Findings Of Fact Petitioner applied for licensure as a physician through endorsement by application dated May 20, 1986. On October 9, 1986, Petitioner appeared before the Board of Medical Examiners, Foreign Graduate Committee regarding his application for licensure. The Board of Medical Examiners (hereinafter "Board") at its meeting of October 11, 1986, voted to deny his application for licensure by endorsement. The Board stated as grounds for the denial that Petitioner had failed to document that he was a legitimate graduate of a foreign medical school. The Petitioner attended the National Autonomous University of Nicaragua in the country of Nicaragua. The National Autonomous University of Nicaragua requires, under Nicaraguan law, the completion of "social service" prior to receipt of a medical school diploma. The social service requirement involves between 1 and 3 full years of medical service in Nicaragua, usually at or very near to, the war zone. The Petitioner completed all course work required for the Diploma of Doctor in Medicine and Surgery from the National Autonomous University of Nicaragua but completed only eleven months of the social service requirement. The Petitioner left Nicaragua and came to the United States in April 1981. The Petitioner was not awarded his medical diploma because he failed to complete the social service requirement. The Petitioner testified at the final hearing that he failed to complete the social service requirement and fled his native country because of political persecution. The Petitioner stated that he was in fear for his life when he left Nicaragua. In order to take the Federation of State Medical Board's licensure examination (FLEX), Petitioner needed a medical school diploma. While in this country, the Petitioner searched for a medical school that would award him a diploma for his work in Nicaragua. The Petitioner's search included schools in Mexico, Honduras, Puerto Rico and the Dominican Republic. The Petitioner received a favorable response from CIFAS University in the Dominican Republic. CIFAS reviewed the Petitioner's transcripts of completed course work from the National Autonomous University of Nicaragua. Petitioner did not do any additional course work or training through CIFAS. Upon completion of its review of the Petitioner's medical education and training, CIFAS awarded Petitioner a medical degree on January 10, 1983. On February 17, 1983, Petitioner was issued a certificate from the Education Commission for Foreign Medical Graduates. The Petitioner took and passed the FLEX in June of 1983 and received a medical license in the State of Georgia. At the time of filing his application, Petitioner was a permanent resident of the United States.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medicine enter a Final Order granting Petitioner's application for licensure by endorsement. DONE and ORDERED this 25th day of May, 1988 in Tallahassee, Leon County, Florida. W. MATTHEW STEVENSON Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 25th day of May, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-0979 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. Rulings on Proposed Findings of Fact Submitted by the Petitioner: (None submitted). Rulings on Proposed Findings of Fact Submitted by the Respondent: 1. Adopted in substance in Finding of Fact 1. 2. Adopted in substance in Finding of Fact 2. 3. Adopted in substance in Finding of Fact 3. 4. Adopted in substance in Finding of Fact 4. 5. Adopted in substance in Finding of Fact 7. 6. Adopted in substance in Finding of Fact 9. 7. Adopted in substance in Finding of Fact 6. 8. Adopted in substance in Finding of Fact 6. 9. Adopted in substance in Finding of Fact 7. 10. Adopted in substance in Finding of Fact 7. 11. Adopted in substance in Finding of Fact 13. 12. Adopted in substance in Finding of Fact 10. 13. Adopted in substance in Finding of Fact 11. 14. Adopted in substance in Finding of Fact 12. 15. Adopted In substance in Finding of Fact 12. 16. Adopted in substance in Finding of Fact 14. 17. Adopted in substance in Finding of Fact 15. COPIES FURNISHED: Alfonso Oviedo-Reyes, Esquire 2100 Coral Way, Suite 403 Miami, Florida 33145 Allen R. Grossman, Esquire Department of Legal Affairs The Capitol LL04 Tallahassee, Florida 32399-1050 William O'Neil, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Ms. Dorothy Faircloth Executive Director Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact Respondent graduated from the University of Havana Medical School in 1951 and practiced medicine in Cuba from that time until he immigrated to the United States in 1960. In Cuba his practice was primarily in the fields of obstetrics and gynecology. In his application dated 9 February 1975 to take the Florida Medical Examination, Respondent listed work at Hudson County Hospital for Mental Diseases (New Jersey) in 1960, work for the American Plasma Company (Miami) from 1965 to 1968, work at the Opa Locka General Hospital from 1967 to 1970, and that he was presently working as assistant doctor at 620 Southwest 1st Street, Miami. Prior to commencing this work at the Southwest Medical Clinic he contacted Physicians's Association of Clinics, Hospitals and Annex (PACHA), an organization which helps Cuban doctors obtain Florida licenses, and was told he could work at the clinic under Dr. Tomas and should register with the Board of Medical Examiners. Respondent registered with the Florida State Board of Medical Examiners as an unlicensed physician in two undated registrations, copies of which were admitted into evidence as Exhibit 5. In the earlier registration he states he is not a naturalized citizen and in the later application he states he is a naturalized citizen, although the year of naturalization is not shown. Anne West, who was apparently running an abortion referral service, called the State's Attorneys office in Miami on behalf of Respondent and was told Respondent could work at the clinic under a licensed doctor. She subsequently became Mrs. Bulas. Respondent testified he commenced doing medical work in the Miami area in 1975 when he became associated with and worked under the supervision of Kamel Tomas, M.D. in a clinic located at 620 Southwest 1st Street, Miami. He subsequently worked at this clinic under the supervision of two other licensed doctors whose names are Hernandez and Martin. In 1976 Respondent successfully passed the Florida Medical Examination and was licensed in July 1976. While working at the clinic on Southwest 1st Street Respondent performed several abortions. In an 18-count Information filed 23 March 1978 (Exhibit 1) for the period 1 May 1975 through 5 March 1976 Respondent was charged with 11 counts of unlawful practice of medicine, 6 counts of larceny and one count of unlawful termination of pregnancy. At his trial and upon the advice of counsel he pleaded nolo contendere, was found guilty of 10 counts of unlawful practice of medicine, six counts of grand larceny and one count of unlawful termination of pregnancy, and Adjudication of Guilt was withheld (Exhibit 2). Most of these charges alleged felonies. In Exhibit 3 the court stayed imposition of sentence and placed Respondent on probation for 5 years with a condition of probation that he be confined in the Dade County Jail for a term of one year. From reading the counts of the Information, as well as from the testimony of Respondent, it is clear that the larcenies alleged resulted from the fees charged by the clinic to those patients treated by Respondent, which formed the bases for the unlawful practice of medicine counts. The information alleging unlawful termination of pregnancy was based upon the performance of an abortion by Respondent while not licensed in Florida. The testimony was unrebutted that numerous clinics in Miami employ Cuban doctors who are unlicensed in Florida. In a class conducted at Jackson Memorial Hospital to prepare former Cuban doctors for the Florida examination there were about 460 in the class attended by Respondent, most of whom worked in clinics in Miami. At the time Respondent worked at the clinic he believed that so long as he was under a licensed doctor the medical work he performed was lawful. However, Respondent was not under the direct supervision of the licensed doctor as each was working on a different patient in separate examining rooms at the same time. No evidence was presented to indicate Respondent was not fully qualified by training and experience to perform the medical practices that he performed prior to receipt of his Florida license.
The Issue The issues for consideration in this case are those promoted by an administrative complaint in which the Petitioner has accused the Respondent of violating certain provisions within Chapters 455 and 458, Florida Statutes, pertaining to licensure. This relates to the contention by Petitioner that Respondent has obtained his license to practice medicine in Florida by fraudulent means. These allegations are more completely described in the conclusions of law.
Findings Of Fact Respondent is a licensed physician having been issued license number ME0043541. On or about September 9, 1983, Respondent submitted an application to the Board of Medical Examiners, now known as the Board of Medicine, seeking a license to practice medicine in Florida. This request was for licensure by endorsement. On the form application there is a section which refers to the applicant's medical education. It instructs the applicant to be specific and account for each year of the medical education calling upon the applicant to give the name of the medical school and the location. In response to this requirement, Respondent indicated that he attended the Universidad del Noreste in Tampico, Mexico, from July, 1977 to May, 1978; from July, 1978 to May, 1979 and from June, 1979 until May, 1980. He further stated that he attended Universidad Cetec, Santo Domingo, Dominican Republic, from June, 1980 until May, 1981 and received a degree of doctor of medicine from that university on June 8, 1981. In submitting the application for licensure by endorsement, he did so under oath and in the course of signing the application he acknowledged the following in his affidavit and oath: "I have carefully read the questions in the foregoing application and have answered them completely, without reservation of any kind, and I declare under penalty of perjury that my answers and all statements made by me herein are true and correct. Should I furnish any false information in this application, I hereby agree that such action shall constitute cause for the denial, suspension or revocation of my license to practice medicine and surgery in the State of Florida. As part of the application process, Dorothy J. Faircloth, Executive Director to the Board of Medical Examiners, sent a letter to Dr. Traynor on September 30, 1983, requesting additional information. The text of that letter was as follows: Dear Dr. Traynor: With further reference to your application for licensure in Florida by you are required to provide to this office, in the form of an affidavit, a narrative report on all your activities relating to your medical education beginning with date of enrollment in medical school. Such report should include, but not be limited to, all classes attended (dates and name and location of institution) which were not conducted at the main teaching hospital of the medical school from which you received a medical diploma. You are also required to complete the enclosed form, providing additional information regarding your medical education and places of residence while in medical training. Upon receipt of the above requested material, you may be required to make a personal appearance before the Board for consideration of your application. The form referred to in the second paragraph of the correspondence from Ms. Faircloth is the form entitled: Attachment for Application for Licensure. Within that form it asks that the applicant "list all places of residence during medical school." This is broken down into various lines on the form requiring the applicant to state the city, state or country and the various period in which he resided in those places. A copy of the executed form offered by the Respondent on October 7, 1983 may be found as a part of Petitioner's composite exhibit 5 admitted into evidence. In the course of describing his residence, he refers to Tampico, Mexico in the period August, 1977 through July, 1978; August, 1978 through July, 1979 and August, 1979 through July, 1980. He then describes his place of residence during medical school as being Santo Domingo, Dominican Republic, in the period July, 1980 through June, 1981. The attachment for application for licensure form then has a section which states "Medical Education: be specific. Account for each year. List all universities or colleges where you attended classes and received training as a medical student." In response to this request, the Respondent provided the same information which he had given in his initial endorsement application form described before. In swearing to the accuracy of those matters set forth in the Attachment for Application for Licensure offered on October 7, 1983, Respondent gave the same oath as related to the endorsement application form acknowledging the possibility of denial, suspension or revocation of any license which was received by the giving of false information. In reply to the first paragraph of the September 30, 1983 correspondence from Ms. Faircloth, Respondent offered a document entitled "Clinical Training." A copy of that document may be found as part of Petitioner's composite exhibit 5. That document states: CLINICAL TRAINING Kevin M. Traynor Aug. '77 - July '79: Basic science courses at Del Noreste; Tampico, Mexico August - Dec. '79: Del Noreste Hospital, Tampico, Mexico Pulmonary Ear, nose & throat Cardiology Ophthalmology Jan. - June '80: Del Noreste Hospital; Tampico, Mexico Traumatology (orthopedics) Forensic medicine Gastroenterology Dermatology July - Dec. '80: University Hospital; Cetec School of Medicine, Santo Domingo, Dominican Republic Neurology Infectious disease Endocrinology General surgery Jan. - June '81: University Hospital; Uni- versity Cetec School of Medicine, Santo Domingo, Dominican Republic Psychiatry Internal medicine OB-GYN Pediatrics By the representations set forth in the statement of clinical training which were made by the Respondent, the impression is given that all of his activities related to his medical education from the point of enrollment to the completion of his medical school training were conducted at the Universidad del Noreste and University Cetec and the hospitals affiliated with those institutions. Given that the Respondent is silent on other activities outside those settings, a reading of his explanation leads one to believe that he had no such activities. This is not a true depiction of his training in medical school. In this respect, the Respondent has misled the Florida Board of Medical Examiners in that the vast majority of clinical rotations which the Respondent participated in during his medical school education occurred during externships in the United States. In addition, Respondent, in his comments in the endorsement application form and in the Attachment for Application for Licensure form, has misled the Board of Medical Examiners by describing his residence in medical school as Santo Domingo, Dominican Republic, in the period July, 1980 through June, 1981. He was not residing in the Dominican Republic until January, 1981. Respondent's domicile or official residence was in Tampico, Mexico, until the end of 1980. Respondent did not receive medical education in the sense of attending classes and receiving training as a medical student in affiliation with the Universidad Cetec until January, 1981. This is contrary to his representations about residence and medical education in which he describes his association with Universidad Cetec dating from July, 1980. Respondent had made an inquiry about being admitted to Universidad Cetec in December, 1980, and was given the impression that that request would be approved. Respondent's official acceptance by Universidad Cetec occurred on January 8, 1981. In referring to the activities related to medical education spoken to in the September 30, 1983 correspondence from Ms. Faircloth, the records reveal that Respondent did externship at St. Francis Hospital in Miami Beach, Florida from July 9, 1975 through November 20, 1979. He further did externship at Kingsbrook Jewish Medical Center in Brooklyn, New York, from January, 1980 through May, 1980, rotations involving medicine, pediatrics and surgery. In that same institution from June 30, 1980 through July 13, 1980, Respondent did a rotation in neurology. In the period July, 1980 through December, 1980, Respondent performed unofficial and uncredited externship at Kingsbrook. All of these activities occurred under the aegis of his status as a medical student at Universidad del Noreste. In the period February, 1981 through May, 1981, while at Universidad Cetec, Respondent did an externship at Brookdale Hospital Medical Center in New York in hematology and renal and electrolytes. In April, 1981, as an extern at Nassau County Medical Center in East Meadow, New York, Respondent performed a clerkship in urology. Under the circumstances in examining the places of residence during medical school, while Respondent may have been in official residence in Mexico and the Dominican Republic, his actual residence was in various locations within the United States in the periods described in the preceding paragraphs. Following his graduation, Respondent also participated in training programs at Brookdale Hospital Medical Center related to an elective in emergency services from the period August 10, 1981 through September 4, 1981. He performed an elective in the period September, 1981 through October, 1981 in the Division of Pulmonary Medicine at the Down State Medical Center which is affiliated with the Department of Medicine, AIE University of New York. From 1981 through June, 1984, Respondent was involved in an internal medicine residency at Jersey Shore Medical Center/Fitken Hospital in Neptune, New Jersey. Beginning in 1984 through June, 1986, Respondent completed a cardiology fellowship program in Jacksonville, Florida, at the University Hospital which is part of JHEP, a training program associated with the University of Florida medical school. In explaining why he has reported his residence in his medical education as commencing in July, 1980 at Universidad Cetec, Respondent indicates that he had been told by the dean of the medical school at Cetec, upon his admission there, that his enrollment would be back-dated to the beginning of the fall semester, or June, 1980. To this end Respondent paid Universidad Cetec $2,500 which represented a tuition payment for the seventh semester running from approximately June, 1980 to December, 1980. This payment for back-dating and credit for the seventh semester was made on April 23, 1981. There is no indication that those records were back-dated to show acceptance of a seventh semester under association with Universidad Cetec. Respondent did not undertake any clinical training in that period which could be credited, with the exception of his urology clerkship at Kingsbrook Jewish Medical Center in the period June 30, 1980 through July 13, 1980. He did not stand examination in any of the subject areas pertaining to his medical education in that seventh semester running from June, 1980 to December, 1980, having foregone the examination sessions given by Universidad del Noreste at the conclusion of that seventh semester. In the final analysis, Respondent did not accomplish anything toward advancing his medical education in the seventh semester running from approximately June, 1980 through December, 1980 as recognized by either medical school which he attended. There is evidence that part of the unofficial work done by the Petitioner in the fall of 1980 at Kingsbrook Jewish Medical Center related to dermatology and E.R. Even accepting the concept explained by the Respondent to the effect that both of the medical schools he attended would allow a student to stand examination in medical subjects at times not correlated with the performance of clinical clerkships, to the extent that the seventh semester unofficial clinical clerkships being performed are germane, they have not been credited. Respondent claims that the period from the end of the fall of 1980 was not crucial in that he had fulfilled enough weeks in clinical rotation to allow his graduation. In any event, Respondent did graduate, was certified by the Educational Commission for Foreign Medical Graduates, passed the FLEX examination and has been licensed in the states of Georgia and New Jersey. In explaining his response to the requirements related to his application for licensure in Florida to practice medicine, Respondent indicates that he was of the persuasion that he need only provide information pertaining to his clinical training as credited by the two schools he attended. This is not a fair reading of the requirements expressed in the correspondence of September 30, 1983, in which all activities involving the medical education are sought. This contemplates that specific information as to the exact nature and location of the externship rotations performed in the United States should be explained. Respondent failed to do this and what he did offer by way of explanation is misleading in that clerkships are set forth pertaining to experience in the period July, 1980 through December, 1980 associated with the Universidad Cetec which did not occur at that time because the Respondent was not enrolled at Universidad Cetec during that period. In addition, the statement about clinical training given by the Respondent would have one believe that the training occurred in the affiliated hospitals associated with the two medical schools he attended which is erroneous. The clinical training statement by the Petitioner does not coincide with his actual clinical training, an example being that during the period January, 1980 through June, 1980 while affiliated with the Universidad del Noreste, he says that he received training in traumatology (orthopedics), forensic medicine, gastroenterology, and dermatology when in fact the training he was receiving at that time at Kingsbrook Jewish Medical Center was in the fields of medicine, pediatrics and surgery. It appears that Universidad del Noreste gave him credit for those subjects he relates, but this was not the clinical training he was undergoing in that time sequence. During the period July through December 1980 where he indicates that he received clinical training in neurology, infectious disease, endocrinology and general surgery, the only official training he received was in neurology. It is debatable whether the requirements for establishing residence as described in the endorsement application form and the Attachment for Application for Licensure form sought the official residence, that is, his residence in the country where he attended medical school or the actual residence where externships were being performed as well as when he was actually at the university. In any event, if it was seeking the official residence, his information is misleading in that he describes his official residence as Santo Domingo in the period July, 1980 through December, 1980, when in fact his official residence was Tampico, Mexico. Respondent was given his medical license by the State of Florida on December 5, 1983, based in part upon the information as set out in the endorsement application form, the Attachment for Application for Licensure form and the narrative on clinical training provided by the Respondent. Before the occasion of the present administrative complaint, there is no indication that the Respondent has been disciplined by the State of Florida. At present, Respondent is practicing medicine in Florida and is a resident of Stuart, Florida.
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
The Issue The sole issue, as reflected in the Joint Stipulation, is whether the Petitioner fraudulently misrepresented his places of residence (where lived) since the initiation of medical training or his medical education as called for on his application for licensure.
Findings Of Fact Raymond Francis Caron was licensed as a physician in the State of Minnesota in November 1986. He currently lives in Orlando, Florida, and is employed as a pediatric resident at Orlando Regional Medical Center. He is seeking licensure by endorsement to practice medicine in the State of Florida. On his application submitted to the Board of Medical Examiners, Dr. Caron responded in the following manner regarding his places of residence: LIST ALL PLACES OF RESIDENCE (WHERE LIVED) SINCE INITIATION OF MEDICAL TRAINING: FROM: 1 , 1982 TO 3 , 1983 FROM: 3 , 1983 TO 6 , 1984 55434 FROM: 6 , 1984 TO 6 , 1986 Siervas de Maria #10 Plaza Naco Santa Domingo Dominican Rep. (city, state or county) 1800 Senate #109 Columbia, S.C. (city, state or county) 349-96th Lane NE, Minneapolis MN Minneapolis MN (city, state or county) 4604 Middlebrook, Unit J Orlando, Fla FROM: 6 , 1986 TO PRESENT 19 (city, state or county) Carretera La Romeno #79, San Pedro Dom Rep From 3-78 to Jan 1982 The following response was provided on the application with regard to his medical education: MEDICAL EDUCATION: BE SPECIFIC. ACCOUNT FOR EACH YEAR. LIST ALL UNIVERSITIES/COLLEGES WHERE ATTENDED CLASSES/RECEIVED TRAINING AS A MEDICAL STUDENT. May, 1978 TO May, 1981 May, 1981 TO May, 1982 May, 1982 TO May, 1983 UNIVERSIDAD CENTRAL DEL ESTE FROM: (name of medical school/location) SAN PEDRO DEMACORIS DOMINICAN REPUBLIC CENTRO DE ESTUDIOS TECHNOLOGICOS FROM: (name of medical school/location) SANTA DOMINGO DOMINICAN REPUBLIC UNIV. TECHNOLOGICA DE SANTIAGO FROM: (name of medical school/location) SANTA DOMINGO DOMINICAN REPUBLIC FROM: , 19 TO , 19 (name of medical school/location) At his appearance before the Board's Foreign Graduate Committee in March 1987, Dr. Caron disclosed that he left the Dominican Republic in December 1979, and lived in Columbia, South Carolina until January 1981. During this time he tried to get into a medical school in the United States, but after the attempt proved unsuccessful he returned to the Dominican Republic. He also lived in Columbia, South Carolina from approximately June 1982 until December 1982, while he fulfilled some elective credit requirements for his degree from the University Technologica de Santiago. (UTESA) Those electives were taken under the sponsorship and tutelage of two physicians associated with the University of South Carolina, Department of Medicine in Columbia, S.C. Given the choice of fulfilling elective requirements in the Dominican Republic or in Columbia, South Carolina, Dr. Caron preferred the training in the United States. He was not enrolled at the University of South Carolina, but rather at UTESA. These electives are reflected on his UTESA transcript as clerkships, for which he received passing grades and twenty-eight (28) credit hours. The disclosures to the Committee regarding time spent in the United States in 1980 and 1982, as well as the elective credits taken under the aegis of the University of South Carolina created an obvious conflict with the information provided on the application. The application provides, as stated in paragraph 2, above, that Dr. Caron resided in the Dominican Republic from March 1978 to March 1983, with no breaks. The application, as stated in paragraph 3, above, does not reflect any training at the University of South Carolina Medical School. At the end of the application form is an affidavit from the applicant including, in part, this statement: I have carefully read the questions in the foregoing application and have answered them completely, without reservations of any kind, and I declare under penalty of perjury that my answers and all statements made by me herein are true and correct. Should I furnish any false information is [sic] this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice medicine/surgery in the State of Florida. Dr. Caron filled out the application at various times while he was between duties at the Orlando Regional Medical Center. It took several weeks, as he took the papers to the hospital when he was on call and worked on them at all times of the day or night. He was in a hurry as he felt it preferable to have a license going into his third year of residency at the Orlando Regional Medical School. He consulted with his wife regarding the places of residence and she counselled him based on her recent experience with a mortgage application. In that situation she had put detailed information regarding a pregnancy leave from school. The lending institution questioned this because her transcript apparently indicated that she was still enrolled. The mortgage company told her she was being too specific. Dr. Caron also talked to his brother-in-law, a pediatric neurologist licensed as a Florida physician. The brother-in-law, himself a foreign medical graduate, suggested that the Board was probably interested in the different places he had resided and the details would be elicited when he appeared before the Foreign Medical Graduate Committee. Dr. Caron's discussion with the members of the Committee in March 1987, lends credibility to that explanation. He appeared before the Committee with his box of documents, prepared and expecting to show them to the Committee; he became frustrated and chagrined when they concentrated on the discrepancies between the information on his application and the verbal information he was providing them. He ultimately agreed that the accuracy of the application was relevant. Besides being in a hurry and relying on the advice of his wife and brother-in-law, Dr. Caron sincerely believed that he provided the Board with he information they sought. While the dates were clearly off, he provided the four places he has lived since starting Medical School: the Dominican Republic; Columbia, South Carolina; Minneapolis, Minnesota; and Orlando, Florida. He did not put the University of South Carolina as a place of medical training because he was never enrolled there. Nothing in the record of this proceeding suggests that Dr. Caron was deliberately misleading or attempting to defraud the Board. He gained nothing by omitting certain information from his application; nothing whatsoever suggests that he was involved in misdeeds or had any motive for disguising his true whereabouts in 1980 and 1982. He has explained the discrepancies and conceded his error in judgment. Two competent physician witnesses who are familiar with his work testified as to his ability to practice medicine with reasonable skill and safety, including the ability to maintain proper medical records.
Recommendation For the foregoing reasons, it is hereby, RECOMMENDED: That a Final Order be issued granting licensure by endorsement to Raymond Francis Caron. DONE and RECOMMENDED this 12th day of October, 1987 in Tallahassee, Florida. MARY CLARK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 12th day of October, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-2483 The following constitute my rulings on the findings of fact proposed by Petitioner: 1-5. Addressed in "Background" of this order. 6-7. Addressed in the statement of issue. Adopted in paragraph 3, Conclusions of Law. Adopted in Findings of Fact, paragraph 2. Adopted in Findings of Fact, paragraph 4. Adopted in Findings of Fact, paragraph 2. Adopted in Findings of Fact, paragraph 4. Rejected as unnecessary. Adopted in Findings of Fact, paragraph 2. Adopted in substance in Findings of Fact, paragraphs 4 and 6. 16-17. Adopted in Findings of Fact, paragraph 8. 18. Adopted in substance in Findings of Fact, paragraph 9. 19-20. Adopted in Findings of Fact, paragraph 10. Rejected as unnecessary. Adopted in Findings of Fact, paragraph 3. Adopted in Findings of Fact, paragraphs 5 and 6. Adopted in Findings of Fact, paragraph 5. Adopted in Findings of Fact, paragraph 5, except that Dr. Caron's testimony was that the electives were under the aegis of the University of South Carolina. (Transcript of meeting of FMGC, p. 25.) Adopted in Findings of Fact, paragraphs 9 and 10. Adopted in Findings of Fact, paragraph 10. Adopted in substance in Findings of Fact, paragraph 10. Adopted in Findings of Fact, paragraph 1 30-31. Rejected as unnecessary. The following constitute my rulings on the Findings of Fact proposed by the Respondent. Addressed in "Background" and Findings of Fact, paragraph 1. Adopted in Findings of Fact, paragraph 2. Adopted in Findings of Fact, paragraph 7. Adopted in Findings of Fact, paragraphs 4 and 5. Adopted in Findings of Fact, paragraph 3. Rejected as cumulative. Adopted in substance in Findings of Fact, paragraph 6. Rejected as unnecessary. Rejected as cumulative. Addressed in the "Background". Adopted in substance in Findings of Fact, paragraph 8. 12-13. Rejected as unnecessary. Adopted in Findings of Fact, paragraph 8. Rejected as unnecessary. COPIES FURNISHED: Charles L. Curtis, Esquire Allsworth, Doumar, Cazel & Curtis 1177 S. E. Third Avenue Fort Lauderdale, Florida 33316 Basil E. Dalack, Esquire 350 South Country Road Palm Beach, Florida 33480 M. Catherine Lannon, Esquire Assistant Attorney General Department of Legal Affairs 1601 The Capitol Tallahassee, Florida 32399-1050 Dorothy Faircloth, Executive Director Board of Medicine Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Tom Gallagher, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 William O'Neil, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue The issue in this proceeding is whether Petitioner attempted to obtain his license by fraudulent misrepresentations to the Board, related to his medical education at Loma Linda University, thereby lacking good moral character and ineligible for licensure as a physician in the State of Florida.
Findings Of Fact William E. Dalton, fifty-seven years of age, is currently licensed as a medical doctor in the States of California, Texas, Georgia and Arkansas. He commenced his medical school education in Loma Linda, California, in 1962. He failed no courses that first year and was ranked 54 out of 94 in his class. The second year he failed Medical Microbiology and Human Pathology, and made "D" in General Pharmacology. He was ranked 104 out of 104. He repeated the second year and achieved a "C-" in Medical Microbiology, a "C" in Human Pathology and a "D" again in General Pharmacology. At Loma Linda, a "D" was considered a passing grade. After Dr. Dalton repeated the three courses, the Associate Dean at Loma Linda visited his house and explained that the Executive Committee at the University did not believe that he was proficient enough to pass the National Board exam. Dr. Dalton assumed that he was dismissed from Loma Linda, because it was his understanding that you had to have a sponsor to take the exam and that, without the exam, you could not continue with the third and fourth years of medical school training. In September 1966, he enrolled as a medical student at the University of Guadalajara in Mexico. He completed his third, fourth and fifth years of medical school at the University of Guadalajara, completed other requirements for graduation and was awarded a degree from that institution. After satisfying its requirements and passing its examination, Dr. Dalton was certified by the Educational Council for Foreign Medical Graduates (ECFMG) on September 15, 1971. He passed the California FLEX examination in December 1972. In addition to the various state licenses addressed above, William Dalton received a license to practice medicine in Florida in 1981. This was a license by endorsement and required that he commence practice in Florida within three years. He started practicing after the June 16, 1984 deadline and his license was revoked. He submitted his application for licensure by examination in February 1985. At the request of the Foreign Medical Graduate Committee of the Board of Medical Examiners, he appeared before the Committee on May 30, 1985. Then asked by the committee whether he had all his training in Mexico, he replied that he had ". . . two years at Loma Linda, the first and second." [JE #1, transcript, p.3] He told the committee that he was successful in both years but did not return because the university did not think he was strong enough to pass the national boards. He said he was dismissed from the school. He also made these responses: Q. Did you fail any courses at Loma Linda? A. I did not fail any course. Q. Did you get credit for all of those courses at Guadalajara? A. That's right. Unable to resolve what they deemed was a conflict between the "dismissal" and "passing," the committee voted to permit Dr. Dalton to take the examination but that a transcript would be obtained from Loma Linda and he would have to appear before the committee again before being licensed. Even after the committee voted, and Dr. Dalton was aware of the committee's decision, he responded again: DR. KATIMS: You have testified to us that you passed all your courses? THE WITNESS: I did. [JE #1, transcript, p. 13] After passing the examination, Dr. Dalton appeared again before the Board of Medicine on October 12, 1986. On this occasion he stated that he took pharmacology twice; the first time he didn't pass; the second time, he did. He also stated, "I have no failing subjects at Loma Linda, which the transcript should indicate." [JE #1, transcript, p. 3] When confronted with the two failing grades in Medical Microbiology and Human Pathology, he explained that he repeated the courses and passed them, and had passed all his courses. The Board voted to deny Dr. Dalton licensure by examination. At the formal hearing, Dr. Dalton explained the circumstances of his apparent inconsistencies in careful detail. It was never his intention to deliberately mislead the Board; he passed the courses; he got his medical education and that was, to him, the significant fact. He had not taken the time to review his paperwork prior to testifying before the Board. Although it took him three years to complete the first and second years of medical school at Loma Linda, he did complete those years with passing grades. Counsel for the Board theorizes, in her proposed recommended order, that Dr. Dalton knowingly and deliberately misled the Board until it was apparent that they had the true facts at hand; then he became candid and forthright. This is not supported by the record. If misleading the Board had been his intent, he never would have testified at his first appearance in May 1985 that he was dismissed from Loma Linda. He could have simply said he transferred to a different school. Further, it is not clear from the record that he was "dismissed" from Loma Linda. He did successfully complete two years there, but had a sincere belief that since the school felt he was not prepared to take the National Board examinations, he could not take them, that he needed the Boards to go on with his medical school education, and he was, therefore, de facto dismissed. Even after the Foreign Medical Graduate Committee voted to get the Loma Linda transcript for verification, Dr. Dalton still affirmatively responded that he passed all his courses. At this point, given Respondent's theory, he should have started recanting his earlier testimony. Some of Dr. Dalton's erroneous testimony was against his interests -- for example, in his second appearance, before the full Board, he stated that he first failed, then passed Pathology. He never failed that course. Dr. Frank David Kuitems testified as a character witness. He has worked closely with Dr. Dalton during the past fifteen months. Dr. Kuitems has high regard for Dr. Dalton, both as to his proficiency as a physician and as to his integrity and honesty. Dr. Kuitems' testimony corroborates and is consistent with the letters of recommendation in Dr. Dalton's application file. Dr. Dalton is licensed to practice in four states and has actively practiced medicine for over fifteen years. The Board's investigation reflects no blemishes on his professional record. He is a Board-certified diplomate of the American Board of Family Practice. It is apparent from the evidence in this proceeding that Dr. Dalton did not deliberately mislead or lie to the Board. He never contemplated that the Board would deny him access to a license if they knew he had originally failed two courses at Loma Linda. He was previously licensed by endorsement in Florida without any apparent difficulty. What the Board perceived as persistent evasive answers was more likely "tunnel-vision" and failure to grasp the Committee's concern about his peculiar story that although he passed his courses, he was still "dismissed." Dr. Dalton meets the requirements for licensure by examination, including good moral character. He has not attempted to obtain his license through fraudulent misrepresentations.
Recommendation Based on the foregoing, it is, hereby RECOMMENDED: That a Final Order be entered by the Board of Medicine approving William E. Dalton's application for licensure as a physician in the State of Florida. DONE AND RECOMMENDED this 13th day of August, 1987, in Tallahassee, Leon County, Florida. MARY CLARK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 13th day of August, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-1147 The following constitute my specific rulings on the parties' proposed findings of fact: Petitioner: 1-2. Rejected as irrelevant to the issues framed in the pleadings in this case. Adopted in substance in paragraph 2. Adopted in substance in paragraph 3. 5-8. Adopted in substance in paragraph 5. The details of his education at Guadalajara are omitted as immaterial. Adopted in paragraph 5. Adopted in paragraphs 1 and 12. Rejected as cumulative and unnecessary. Adopted in paragraph 12. Adopted in paragraph 6. Rejected as cumulative and unnecessary. Adopted in substance in paragraph 6. 16-19. Adopted in paragraph 7. 20-21. Rejected as immaterial. 22-23. Adopted in paragraph 8. Adopted in substance in paragraph 10. 25&27. Rejected as immaterial and unnecessary. 28&29. Adopted in paragraph 11. Respondent: 1-2. Adopted in paragraph 7. Adopted in paragraph 8. Addressed and essentially adopted in the Background portion of this Recommended Order. 5-6. Adopted in substance in paragraphs 2 and 3. 7-10. Rejected as argumentative and unsupported by the evidence as a whole. 11. Rejected as inconsistent with the evidence as a whole. COPIES FURNISHED: Charles A. Stampelos, Esquire Finley, Kumble, Wagner, Heine, Underberg, Manley, Myerson & Casey Post Office Box 2174 Tallahassee, Florida 32316-2174 M. Catherine Lannon, Esquire Assistant Attorney General Suite 1601, The Capitol Tallahassee, Florida 32399-1050 Ms. Dorothy Faircloth Executive Director Board of Medicine 130 North Monroe Street Tallahassee, Florida 32399-0750 Honorable Van B. Poole Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Joseph A. Sole, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact The application of Petitioner, John David Young, M.D., for licensure by endorsement initially was filed on March 13, 1991. The initial application was not completed within one year and, under F.A.C. Rule 61F6-22.016, was not acted upon by the Board of Medicine. The Petitioner reapplied on September 1, 1992, and his application was denied by Respondent's Order rendered on November 4, 1993. The basis of denial stated in the November 4, 1993, Order is: You failed to show a medical education as that term is used in Chapter 458 in Sections 458.313(1)(a) and 458.311(1)(f) and have failed to show medical practice as required by Section 458.313(1)(c). Additionally, you have misrepresented your education. Sections 458.313(1)(a) and (7); 458.311(1)(c) and (d); 458.331(1)(a) and (gg), F.S. Medical Education Dr. Young received his Doctorate of Medicine Degree from Grace University School of Medicine, St. Kitts, Nevis, West Indies, June 4, 1986. Grace University is registered with the World Health Organization. Dr. Young began his medical education on May 5, 1981, at the Universidad de Mundial, Dominican Republic, where he completed one year as reflected by the transcripts found at Joint Exhibit 1, page 195. Dr. Young transferred to CETEC, Dominican Republic, because of his concerns that Universidad de Mundial would close within a few years. The transfer to CETEC occurred in late December, 1981. CETEC allowed Dr. Young to take pathology and physiology at the University of Southern California on the condition that CETEC would administer exams on those subjects before they would give him credit. The University of Southern California did not give credit for the courses, which was not a concern to Dr. Young because he was seeking credit from CETEC upon taking the CETEC examination. CETEC attempted to establish a liaison with Orange State University School of Medicine in Southern California whereby students could take courses at Orange State and receive credit by CETEC. Dr. Young completed his basic science course work at Orange State as reflected by the transcript at Joint Exhibit 1, page 193, for which CETEC gave him credit. Melvin A. Shiffman, M.D., was temporary dean at Orange State University and submitted a letter to the Board of Medicine confirming Dr. Young's attendance from May through August, 1982, and that Dr. Young took the CETEC final examinations on all the subjects taught at Orange State for which they gave credit. Dr. Young began his clinical rotations upon completion of his basic sciences as follows: Basic Medicine at Pine Ridge Indian Health Hospital, Pine Ridge, South Dakota, from August 31, 1982 to September 30, 1982; surgery at Oral Roberts University School of Medicine from October 4, 1982 to December 22, 1982; surgery at Fitkin Hospital, Swaziliand, South Africa, in 1983; basic medicine at Pine Ridge Indian Hospital, Pine Ridge, South Dakota, from April 18, 1983 to May 29, 1983. While at Pine Ridge Indian Hospital the second time, Dr. Young was asked to leave by the acting hospital administrator, on the allegation that he was attending CETEC, which was not an approved school, which in fact it was. In shock at being asked to leave based on those allegations, Dr. Young travelled to Kansas City to stay with relatives to study for the Educational Commission for Foreign Medical Graduates (ECFMG) examination required for all foreign medical graduates. The Petitioner took and passed the ECFMG examination on July 27, 1983. Upon completion of the examination, Dr. Young continued his clinical rotations as follows: Psychiatry at Bay Front Medical Center, University of South Florida, St. Petersburg, Florida; medicine at University of Natal, Republic of South Africa, from September 26, 1983 to January 1, 1984; obstetrics/gynecology at Addington Hospital, University of Natal, Republic of South Africa, from January 3, 1984 to March 4, 1984; pediatrics from March 12 to May 13, 1984 at Addington Hospital; University of Natal; and surgery from May 13, 1984 to July 16, 1984 at Addington Hospital, University of Natal. In late May or early June, 1984, while Dr. Young was in the surgery rotation, he learned, upon calling home and speaking to his mother, that CETEC closed as of March 4, 1984. Dr. Young was shocked at learning of the closing, but decided to complete the surgery rotation, since he was working with a well known professor, and to return to the U.S. after that to try to find another medical school. Dr. Young registered at the University of Health Science in Antigua in September, 1984. The University of Health Science required Dr. Young to take their exams for credit of his basic sciences course work, which he took in December, 1984. Because the transcripts from CETEC were not available, Dr. Young produced to the University of Health Sciences cancelled checks showing payment for his tuition, which was accepted. The University of Health Sciences, therefore, required Dr. Young to pass their examinations for the basic science courses in lieu of the CETEC transcript. Dr. Young found the exams to be suspicious in that they seemed to be random photocopies of medical text book pages. Accordingly, Dr. Young went to the U.S. Embassy at Antigua to discuss the medical school and was advised to change schools because of problems they were having with the school. Dr. Young learned later that 30 former students filed suit in federal court against the school for the irregularities. Upon completion of the examinations, Dr. Young continued his rotations. He did a rotation in cardiology at Bay Pines Veterans Hospital, St. Petersburg, Florida from December 18, 1984 to January 31, 1985. He did a rotation in internal medicine at Metropolitan General Hospital, Pinellas Park, Florida from February 1, 1985 to April 30, 1985. He did a rotation in pediatrics with Dr. DeGall at All Childrens Office in St. Petersburg, Florida from May 1 to July 29, 1985. Dr. Young then enrolled in Grace University Medical School, St. Kitts, Nevis, West Indies, in December, 1985. Grace University gave Dr. Young credit for course work done for previous medical schools approved by the World Health Organization, but told him that he would be required to take validation exams for that course work and would probably need to take some additional clerkships. This was explained to the Board of Medicine by the Vice President and CEO of Grace University, J.P. McNaughton-Louden, M.D., by letter dated February 20, 1991, found at Joint Exhibit 1, page 103. In that letter, Dr. Louden also confirms that CETEC was approved by the World Health Organization, that CETEC closed while Dr. Young was taking rotations in South Africa, that students at University of Health Sciences in Antigua were advised by the U.S. Consul authorities to transfer because of problems, that Dr. Young would be given credit for studies done at medical schools approved by the World Health Organizations co-validated by examinations at Grace University, and that Dr. Young's clerkships had been accepted and that he graduated on June 4, 1986. The transcripts of Grace University found at Joint Exhibit 1, page 104, shows that Dr. Young was admitted in March, 1984, even though his actual enrollment was December, 1985, because the school dated the admission retroactively to the date that CETEC closed. Dr. Young listed what he considered to be his accurate date of enrollment on his application for licensure as December 21, 1985. Dr. Young did the following additional rotations for Grace University: pediatrics with Dr. DeGall in St. Petersburg, from December 29, 1985 to February 26, 1985; and general medicine and emergency medicine at a refugee camp under the auspices of the United States and Christian Missionary Life from March 3 to April 30, 1985. FLEX Exam Dr. Young took and passed the Federation of State Medical Boards' Licensing Examination (known as "FLEX") on the first attempt in December, 1988. Residency 21 Dr. Young completed one year of residency in internal medicine at Marshall University on January 31, 1989. Maurice A. Mufson, M.D., Dr. Young's professor and Chairman of the Department of Internal Medicine, submitted an evaluation of the residency to the Board of Medicine recommending him as qualified and competent. After completion of the one year residency in internal medicine, Dr. Young realized that in order to fulfill his desire to practice missionary medicine, he would need a broader education. Accordingly, he changed his residency to family practice. Marshall University gave Dr. Young seven months credit from his one year of internal medicine residency towards his family practice residency which was completed in June, 1991. Robert B. Walker, M.D., Dr. Young's professor and Chairman of the Department of Family and Community Health, submitted to the Board of Medicine and evaluation of Dr. Young's family practice residency recommending him as qualified and competent. The AMA physician profile on Dr. Young, submitted to the Board of Medicine by the AMA, shows that Dr. Young completed the family practice residency and one year of internal medicine residency. However, the AMA profile mistakenly shows Dr. Young's internal medicine residency as from 2/87 to 1/88, instead of the accurate dates of 2/88 to 1/89. Dr. Young brought this error to the attention of the AMA which did not correct it. Letters recommending Dr. Young for licensure were sent to the Board of Medicine by: Stephen Petrany, M.D., Dr. Young's former Director of the Family Medicine Residency at Marshall University; and Jack Ditty, M.D., a Board certified dermatologist in Kentucky who was adjunct professor at University of Kentucky and Marshall University (who writes that Dr. Young is of high moral character and has knowledge and experience which would be necessary to practice medicine in Florida.) Post-Residency After completion of his residency in 1991, Dr. Young became licensed to practice medicine in West Virginia. Since his licensure, there have been no complaints or probable cause determinations made against his license, and no malpractice claims have been filed against him. Since completion of his residency, he has served as Assistant Professor of Clinical Medicine at the University of West Virginia and as Adjunct Professor of Medicine at Marshall University School of Medicine. He also has worked as a ship's doctor for a cruise line, worked as Assistant Professor of Medicine at University of West Virginia, moonlighted as an emergency room doctor in Beckley, West Virginia, lectured extensively in the Republic of South Africa on sexually transmitted diseases, and has worked as an emergency room doctor for the U.S. Military in Arizona. ECFMG Certification The Educational Commission for Foreign Medical Graduates (ECFMG) verifies the medical education of each person to whom it awards a certificate following passage of its examination. The ECFMG's investigation of Dr. Young's medical education took several years, because of allegations involving a Mr. Pedro de Mesones falsifying information from some medical schools in the Dominican Republic, including CETEC, on behalf of some applicants to various state medical boards. Dr. Young never met nor spoke with Pedro de Mesones nor was he involved with him in any way. The ECFMG advised Dr. Young of this investigation by letter dated June 7, 1984, found at Joint Exhibit 1, page 167. Further complicating the ECFMG investigation of Dr. Young's medical education was the closing of CETEC. The Dominican Republic government established an agency known as CONES to assist in getting transcripts of students who attended CETEC. Dr. Young wrote to CONES in an attempt to obtain his CETEC transcript from CONES. Even though Dr. Young was unable to obtain transcripts of CETEC from CONES, ECFMG verified all of Dr. Young's medical education, clinical rotations, and residency. The ECFMG investigation of Dr. Young's medical education concluded with no irregularities in his credentials having been found. The ECFMG issued its certificate to Dr. Young on October 13, 1987; it is valid indefinitely. Specialty Board Certification Dr. Young is certified as a diplomate of the American Board of Family Practice for the period of 1992 - 1999. The certificate from the American Board of Family Practice indicates: that Dr. Young met the requirements to be certified as a Diplomate of the Board; that he has completed a 3-year residency; and that the American Board verified Dr. Young's medical education and found it to be authentic. Board of Medicine Investigation As part of the routine investigation of Dr. Young's application for licensure filed with the Board of Medicine, the Board staff wrote to CONES requesting confirmation of the CETEC education and received a response dated March 6, 1992, by letter found at Joint Exhibit 1, page 87, stating that Dr. Young was not found on their lists and that they could not process the Board's request until they had Dr. Young's student registration number. However, an earlier certification by CONES dated May 12, 1987, found at Joint Exhibit 1, pages 9 and 10, shows that CONES did have Dr. Young's student identification number and had a file on him. Paul L. Allyn, M.D. also confirmed to the Board of Medicine by letter dated June 30, 1993, found at Joint Exhibit 1, page 88, that Dr. Young did attend CETEC. The transcript of the Credentials Committee Meeting at Joint Exhibit 2 shows that the committee focused on the March 6, 1992, letter rather than the May 12, 1987, letter. The Board staff contacted the University of Health Sciences to confirm Dr. Young's attendance and received a letter from its President dated October 21, 1991, found at Joint Exhibit 1, page 99. That letter states that Dr. Young did not receive credit for his previous medical education, that he attended the institution from September 19, 1984 to July 11, 1985, that he did not leave the institution in good standing, and that he was dismissed because he was unable to provide the school with official transcripts from the previous medical school he attended. Dr. Young had not seen that letter until a few months before hearing while reviewing the Board's file on him in preparation for the hearing. Dr. Young takes issue with the statements in the letter because the school did give him credit for the rotations he completed while enrolled at Universidad de Mundial and because he never had been told that he left the institution in poor standing. Dr. Young left the University upon advice of the U.S. Consulate in Antigua. The transcript of the Credentials Committee Meeting at Joint Exhibit 2 shows that the committee focused on this letter rather than Dr. Young's affidavits submitted with his application which contradict the letter. The Board obtained and reviewed the ECFMG file on Dr. Young in considering his application. In the ECFMG file at Joint Exhibit 1, page 230, is a letter to the ECFMG from John Casken, Quality Assurance Coordinator, Department of Health, Education, and Welfare, dated May 15, 1985, relating to Dr. Young's second clinical rotation at Pine Ridge Indian Health Hospital in 1983. In the letter, Mr. Casken states: that a closer look at Dr. Young's credentials after he presented himself for the second time showed that he had basically no medical education; that Dr. Young was asked to leave; and that, had they known in 1982 when he appeared for his first rotation what they knew in 1983, they would not have taken on Dr. Young as a m edical student. Dr. Young first saw that letter a few months before the hearing while preparing for trial. Dr. Young disagrees with that letter in that the schools he was attending, Universidad de Mundial, and after that, CETEC, were both approved by the World Health Organization. Further, a letter written on April 18, 1985, by Leonard L. Finger, Hospital Administrative Officer, Department of Health, Education, and Welfare, to the ECFMG, found at Joint Exhibit 1, page 231 , verifies Dr. Young's rotation without adverse comment. Further, the ECFMG found no problem with Dr. Young's education or with the rotations at Pine Ridge. The transcript of the Credentials Committee Meeting at Joint Exhibit 2 shows that the committee focused on Dr. Caskin's letter rather than Mr. Finger's letter and the fact that all of Dr. Young's medical schools were approved by the World Health Organization. Board of Medicine Practice and Policy The Board of Medicine has licensed individuals who have attended CETEC. The Board of Medicine and its staff rely upon the ECFMG certifications of applicants as verification of their education. The certification by the American Board of Family Practice complies with the requirement of Rule 61F6-22.004(2) and 61F6-22.018(3)(d). The ECFMG certificate complies with the requirements of Section 458.311(1)(f), (2), and (3), Florida Statutes; There is nothing in the rules of the Board or Chapter 458, and no Board policy or practice, which prohibits an applicant from going to more than one university or medical school, from going to more than one medical school and failing out of one, or from going to a school that later goes out of business.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Agency for Health Care Administration, Board of Medicine, enter a final order granting the Petitioner's application for licensure by endorsement. RECOMMENDED this 30th day of September, 1994, in Tallahassee, Florida. J. LAWRENCE JOHNSTON 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 30th day of September, 1994. APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-7146 To comply with the requirements of Section 120.59(2), Fla. Stat. (1993), the following rulings are made on the parties' proposed findings of fact: Petitioner's Proposed Findings of Fact. 1. Accepted and incorporated. 2.-4. Accepted but subordinate and unnecessary. 5.-15. Accepted and incorporated. 16. The pediatrics rotation at Addington Hospital, University of Natal was from March 12 to May 13, 1984, and the surgery rotation was from May 13, 1984 to July 16, 1984. Otherwise, accepted and incorporated. 17.-30. Accepted and incorporated. 31.-37. Accepted but subordinate and unnecessary. 38. Accepted and incorporated to the extent not subordinate or unnecessary. Respondent's Proposed Findings of Fact. 1.-4. Accepted and incorporated to the extent not subordinate or unnecessary. Accepted but subordinate and unnecessary. First sentence, rejected as being contrary to the greater weight of the evidence. Second sentence, accepted but subordinate and unnecessary. 7.-8. Accepted and incorporated to the extent not subordinate or unnecessary. 9.-10. Accepted and incorporated to the extent not subordinate or unnecessary. However, the lack of a credible Orange State transcript to support the Petitioner's testimony is more a reflection on Orange State's credibility than on the Petitioner's. Orange State was in existence for a short period of time, never was recognized by the State of California, and has been defunct for about ten years. It is understandable why the Petitioner has had difficulty getting a credible response from Orange State. The irregularities in the response from Orange State do not impugn the Petitioner's truthfulness in attempting to describe his unorthodox and circuitous medical education in his application for licensure. Last sentence, rejected as contrary to the greater weight of the evidence. Otherwise, accepted and incorporated to the extent not subordinate or unnecessary. However, it is even more understandable why the Petitioner has had difficulty getting a credible response from CETEC. As with Orange State, CETEC was closed about ten years ago. In the case of CETEC, which was in the Dominican Republic, the closing was under allegations of misconduct and fraud. Records were unavailable for a period of time while the government of the Dominican Republic investigated. Later, records were destroyed. As with Orange State, the irregularities in the response from CETEC do not impugn the Petitioner's truthfulness in attempting to describe his unorthodox and circuitous medical education in his application for licensure. Rejected as contrary to the greater weight of the evidence that the Respondent did not leave UHSA in good standing. Otherwise, accepted and incorporated to the extent not subordinate or unnecessary. Accepted but subordinate and unnecessary. 14.-16. Accepted and incorporated to the extent not subordinate or unnecessary. Second sentence, rejected as contrary to the greater weight of the evidence. First sentence, accepted and incorporated. Accepted and incorporated to the extent not subordinate or unnecessary. Third and fourth sentences, rejected as contrary to the greater weight of the evidence. First two sentences, accepted and incorporated to the extent not subordinate or unnecessary. 20.-21. Accepted and incorporated to the extent not subordinate or unnecessary. The city in South Africa was Durban, not Durham. CETEC was the affiliate until it closed in March, 1994. The rest is accepted and incorporated to the extent not subordinate or unnecessary. First sentence, accepted. The rest is rejected as being contrary to the greater weight of the evidence. 24.-25. Accepted and incorporated. 25. Accepted but unnecessary. (No such finding was made.) COPIES FURNISHED: Paul Watson Lambert, Esquire 2851 Remington Green Circle Suite C Tallahassee, Florida 32308-3749 Gregory A. Chaires Assistant Attorney General Department of Legal Affairs Administrative Law Section PL-01, The Capitol Tallahassee, Florida 32399-1050 Dr. Marm Harris Executive Director Board of Medicine Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-0792 Harold D. Lewis, Esquire General Counsel Agency for Health Care Administration The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303
