The Issue Whether disciplinary action should be taken against Dr. Vizcarra's Florida license to practice medicine for violating Sections 458.33l(1)(m), (q) and/or (t), Florida Statutes, as alleged in the Administrative Complaint against Dr. Vizcarra?
Findings Of Fact The Petitioner is the state agency charged with the responsibility to prosecute administrative complaints against licensed physicians in the State of Florida. Eulogio Vizcarra, M.D., is, and has been at all times relevant to this proceeding, a licensed physician in the State of Florida. Dr. Vizcarra's license number is ME 0030012. On January 2, 1984, Dr. Vizcarra saw patient S.L. for the first time. S.L. was diagnosed by Dr. Vizcarra as suffering from tension headaches and hypertension. Dr. Vizcarra continued to see S.L. from January, 1984, until at least June 6, 1987. Throughout the period of time that Dr. Vizcarra treated S.L., including the period of June 14, 1986, through June 6, 1987, S.L. complained of, and was diagnosed as suffering from, numerous ailments, including hemorrhoids, nasal conjunction, lacerations, back pain, abdominal cramps, sore throat, diarrhea, gastrointestinal bleeding, laryngitis, chest pain, tooth ache, rhinitis, upper respiratory tract infection, viral syndrome, impotence and a ganglion cyst. During the time that Dr. Vizcarra treated S.L., including the period of June 14, 1986, through June 6, 1987, S.L. was seen by Dr. Vizcarra and other physicians on numerous occasions. The primary and most repeated diagnosis of S.L. by Dr. Vizcarra during the period of time that Dr. Vizcarra treated S.L. was migraine headaches and hypertension. In January of 1984, when S.L. first saw Dr. Vizcarra, S.L. was initially given Amitriptyline, a prophylactic drug, for his migraine headaches. The use of Amitriptyline, or other prophylactic drugs, was not continued by Dr. Vizcarra in his treatment of S.L., however. In April, 1984, Dr. Vizcarra referred S.L. to Dr. Kohler, a neurologist, for tests concerning S.L.'s migraine headaches. Dr. Vizcarra also referred S.L. to Dr. Loucshmann (phonetic) in April, 1984, for treatment of his migraine headaches and his hypertension. Neither physician continued to see S.L. after April, 1984. Dr. Vizcarra referred S.L. to other physicians: (1) Dr. Hernandez saw S.L. in May, 1986, for hemorrhoids; Dr. Baker, a cardiologist, saw S.L. in July, 1986, for chest pain; (3) Dr. Desai, a general surgeon, saw S.L. in August, 1986, for hemorrhoids and in June, 1987, for abdominal pain; and (4) Dr. Bonzon saw S.L. from January, 1987, through April, 1987, for the removal of a ganglion cyst. Dr. Vizcarra did not, however, refer S.L. to any other physician after April, 1984, for treatment of, or testing concerning, S.L.'s migraine headaches. During the period of time from June 14, 1986, through June 6, 1987, S.L. also was seen by various emergency room physicians, including Dr. Sklar, Dr. Amadio and Dr. Adams. All of these physicians listed Dr. Vizcarra as the "family physician" or as the "physician notified" on their record of S.L.'s visit. Finally, S.L. was seen in July and August, 1986, by Dr. Adom. Dr. Vizcarra's medical records concerning S.L. include information concerning S.L.'s treatment by the physicians listed in findings of fact 9-12. During the period of time from June 14, 1986, through June 6, 1987, Dr. Vizcarra prescribed over 60 injections of Talwin, Nubain and Stadol for S.L. S.L. also received injections of these drugs from some of the other physicians S.L. was seen by during this period of time. S.L. was also given approximately 25 to 30 prescriptions for Tylox and Darvocet, as well as other analgesic medications, during the period of time at issue in this proceeding. S.L. also received prescriptions for these drugs from some of the other physicians S.L. was seen by during this period of time. Talwin, Nubain, Stadol, Tylox and Darvocet (hereinafter referred to as the "Five Legend Drugs") are narcotic analgesic medications. They are all legend drugs and have the potential for addiction. Dr. Vizcarra indicated that he prescribed the Five Legend Drugs given to S.L. in order to relieve the pain that S.L. was suffering from. The rapid relief of pain with narcotic analgesics is acceptable only on an infrequent basis. Dr. Vizcarra's use of the Five Legend Drugs during the period of June 14, 1986, through June 6, 1987, was excessive. Dr. Vizcarra's use of the Five Legend Drugs during the period of June 14, 1986, through June 6, 1987, constituted an inappropriate use of legend drugs. Dr. Vizcarra failed to provide proof that he made an adequate medical assessment of S.L.'s condition or the possible consequences of S.L.'s exposure to the Five Legend Drugs prescribed for him by Dr. Vizcarra or the other physicians who treated S.L. from June 14, 1986, through June 6, 1987. The medical records maintained by Dr. Vizcarra fail to justify his treatment of S.L. during the period of June 14, 1986, through June 6, 1987. Dr. McCoy's testimony concerning whether Dr. Vizcarra's treatment of S.L. constituted a violation of Section 458.331(1)(t), Florida Statutes, was based upon Dr. McCoy's review of Dr. Vizcarra's medical records. Dr. Vizcarra provided further details concerning his treatment of S.L. during the hearing which were not included in his medical records. Dr. McCoy did not hear this testimony. Therefore, Dr. McCoy's opinions concerning whether Dr. Vizcarra's treatment of S.L. constituted a violation of Section 458.331(1)(t), Florida Statutes, did not take into account all of the evidence.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Eulogio Vizcarra, M.D., be found guilty of having violated Sections 458.331(1)(m) and (q), Florida Statutes. It is further RECOMMENDED that the portion of the Administrative Complaint against Dr. Vizcarra alleging that he violated Section 458.331(1)(t), Florida Statutes, be dismissed. It is further RECOMMENDED that Dr. Vizcarra be subjected to the following penalties: Payment of an administrative fine in the amount of $2,500.00; Placement on probation for a period of one year. Dr. Vizcarra should be placed under the indirect supervision of a Board of Medicine physician who should receive copies of all prescriptions for controlled substances written by Dr. Vizcarra during his probation. Quarterly reports should be made by the monitoring physician to the Board of Medicine's probation committee; and Attendance of twenty-one hours of Continuing Medical Education in courses concerning appropriate drug prescribing, in addition to Continuing Medical Education hours required for license renewal. DONE and ENTERED this 24th day of April, 1989, in Tallahassee, Florida. LARRY J. SARTIN Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 24th day of April, 1989. APPENDIX The Petitioner has submitted proposed findings of fact. It has been noted below which proposed findings of fact have been generally accepted and the paragraph number(s) in the Recommended Order where they have been accepted, if any. Those proposed findings of fact which have been rejected and the reason for their rejection have also been noted. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in Recommended Order of Fact Number of Acceptance or Reason for Rejection 1 2. 2 14, 16 and 18. 3 This summary of testimony supports findings of fact 15-18. 4-5 Argument and summary of positions. 6 19. COPIES FURNISHED: Joseph Harrison Senior Attorney Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 John R. Weed, Esquire 605 South Jefferson Street Perry, Florida 32347 Ms. Dorothy Faircloth Executive Director Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Kenneth Easley General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
