The Issue This is a license discipline case in which the Petitioner, by means of a one-count Administrative Complaint, seeks to take disciplinary action against the Respondent on the basis of his alleged violation of Section 458.331(1)(c), Florida Statutes (2002).
Findings Of Fact The Respondent, Eduardo S. Mendez, M.D., was born in Cuba, was reared in Cuba, and was educated in Cuba. His education in Cuba included a degree in Medicine. He came to the United States of America in 1995. Shortly after moving to this country, the Respondent became the owner of a retail pharmacy and medical equipment business in Florida. The Respondent did not have a license to practice pharmacy in Florida. On the basis of conduct which took place between July of 1998 and June of 2000, an Information was issued in Case No. 02-20859 in the United States District Court for the Southern District of Florida charging the Respondent with engaging in a conspiracy to pay and receive health care kickbacks in violation of Title 18, United States Code, Section 371. The basic facts forming the basis for the criminal charge are described as follows in the Information: Medicare was a "Federal health care program" as defined in Title 42, United States Code, Section 1320a-7b(f)(1). Confortec D.M.E., Inc. ("Confortec") was a pharmacy located in Miami, Florida. Confortec was authorized by Medicare to submit claims to Medicare Part B for reimbursement of the cost of certain medications that Confortec dispensed by prescription to Medicare beneficiaries. Defendant EDUARDO S. MENDEZ was a resident of Miami and the sole owner of Confortec. Defendant EDUARDO S. MENDEZ offered to pay kickbacks to various patient recruiters so that they would provide the names and Medicare identification numbers of Medicare beneficiaries, along with prescriptions relating to these beneficiaries. Confortec filled these prescriptions and then filed claims with Medicare for reimbursement of the cost of the prescribed medications. After receiving payment on these claims from Medicare, defendant EDUARDO S. MENDEZ used a portion of the payments to pay kickbacks to the patient recruiters or their associates. * * * 12. Using a portion of the money received from Medicare payments, defendant EDUARDO S. MENDEZ paid or caused to be paid approximately $200,000 in kickbacks to the patient recruiters or their associates so that the recruiters would continue to refer Medicare beneficiaries and related Medicare prescription business to Confortec. Following his arrest, the Respondent cooperated extensively with the Federal Bureau of Investigation (FBI) and assisted the FBI in their investigation of his own activities, as well as in their investigation of similar criminal activities by others. Because of the Respondent's assistance to the FBI, the federal prosecutor recommended a substantial reduction in the sentence that might otherwise have been imposed on the Respondent. On November 14, 2000, the Respondent entered into a plea agreement in which he agreed "to plead guilty to an Information or an Indictment that charges him with the crime of conspiracy to commit an offense against the United States, namely, a violation of Title 42, United States Code, Section 1320a-7b(b)(2)(knowingly and intentionally offering and paying kickbacks and bribes to any person to induce the referral of individuals for the furnishing of services or items for which payment may be made under a Federal health care program), in violation of Title 18, United States Code, Section 371." On or about February 12, 2003, a United States District Judge signed a judgment in which the Respondent was adjudicated guilty of the criminal offense described above. The Respondent's sentence was three years of probation, three months of home confinement (with electronic monitoring), 150 hours of community service, and a fine of $100.00. The Respondent has fulfilled all of the terms of his sentence. Although the recruitment methods described above are prohibited by federal law and are a crime, that criminal activity does not involve any element of fraudulent billing seeking reimbursements from the Medicare program for services or items that were not provided. To the contrary, all of the prescriptions for which Confortec sought Medicare reimbursement were prescriptions that were actually filled for medications that were actually provided to the Medicare beneficiaries. During the period from July of 1998 through June of 2000, the Respondent did not have a license to practice medicine in Florida. Accordingly, the criminal conduct described above was not related to the Respondent's practice of medicine, because the Respondent was not practicing medicine at that time. As discussed in greater detail in the conclusions of law, the criminal conduct described above was directly related to the practice of medicine by the physicians who wrote the prescriptions that were filled in the course of the subject criminal activity. As also discussed in greater detail in the conclusions of law, the criminal conduct described above was directly related to the ability to practice medicine. The Respondent is presently a physician licensed to practice medicine in the State of Florida. He has been so licensed since November of 2001. His license number is 83615. The criminal charges described above are the only criminal charges that have ever been filed against the Respondent. There has never been any prior disciplinary action taken against the Respondent's license to practice medicine.
Recommendation On the basis of all of the foregoing, it is RECOMMENDED that a final order be entered finding the Respondent guilty of violating Section 458.331(1)(c), Florida Statutes (2002), and imposing the following penalties: Suspending the Respondent's license to practice medicine for a period of nine months; Imposing an administrative fine in the amount of five thousand dollars; and When the Respondent is reinstated following the nine- month period of suspension, placing the Respondent on probation for a period of two years subject to such terms of probation as may appear to the Board of Medicine to be necessary and appropriate. DONE AND ENTERED this 16th day of September, 2005, 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 16th day of September, 2005.
Findings Of Fact At all times material hereto, Respondents have been physicians licensed in the State of Florida, with Dr. Arias having been issued license number ME 0018151 and Dr. Belle having been issued license number ME 0002207. Robert Furman was a college-educated executive who was born November 16, 1905. He died November 8, 1988, of pancreatic cancer. About 1940, Furman complained to his personal physician Jules Gordon, M.D., of a lack of energy. Dr. Gordon diagnosed Furman as having "a low thyroid" and prescribed a thyroid medication which improved Furman's low energy level to a degree. Furman continued to complain of lack of energy, and Dr. Gordon prescribed Dexedrine for Furman in 1943. The amount of Dexedrine first prescribed was too much, and Furman did not take it. However, in 1945 Furman started a regimen of a daily 5 milligram Dexedrine pill, which helped his lack of energy allowing him to perform his daily employment responsibilities. Dr. Gordon also prescribed Seconal to Furman in 1945 which he began taking each night. Dr. Gordon also started Furman on a regimen of Testosterone/vitamin B-1/vitamin B-12 injections for the purpose of developing more energy. While Furman was the president of an international real estate company in New York from 1950 until 1970, he spent quite a bit of time in the company's West Palm Beach office from 1965 until 1970. In 1970 he retired from the company and began permanently residing in South Florida. In 1970, at 65 years of age, Furman started another career as marketing director for the Keyes Company in Miami and remained in that position through September, 1988. Furman began seeing Drs. Belle and Arias, partners in a medical practice, in 1970 upon referral. At that time, Furman was taking two 5 mg. Dexedrine pills per day. Dr. Arias began treating Furman as his primary physician from 1970 until 1983. Dr. Belle treated Furman as his primary physician after 1983. Furman had the problem of lack of energy throughout his adult life. Furman had no complaints regarding the treatment he received from Drs. Belle and Arias. He had great confidence in them. As of September, 1988, Furman was taking nine 5 mg. Dexedrine pills per day and one 100 mg. and one 50 mg. Seconal pills per day. Furman unsuccessfully tried to cut back on Dexedrine in 1986, but could not function without it; he was foggy, mentally slow and unable to perform his job. He also cut back on Seconal from two pills to one half pill per day. Furman was unwilling to stop taking Dexedrine, especially after taking it for so long. Furman had been told by Respondents on a number of occasions that it would be better if he did not take Dexedrine and Seconal. Since he had been taking them since 1945 without any problems, he was unwilling to stop taking them because he knew he could not function without them. He continued to take them until his death at age 83, a total of 43 years. Since he never suffered any ill effects from them, he saw no reason to be concerned. Furman jogged five times per week until he was 80 years old. At that time Respondents told him to stop jogging due to a back injury. He then switched to exercising twenty-five minutes per day on a stationary bicycle. Furman was never contacted by anyone from the Department of Professional Regulation about his case, was unaware that the Department had subpoenaed his medical records and made them public, was never requested to give his permission for the release of his medical records, would not have given his authority to release his medical records if he had been asked, and was very distressed by the Department's subpoena and use of his records. This prosecution of Drs. Belle and Arias had a tremendous effect of Furman's personal and professional life. It cost him a lot of time and money; it required him to travel to New York to continue his prescription for Dexedrine from Dr. Jules Gordon; it required him to consult with Dr. Cohn; and it affected his concentration in his day-to-day life. An autopsy was performed on Robert Furman at the request of his family. The autopsy was performed by Board- certified pathologist Miguel Gonzalez, M.D. The autopsy was confined to the pancreas, but had Dr. Gonzalez seen anything else abnormal, he would have noted it in the report. No such notations were made. Dr. Gonzalez reviewed the microscopic section slides which would reveal the presence of chronic hypertensive state and Furman's general vascular condition. The review of the microscopic section slides did not reveal any evidence of sustained hypertensive state or hypertensive disease; it revealed that Furman's vascular condition was normal for a man of 83 years of age. One of the side effects of Dexedrine is hypertension; in small vessels, one might see changes that are suggestive or at least indicative that a patient had a sustained hypertensive state. The only thing seen in the microscopic slides of Furman's arteries was normal hardening of the arteries in the large blood vessels. This case came about, not as a result of a patient complaint, but as a result of analyses of data from the Epson Survey, a computer review of prescriptions filled by Florida pharmacies. The computer is programmed to identify prescriptions which do not match its profile for appropriate quantities or combinations. The Epson survey identified four prescriptions for Dexedrine filled on 6/13/85, 6/14/85, 8/19/85, and 8/30/85 and three prescriptions for Seconal filled on 6/12/85, 6/14/85, and 6/14/85, written by Dr. Belle. The Epson survey identified one prescription each for Dexedrine and Seconal filled on 8/2/85, written by Dr. Arias. The DPR investigative report states that the data appears to indicate large amounts of Dexedrine and Seconal being prescribed by Doctors ARIAS and BELLE to a patient named Robert Furman. Investigation reveals both doctors (same practice) treating patient FURMAN for diagnosed severe depression. Patient is an 80 year old male who has been treated "for this condition for over 36 years. Patient is in good physical health and holds down a full time job. The Department subpoenaed the medical records of patient Furman without his consent or knowledge and submitted them to one of the Department's consultants, John V. Handwerker, M.D.. Dr. Handwerker gave the Department a written letter opining that a review of the records revealed no violations of the Medical Practice Act. Unsatisfied with Dr. Handwerker's opinion, the Department requested a supplemental investigation consisting of sending the patient records of Furman to a second consultant, Laurence Neufeld, M.D., who practices medicine in Tampa. Dr. Neufeld issued a conflicting written opinion stating both that the medical records of Furman supported the long-term prescribing of Seconal to him and that the prescription of Seconal to him was inappropriate. Contrary to representations made to the Board of Medicine's probable cause panel by Department attorney, Leslie Brookmeyer, neither Dr. Arias nor Dr. Belle knew Dr. Handwerker, except on a casual basis; they would say "hello" while passing in the halls of Mercy Hospital where all three had hospital privileges, they did not socialize with each other, and they did not refer patients to one another. The investigative reports, with the opinions of Drs. Handwerker and Neufeld, were considered by the probable cause panel of the Board of Medicine on April 27, 1987. One panel member physician commented that he had never before seen such well-documented records. Dr. Arias has been certified by the American Board of Internal Medicine since 1972. He graduated first in his medical school class in 1948, studied under a British Council Scholarship in London (1950-51), studied on scholarship at Massachusetts General Hospital in the Department of Cardiology, and taught electrocardiography and phonocardiography during a fellowship at Massachusetts General Hospital, after which he practiced medicine in Cuba. He completed a residency at the Miami Heart Institute (Chief Resident) in 1961, and practiced at the V.A. Hospital in Nashville, after which he began a private practice in Miami in 1968. Dr. Arias served as Associate Professor (1967) and Clinical Professor (1968) of Medicine at the University of Miami Medical School. He is a member of the Florida Medical Association, the Dade County Medical Association and the American College of Physicians. He has written and published a number of articles. Dr. Arias has practiced in partnership with Dr. Belle since about 1970. Dr. Belle has been certified by the American Board of Internal Medicine since 1948 and Board-certified in cardiovascular diseases since 1954. He received his medical degree from Emory University Medical School in 1939, completed his internship and residency at Grady Hospital in Atlanta, served in the Army Medical Corps, and served as Associate Clinical Professor of Medicine at the University of Miami School of Medicine (1962-present). He is a member of the Heart Association of Greater Miami (President 1962), the Florida Society of Internal Medicine, the American Society of Internal Medicine, the Dade County Medical Association, the American College of Physicians, the American Diabetes Association, and the American College of Chest Physicians. Dr. Arias originally prescribed Dexedrine to Robert Furman in 1970 based upon, and after performing, a complete physical examination and based upon his past history of poor energy state, lassitude, fatigue, and sleepiness. He continued Furman on the regimen of Dexedrine which Furman had been on for the prior 25 years, because it allowed Furman to function normally in society, which he could not do without the Dexedrine. The doses prescribed to Furman were within the recommended doses set forth in the Physicians' Desk Reference (hereinafter "PDR"). Dr. Arias never formally diagnosed Furman as having narcolepsy, but treated him for lassitude, loss of energy, weakness, and mild depression, which are symptoms of narcolepsy. When Furman first came for treatment in 1970, the diagnosis of narcolepsy was not used by family practitioners, and Dexedrine was the medication used to treat the symptoms of lassitude, loss of energy, weakness, and mild depression. Physicians did not generally know, in the 1970s and early 1980s that the symptoms presented by Furman were narcoleptic symptoms. The narcolepsy explains why Furman could not function without Dexedrine and why he was always tired and could not function with the other medications Respondents prescribed when they attempted to switch him away from the Dexedrine. Furman was the only patient out of 5,000 patients in the office of Dr. Arias and Dr. Belle whom they treated with Dexedrine. Dr. Arias tried to wean Furman from Dexedrine in the first few years of treatment with Ritalin and Ascendin, but Furman complained that the alternative methods did not work, and he returned to taking Dexedrine. Dr. Belle continued to prescribe Dexedrine to Furman in 1983 for the continuing symptoms of fatigue, sleepiness, and poor energy state. Furman was even hospitalized in 1984 to try to find the reason for the poor energy state. Though Dr. Belle felt that Furman could be classified as narcoleptic, narcolepsy was not a common term for family practitioners in the 1970s. Dr. Belle did not write the diagnosis of narcolepsy in Furman's medical records, but did write the symptoms of narcolepsy, i.e., poor energy state, lassitude. Dr. Belle did not learn about sleep tests before about 1985. Furman had been doing well on Dexedrine for the prior 40 years before Dr. Belle continued prescribing it to him. A dosage of Dexedrine within the PDR recommended limits for an indicated usage is in keeping with appropriate medical usage. A physician may even decide to use a dose higher than the PDR recommended dose. Not every person reacts in the same way to Dexedrine, and the best judge of how Dexedrine is affecting a patient is the patient's physician. A person who has taken Dexedrine on a daily basis for forty-three years, who lives a vigorous and productive personal and professional life until 83 years of age, and who suffers no adverse effect from the Dexedrine is not taking dangerous doses. Further, the only other effective drug for narcolepsy generally available during 1983 and 1984 was Ritalin, which did not work for Furman. Comparison of the doses of Dexedrine taken by Furman with the doses recommended in the PDR reveals that the doses he was taking were always below the maximum PDR recommended limits. Martin A. Cohn, M.D., an expert in sleep disorders, served as Chief, Sleep Disorders Center, at Mt. Sinai Medical Center in Miami Beach. Dr. Cohn examined Furman in 1987 at the request of Dr. Belle. Based upon that examination, Dr. Cohn wrote a report in which he stated: It is my medical opinion that the diagnosis of narcolepsy is probable but cannot be proven at this time in the face of continued treatment. It is also my opinion that it is in the best interest of the patient and society that he be continued on treatment for narcolepsy with Dexedrine especially in view of his continued functioning ability to work and relatively low dosage of medication required. Dr. Cohn concluded that the dosage of Dexedrine prescribed by Respondents to Furman was not excessive. Moreover, Dr. Cohn saw no evidence at the time he examined Furman of physical damage from taking Dexedrine or any evidence that Furman needed a referral to a psychiatrist. Dr. Cohn describes narcolepsy as an uncommon but not rare disease, characterized by recurrent and excessive drowsiness or sleepiness from which subjects are readily awakened. It is frequently accompanied by cataplexy, a phenomenon of acute, brief, generalized muscular weakness, precipitated by feelings of emotion. If no cataplexy occurs, the disease is diagnosed as pure narcolepsy. The symptoms range from mild drowsiness to severe sleepiness in which subjects spend the day drifting in and out of sleep. The attacks may occur one or several times a day and may last minutes to hours. The sleep is similar to normal sleep but is apt to occur at inappropriate times. The usual onset of the disease is in adolescence or young adulthood, though some cases do not occur until later years. Once diagnosed, the symptoms generally remain forever, although in some cases they go into remission. Ideopathic narcolepsy is diagnosed when four symptoms are present: excessive daytime sleepiness, cataplexy, hypnogogic hallucinations, and sleep paralysis whereby the patient is unable to move although the limbs are not rigid. Only 10% of patients legitimately diagnosed as narcoleptic present all four of the above mentioned symptoms, and, therefore, most of the medical community uses the term "narcolepsy" in a broader, more general sense to mean essentially excessive, inappropriate daytime sleepiness, especially at inappropriate times. Narcolepsy can be a permanent or a transient condition and can be a by-product, of unusual psychological or physical stress. The best test to diagnose narcolepsy is the physician's clinical evaluation of the patient, and the mere response to medication alone cannot be the sole basis for diagnosing the disease. A combination of fatigue, lassitude, poor energy state and depression is consistent with a diagnosis of narcolepsy. The most generally accepted treatment for narcolepsy is the dispensing of amphetamines. Once a person is under treatment with amphetamines, confirming a diagnosis of narcolepsy is not possible because the amphetamines affect the objective testing procedures. The best way to diagnose narcolepsy is by sleep tests which did not become available in the Miami area until about 1978; even then, the medical community did not begin generally using them until about 1984. It would not have been appropriate to withdraw Dexedrine and Seconal from Furman just to administer a sleep test to confirm a diagnosis of narcolepsy. However, the treatment administered by Drs. Belle and Arias was appropriate and would probably have been confirmed, if a sleep test could have been administered and the diagnosis of narcolepsy confirmed. The treatment received by Furman from Drs. Belle and Arias is consistent with treatment for narcolepsy. Since the medical records of Drs. Belle and Arias contained symptoms of fatigue, lassitude, poor energy state and depression, that is equivalent to having written narcolepsy. Prescribing Dexedrine to Furman without referring him to a sleep disorder center was within community standards, especially in view of the length of time over which Furman took the Dexedrine. Dexedrine was a very common way years ago to treat patients with the symptoms presented by Furman. Such a diagnosis by a name other narcolepsy is consistent with the standard of medical practice in the 1970s and early 1980s. Furman would have had a deleterious effect had he been withdrawn from Dexedrine in 1970, at age 65, after taking Dexedrine for 25 years, or in 1980, at age 75, after taking it for 35 years. It would have been unethical for Respondents to discontinue treatment of Furman with Dexedrine under the circumstances of this case. Furman did not develop hypertension in October, 1977, or at any time while he was treated by Respondents. There was no evidence of hypertension revealed in the 1988 autopsy of Furman. Furman's blood pressure was no cause for alarm. Furman had brief episodes of slight labile hypertension on a few visits, which was effectively reduced to normal with diuretics. A review of his blood pressure readings reveals overall normal readings for a man of Furman's age and condition. If a person has taken Dexedrine in the quantities taken by Furman and does not experience an elevation in blood pressure until after 30 years, then that would indicate that the Dexedrine is not the cause of the elevation. Dr. Arias did not refer Furman to a psychiatrist or for an electroencephalogram, because he did not feel Furman needed it. Dr. Belle did not refer Furman to a psychiatrist or for an EEG, because, even though Furman was mildly depressed, he saw no need to take him off his prescriptions merely to confirm or justify the prescriptions with which he was doing well; at Furman's age, he did not feel that the expense and anxiety of a psychiatric referral was justified and Dr. Belle felt that he could treat Furman's mild depression well, which was born out by Furman continuing to function successfully in society. Dr. Arias originally prescribed Seconal to Furman in 1970 based on, and after performing, a complete physical examination on Furman and based upon his past history. Furman had been taking Seconal in small doses for 25 years before coming to Dr. Arias, and Arias kept him on it as the medicine of choice at that time for his symptoms of difficulty in sleeping. He continued Furman on the regimen of Seconal on which he had been for the past 25 years, because it allowed Furman to function normally in society, and because it could not safely be withdrawn. Dr. Belle continued to prescribe Seconal to Furman in 1983, because of his symptoms and because Furman had been taking it for 38 years. It was unusual to see patients who had taken Seconal over a long period of time who were healthy and had not been harmed by it. There was no other drug to effectively substitute for Seconal that was not equally addictive. The dosage prescribed was a small therapeutic dose. The Seconal was prescribed to Furman within the standard of the community, without referring him to a sleep disorder center, especially in view of the length of time over which Furman took the Seconal. Seconal was a very common way to treat patients years ago with the symptoms presented by Furman. It was appropriate to prescribe the Seconal, particularly in the low dosages prescribed. Furman would have suffered a deleterious effect had he been withdrawn from Seconal in 1970 at age 65, after taking Seconal for 25 years, or in 1980, at age 75, after taking it for 35 years. Dr. Cohn, the expert in sleep disorders who examined Furman in 1987, saw no adverse effects on Furman from taking the Dexedrine or the Seconal. It was common to combine the prescription of Seconal with the prescription of Dexedrine at the time Furman saw Respondents and continuing for some time. All patients do not respond the same way to Seconal. The best judge of how Seconal is affecting a patient is the patient's physician. It would have been unethical for Respondents to discontinue treatment of Furman with Seconal under the circumstances of this case. Withdrawing Furman from Seconal in 1970, at age 65, when he first came to Dr. Arias, after taking it for 25 years, could have been lethal. The risks of withdrawal would increase every year thereafter. Dr. Arias did not treat Furman with systemic steroids between May, 1983, and September, 1983. Dr. Belle treated Furman with the systemic steroid cortisone during that period of time. Further, Dr. Arias was weaning Furman off the cortisone in September, 1983, not treating him with it. Dr. Belle had sound medical reason stated in the records for that treatment. The prescription of the cortisone met the appropriate standard of care and was within the limits of good practice. There is no evidence that Furman needed a referral to a psychiatrist for the mild depression from which he suffered but from which he experienced no disabling effects. Dr. Neufeld testified on behalf of Petitioner that Dr. Arias and Dr. Belle fell below minimum standards by not referring Furman to a psychiatrist. Dr. Lindberg, the other expert witness on behalf of Petitioner, disagreed with Dr. Neufeld on that point; Dr. Lindberg testified that Furman should not have been referred to a psychiatrist. Dr. Neufeld himself does not refer his patients to a psychiatrist for slight depression and Dr. Neufeld recognizes that Furman did not have severe depression.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered finding Respondents not guilty of the allegations contained in the Administrative Complaints filed against them and dismissing those Administrative Complaints, with prejudice. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 13th day of December, 1989. LINDA M. RIGOT Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 13th day of December, 1989. APPENDIX TO RECOMMENDED ORDER DOAH CASE NOS. 87-2389 AND 87-2484 Petitioner's proposed findings of fact numbered 1-6, 8, 9, 11, 12, 14, 16, 17, 19, 20, 22, 24, 25, 29-34, and 64 have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed findings of fact numbered 13, 15, 21, 23, 26, 48, and 60 have been rejected as not being supported by the competent, substantial evidence in this cause. Petitioner's proposed findings of fact numbered 18, 35, 36, 38-47, 49, 51-59, 63, and 65-96 have been rejected as not constituting findings of fact but rather as constituting recitations of the testimony, conclusions of law, or argument of counsel. Petitioner's proposed findings of fact numbered 10, 27, 37, and 50 have been rejected as being subordinate to the issues under consideration in this cause. Petitioner's proposed findings of fact numbered 7, 28, 61, and 62 have been rejected as being irrelevant to the issues under consideration herein. Respondents' proposed findings of fact numbered 1-17, 19, 20, 22, 23, 25, 26, 29 the first 32, 34, the first 35, the second 40, 41, 45-47, 51, 53, and 54 have been adopted either verbatim or in substance in this Recommended Order. Respondents' proposed findings of fact numbered 18, 24, 28, the second 35-the first 40, 43, 44, 48, and 49 have been rejected as being unnecessary for determination of the issues under consideration in this cause. Respondents' proposed findings of fact numbered 21, 27, the second 32, 33, 50, and 52 have been rejected as not constituting findings of fact but rather as constituting conclusions of law, recitation of the testimony, or argument of counsel. COPIES FURNISHED: Paul Watson Lambert, Esquire 1355 Mahan Drive Tallahassee, Florida 32308 Peter S. Fleitman, Esquire Department of Professional Regulation 401 Northwest Second Avenue Suite N621 Miami, Florida 33128 Kenneth D. Easley, General Counsel Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0792 Dorothy Faircloth, Executive Director Department of Professional Regulation Board of Medicine 1940 North Monroe Street Tallahassee, Florida 32399-0792 =================================================================
