The Issue Whether Petitioner is entitled to additional credit for the answer he gave in response to Question 21 on the physical diagnosis portion of the November 1999 chiropractic licensure examination.
Findings Of Fact Based upon the evidence adduced at hearing and the record as a whole, the following findings of fact are made: Petitioner took the chiropractic licensure examination administered in November of 1999. The practical examination consisted of three parts: "technique," "physical diagnosis," and "x-ray interpretation." The minimum passing score for each part was 75. Petitioner passed the "technique" and "x-ray interpretation" portions of the examination; however, he failed the "physical diagnosis" portion of the examination (PD Test), with a score of 68. On this portion of the examination, candidates demonstrated their knowledge of "physical diagnosis" by responding to test questions, in the presence of two examiners, verbally and/or, where appropriate, by demonstrating on a "patient." Their responses were independently evaluated and graded by the two examiners. A candidate's final score was the average of the two examiners' scores. Prior to the administration of the PD Test, all examiners were provided with instructions regarding their role in the examination process and the standards they should follow in grading the candidates' performance. Candidates were provided with a Candidate Information Booklet (CIB) in advance of the licensure examination. Among other things, the CIB listed, by category ("acupuncture," "physical diagnosis," "technique," and "x-ray") reference materials that could "be used to prepare for the examination." The list was preceded by the following advisement: The list is not to be considered all- inclusive. Thus, other comparable texts may be used to prepare for the examination. Under the category of "x-ray" the following "references" were listed: Eisenburg, Gastrointestinal Radiology- A Pattern Approach, Hagerstown, MD: Lippencott, Second Edition, 1989. Paul & Juhl, Essentials of Radiologic Imaging, Hagerstown, MD, Lippencott, Sixth edition, 1993. Taveras & Ferrucci, Radiology: Diagnosis- Imaging-Intervention, Hagerstown, MD: Lippencott, 1986. Five-volume set, loose- leaf renewed in July 1994. Yocum, T. R., & Rowe, L. J., Essentials of Skeletal Radiology, Baltimore: Williams & Wilkins, First Edition 1986. Not on the list under "x-ray" or under any other category was Dr. Robert Percuoco's Radiographic Positioning for the Chiropractor (Dr. Percuoco's Publication), the text book used by Dr. Percuoco in the radiology classes he teaches at the Palmer College of Chiropractic in Davenport, Iowa (Palmer). Palmer was the nation's first college of chiropractic, and is accredited by the Council of Chiropractic Education. Petitioner graduated from Palmer and was taught radiology by Dr. Percuoco. Question 21 on the PD Test was an eight-point "diagnostic imaging" question (with no provision for partial credit) that asked the candidates to "demonstrate a Lateral Thoracic view." Among the six items the candidates had to address in answering the question was the central ray. Page 54 of the Dr. Percuoco's Publication describes what, according to the author, needs to be done to obtain a view of the lateral thoracic spine. It provides, in pertinent part, as follows (Dr. Percuoco's Approach): Center the central ray to the film. The vertical portion of the central ray should pass posterior to the head of the humeri. In responding to Question 21 on the PD Test, Petitioner relied on the foregoing excerpt from Dr. Percuoco's Publication. He told the examiners that the central ray should be centered to the film and that the vertical portion of the central ray should pass one inch posterior to the head of the humerus. The two examiners evaluating his performance both gave Petitioner an "A" (or no points) for his response to Question 21. In so doing, they acted reasonably and in accordance with the grading instructions they had received prior to the administration of the PD Test. Dr. Percuoco's Approach (upon which Petitioner relied) is not generally accepted in the chiropractic community. A reasonably prudent chiropractor, in taking an x-ray of the lateral thoracic spine, would do what was necessary to have the central ray pass, not "posterior to the head of the humeri," but "approximately 3 inches inferior to [the] sternal angle," as Drs. Yocum and Rowe, two of the most respected radiologists in the country today, instruct in their text, Essentials of Skeletal Radiology, which was one of the reference materials listed in the CIB (Dr. Yocum's and Dr. Rowe's Approach). Dr. Yocum's and Dr. Rowe's Approach yields a more exact and complete view of the lateral thoracic spine than does Dr. Percuoco's Approach. Because Petitioner failed to incorporate Dr. Yocum's and Dr. Rowe's Approach in his response to Question 21, the examiners were justified in determining that Petitioner did not answer all six parts of the question correctly and that he therefore should be awarded an "A" (or no points) for his response.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered rejecting Petitioner's challenge to the failing score he received on the physical diagnosis portion of the November 1999 chiropractic licensure examination. DONE AND ENTERED this 7th day of November, 2000, in Tallahassee, Leon County, Florida. STUART M. LERNER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 7th day of November, 2000.
Findings Of Fact At all times relevant hereto, the Respondent, Michael F. Petrie, was licensed as a chiropractic physician by the Florida Board of Chiropractic. The Petitioner introduced no evidence relating to Count I of the Administrative Complaint. On or about February 3, 1982, the Respondent placed an advertisement in the Pompano Shopper's Guide, advertising the Petrie Chiropractic Life Center. (See Joint Exhibit 1.) This advertisement states, in pertinent part, ". . . To take a pill or more each day is dependency. Dependency is addiction! Whether these drugs are pushed or prescribed, you are an addict! CHIROPRACTIC can many times free you from drug dependency. . ." The advertisement makes reference to specific medical conditions, such as headaches, diabetes, stroke, high blood pressure and skin problems, which can be helped by chiropractic treatment. The testimony of Kenneth C. Lasseter, M. D., was offered via deposition as Petitioner's Exhibit 2. Dr. Lasseter stated his professional opinion that dependency on a drug is not the same as addiction. Drs. Michael Nathanson, Thomas Pasterski and Richard Hodish, all of whom are doctors of chiropractic and were accepted as experts in this field, testified that addiction and dependency are synonymous. (See Transcript, pages 48, 49, 95 and 101.) Their testimony was further substantiated by the definitions of addiction and dependency as found in the Encyclopedia and Dictionary of Medical and Nursing. Joyce Quintavalli, R. N., a psychiatric nurse specializing in the treatment of young people for drug problems, stated that from the practical standpoint there was no difference between dependency and addiction. Dependency and addiction are synonymous. Robert S. Butler, Jr., D. C., who was accepted as an expert in chiropractic, testified that the advertisement indicated that the Respondent's treatment could reduce a patient's need for medication for the enumerated conditions or illnesses and therefore opined that the advertisement was misleading. However, Dr. Butler stated that the medical conditions enumerated in the advertisement fall within the scope of practice of chiropractic, that chiropractic can treat patients for these problems with good results, and that treatment can lessen or free the patient from drug dependency. Dr. Butler stated his concern that the advertisement could encourage people to stop their medications, although he admitted that the advertisement does not urge or recommend to people that they cease taking medication. The chiropractic physicians enumerated in Paragraph 5 above testified that the conditions enumerated in the advertisement were within the scope of treatment of chiropractic, that they had treated patients for these diseases or conditions with good results, and that as a result of treatment their patients had reduced or ceased altogether taking medication which had been necessary prior to their treatment for control of their condition. The statements made in the advertisement are accurate and do not mislead the public concerning the scope of chiropractic, the benefits of chiropractic, or the Respondent's qualifications.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Administrative Complaint filed against Michael F. Petrie be dismissed. DONE and RECOMMENDED this 15th day of April, 1983, in Tallahassee, Leon County, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 15th day of April, 1983. COPIES FURNISHED: Jerry Frances Carter, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Michael F. Petrie, D. C. 410 NE 44th Street Fort Lauderdale, Florida 33334 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Jane Raker, Executive Director Board of Chiropractic Examiners 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issue presented is whether or not Petitioner passed the 1987 chiropractic examination.
Findings Of Fact Petitioner, Mary Campilii, was a candidate for the May 14-17, 1987 chiropractic examination. Petitioner achieved an overall score of 72, as reflected by an upward revision to her original score of 66, on the practical section of the examination. Petitioner achieved a score of 76 on the Florida laws and rules section of the examination. A minimum score of 75 is required to pass both the practical and laws and rules sections of the examination. Petitioner has challenged the method of grading utilized by the Respondent contending that it is subjective as it elates to her, and did not properly reflect her level of achievement and knowledge to the questions that she answered on the May 1987 examination. Petitioner failed to demonstrate that she demonstrated expert or superior knowledge in her answers to any of the questions on the May 1987 exam that she now challenges. The oral practice examination for chiropractic certification is an independent, subjective grading of a candidate's responses to questions asked by two graders. The graders have all been licensed to practice chiropractic for more than five (5) years in Florida and have undergone several hours of standardization training prior to examining the candidates for license certification. One of the techniques required of graders is that they must write their comments if they give a candidate any score less than a 3, which is a passing grade. The grade range is from 1-4. A score of 3 is assigned when a candidate demonstrates minimum competency and a score of 4 is given when a candidate demonstrates superior or expert knowledge in the subject area tested. Petitioner presented Thomas P. Toja, an expert in grading chiropractic examinations for the Board, who offered his opinion that had the grading system utilized by Respondent been different, i.e. a system whereby a candidate could be accorded a score somewhere between a 3 and 4, when such candidate has demonstrated more than minimum competency but less than superior or expert knowledge in the subject area tested, a candidate, such as Petitioner, could have achieved an additional 3 points to her score of 72, and thereby received a passing score of 75. Petitioner has not, however challenged validity of the existing rule which permits Respondent to utilize the grading procedures applied in this case. Stephen Ordet, a licensed chiropractor in Florida for more than 7 years was received as an expert in the grading of chiropractic examinations in Florida, and was one of the graders during the May 1987 examination. Ordet's opinion, which is credited, was that Petitioner did not earn a score of 4 on any of the questions that she now challenges, and was correctly assigned a score of 3 for each of the responses she gave to questions she challenged. Thomas P. Hide, a chiropractor who specializes in the area of sports related injuries, was tendered and received as an expert in the area of reviewing x-rays and the grading of the chiropractic examination. Hide credibly testified and it is found that Petitioner was properly assigned a score of 3 on questions 8, 12, 20, 22, 28, 29, 30 and 33.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Respondent enter a Final Order finding that Petitioner failed to demonstrate that she met the minimum criteria to pass the challenged chiropractic examination and deny her request for licensure. DONE and ENTERED this 8th day of December, 1988, in Tallahassee, Florida. JAMES E. BRADWELL 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 8th day of November, 1988. COPIES FURNISHED: H. Reynolds Sampson, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Dr. Mary Camiplii 2921 Buckridge Trail Loxahatchee, Florida 33470 Bruce D. Lamb, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Lawrence A. Gonzalez, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue This is a license discipline case in which the Petitioner seeks to take disciplinary action against the Respondent on the basis of alleged violations of paragraphs (i), (m), (n), (r), and of Section 460.413(1), Florida Statutes, as set forth in a five-count Administrative Complaint.
Findings Of Fact The Respondent is a licensed chiropractic physician, having been issued license number CH 0002560. He has been so licensed at all times material to this proceeding. On or about March 4, 1994, patient L. M. was involved in a motor vehicle accident. On November 7, 1994, patient L. M. presented to the Respondent with the following ten major complaints: frequent headaches, neck pain, black stool, upper- back pain, mid-back pain, lower-back pain, painful feet, bilateral thigh pain, bilateral knee pain, and bilateral calf pain. The Respondent presented his fee schedule to patient L. M. and the patient signed a copy of the fee schedule. The fee schedule stated, among other things, that missed appointments would be charged to the patient. The patient was a nursing assistant who had been treating herself at home with hot water and Tylenol. On November 7, 1994, the Respondent took a surgical and medical history, a history of the March 4, 1994, accident, a history of the onset of symptoms, and a history of the home care the patient had been attempting. The Respondent reviewed the nature of the patient's pain and how each area of her body was affected by her activities. The Respondent decided to perform physical, orthopedic, and neurological examinations of the patient. He also decided to obtain x-rays of her pelvis, of the lumbar, dorsal, and cervical areas of her spine, and of both of her knees. On November 8, 1994, the Respondent saw the patient again, at which time he began an examination of the patient by noting her height and weight, making a structural visual evaluation, checking her motor coordination, performing a cardiovascular examination, measuring her extremities, performing a sensory examination, and checking her reflexes. On November 8, 1994, the Respondent also took x-rays of the patient and read the x-rays that same day. The x-rays revealed subluxations. Based on the information he had obtained up to that point, the Respondent elected to commence treatment to the patient's lumbar spine. On November 8, 1994, he adjusted the patient's lumbar spine and also applied ultra sound and low voltage to the patient's lumbar spine. Where there are many complaints involving several areas of the patient's body, it is not unusual for a chiropractic physician to begin treatment prior to the completion of the full examination. It is not a deviation from the appropriate standard of care for a chiropractic physician to begin treatment prior to the completion of the full examination under such circumstances. Under the circumstances presented by the patient in this case, it was reasonable for the Respondent to commence treatment to her lower back on November 8, 1994, and to complete the examination the following day. On November 9, 1994, the Respondent did range of motion measurements and performed various orthopedic tests. He also performed a series of muscle tests. Based on the information he received on November 7, 8, and 9, 1994, the Respondent developed a treatment plan and treatment goals. His treatment plan called for adjustment to subluxated vertebrae and knees, ultrasound for tissue repair, low voltage muscle stipulation for spasm, traction to decrease intersegmental joint irritation, and acupressure for stimulation of the acupuncture points. He also proposed to brace the knees and the lumbar spine. The Respondent noted in his records that his treatment goals were to stabilize the patient's condition, increase range of motion, promote tissue repair, decrease spasm, and reduce subluxation. The Respondent also recorded a treatment frequency plan which provided for daily treatment for the first one or two weeks, followed by three weeks of treatment at a frequency of three times per week. The frequency plan was to be reevaluated at the end of one month. The Respondent's records provide a reasonable rationale for the services provided to the patient on November 7, 8, and 9, 1994. The course of treatment of the subject patient consisted of chiropractic adjustments and physiotherapeutic modalities such as low voltage, ultrasound, and traction. Chiropractic adjustment is performed to promote the reduction of subluxations, to increase the healing processes within the body, to increase the normal transmission of nerve impulses, and to reduce spasm. Ultrasound is administered to affect tissue where two dissimilar tissues come together. Low voltage stimulation is designed to relax tissue. All of the treatments administered by the Respondent were designed to meet the treatment goals he had previously established. Such treatments were consistent with a therapeutic outcome. The Respondent's course of treatment was appropriate for the various complaints and symptoms presented by the subject patient. The x-rays taken by the Respondent were appropriate under the circumstances presented by the subject patient. Justification for those x-rays is contained in the patient records. On December 16, 1994, the patient was involved in a second motor vehicle accident. The Respondent's records contain a history regarding the second accident. The Respondent obtained a copy of the accident report regarding the second accident. He also obtained x-ray reports from the hospital to which the patient was taken after the second accident. The Respondent noted in the patient records that he was going to continue with the same course of treatment following the second accident. That was a reasonable course of action under the circumstances of this case. Following the second motor vehicle accident, the Respondent concluded there was reason to suspect that the patient had a herniated disc. This conclusion was based on the chronicity of the patient and the acuteness of her problems. Accordingly, the Respondent ordered an MRI. The Respondent's patient records document a reasonable basis for the tests he ordered for the patient. The testing was reasonably calculated to assist in arriving at a diagnosis and treatment plan for the patient. The Respondent's patient records are legible in all material details. The few instances of illegible words do not materially affect an understanding of what is written in the records. The Respondent's patient records are sufficient to meet the record-keeping requirements of the rules that were in effect at the time the records were created. On or about November 7, 1994, the Respondent billed the patient's insurance company for a detailed one-hour consultation. On or about November 8, 1994, the Respondent billed the patient's insurance company for a half-hour consultation, a spinal adjustment, and two therapeutic modalities. On or about November 8, 1994, the Respondent also billed the patient's insurance company for skull, neck, thoracic, lumbar, left and right knee, and pelvic x-rays. On or about November 9, 1994, the Respondent billed the patient's insurance company for completion of the detailed physical, orthopedic, and neurological examination. Each time the patient visited the Respondent's office, the Respondent billed for an office visit. On numerous occasions, the Respondent billed the patient's insurance company for an office visit and for manipulations on the same day. On or about December 6, 1994, the Respondent billed the patient's insurance company for an office visit and for a re-examination. On or about January 3, 1995, the Respondent billed the patient's insurance company for an intermediate office visit and a consultation. On or about January 18, 1995, the Respondent billed the patient's insurance company for multiple vertebral segment manipulations. The Respondent has his own unique billing system in place. He does not use the current procedural terminology codes that are generally used by other chiropractic physicians in their billing.
Recommendation On the basis of all of the foregoing it is RECOMMENDED that a Final Order be issued in this case dismissing all counts of the Administrative Complaint. DONE AND ENTERED this 19th day of December, 1997, in Tallahassee, Leon County, Florida. 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 Filed with the Clerk of the Division of Administrative Hearings this 19th day of December, 1997.
