMG certification which, in fact, the Petitioner was able to do. Ms. Deborah Miller, an attorney specializing in administrative and governmental law, represented Petitioner in his efforts to apply for licensure in Florida. He was concerned that foreign medical graduates were being unduly scrutinized and discriminated against in the licensing process. In this case, the Board of Medicine had asked Petitioner to waive the 90 days they had to rule one way or another on his application and she looked into this for him. In doing so, she procured the Petitioner's application file and went over it item by item with a representative of the Board. It was after this that Dr. Chames was notified of his requirement to appear before the FMGC, as were most foreign medical graduates and all CETEC graduates. Ms. Miller wrote to the Board just before the meeting to see if there was anything else in Petitioner's file than that of what she had been notified and was told that there was not. However, an AMA profile on Petitioner was in the file which listed both CETEC and Dominica (Ross) medical schools and this document may not have come to her. In the past, it has been Ms. Miller's experience that the Board does not always give a "full" file upon request, at times holding matters back. Based on what she knew, Ms. Miller had no reason to believe Dr. Chames had concealed anything regarding his application. Had Petitioner told her that he had applied to both CETEC and Dominica (Ross), she would have advised him to amend his application to correctly reflect the situation which could have been done at that time. On cross examination, Ms. Miller indicated that Petitioner told her that he applied to CETEC and Dominica (Ross) because he had heard of CETEC and was impressed by its good reputation. When he was accepted at CETEC, he dropped all further dealings with Dominica (Ross). He felt the board was concerned more with the courses and rotations not with which school was listed on the application form. This third story regarding Dr. Chames' reasons for switching from Dominica (Ross) to CETEC, clearly establishes that his application forms were consciously filled out; that he knew what he was doing; that his omission was more-than mere oversight; and that he was not particularly concerned with the accuracy of his application and the requirements for forthrightness contained on the face of it. On all of the reports of rotations and clerkships submitted to Dominica (Ross) during the time he was enrolled there and performing them, Dr. Chames was always highly rated and no adverse comments about his ability, his sensitivity, his patient relationships or his integrity was ever raised. There is no doubt that Dr. Chames possesses the clinical and technical skills necessary to be an excellent physician. He also apparently possesses the sensitivity to patients which separates a healer from a technician. In substance, then, it is found that Dr. Chames was enrolled for the last two years of his medical education at Dominica (Ross) and completed the course work/rotation/clerkships satisfactorily. Unfortunately for him, Dominica (Ross) required the passing of an examination prior to the award of the medical diploma, which Dr. Chames failed once and chose not to taken again. He found another school, CETEC, that would award him his medical degree upon payment of the required fees on the basis of the work done while a student at Dominica and without any work being done under the auspices or supervision of CETEC at all. Thereafter, when he applied for licensure in Florida, notwithstanding the fact that the application form clearly required a listing of all medical schools attended, Dr. Chames neglected to list his enrollment at Dominica (Ross), choosing instead, to list only his graduation from CETEC. It is this failure to list Dominica, coupled with the apparently false listing of the true term of the CETEC enrollment which constitutes the discrepancy of such grave concern to the Board and, the ultimate basis for its denial of Petitioner's application. Notwithstanding the apparent hostility of the Chairman of the FMGC and his predisposition to vote unfavorably on this Petitioner's application, it would appear that the unfavorable vote was justified and appropriate.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law it is, therefore, RECOMMENDED that Petitioner's current application for examination as a physician in Florida be denied. RECOMMENDED this 14th day of April, 1987, in Tallahassee, Florida. ARNOLD H. POLLOCK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 14th day of April, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-1438 The following constitutes my specific rulings pursuant to Section 120.57(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. By Petitioner Petitioner failed to number his proposed Findings of Fact. To facilitate identifying them for ruling, I have numbered them consecutively as they appear in the Proposed Recommended Order. Accepted. Accepted. Accepted. Accepted except for the reason for changing schools which is contrary to the better evidence. Accepted. Accepted. Accepted. Accepted. Accepted as to date of filing and schools listed. Rejected as to his reason for failing to list Dominica, Petitioner's different stories as to the point make it impossible to determine why he failed to list Dominica. Accepted. Accepted. Accepted. Accepted except for words "sting of corruption" which should be "stink of corruption." Accepted. Accepted. Accepted. Accepted. Sentence 1 rejected as comment and not a Finding of Fact. Sentence 2 accepted. Sentence 3 & 4 rejected as speculation. Sentence 5 accepted. Sentence 6 rejected as argument. Sentence 7 accepted. Sentence 8 rejected as argument or contrary to the weight of the evidence. Rejected as contrary to the weight of the evidence. Rejected as irrelevant except for the last sentence which is argument, not Finding of Fact. Sentences 1-3 rejected as argument. Sentence 4 et seq. accepted. By Respondent Accepted. Accepted. Accepted. Accepted. First sentence accepted, Second sentence rejected as irrelevant. Accepted. Accepted. Accepted. Sentences 1 & 2 accepted. Sentences 1 & 2 rejected as recitations of the evidence. Sentence 3 rejected as contrary to the better evidence. Sentence 4 et seq. are recitations of the evidence and not Finding of Fact. Rejected as a recitation of the evidence. Accepted. No numbered paragraph. Accepted. COPIES FURNISHED: Dorothy Faircloth, Executive Director Florida Board of Medicine 130 North Monroe Street Tallahassee, Florida 32301 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Harold M. Braxtone Esquire Suite 406, Datran Center 9100 South Dadeland Blvd. Miami, Florida 33156 Catherine Lannon, Esquire Department of Legal Affairs Room 1601, The Capitol Tallahassee, Florida 32399-1050 =================================================================
