Findings Of Fact Petitioner applied for certification as a physician assistant by application dated June 29, 1991. Under the statutory scheme regulating physician assistants, in certain circumstances, the Board of Medicine may grant temporary certification to applicants for licensure. The temporary certification is good only until the applicant receives notice of the applicant's scores received on the first available examination. At its meeting of October 30 through November 1, 1992, the Board approved Petitioner for temporary certification contingent upon his completion of specified requirements prior to such temporary certification and his completion of 25 hours of continuing medical education after issuance of such certification. Petitioner completed the specified requirements for issuance of the temporary certification and was issued a temporary certificate. Petitioner was so notified by letter dated October 4, 1993. Petitioner was first notified of the need to pay a required fee for the licensure examination by letter dated February 27, 1993. That letter set forth that the fee must be paid by March 31, 1993. Petitioner did not pay the fee by that deadline. On June 8, 1993, Petitioner was notified that the deadline for payment of the required examination fee had been moved to June 25, 1993. The extension had been given because the Board was still involved with processing applications for this special licensure program. Petitioner did not pay the fee by that deadline. On October 11, 1993, Petitioner was sent another letter notifying him that the deadline had been extended once again. This time the deadline was set for November 15, 1993. The notice sent to Petitioner specified three times that the required examination fee must be received in the office of the Board by November 15, 1993. It specifically informed Petitioner that a postmark of November 15, 1993, would not be sufficient. Furthermore, the notice informed Petitioner that if he failed to submit the required examination fee in a timely fashion, he would not be eligible to take the licensure examination. Although Petitioner testified that he was confused with regard to when the required fee could be sent, it was established that he could read the letter and that he understood that his failure to timely pay the examination fee would result in his not being permitted to take the licensure examination. Petitioner did not have the money for the required examination fee until November 14, 1993. Petitioner mailed the examination fee from Miami to the Board office in Tallahassee by certified United States mail on November 15, 1993. Although Petitioner testified that he believed the fee would be delivered the same day or the next day, Petitioner did not use any type of special delivery to provide same day or next day delivery at the Board's office. The fee submitted by Petitioner in the form of three Travelers Express Company checks was received in the Board's office on December 22, 1993. Petitioner did not submit the required examination fee in a timely manner for any of the three deadlines set by the Board. With the exception of one case involving an applicant with a heart condition, the Board has uniformly denied any request for the late payment of the required examination fee. If he does not take and pass the first available licensure examination, Petitioner will not be able to receive his permanent certification as a physician assistant. The licensure examination for persons in Petitioner's category has not yet been given by the Board. Therefore, none of the applicants for certification as physician assistants through this special licensure program have yet been tested.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED that a Final Order be entered finding that Petitioner is not eligible to take the physician assistant examination and that Petitioner's temporary certification is null and void. DONE and ENTERED this 9th day of February, at Tallahassee, Florida. LINDA M. RIGOT Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 9th day of February, 1995. APPENDIX TO RECOMMENDED ORDER Petitioner's proposed findings of fact numbered 1-4, 7-9, and 13 have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed finding of fact numbered 5 has been rejected as being irrelevant. Petitioner's proposed finding of fact numbered 6 has been rejected as being subordinate. Petitioner's proposed findings of fact numbered 10-12 have been rejected as being not supported by any evidence. Respondent's proposed findings of fact numbered 1-17 have been adopted either verbatim or in substance in this Recommended Order. Respondent's proposed finding of fact numbered 18 has been rejected as not constituting a finding of fact. COPIES FURNISHED: Allen R. Grossman, Esquire Office of the Attorney General PL-01, The Capitol Tallahassee, Florida 32399-1050 Alexander J. Alfano, Esquire 45 Southwest 9th Avenue Miami, Florida 33130 Dr. Marm Harris, Executive Director Agency for Health Care Administration, Board of Medicine 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Tom Wallace, Assistant Director Agency for Health Care Administration, Board of Medicine 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792
The Issue Whether or not the Petitioner is eligible for licensure by endorsement.
Findings Of Fact Based upon the documentary evidence received, the statement of position offered by counsel for Respondent, State of Florida, Department of Professional Regulation, Board of Medical Examiners, and the entire record compiled herein, the following relevant facts are found: Petitioner, Ariel Hollero Garcia, M.D., filed an application for licensure by endorsement with the Department of Professional Regulation, Board of Medical Examiners (Respondent) on or about September 29, 1981. Petitioner's application for licensure by endorsement was denied by the Respondent based on its determination that Petitioner has not been certified by licensure examination of the National Board of Medical Examiners and that, while he was certified by the Federation of State Medical Boards of the United States, Inc., as having completed its examination, it was not within the ten (10) years immediately preceding the filing of his (Petitioner's) application for licensure by endorsement. Petitioner was certified by the Federation of State Medical Examiners in June of 1971. Petitioner agrees with the above-recited facts; however, he feels that the ten (10) year requirement should be waived for him in these circumstances, inasmuch as his application was submitted for licensure by endorsement within only approximately three (3) months beyond the ten (10) year filing period during which an applicant can be certified (licensed) by endorsement.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is hereby RECOMMENDED: That Petitioner's application for licensure by endorsement be DENIED. 1/ 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 12th day of August, 1982.
The Issue The issues presented here are based upon an Administrative Complaint filed by the Petitioner against the Respondent seeking the revocation, suspension, or other disciplinary action against the Respondent, and his license to practice medicine in the State of Florida. Count I to the Administrative Complaint accuses the Respondent of making misleading, deceptive, untrue and fraudulent representations in obtaining his license to practice medicine in the State of Florida. It is further contended that Respondent has not and cannot demonstrate that he graduated from medical school, and alleges that Respondent cannot demonstrate that he has met the minimal medical education, training and experience necessary for licensure by the Petitioner. Based upon these allegations, Respondent has purportedly violated Subsection 455.1201(1)(a), Florida Statutes (1977), by failing to demonstrate qualifications and standards for licensure contained in Chapter 455, Florida Statutes, or the rules and regulations of the Board of Medical Examiners. Count II, utilizing the same factual basis as has been alleged in the initial count, accuses the Respondent of violating Subsection 455.1201(1)(b) , Florida Statutes (1977), by practicing fraud or deceit in obtaining a license to practice medicine. Count III accuses the Respondent, based upon the aforementioned facts, with violating Subsection 458.1201(1) Florida Statutes (1977), by engaging in unethical, deceptive or deleterious conduct or practice harmful to the public. Count IV is based upon the facts as related in Count I and asserts that Respondent has violated Subsection 455.1201(1)(m), Florida Statutes (1977), by being guilty of immoral or unprofessional conduct, negligence or willful misconduct. Count V, utilizing the facts related in Count I, alleges that Respondent has violated Subsection 455.327(2)(c), Florida Statutes (1951), and thereby violated Subsection 458.331(1)(x), Florida Statutes (1981), by violating a provision of Chapter 455, Florida Statutes. Finally, Count VI, asserting the facts as discussed herein, alleges that Respondent has violated Subsection 455.331(1)(a), Florida Statutes (1951), by attempting to obtain and obtaining a license to practice medicine by fraudulent misrepresentations CASE HISTORY On September 24, 1981, the Petitioner filed the Administrative Complaint against the Respondent which is the subject of this proceeding and which is referred to in summary fashion by the Issues statement to this Recommended Order. Subsequently, Respondent requested a hearing in this cause on November 11, 1981, by indicating, in substance, that he disputed the allegations as contained in the Administrative Complaint. On that same date, Respondent, through counsel, answered the Administrative Complaint. This answer was made a part of the record in the course of the final hearing and is being forwarded with the Recommended Order in this action. On November 30, 1981, the Division of Administrative Hearings received the case from Petitioner, the Petitioner having requested the Division to conduct a formal hearing in this matter. On December 3, 1981, Respondent's initial counsel withdrew from representation of Respondent. Respondent subsequently obtained the assistance of his present counsel, Rodney Smith, Esquire, and a final hearing was conducted on March 9, 1982, in keeping with Subsection 120.57(1), Florida Statutes. Petitioner's presentation consisted of testimony by Dorothy J. Faircloth, Executive Director, Board of Medical Examiners, State of Florida. Petitioner also offered seven (7) items as evidence. All those items, with the exception of Nos. 5 and 6, have been received. Respondent gave testimony and presented as witnesses Edward M. Crawford, President, High Springs, Florida, Chamber of Commerce; Lorna J. Peters, resident, High Springs, Florida; Leslie Ann Morgan, X-Ray Technologist in the office of Respondent; Angela Anderson, employee of Respondent; Mireya Braga, Respondent's wife; Lacey William Register, Mayor, High Springs, Florida; a Mr. Westmoreland, resident, High Springs, Florida; Cybil M. Crawford, Vice- President, High Springs Bank, High Springs, Florida; and Thomas William Wolfe, Chief of Police, High Springs, Florida. Respondent offered six (6) items of evidence. All items have been received. The parties, in the person of counsel, have offered proposed recommended orders and supporting argument. Those matters have been reviewed prior to the entry of this Recommended Order. To the extent that those items are consistent with this Recommended Order, they have been utilized. To the extent that the matters are inconsistent with this Recommended Order, they are hereby rejected.
Findings Of Fact In February, 1976, Respondent made his initial application to the Board of Medical Examiners to become a licensed physician in the State of Florida. A copy of that application may be found as Petitioner's Exhibit No. 1, admitted into evidence. This application was received beyond the time of the deadline for filing and as a consequence, Respondent was required to submit a further application. The second application was made on January 17, 1977. A copy of that application may be found as Petitioner's Exhibit No. 2, admitted into evidence. Both applications were prepared by the Respondent and sworn to as to their accuracy. This attestation also acknowledged that if false information was given in the application, that Respondent agreed that the act of falsifying the application constituted cause for denial, suspension or revocation of his license to practice medicine in the State of Florida. Following the submission of the second application for licensure, Braga stood the Board of Medical Examiners' license examination, given in English, and was a successful candidate for licensure. He was awarded License No. ME0032004 and has renewed that license by the payment of applicable fees since the initial award of the license in 1978. The Administrative Complaint which has been discussed in the course of this Recommended Order challenges the accuracy of the information presented in the applications which were submitted by Respondent. In the initial application filed by the Respondent for licensure dating from February, 1976, Braga states that he attended Faculdade de Ciencias Medicas de Santos in Sao Paulo, Brazil, from February, 1971, through December, 1967. In the application, Respondent indicates that he practiced and/or was employed at the INPS (Institute National of Providence Social) , Sao Paulo, Brazil, in General Practice, between 1970 through 1972; Clinica Nuesta Senora, Sao Paulo, Brazil, in General Practice, between 1971 through 1972; Heliopolis Hospital, Sao Paulo, Brazil, between 1969 through 1970, and the Fundacao Centro Nacional, San Paulo, Brazil, between January, 1968 and December, 1968. The initial application of February, 1976, also contained a document written in Portuguese, which was sworn and certified to by Braga as being a true, authentic and legitimate photocopy of the original of his medical diploma issued by Medic Sciences of Santos in Brazil. (See Petitioner's Exhibit No. 1) There is also contained in the application of February, 1976, an indication, under oath by Respondent, concerning a document as attached, purportedly issued by Heliopolis Hospital in San Paulo, Brazil. Finally, Respondent had attached to the form application, and found in Petitioner's Exhibit No. 1, affidavits from three physicians; Antonio J. Maniglia, Jorge Macedo and Humberto Munoz. These affidavits indicated that the physicians swore and affirmed that, by their personal knowledge, Respondent attended and graduated from Faculdade de Ciencias Medicas de Santos, and practiced lawfully in the profession of medicine in Brazil in the years 1968 through 1972, and further indicated that the physicians had practiced in Brazil during that time. It has been proven and Respondent acknowledges that the application of February, 1976, Petitioner's Exhibit No. 1, was false to the extent that it indicated his attendance at Faculdade de Ciencias Medicas de Santos in Sao Paulo, Brazil, during the years 1971 through 1967; to the extent that the application indicated he practiced in the hospitals and clinics as set forth above, and to the extent that the application indicated that the physicians who had signed the affidavits had personal knowledge of Respondent's graduation from the medical school and his practice of medicine in Brazil. In the January, 1977, application with associated documents, found as Petitioner's Exhibit No. 2, admitted into evidence, Respondent indicates to the Board of Medical Examiners that he attended Faculdade de Ciencias Medicas de Santos, Sao Paulo, Brazil, from December 1967 to February, 1971, and received his degree of Doctor of Medicine from that school on January 7, 1967. He indicates in the application, on the subject of residency or other postgraduate training, that he worked at the Fundacao Lusiada, Faculdade de Ciencias Medicas de Santos, from January, 1967, through October, 1967; and attended a Vascular Surgery Course, in the Heliopolis Hospital, Sao Paulo, Brazil, November, 1970. His employment was described in the application as being at the INPS (Institute National of Providence Social) Hospital, Sao Paulo, Brazil, General Practice, 1970 through 1972; at Clinica Nuestra Senora, Sao Paulo, Brazil, General Practice, 1971 through 1972; at Heliopolis Hospital, Sao Paulo, Brazil, General Practice, 1969 through 1970; and Fundacao Centro Nacional, General Practice, January, 1968 through December, 1968. The second application, which is found as Petitioner's Exhibit No. 2, attached a medical diploma purportedly from the School of Medical Sciences of Santos (Faculdade de Ciencias Medicas de Santos). This document shows a date of January 7, 1967, and was dissimilar to the diploma document which was attached to the February, 1976, application. There were certain affidavits with the January, 1977, application from physicians Jose A. Pardo, Jaime Motta and Pedro Melo, which affidavits indicated that the physicians had personal knowledge of Braga's attendance and graduation from Faculdade de Ciencias Medicas de Santos, in Sao Paulo, Brazil, and that he had lawfully practiced the profession of medicine in Brazil in the years 1967 through 1972. It was shown and Respondent admits that the January, 1977 application for licensure was false, in that Respondent did not attend the Faculdade de Ciencias Medicas de Santos in Sao Paulo, Brazil, from December 1967 through February, 1971; that be had not practiced medicine in the hospitals and clinics as listed; that be had not attended residency or postgraduate training programs as shown in the application; and that the physicians who signed the affidavits for Respondent did not have personal knowledge of his graduation from medical school or his practice of medicine in Brazil. In reality, while it is accepted, that Respondent, who is a native of Brazil, has obtained a medical doctor's knowledge, Braga is not found to have graduated from a medical school either in that country or elsewhere or to have, following graduation from a medical school, practiced medicine as a general practitioner for five years or practiced in a one-year internship program, prior to licensure in Florida. Respondent departed Brazil sometime either in 1968 or 1969. Fe did so in the face of circumstances in his country, in which Respondent had been imprisoned. After gaining his freedom he migrated to the United States. When Braga arrived in the United States, he moved to Chicago, Illinois, and practiced medicine in that community without the benefit of a medical license. He subsequently left the State of Illinois and moved to Florida. After arriving in Florida and while employed in the Milagrosa Clinic in Miami, Florida, practiced medicine. At that time he had not been licensed by the State of Florida to practice medicine. Prior to the date of licensure by the State of Florida, Respondent attended and successfully completed the Florida State Board of Medical Examiners' continuing education program for 1977, which was offered by the Office of International Medical Education, University of Miami, School of Medicine, In turn, he successfully stood the requisite medical examination offered in English and was licensed. After receiving his medical license in 1975, Respondent moved to High Springs, Florida, and opened a medical practice which is primarily involved with the general practice of medicine. In the course of his practice, he has treated some 15,000 to 20,000 patients. Respondent offered as witnesses many persons from the community of High Springs, Florida, who, from the point of view of these individuals, are impressed with his good moral character. No evidence was presented from either side on the subject of Respondent's reputation as a medical practitioners as perceived by members of his profession.
The Issue At the commencement of the final hearing the parties stipulated that the specific issue for determination is whether Dr. Walker's medical clerkships constituted allopathic medical education. Counsel for respondent argued that this proceeding affects only Dr. Walker's eligibility to take the licensure exam. For the reasons set forth below, that characterization is rejected.
Findings Of Fact Ralph Waldo Walker II graduated from the American University of the Caribbean in Plymouth, Montserrat, British West Indies. He obtained his medical school diploma in May 1982. As part of the curriculum in medical school he partiipated in clinical clerkship training at Mercy Medical Center in Des Moines, Iowa. All of his clerkships, except psychiatry, were at that hospital and were completed during 1981 and 1982. (Exhibit 1) In Iowa, hospitals are not licensed as osteopathic or allopathic, but rather are simply licensed as hospitals. In Des Moines there is only one hospital that is identified as osteopathic: Des Moines General. Unless a hospital is specifically identified as osteopathic, it is considered allopathic. It is possible, however, for both allopathic medical doctors and osteopaths to practice at either hospital. (transcript, p. 17, 18; Deposition of Dr. Gay, p. 5-7) During the time that Dr. Walker served his clerkship, Mercy Hospital had medical students from the medical school in Guadalajara, Mexico, the American University of the Caribbean, and the University of Osteopathic Medicine and Health Sciences in Des Moines. Less than half of the students rotating on a regularly scheduled basis were from the osteopathic school. Less than half of the students at Mercy during 1981 and 1982 were under the direct supervision of an osteopathic physician. (deposition of Dr. Gay, pp. 8, 10) In his clerkship experience at Mercy Medical Center, Dr. Walker was never supervised by an osteopathic physician. (transcript, p. 17) Mercy Medical Center is listed in the 1980-81 Directory of Residency Training Programs as a hospital approved by the American Medical Association for allopathic residency training in the speciality area of pathology. (deposition of Dorothy Faircloth, pp. 10-11) Dr. Waldo first applied for licensure in Florida in 1983. He paid the $350 application fee, and on February 10, 1984, he appeared before the Board of Medical Examiners' Foreign Medical Graduate Committee where he was guestioned at length regarding his background and education. Upon the affirmative recommendation of that committee, the full board voted to allow him to take the examination. (Exhibit 1, including transcript of the February 10, 1984, appearance) He took the June 1984 exam and failed; he repeated the process and failed the December 1984 exam. He applied for the June 1985 exam and was sent an admission card, but he decided instead to stay out and study. He applied again in August l985, and was sent an admission card for the December 1985 exam. (Exhibit 1) He was a1so reguired to appear again before the Board on November 23, 1985. The basis for the appearance, as stated by Executive Director Dorothy Faircloth, was a letter from a patient in Georgia. The letter was discussed and explained, and the Board questioned Dr. Waldo regarding his clerkships at Mercy Medical Center. The outcome of this appearance was denial of Dr. Waldo's application for licensure. The grounds for denial stated in the Board's order filed on February 6, 1986 are: The applicant's supervised clinical training was not obtained in either a hospital affiliated with a medical school accredited by the Liaison Committee on Medical Education or in a residency program accredited by the Accreditation Council for Graduate Medical Education in the specialty area in which the clinical training is being obtained, as required by Florida Administrative Code Rule 21M-22.18. Furthermore, the applicant's core clerkships were performed in an osteopathic institution, rather than an allopathic institution and do not constitute medical education as that term is used in Chapter 458, Florida Statutes. (Exhibit 1, including transcript of November 23, 1985, appearance before the Board) Dr. Walker. took the Federation licensing Examination (FLEX) in the State of Iowa and passed with scores of 78 and 81. A score of 75 on each component is considered a passing score in Florida. Dr. Walker became licenced to practice medicine in Iowa on August 22 1986. (Exhibit l, transcript, pp. 14, 26)
Recommendation Based on the foregoing, it is recommended that a final order be entered approving Ralph Waldo Walker's application for licensure to practice medicine in the state of Florida. DONE and RECOMMENDED this 31st day of December, 1986 in Tallahassee, Florida. MARY CLARK Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 31st day of December, 1986.
The Issue Whether the Petitioner correctly answered questions 37, 44, 49, 83, and 206 of the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998.
Findings Of Fact Based on the oral and documentary evidence presented at the final hearing and on the entire record of this proceeding, the following findings of fact are made: The Department of Health is the state agency responsible for licensing and regulating physician assistants. Sections 455.574 and 458.347(7), Florida Statutes (1997). Mr. Molina sat for the Physician Assistant Examination administered on June 25 though 29, 1998. At the hearing, he disputed the Department's determination that the answers he gave to questions 37, 44, 49, 83, and 206 are incorrect. The questions that comprise the General Written Exam portion of the June 1998 Physician Assistant Examination were objective, multiple-choice questions. The questions were drawn from a bank of questions written by licensed physician assistants trained by a psychometrician employed by the Department. Prior to being included in the question bank, these questions were reviewed and field-tested to ensure that they were good, fair questions that adequately and reliably tested the applicant's ability to practice as a physician assistant with reasonable skill and safety. After the test questions for the June 1998 examination were selected from the question bank, the questions were reviewed before the examination and after the examination. The candidates taking the examination in June 1998 were directed in the instructions to the examination to choose the best answer from among four possible answers. This instruction was included in the examination booklet provided to each candidate, and the Department's normal procedure was to read the instructions aloud prior to the examination. According to the Department, the correct answer to question 37 is "C"; Mr. Molina chose answer "B." Although question 37 is, on its face, clear and unambiguous, the reference book relied upon by the Department to support its answer, although an authoritative source for physician assistants, does not, in fact, unambiguously support the Department's answer. Question 37 refers to the "entire anterior chest," and the answer to the question can be derived from the "Rule of Nines." The "Rule of Nines" is a standard rule used in the practice of medicine and is illustrated in an authoritative text entitled Current Medical Diagnosis and Treatment, which contains a chart showing the outline of the human body divided into sections, each representing approximately nine percent of the body's surface area. The chart shows, in pertinent part, the trunk of the human body divided into the "posterior" upper trunk and the "posterior" lower trunk, with a line drawn somewhat above the umbilicus to illustrate the division of the trunk into the upper and lower portions. The Department's expert testified, without explanation, that the "entire anterior chest" is composed of both the upper and the lower trunk. This conclusion cannot be drawn from the chart contained in the reference book relied upon by the Department, and Mr. Molina's answer to question 37 is as reasonable as the answer the Department considers correct. Accordingly, Mr. Molina should receive credit for his answer to question 37. According to the Department, the correct answer to question 44 is "D"; Mr. Molina chose answer "B." Question 44 asks for the "MOST likely diagnosis" based on the facts contained in the question. Question 44 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be derived from information included in the reference book entitled Ophthamology for the Primary Care Physician, which is considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 44 because the answer he gave is not the correct answer. 3/ According to the Department, the correct answer to question 49 is "A"; Mr. Molina chose answer "C." Question 49 asks for the "MOST likely" diagnosis based on the facts contained in the question. Question 49 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be found in volume 1 of Harrison's Principles of Internal Medicine, a reference book included in the list of recommended books sent to the candidates for the Physician Assistant Examination and considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 49 because the answer he gave is not the correct answer. According to the Department, the correct answer to question 83 is "D"; Mr. Molina chose answer "C." Question 83 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be found in volume 1 of Harrison's Principles of Internal Medicine, a reference book included in the list of recommended books sent to the candidates for the Physician Assistant Examination and considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 83 because the answer he gave is not the correct answer. According to the Department, the correct answer to question 206 is "C"; Mr. Molina chose answer "A." Question 206 asks for the "MOST common" presentation of a precancerous lesion. Question 206 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be found in volume 2 of Harrison's Principles of Internal Medicine, a reference book included in the list of recommended books sent to the candidates for the Physician Assistant Examination and considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 206 because the answer he gave is not the correct answer.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health enter a final order finding that Nigel Molina is entitled to credit for his answer to question 37 of the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998; finding that Mr. Molina is not entitled to credit for his answers to questions 44, 49, 83, and 206 of the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998; and recalculating Mr. Molina's score on the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998. DONE AND ENTERED this 8th day of February, 2000, in Tallahassee, Leon County, Florida. PATRICIA HART MALONO 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 8th day of February, 2000.
The Issue Whether the Petitioner has met the requirements for licensure as a medical doctor in the State of Florida set forth in Section 458.311(1)(f), Florida Statutes (1986 Supp.), as required by Section 458.313(1), Florida Statutes (1986 Supp.)?
Findings Of Fact The Petitioner applied for licensure by endorsement as a medical doctor in Florida in September of 1986. Following notification by the Respondent that additional materials were required to complete the Petitioner's application, the Petitioner timely submitted the materials. In March of 1987, the Petitioner appeared before the Foreign Medical Graduate Committee of the Respondent. On April 5, 1987, the Respondent entered an Order titled Notice of Intent to Deny the Application for Licensure by Endorsement of Hien B. Nguyen. The stated basis for the denial of the Petitioner's application was that the Petitioner had failed to demonstrate that he graduated from a medical school. The Petitioner began medical school in 1967 at the University of Saigon, Faculty of Medicine, in Saigon, Republic of Vietnam. The Petitioner Successfully completed the six years required course work in medicine at the University of Saigon, Faculty of Medicine, in 1974. Following the completion of the course work required to earn a medical degree at the University of Saigon, Faculty of Medicine, the Petitioner was drafted into the Republic of Vietnam's military. He attended training for approximately six months immediately following the completion of his medical degree course work. The Petitioner was required to complete a thesis before being eligible for a medical degree from the University of Saigon, Faculty of Medicine. Upon completion of military training, the Petitioner commenced and completed work on his thesis. The Petitioner's thesis consisted of a translation of "Central Nervous Disease in Children," of Nelson's Pediatric Textbook, from English into Vietnamese. The Petitioner presented his thesis on April 14, 1975. Thuc R. Bach, M.D. attended the presentation of his wife's thesis on April 14, 1975, and witnessed the Petitioner's thesis presentation. The Petitioner was awarded a Certificate from the University of Saigon, Faculty of Medicine, on April 14, 1975, which indicated that the Petitioner had completed work necessary to be awarded a medical degree. The Certificate was issued temporarily. After approximately five years the Petitioner was required to return the Certificate at which time he could be issued an official diploma. On approximately April 30, 1975, the government of the Republic of Vietnam fell to the army of North Vietnam. Following the fall of the Republic of Vietnam, the Petitioner was confined to a concentration camp where the Petitioner acted as camp doctor. Following the Petitioner's release from confinement in 1976, the Petitioner worked as a physician at Saint Paul Clinic in Saigon until 1979. From 1977 until 1980 the Petitioner also attended and taught at a medical training center in Saigon. In October, 1980, the Petitioner escaped from Vietnam. He resided in Galang, Indonesia until March, 1981, when he moved to the United States. The Petitioner has completed the following since his arrival in the United States: December, 1981: Sat for the Federation Licensing Examination and was subsequently certified by the Federation of State Medical Boards; January 24, 1983: Certified by the Educational Commission for Foreign Medical Graduates; July, 1984 - June, 1985: Interned at the Cook County Hospital, Chicago, Illinois; July, 1985 - June, 1987: Residency program at Cook County Hospital, and February 19, 1986: Licensed as a physician by the State of Illinois (the license is currently active and unrestricted). The Petitioner was presented with a certificate from the Faculty- Council-in-Exile of the Faculty of Medicine of the University of Saigon dated April 20, 1981. The certificate affirms that the Petitioner "Successfully completed the course of study leading to the degree of Doctor of Medicine..." The certificate is signed by the Dean Emeritus of the University and Dao Huu Anh, M.D., Associate Dean of the University. Prior to the fall of the government of the Republic of Vietnam, graduates of the University of Saigon, Faculty of Medicine, were presented with a certificate authorizing them to practice as a physician without restriction upon completion of the required courses of study and a thesis. Graduates were not issued an Official Diploma until five years had passed since the issuance of their certificate. Although the Petitioner completed the required courses of study, presented his thesis and received a certificate authorizing him to practice as a physician, the Petitioner was not able to obtain an Official Diploma five years later because of the fall of the government of the Republic of Vietnam. In light of the fall of the government of the Republic of Vietnam, it is doubtful that the records of the University of Saigon, Faculty of Medicine are available or that the Petitioner could obtain an Official Diploma. The Petitioner is a graduate of the University of Saigon, Faculty of Medicine, a medical school.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be issued GRANTING the Petitioner's application for licensure by endorsement as a medical doctor in the State of Florida. DONE AND ORDERED this 25th day of January, 1988, in Tallahassee, Florida. LARRY J. SARTIN 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 28th day of January, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-2969 The parties have submitted proposed findings of fact. It has been noted below which proposed findings of fact have been generally accepted and the paragraph number(s) in the Recommended Order where they have been accepted, if any. Those proposed findings of fact which have been rejected and the reason for their rejection have also been noted. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in Recommended Order of Fact Number of Acceptance or Reason for Rejection 1 1. 2 2. 3 3. 4 4 and 5. 5 6. 6 7-10. 7 11-12. 13. The Petitioner worked at the training center from 1977 through 1980. 15. The Petitioner went from Vietnam to Indonesia in October of 1980. He did not travel to the United States until March of 1981. 10-12 Cummulative, summary of the evidence and unnecessary. Dr. Nghia Van Tran's letter was not accepted into evidence. 13 16. The last sentence is cummulative, a summary of evidence and unnecessary. The footnote is irrelevant. The burden of proof in this proceeding was on the Petitioner. The Respondent is not required to verify the signature of Dr. Dao. 14 10 and 17. 15 17-18. 16-18 Cummulative, summary of the evidence and unnecessary. The Respondent's Proposed Findings of Fact 1 1 and 3. 2-5 The Respondent's remaining proposed findings of fact are essentially summaries of the Respondent's inter- pretation of the evidence and argument concerning the evidence. The Respondent's interpretation of the evidence is rejected. The following is a brief discussion of why the Respondent's arguments have been rejected. The first two sentences are true and support the finding of fact that the Petitioner began medical school in 1967, completed his course work in 1974 and presented his thesis in April of 1975. See findings of fact 4-5 and 9. The third and fourth sentences are true but the Respondent has overlooked the fact that the Petitioner presented other evidence which supports his position. Therefore, even if the fifth sentence were correct, there is other evidence which supports findings of fact 4-5 and 9. The sixth sentence is irrelevant. Although the Board may have raised a question, the correct answer to that question is a matter of proof. The seventh sentence is true but irrelevant. The eighth sentence is not supported by the weight of the evidence. There was no testimony sufficient to support any finding of fact concerning Dr. Dao's signature on any document. Although the ninth sentence is correct, the weight of the evidence does not support the alleged fact set out in the tenth sentence. The eleventh sentence was taken into account in the weight given to Dr. Dao's statement. Although the twelfth sentence is correct the thirteenth and fourteenth sentences are not supported by the weight of the evidence. While it is true that the Petitioner's testimony with regard to when he completed his course work at the University of Saigon was not totally consistent, the weight of the evidence supports a conclusion that the Petitioner finished his course work in June of 1974. The Petitioner's explanation concerning the inconsistency in his testimony was credible. The first and second sentences are true. The third sentence is true but overlooks the fact that it corroborates non-hearsay evidence. The fourth sentence is law. The fifth sentence is true. The sixth and seventh sentences are true. The eight sentence is not supported by the weight of the evidence. The ninth and tenth sentences are true but they do not support the ultimate conclusion the Respondent suggests. It is possible that the Certificate in question could have been based upon other credible evidence. The first sentence is true. The second sentence is not supported by the weight of the evidence. The Petitioner testified that he completed his course work in 1974. The third sentence is true. The fourth and fifth sentences are not supported by the weight of the evidence. COPIES FURNISHED: Carolyn S. Raepple, Esquire Cheryl G. Stuart, Esquire Hopping, Boyd, Green & Sams 420 First Florida Bank Building Post Office Box 6526 Tallahassee, Florida 32314 M. Catherine Lannon, Esquire Assistant Attorney General Administrative Law Section Department of Legal Affairs Room 1601, The Capitol Tallahassee, Florida 32399-1050 Ms. Dorothy Faircloth Executive Director 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 Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue Whether Petitioner's application for medical licensure by endorsement has expired and Respondent is therefore without authority to act on the application, as Petitioner claims? If not, whether the application should be denied on the grounds that Petitioner is guilty of violating Section 458.331(1)(a) and (gg), Florida Statutes,1 as Respondent has preliminarily determined.
Findings Of Fact Based on the evidence adduced at hearing, and the record as a whole, the following findings of fact are made to supplement and clarify the factual stipulations set forth in the parties' December 8, 2005, Prehearing Stipulation3: Petitioner is now, and has been since 1998, a Napperville, Illinois anesthesiologist licensed to practice medicine in the State of Illinois. At no time has she resided in Florida or used a Florida mailing address. "[A]t the end of 2002," Petitioner hired US Medical Licensing (USML) to help her obtain licenses to practice medicine in Florida, California, and Nevada, including "put[ting] together the application[s for such licensure] for [her]." In making these arrangements with USML, Petitioner dealt with USML's Melinda Hilterbrand, with whom she spoke over the telephone. Petitioner paid USML by credit card. USML first "charged [Petitioner's] credit card in January" of 2003 (using the credit card number Petitioner had given Ms. Hilterbrand during their telephone conversation). Petitioner provided USML, at USML's request, information and documentation (including a "standard credentialing application [she used in] Illinois") for USML to utilize in "put[ing] together [her Florida, California, and Nevada] application[s]." None of the information and documentation Petitioner provided was, to her knowledge, false or inaccurate. USML "put together the application[s]," as it had agreed to do. It then submitted them to the Florida, California, and Nevada medical licensing agencies without Petitioner's review, approval, or signature, notwithstanding that Petitioner had not given USML authorization to make such submissions. On June 16, 2003, Respondent received the Florida application that USML had "put together" for Petitioner (Petitioner's Florida Application) using the appropriate Respondent-developed form . Petitioner's Florida Application gave Petitioner's mailing address as "5631 Ballybunion Drive, Pace, Florida" (Pace, Florida Address). This was actually USML's mailing address, not Petitioner's. Petitioner's Florida Application gave Petitioner's telephone number as "(850) 994-4646." This was actually USML's telephone number, not Petitioner's. 10. Items 12, 12a., 12b., 15a., and 19b. on the application form on which Petitioner's Florida Application was submitted (Florida Application Form) asked the following questions: 12. Was attendance in Medical school for a period other then the normal curriculum? (If "yes," explain on a separate sheet providing accurate details.) 12a. Did you take a leave of absence during medical school? (If "yes," explain on a separate sheet providing accurate details.) 12b. Were you required to repeat any of your medical education? (If "yes," explain on a separate sheet providing accurate details.) 15a. Have you ever been dropped, suspended, placed on probation, expelled or requested to resign from a postgraduate training program? (If "yes," explain on a separate sheet providing accurate details.) 19b. Have you ever applied for, taken an examination for, or failed to receive specialty board certification or recertification for any reason?" (If "yes," explain on a separate sheet, providing full details). Each of these questions was incorrectly answered "no" on Petitioner's Florida Application. Item 15 on the Florida Application Form asked the applicant to "[l]ist in chronological order from date of graduation from Medical school, to present, all professional/postgraduate training (Internship/Residency/ Fellowship)." In response to this request, Petitioner's Florida Application listed her participation (following graduation from medical school) in programs at the University Medical Center in Las Vegas, Nevada, at the Medical College of Ohio in Toledo, Ohio, at the Advocate Illinois Masonic Medical Center in Chicago, Illinois, and at St. Anthony's Hospital in Chicago, Illinois. No other post-graduate programs were listed, notwithstanding that Petitioner had also received post-graduate training at the Vanderbilt University Medical Center. At the time, Petitioner did not even know that her Florida Application had been submitted, much less that it contained any erroneous information, inasmuch as she had not seen it or been made aware of its contents. As will be discussed in more detail below, it was not until approximately three months later that she first learned of her Florida Application’s submission, and it was even later, at her July 24, 2004, appearance before Respondent’s Credentials Committee, that she first became aware "that there was any incorrect information on [her] application." No one from USML had ever contacted Petitioner and asked her for her responses to items 12, 12a., 12b., 15, 15a., 19b. or any other item on the Florida Application Form. Item 18 on the Florida Application Form was an Affidavit of Applicant, which read, in pertinent part, as follows: I affirm that these statements are true and correct and recognize that providing false information [ma]y result in disciplinary action against my license or criminal penalties pursuant to Sections 456.067, 775.083 and 775.084, Florida Statutes. I hereby authorize all hospitals, institutions, my references, personal physicians, employers (past and present) and all governmental agencies and instrumentalities (local, state, federal or foreign) to release to the Florida Board of Medicine information which is material to my application for licensure. 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 in this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice Medicine in the State of Florida. * * * Date of Expiration (Signature of Applicant required) 4 (Date Signed required) The Affidavit of Applicant in Petitioner's Florida Application contained what purported to be, but was not, Petitioner's signature. It was dated May 30, 2003. Petitioner had not authorized USML to sign her Florida Application on her behalf or otherwise "submit documents using [her] signature," nor was she "aware that [USML was] going to do [so]." On July 14, 2003, Respondent prepared and sent to the Pace, Florida Address (which, as noted above, was USML’s, not Petitioner’s, mailing address) a notice advising that Petitioner's Florida Application was "deficient" and explaining what needed to be done in order for the application to be considered "complete" (July 14, 2003, Deficiency Notice). The July 14, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). A letter has been sent to St. George's University to confirm you left the medical school in good standing. Your file has been submitted in for advisement regarding your examination score reports submitted to the board office. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? A letter has been sent to the Medical College of Ohio to retrieve[] further information on your performance. Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit two current letters of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). We await licensure verification from the Illinois State Medical Board. The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800)767-6732. The AMA Physician Profile sheet has not been received. You may contact the AMA at (312) 484-5199. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -University Medical Center, regarding your Internship, from 6/92 to 6/93 -Medical College of Ohio, regarding your Residency, from 4/94 to 5/96 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 -Valley Ambulatory Surgery Center, verifying your staff privileges and good standing. * * * On August 15, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (August 15, 2003, Deficiency Notice). The August 15, 2003 Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). We are in receipt of the evaluation form submitted by Valley Ambulatory Surgery Center. They indicate you did not perform competently and you were not regularly appointed. Please submit a written explanation. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit two current letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile sheet has not been received. You may contact the AMA at (312) 484-5199. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -University Medical Center, regarding your Internship, from 6/92 to 6/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * It was not until sometime in or around September of 2003, during a telephone conversation (she had initiated) with USML's Ken Carroll, that Petitioner first learned that her Florida Application had been submitted to Respondent. Petitioner was "very surprised" when Mr. Carroll told her about the application's submission because she had thought that she was "going to get to look at the application" and "go over it" before it was sent to Respondent and she had not been given this opportunity. Nonetheless, she did not voice any objections to Mr. Carroll during her telephone conversation with him. Rather, "[she merely] asked him if there were any problems with [the application], and he said that everything was okay." Petitioner assumed, erroneously, that USML had completed the application accurately. She did not, at that time, request a copy of the application to verify the application's accuracy, nor did she do anything to indicate that she did not want Respondent to treat the application as hers. Indeed, until becoming aware of the actual contents of the application, it was her desire that Respondent act on the application and grant her licensure, and her actions were consistent with such a desire. On September 17, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application remained "deficient" and explaining what needed to be done in order for the application to be considered "complete" (September 17, 2003, Deficiency Notice). The September 17, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). We are in receipt of the evaluation form submitted by Valley Ambulatory Surgery Center. They indicate you did not perform competently and you were not regularly appointed. Please submit a written explanation. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit one current letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 464-5199. The AMA Physician Profile submitted to the board office indicates you had training with Vanderbilt University in Anesthesiology from 7/93 to 11/93. However, this training is not listed on question 15 of your licensure application. Please submit a written explanation. Also, a training evaluation form will have to be completed. A letter has been sent to the training program to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board office indicates your training with Medical College of Ohio is incomplete. Please provide a written explanation. A letter has been sent to the program to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to . . . our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On September 26, 2003, Respondent received a letter, dated September 23, 2003, that was addressed to one of its employees, Lakeisha Henderson, and purported to be, but was not, from Petitioner and signed by her (September 26, 2003, Letter). The September 26, Letter, of which Petitioner had no knowledge, read as follows: In answer to your questions in the letter you sent me 9/17/03 [sic], I am providing these answers: I left St. George's because of the war in Grenada. I waited till I was sure the situation was stable and I also took a leave to study for my ECFMG. I was not satisfied with the situation at the school so I transferred/moved to Ross. One course prior to the start of my clinicals was required at Ross before I could start there in the clinical phase. This was a repeat from St. George[']s, but the only one. During this period, I had numerous child care and child health issues with my children which caused me to not be available for work and surgery. Page one is attached. Page three is attached. Page 4 is attached. In answer to question #7, there was a change at Medical College of Ohio. The Program Director left due to illness and subsequently the program started changing, so I finished my second year and then did my third year at another program. I left in good standing, getting credit for everything. I could have continued if I had elected to do so but I declined. In question 8, I started my third year based on what was needed to complete and where the class was. I was having a child and was allowed to start off cycle. Non-Employment Dates: 01/89-6/92-Child Birth and child care, studied for tests. 05/96-01/97-Unemployed 11/98-02/99-Moving and vacation 11/02-04/03-Unemployed 05/03-Present @ Surgical Center of Downers Grove, IL I thought the fingerprint card had been sent to your office (Question #9) Item #11 has been requested. Question #12. I was married for a short period of time and while married took the last name of husband Prochazka. When we divorced I retained my maiden name. Question #18- The program was overfilled with Residents and I elected to leave with no credit as I only attended for a short period of time. Question #19- I was given full credit for my training there, so I do not understand the question. I have attached my diploma. All other items have been requested and will be sent directly to you. On September 30, 2003, Respondent received another letter, also dated September 23, 2003, that was addressed to Ms. Henderson and purported to be, but was not, from Petitioner and signed by her (September 30, 2003, Letter). The September 30, 2003, Letter, of which Petitioner had no knowledge, read as follows: I am sorry I forgot to include the fact that I was arrested for disturbing the peace. I have included all those documents. I forgot till Ken Carroll asked. I thought it was not needed as it was over 10 years ago, sorry to cause any issues. I have also included my divorce papers. Among the documents that were "included" with the September 30, 2003, Letter to Ms. Henderson was a statement in Petitioner’s handwriting, dated June 10, 1996, which provided an explanation of the circumstances surrounding Petitioner’s arrest. This handwritten statement was among the materials that Petitioner had furnished USML for use in the application preparation process. On October 16, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (October 16, 2003, Deficiency Notice). The October 16, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the letter dated September 23, 2003, [in which] you indicate employment with Surgical Center of Downers [Grove]. Do you hold staff privileges with this hospital? If so, an evaluation form will have to be completed. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. Submit a written account of your employment/non-employment activities from 6/93 to 4/94. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. We are in receipt of the letter of recommendation from Dr. Kianoosh Jafari. Please submit an additional letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. 19. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * Respondent received, in response to the October 16, 2003, Deficiency Notice, a letter that purported to be, but was not, from Petitioner and signed by her. The letter, of which Petitioner had no knowledge, read as follows: Question #5 from letter of 10/13/03 [sic] I left [the] program after one year to move closer to my husband at the time wh[o] was in the Midwest. I spent the time from 7-93 till 4-94 looking for a program and applying to programs. Petitioner was not married during the time period referenced in the letter. To the extent that the letter suggests otherwise, it is inaccurate. In or around the end of October of 2003, Petitioner received a letter from the Nevada State Board of Medical Examiners (Nevada Board) concerning an application for licensure that USML had submitted to the Nevada Board on her behalf. The letter, which was dated October 28, 2003, read as follows: Dear Dr. Sawan: Please find enclosed a new application for medical licensure for the State of Nevada. You will be required to complete this application without the assistance of a credentialing service. The Nevada State Board of Medical Examiners does not accept any documentation from the credentialing company U.S. Medical Licensing and Credentialing. After receiving this letter, Petitioner telephoned Mr. Carroll and asked him why "this Nevada licensure application . . . was not accepted." Mr. Carroll, in response to Petitioner’s inquiry, explained that "there were some other doctors that did not get their licenses and they were upset with [USML]" and had complained to the Nevada Board. Having received this response to her inquiry, Petitioner "did not dig anymore" into the matter. Petitioner subsequently completed the application form she had been sent by the Nevada Board and then returned it. Approximately, four and a-half months later she received her Nevada medical license On November 17, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (November 17, 2003, Deficiency Notice). The November 17, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the letter dated September 23, 2003, [in which] you indicate employment with Surgical Center of Downers [Grove]. Do you hold staff privileges with this hospital? If so, an evaluation form will have to be completed. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * Respondent received, in response to the November 17, 2003, Deficiency Notice, a letter that purported to be, but was not, from Petitioner and signed by her. The letter, of which Petitioner had no knowledge, read as follows: Question #2 from letter of 11/14/03 [sic] Downers Grover Surgical Center is an out patient center. Not a hospital. Question #5 A copy of my ECFMG is enclosed. On December 19, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (December 19, 2003, Deficiency Notice). The December 19, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * The December 19, 2003, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (December 19, 2003, Deficiency Letter), which read as follows: Your application remains incomplete. Please review the attached update [the December 19, 2003, Deficiency Notice] outlining the remaining deficiencies. Please be advised previous malpractice, criminal charges, discipline, addictions/impairment, unfavorable evaluations, etc. may require that you appear before the Credentials Committee for determination of eligibility for licensure. If your appearance is required, you will be notified in writing once your file is complete. Any information received by this office may require additional explanation and/or documentation to be requested in order to further determine licensure eligibility. After all requested documentation is received, your file will be submitted for a standard supervisory review. Should additional information be required, you will be notified. Once your file is determined complete, it will be presented to the Board for consideration at the next scheduled meeting. As documentation is received in our office, an updated list of deficiencies will be mailed to you. Your application will remain incomplete until all deficiencies are completed. In addition, notify the Board office immediately in writing of any occurrence(s) that would in any way change or affect any answer given in the application or an answer provided in response to any of our direct questions to you. If I can be of any assistance, please contact me at (850) 245-4131 extension 3512 or e-mail me at Lakeisha_Henderson @doah.state.fl.us. On January 22, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (January 22, 2004, Deficiency Notice). The January 22, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On February 24, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (February 24, 2004, Deficiency Notice). The February 24, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On March 24, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (March 24, 2004, Deficiency Notice). The March 24, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * The March 24, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (March 24, 2004, Deficiency Letter). The body of the March 24, 2004, Deficiency Letter was identical to the body of the December 19, 2003, Deficiency Letter. On March 31, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (March 31, 2004, Deficiency Notice). The March 31, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the training evaluation form from Valley Ambulatory Surgery Center. The evaluation form indicates you resigned and your staff privileges were terminated. It appears you should have answered yes to question 18c. Please submit a written explanation as well [as] explain the no answer given for question 18c. A letter has been sent to Valley Ambulatory Surgery Center to retrieve[] further information. Enclosed for your review is a copy of the evaluation form. A letter will be sent to each training program requesting a copy of your training file. A letter has been sent to the Medical College of Ohio requesting further clarification on the letter submitted from them dated July 22, 2003. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 * * * The March 31, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (March 31, 2004, Deficiency Letter). The body of the March 31, 2004, Deficiency Letter was identical to the bodies of the December 19, 2003, and March 24, 2004, Deficiency Letters. In or around March of 2004, during a telephone conversation with Mr. Carroll, Petitioner inquired as to whether her "talk[ing]" to Respondent "could help expedite" the processing of her Florida Application. Mr. Carroll, in turn, gave Petitioner Ms. Henderson’s name and telephone number and suggested Petitioner call Ms. Henderson. Petitioner followed Mr. Carroll’s suggestion and spoke with Ms. Henderson. Petitioner asked Ms. Henderson "if there [was] any problem with the application" and offered to provide "anything extra that [Ms. Henderson] may need." Ms. Henderson "did not say that there were any problems," but she did indicate "that she would like additional information," which she described for Petitioner. After speaking with Ms. Henderson, Petitioner prepared a handwritten letter, which she sent to Ms. Henderson by facsimile transmission on April 9, 2004. The letter read as follows: You requested an explanation for why staff privileges at Valley Ambulatory Surgery Center were terminated. It has been my understanding from their contract agreement that once I stop working there (resign), the staff privileges are automatically terminated. The following day, April 10, 2004, Petitioner sent to Ms. Henderson by facsimile transmission a handwritten list of references, as well as letters of recommendation (from others about her). Ms. Henderson had not asked Petitioner to provide these materials, but Petitioner sent them anyway, thinking that Ms. Henderson "might like to have them." On May 4, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (May 4, 2004, Deficiency Notice). The May 4, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION EXPIRATION DATE IS: June 15, 2004. APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation form from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter will be sent to each training program requesting a copy of your training file. A letter has been sent to Medical College of Ohio requesting further clarification on the letter submitted from them dated July 22, 2003. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. * * * The May 4, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson addressed to Petitioner at the Pace, Florida Address (May 4, 2004, Deficiency Letter). The body of the May 4, 2004, Deficiency Letter was identical to the bodies of the December 19, 2003, March 24, 2004, and March 31, 2004, Deficiency Letters. Petitioner never received the May 4, 2004, Deficiency Notice or the May 4, 2004, Deficiency Letter; nor had she ever received any of the previous deficiency notices and letters. On June 15, 2004, Petitioner’s Florida Application was still incomplete inasmuch as Respondent had not received all of the information it had requested in the May 4, 2004, Deficiency Notice (including the letter from Petitioner requested in item 1 of the notice, the training files from University Medical Center in Las Vegas, Nevada, and Vanderbilt University Medical Center requested in item 2 of the notice, and the "license verification letter" requested in item 4 of the notice, which were all materials that were reasonable for Respondent to have asked for as part of the application review process). On June 28, 2004, Chandra Prine, Respondent’s Program Operations Administrator (and Ms. Henderson’s supervisor), prepared and sent to the Pace, Florida Address a letter addressed to Petitioner (June 28, 2004, Letter) advising her that she was required to make a personal appearance before the Credentials Committee on July 24, 2004, to discuss: Your medical education and your failure to answer yes to questions numbers 12, 12a & 12b on the licensure application. Failure to list your training at Vanderbilt from 7/93-11/93 and your failure to answer yes to question number 15a on the licensure application. In addition, the Committee may inquire into any other issues relating to your application and eligibility for licensure. Petitioner did not receive this letter. In July of 2004, Petitioner telephoned Ms. Henderson to inquire about the status of Petitioner’s Florida Application. She was unable to speak with Ms. Henderson, so she left a message asking Ms. Henderson to return the call. Petitioner subsequently received a telephone message from Ms. Henderson. In her message, Ms. Henderson stated that she thought Petitioner "was going to be going to a hearing" on her Florida Application, but suggested that Petitioner telephone Ms. Prine "just to be sure." Ms. Henderson did not say anything about there being "questions that were answered incorrectly on [the] application." After receiving Ms. Henderson’s message, Petitioner telephoned Ms. Prine and spoke with her. Petitioner told Ms. Prine that Ms. Henderson had left a message about an upcoming hearing concerning Petitioner’s Florida Application and had suggested that Petitioner contact Ms. Prine regarding the matter. Ms. Prine responded, "Yes, we sent you a letter saying you have to show up for this hearing," referring to the June 28, 2004, Letter. Petitioner replied that she had "not received any letter" from Respondent. Ms. Prine then "gave [Petitioner] the address" to which the June 28, Letter had been mailed. Petitioner informed Ms. Prine that this address (the Pace, Florida Address) was not hers. She then "gave [Ms. Prine] her home address for [Ms. Prine] to send [her] another letter." Petitioner asked Ms. Prine during their telephone conversation "what the hearing was going to be about." Ms. Prine's response was that Petitioner should be prepared to answer questions at the hearing regarding certain specific items on her Florida Application, which Ms. Prine identified by number. Petitioner told Ms. Prine that she "had never seen the application," to which Ms. Prine retorted, "Oh, but you signed it." Petitioner insisted that she "didn’t remember signing anything" and asked Ms. Prine to send her, along with the letter concerning the hearing, "a copy of whatever [she supposedly] signed." At no time during the telephone conversation did Ms. Prine tell Petitioner that her Florida Application contained any incorrect information, nor did she reveal to Petitioner anything about those items on the application that Petitioner would be questioned on at the hearing other than what their numbers were and that they pertained to her "schooling and training." It did not come as surprise to Petitioner that the Credentials Committee "wanted to hear from [her]" about her "schooling and training" given the difficulties she had encountered in these areas. Petitioner did not ask Ms. Prine to elaborate any further on what the Credentials Committee would inquire about at the hearing. Two days after her telephone conversation with Ms. Prine, Petitioner received a letter dated July 14, 2004, from Ms. Prine (July 14, 2004, Letter). The July 14, 2004, Letter was addressed to Petitioner at her Naperville, Illinois address and read as follows: This is in further reference to your application for licensure by endorsement. Please be advised that you are required to make a personal appearance before the Credentials Committee of the Board of Medicine to discuss the following: Your medical education and your failure to answer yes to questions numbers 12, 12a & 12b on the licensure application. Failure to list your training at Vanderbilt from 7/93-11/93 and your failure to answer yes to question number 15a on the licensure application. In addition, the Committee may inquire into any other issues relating to your application and eligibility for licensure. Date: Saturday, July 24, 2004 Time: 8:00 a.m. Location: Radisson Hotel 415 N. Monroe St. Tallahassee, FL 32301 (850) 224-6000 The meeting room will be posted in the lobby of the Hotel. Additionally, the Committee's recommendation on your application will be presented to the Board of Medicine, August 6-7, 2004 for final action. Thank you for your continued cooperation. Should you have any question regarding this matter, please feel free to contact me. Along with the July 14, 2004, Letter, Petitioner received from Ms. Prine the signature page of the September 26, 2003, Letter. After reviewing the latter, Petitioner telephoned Ms. Prine and left a message advising Ms. Prine that the signature on that document was not hers. The July 14, 2004, Letter was not accompanied by a copy of Petitioner’s Florida Application. Petitioner made a "personal appearance" before the Credentials Committee on July 24, 2004, as scheduled. As noted above, it was during this appearance that she first learned that her Florida Application contained information that was incorrect. In response to questioning, Petitioner truthfully told the Credentials Committee that she had not "even seen the application" and that it was "not [her] signature" that was on the application in that she did not sign it. The Credentials Committee voted to recommend the denial of Petitioner’s Florida Application, a recommendation that Respondent subsequently followed. On August 2, 2004, following her appearance before the Credentials Committee, Petitioner prepared and sent a letter to Ms. Prine formally requesting, for the first time, a "complete copy of [her] application for the Florida medical license [be] mailed to [her]" at her Napperville, Illinois address. On August 10, 2004, Petitioner prepared and sent to Ms. Prine another letter, which read as follows: I am writing to ask that you do not accept any communication from the USML agency regarding my application. I am not working through them anymore. Please call me directly at (773) 405-3718, or send all mail to: RANDA SAWAN M.D. 1304 Dunrabin Road Naperville, IL 60540 Your assistance with this matter will be greatly appreciated. Thank you. After Petitioner had made several post-Credential Committee hearing requests to Mr. Carroll that he send her copies of "anything [he had] involving [her] application," Petitioner received the following letter, dated September 23, 2004, from Mr. Carroll: I am sorry to inform you but your files along with several hundred other physicians' files were destroyed while in our storage area due to Hurricane Ivan which made a direct hit on Pensacola. Our Pensacola office is operating but has limited phone and no internet or cable. Again I apologize for this inconvenience. Petitioner never received any of the documents she had requested from Mr. Carroll.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that Respondent issue a final order finding that Petitioner's Florida Application expired, without being acted on, one year after it was filed and that it is therefore too late for Respondent to either approve or deny the application. DONE AND ENTERED this 7th day of March, 2006, in Tallahassee, Leon County, Florida. S 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 March, 2006.
Findings Of Fact After the hearing was called to order in the above styled cause, the parties submitted the following stipulation: Sometime in December of 1978, the Petitioner, MARY KANNER applied tot he DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, Clinical Laboratory Registra- tion and Licensure Program, for a Clinical Laboratory Technologist License. After reviewing the petitioner's application and supporting documents, the DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES discovered that she did not have the sixty (60) semester hours required by Section 10D-41.25(9). MRS. KANNER was notified of her failure to qualify for the requested Technologist license by letter from the Department dated January 30, 1979. Subsequently, MRS. KANNER requested an Administrative hearing. Pursuant to her inquires, Mrs. Kanner received several communications from the Respondent Department. One letter dated January 30, 1979, from Nathan B. Schneider, Director of the Office of Laboratory Services, stated that it was the finding of the Respondent Department that Mrs. Kanner might be eligible for licensure as a clinical laboratory technician, and the letter authorized her to work in that capacity until the next scheduled examination, or no later than July 1, 1979. The letter stated that Mrs. Kanner would be notified in advance of the time and place of the examination. A second letter dated January 30, 1979, to Mrs. Kanner from Nathan B. Schneider, acknowledged the receipt of her application for licensure as a technologist but informed her that she was apparently ineligible because she did not have the required sixty (60) semester hours, but also advised her of her entitlement to an administrative hearing. Petitioner submitted letters as follows: a letter to Dr. Schneider from Alice Browner, Registrar of the Canadian Sociaety of Laboratory Technologist. The letter stated in pat that Petitioner had trained for a period of six (6) months, mainly September, 1966, to March of 1967, in a training program in the hematology department. The training was listed as follows: Bacteriology 1 evening a week February - May Biochemistry Sunday afternoons March - June Histology Saturday mornings March - Middle of May Blood Bank One evening a week January, February & March Hematology 6 months formal training Experience - 23 months (excluding formal training) (Resume in Hematology written previously) A letter dated March 29, 1979, to Dr. Schneider from Arthur Rosenberg, Chief of the Department of Hematology at the Sir Mortimer B. Davis - Jewish General Hospital, stated in part that Petitioner started her course in medical technology in 1966, and that in 1969, she wrote the hematology subject examination and received her Canadian registration. She worked as a hematology technologist until 1971, and as a department supervisor from 1971, to 1974. The letter stated that the preparation time prior to writing her examination subject would be the "equivalent of 60-plus semester hours of study." A letter was submitted to Counsel for the Respondent Department dated July 16, 1979, in which John V. Briscoe, Director of Hospital Services for the Sir Mortimer B. Davis - Jewish General Hospital, supplied a document which stated that the Jewish General Hospital is "an affiliated teaching hospital with McGill University, Montreal, Quebec, and is fully accredited by the Canadian Council on Hospital Accreditation, the date of the last accreditation survey being September 26, 1977." In answer to the statement by the Respondent Department that the Petitioner did not have documented evidence of the required sixty (60) semester hours direct from a university, Petitioner explained that in Montreal, Canada, in 1966, all English-speaking schools for nursing and technology took place in various accredited hospitals, using the same format as would be used at a university. In a separate section of the hospital was the school of nursing and the school of technology, but in recent years all of the schools were at the universities. Dr. Howard R. Rarick, Chief of the Clinical Laboratory Improvement Program for the Respondent Department, reviewed Petitioners application and supporting documents and did not find a transcript showing completion of sixty (60) hours credit or its equivalent as required by the State statute and rule promulgated thereunder. The Respondent Department does not evaluate the credits from foreign schools or institutions but forwards the credits to the International Education Research Foundation, which evaluates and determines the equivalent American credits that should be allowed. The Petitioner had no certified transcript from the hospital or university in which the foreign credits were earned and, therefore, was unable to send this to the Research Foundation to convert the foreign credits. The letters submitted by Petitioner are insufficient to substitute for a certified transcript for evaluation purposes. Both parties submitted a stipulation of facts, and the Respondent Department submitted a memorandum of law. These instruments were considered in the writing of this Order. To the extent the proposed findings of fact have not been adopted in, or are inconsistent with, factual findings in this Order they have been specifically rejected as being irrelevant or not having been supported by the evidence.
Recommendation Based upon the foregoing Findings of Fact and conclusions of Law, the Hearing Officer recommends that the application of the Petitioner, Mary Kanner, to sit for examination as a technologist be denied. DONE and ORDERED this 30th day of August, 1979, in Tallahassee, Leon County, Florida. DELPHIAN C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Harold L. Braynon, Esquire Department of HRS 201 West Broward Boulevard Fort Lauderdale, Florida 33301 Mrs. Mary Kanner 1901 North 51st Avenue Hollywood, Florida 33021
Findings Of Fact Based upon the evidence adduced at hearing, and the record as a whole, the following Findings of Fact are made to supplement the parties' factual stipulations: Petitioner's Pre-Immigration Activities In Nicaragua Petitioner is a native of Nicaragua. He obtained his medical education at the National University of Nicaragua (hereinafter referred to as the "University"). He graduated from the University in 1961 with a Doctor of Medicine and Surgery degree. Petitioner later received a Bachelor of Arts degree in psychology from Nicaragua's Central American University. Thereafter, he completed law school in Nicaragua; however, because he was an outspoken critic of the Sandinista government, he did not receive his law degree. Petitioner practiced medicine in Nicaragua for more than 26 years before immigrating to the United States for political reasons 3/ on March 10, 1988. His reputation as a physician in Nicaragua was excellent. Moreover, he provided at his "White Cross" (also referred to herein as "Cruz Blanca") clinic in the city of Managua, which he established in 1972, free medical services to those who were unable to pay for such services. He also volunteered his time and services to various organizations such as the Nicaraguan Professional Boxing Association, of which he was at one time the President, and the Nicaraguan national baseball team. Petitioner's Application For Licensure As A Physician Approximately 19 months after immigrating to the United States, Petitioner submitted to the Board an application for licensure as a physician pursuant to Section 458.311(10), Florida Statutes. On the application form, under the heading "Medical Education," Petitioner indicated that he had studied at the University's Leon, Nicaragua campus from April 1, 1952, to January 30, 1953, and at the University's Managua, Nicaragua campus from April 1, 1958, to January 30, 1959. He provided no other information under this heading. Under the heading "Practice/Employment," Petitioner indicated that from January 1, 1962, to October 30, 1972, he had seen "[p]rivate [p]atien[t]s" at his "[o]wn [c]linic" in Managua and that from November 1, 1972, to February 20, 1988, he had been the "Director of Internal and Famil[y] Medicine" of the "White Cross of Nicaragua" in Managua. He provided no other information under this heading. On December 1, 1989, the Board sent Petitioner written notification that his application was incomplete for the following reasons, among others: The World Directory of Medical Schools indicates duration of studies six years with one year being a rotating internship and one year social service before you are awarded the Doctor of Medicine and Surgery and registration with the Ministry of Public Health you may engage in private practice. In the form of a sworn affidavit please explain or answer the following questions regarding your application: It appears your studies only lasted 18 mos. (4-52 to 1-30-53) and (4-1-58 to 1-10-59). It is not apparent you completed the required 1 yr social service. Application indicates you were in medical school from 4-1-58 to 1-1-59 and in residency at General Hospital from 1-1-59 to 12-1-59. Please explain the apparent discrepancy. . . . 7. Account for the following time: 2-2-88 to the present. . . . Petitioner responded by writing the Board a letter. The Board received the letter, as well as the attachments Petitioner sent along with it, on January 6, 1990. Petitioner's letter provided in part as follows: Following your letter of December 1, 1989, here are my answers to the questions made to me in order to complete my Application No. 88, within the framework of the law No. 458.311, "Licensure by examination." SEE ENCLOSED ATTACH[MENT] ONE (1).- Studies: 4-1-52 to 12-31-58. I enclose evidence on intense medical practice; when I graduated there was not Social Service for graduated medicine students, however, in addition to the rotatory practice I have 2 internship years. See enclosed Attach[ments] two (2) and three (3) Residency General Hospital from 1-1-59 to 12-31-59. See Enclosed attach[ments] (1) and (3). . . . 7. Since 2-2-88 I live in Miami without practicing my profession; presently I am doing some research and writing two recently finished books. From Miami I am also managing the medical institution "CRUZ BLANCA," of which I am the Director - see enclosed Certificate-; the latter, together with other data-evidence confirms my medical professional practice since I graduated. -See Enclosed attach[ments] (4) and (3). . . . I hope I have completed all the information requested; I will be waiting to hear from you for any other point th[at] may arise regarding my request. Thanks. Attachment (1) referred to in Petitioner's letter was a written statement by Petitioner in which he stated the following: The Medical Education in Nicaragua was of seven years and one year of practice in the General Hospital. The Medical School had two locations respectively in Leon and Managua. My Medical Education was from April 1, 1952, to Dec. 31, 1958 = seven years. MEDICAL EDUCATION Name of Medical School: Medical School of the National University of Nicaragua: LEON- Nicaragua From: April 1, 1952 To: January 30, 1953 April 1, 1953 To: January 30, 1954 April 1, 1954 To: January 30, 1955 April 1, 1955 To: January 30, 1956 April 1, 1956 To: January 30, 1957 April 1, 1957 To: January 30, 1958 Managua- Nicaragua From: April 1, 1958 To: December 31, 1958 There are two months of vacations : February and March, every year. Leon and Managua Nicaragua are the same University in different localities. My INTERNSHIP: General Hospital of Managua from 1-1-59 to 12-31-59. On January 10, 1990, the Board sent Petitioner written notification that his application was still incomplete. In this written notification, the Board requested, among other things, that Petitioner have his letter, "retyped in the form of a sworn affidavit." Petitioner complied with this request and resubmitted the letter, in affidavit form, to the Board, along with other materials. Among the other materials he sent to the Board was a certificate from the Secretary of the Board of Directors of Cruz Blanca, which provided as follows: The undersigned Secretary of the Board of Directors of the Cruz Blanca Institution of Medical Social Service, established according to the laws of the Republic of Nicaragua, issues these presents to certify that Dr. Leon Cesar Delgadillo was our founder in the year nineteen hundred seventy-two and that he has acted as our Medical Director and Executive President of the Board of Directors since then, being also in charge of the responsibility of Internal Medicine. Dr. Leon Cesar Delgadillo is a well-known and experienced doctor in the Republic of Nicaragua. He attended seven years of academic studies at the National University of Nicaragua and one year as intern at the General Hospital of Managua which was destroyed by a devastating earthquake in nineteen hundred and seventy-two. He then became an intern at the Social Security Hospital for one more year followed by another year of residency at the Psychiatric Hospital of Managua, Nicaragua. At that time the Medical Social Service did not exist, but Dr. Delgadillo who has a great human sensibility has practiced Social Medicine at Cruz Blanca. His License to practice both private and institutionally as well as his diploma are legally registered at the Ministry of Health. Dr. Delgadillo is also author of "La Dieta Feliz" (The Happy Diet) a best seller in Nicaragua and Central America and presently he has finished writing two books which will soon be published "VIDA Y SALUD CON FISIODINAMIA" (LIFE AND HEALTH WITH PHYSIODYNAMICA) and an educational novel of intense drama about AIDS titled "INFIERNO EN LA TIERRA" (HELL ON EARTH). Due to political reasons, he has lived in the United States since February 2, 1988, but from there he directs our Institution and has been busy there, in the USA, with the abovementioned books of which he is the author. His degree of Medicine was signed by the President of the Republic because that was the law and practice at that time. On February 19, 1990, the Board, having determined that Petitioner had "substantially complied with the requirements set forth in Section 458.311(10)(a), Florida Statutes," and that it was "likely that [Petitioner would] be able to fully comply with all the requirements," issued an order granting "conditional certification of the application of [Petitioner] pursuant to Section 458.311(10)(a), Florida Statutes," thereby authorizing Petitioner to enroll in the University of Miami's Comprehensive Medical Review Program, which was designed to prepare foreign medical school graduates to take the FLEX licensure examination. Petitioner subsequently enrolled in and successfully completed the program. In response to a letter from the Board indicating what he needed to do to "fully comply with all of the requirements of Section 458.311(10)(a), Florida Statutes," Petitioner sent the Board a letter, dated March 26, 1990, in which he stated, among other things, the "corre[c]t date [he] left [his] country [was] 3- 10-88." On July 10, 1990, Petitioner sent another letter to the Board. In his letter, he stated, among other things, the following: My date and port of entry into E.U. is Miami, Mar. 10-86 and the same day arrived [in] San Francisco. I am newspaper reporter. (see page 3 Immigration Statement). Petitioner enclosed page 3 of the "Immigration Statement" to which he referred in his letter. On this page of the "Immigration Statement," Petitioner had indicated that he was a "travelling correspondent of the news radio 'El Momemto de Radio Mundial de Nicaragua.'" On July 26, 1990, the Board sent Petitioner a letter advising him that he had to submit the following material in order to complete his application file: In the form of a sworn affidavit please account for your activities from the date [you] entered the United States until the present[. Y]ou[r] application and other supporting documents contain discrepancies regarding the exact date, port of entry and your activities in the United [S]tates. INS verification indicates date of entry of 3/10/86. Your letter of July 10, 1990 is not acceptable. In response to this letter, Petitioner submitted to the Board a sworn affidavit, dated August 2, 1990, in which he stated the following: Since I entered [t]he United States [o]n 03-10-88, I have been working as a foreign journalist for a Nicaraguan news agency. On this date I entered into the United States by the International Airport in Miami, Florida. This information is in the Declaration signed by me on March 28th of 1988 and filed in your office. Petitioner applied to take the December 1990 FLEX examination. He submitted the completed application and a $500.00 examination fee to the Board. In a letter, dated October 19, 1990, accompanying the fee, Petitioner reiterated that he was working as a foreign journalist for a news agency. On November 7, 1990, the Board sent Petitioner a letter which contained the following advisement: Pursuant to the Final Order dated February 19, 1990 the following material is required to complete your application file. This material must be received in this office no later than November 14, 1990. The Office of Naturalization and Immigration verifies your date of entry as March 10, 1986; but you give your date of entry as March 10, 1988. Please have INS submit to this office a verification of your exact date of entry into the United States. Information requested above must be received in this office on or before 11/14/90 or you will not be allowed to take the December 1990 FLEX EXAM. Petitioner timely furnished the Board with documentation from the Immigration and Naturalization Service verifying that he entered the United States on March 10, 1988. On November 21, 1990, the Board, through its Executive Director, sent Petitioner the following letter: This is to advise you that your application to take the Course developed by the University of Miami as directed in Chapter 89-374, Laws of Florida, is now complete. Based on your demonstration of full compliance with the requirements of Section 458.311(10)(a), F.S., as amended by 89-541, Laws of Florida, your application will be presented to the Board of Medicine for full certification for the Course at a meeting of the Board November 30,- December 2, 1990. You will not be required to be in attendance at this meeting. Should you have any questions whatsoever, please do not hesitate to contact this office. Petitioner took and failed the December 1990 FLEX examination. He contested his failing grade in a letter received by the Board on March 20, 1991. In his letter, he stated that he was a "Medical Doctor, Ps[y]chologist and Lawyer of Nicaragua" and he accused the Board of discriminating against him and infringing upon his civil rights. Petitioner's examination challenge was referred by the Board to the Division of Administrative Hearings, but was subsequently returned to the Board with the recommendation that the Board dismiss Petitioner's challenge. Petitioner's Application For Certification As A Physician Assistant On or about June 21, 1991, Petitioner filled out an Examination Application for Certification as a Physician Assistant (hereinafter referred to as the "Application"). He thereafter submitted the Application, along with a $400.00 application fee, to the Board. The Board received the Application and fee on June 24, 1991. On the first page of the Application, Petitioner indicated, among other things, that he had received his Doctor of Medicine and Surgery degree from the University on August 11, 1961. On the second page of the Application, Petitioner indicated that on July 1, 1990, his place of residence was Miami, Florida. He further indicated that he wished to be issued a temporary certificate. In response to the question on page 2 of the Application, "Did you attend a college or university," Petitioner answered "no." In response to the question on page 2 of the Application, "Did you receive a degree other than an M.D., to include undergraduate degree," Petitioner also answered "no." On pages 2 and 10 of the Application, Petitioner listed "all places of residence (where lived) during all periods of medical school" as follows: Leon, Leon Nicaragua from April 1, 1952 to January 30, 1958 Managua, Managua, Nicaragua from April 1, 1958 to Dec. 31, 1958 Miam[i], Florida from Feb. 24, 1990 to Nov. 20, 1990. February 24, 1990, to November 1990, was the period that Petitioner attended the University of Miami's Comprehensive Medical Review Program. Petitioner further indicated on pages 2 and 10 of the Application that had attended "medical school" at the Leon campus of the University from April 1, 1952, to January 30, 1958, at the Managua campus of the University from April 1, 1958, to December 31, 1958, and at the University of Miami School of Medicine from February 24, 1990, to November 20, 1990. On pages 2 and 3 of the application form, applicants were asked to provide information regarding their "Postgraduate Training" and "Practice Employment." They were instructed as follows: Account for all time from date of graduation from medical school to present. Do not leave out any time. Under "Postgraduate Training" applicants were requested to "[l]ist in chronological order from date of graduation to present date, all postgraduate training (Internship, Residency, Fellowship)." Petitioner indicated that he was in an internship program at the General Hospital of Managua from January 1, 1959, to December 31, 1959, a residency program at the Social Security Hospital of Managua from January 1, 1960, to December 31, 1960, and another residency program at the Mental Health Hospital in Managua from January 1, 1961, to December 31, 1961. Under "Practice Employment" applicants were requested to "[l]ist in chronological order from date of graduation to present date, all practice experience and/or employment." Petitioner indicated that from November 1, 1972, to February 20, 1988, he was the "Director of Familiar Medicine" at the "White Cross of Nicaragua" in Managua. He listed no other "practice experience and/or employment." On page 8 of the application form, applicants were asked to list their "clerkship(s)" and "all places of residence (where lived) during clerkship(s)." Petitioner indicated that he lived in Managua from January 1, 1959, to December 31, 1959, while in a University-supervised internship program at the General Hospital of Managua, that he lived in Managua from January 1, 1960, to December 31, 1960, while in a University-supervised residency program at the Social Security Hospital of Managua, that he lived in Managua from January 1, 1961 to December 31, 1961, while in a University-supervised residency program at the Mental Health Hospital, and that he lived in Managua from November 1, 1972, to December 20, 1988, while he was the "Director of Medicine Familiar" at the "White Cro[s]s of Nicaragua." On August 2, 1991, the Board's Physician Assistant Section (hereinafter referred to as the "Section") sent Petitioner a letter advising him that his Application was incomplete because he failed to submit the following: An accounting of your activities for the following period(s) of time: clerkships from 12/61 to 11/72, 2/88 to 12/88, 12/88 to 2/90, page 3 application practice employment 2/88 to present. page 2 application did you attend a college or university you marked NO explain. page 4 application question 8 you marked NO correct and resubmit. Petitioner responded to this letter by submitting to the Section an affidavit dated August 7, 1991, in which he stated the following: Page 2 application; I attend at the Universidad Nacional Autonoma de Nicaragua, UNAN. [University].- Leon and Managua, Nicaragua April 1, 52 to December 31, 58. Also I attend 5 years Universidad Centro- Americana, UCA [Central American University] degree Psichologist. Clerkships: from 12/61 to 11/72 own private medicine. From 2/88, 12/88 to 2/90, 2/88 to present: In E.U.; don't work in medicine. Question 8, page 4 application question: since I live in E.U. from 2/88 to present don't work in Medicine for do not have license of M.D. On August 26, 1991, the Section sent Petitioner a letter advising him that his Application was still incomplete. The letter further provided as follows: In your affidavit of August 7, 1991 (copy attached) you indicated that you attended Universidad Centro-Americana, UCA for 5 years and obtained a degree in Psichologist. Please submit diploma and transcripts and translations of transcripts, notarized as stated above, dates of attendance and where the university is located. Please resubmit pages 8 and 9 (attached) listing only core clerkships while attending medical school at Universidad Nacional Autonoma de Nicaragua UNAN. Be specific with dates, location of hospital, institution or individual where clerkship was performed or supervised. List affiliate University/College. We need one additional acceptable source of documentation of Florida residency on July 1, 1990, notarized as stated above. It must verify residency covering the period of July 1, 1990. Please account for your activities for the following periods of time, listing in chronological order from date of graduation to present date, including all practice experience and/or employment or unemployment: From February 20, 1988 to present. Petitioner responded by letter dated August 29, 1991. In his letter, Petitioner argued that it was not necessary for him to provide any additional information regarding his psychology degree because such information was "impertinent or irrelevant." He further contended that he had "sufficiently explained" the "other points [in the Section's August 26, 1991] letter (2,3,4)." In addition, he invited the Section, if it wanted more detailed information about his past, to examine the materials in his physician licensure application file (hereinafter referred to as "File No. 88"). The Section followed Petitioner's suggestion and reviewed his File No. 88. Not having received any response to his August 29, 1991, letter, Petitioner, on September 23, 1991, sent the Section another letter complaining about the "harassment and intimidation" to which, according to him, he was being subjected by the Section. The Section, on October 15, 1991, wrote to Petitioner and advised him that he needed to do the following to complete his Application: In your affidavit of August 7, 1991 and in your "declaration" notarized on March 26, 1990, you stated that you had completed a Bachelors degree in Psychology; and stated that you attended Jesuit University in Nicaragua where you "finished the school of law." Please substantiate these statements with the appropriate documentation and dates of attendance. You have submitted a certificate issued December 15, 1989 from the Nicaraguan Board of Pharmacy indicating your registration in their books. Please send a notarized copy of the license and/or certificate required to prescribe drugs in Nicaragua. In your declaration of March 26, 1990, you state that you are enclosing several documents, none of which were enclosed. Among those documents was a "medical file of U.C. Davis (University of California, Davis) Medical Center of Sacremento of March 19, 1988." Please provide all reports of treatment and/or evaluation from the Medical Center of Sacremento to include diagnosis and prognosis. We need one additional source of information of Florida residency on July 1, 1990, notarized as stated above. It must verify residency covering the period of July 1, 1990. Please resubmit pages 8 and 9 (enclosed) listing only core clerkships and rotations while attending medical school at Universidad Autonoma de Nicaragua. Be specific with dates, location of hospital, institution or individual where the clerkships was performed or supervised. List affiliate University or College. You have failed to respond adequately to questions concerning your activities from the time of your graduation from medical school until the present time. On page 3 of the application form (enclosed) please complete the information under "practice experience" as instructed. List all practice experience and/or employment, including month, day and year of practice and/or employment. Do not leave out any period of time. Your application will not be considered complete until you have adequately explained your activities from graduation until the present. You have reported your date of entry into the United States as a Nicaraguan exile as: March 10, 1986; February 6, 1988; February 23, 1987; February 2, 1988 and March 10, 1988, in letters and affidavits prepared by you. Please explain these discrepancies. Also we have received two conflicting statements from the Immigration and Naturalization Service regarding your date of entry as an exile. It will be necessary for you to request an explanation from the Immigration and Naturalization Service to clarify their conflicting documents. Petitioner responded by letter dated October 23, 1991. In his letter, he stated the following: I see you have my file 88 of the Board of Medicine. I am attempting to reconcile your accustomed hostility and for this reason I send you letter Nov. 21/90 of "full compliance from Dorothy Faircloth, Executive Director, Florida Board of Medicine. Please, you think, think, think . . . and you don't contradict and the Board of Medicine and its Executive Director. For politeness I send you "personal documents" and I feel you are intimidateing to me or also You are inciteing to me at to lie. Documents: Letter Florida Board of Medicine 11/21/90 Original FPL's Bill Jul. Aug. -Ju Jul. -May. Jun., 90 Medical File of U.C. Davis . . . Sacramento . . . "PRIVATE" Two Verifications of Information from Migration . . . Below Signed for Richard B. Smith (on Yellow) District Director. - You don't have jurisdiction in this. (Abuse of authority). -Bachelors in Psychology and "finihes the school of law" degree is impertinent and irrelevant to Physician Assistant Section and all this in Nicaragua. -I have only certificate from the Nic. Board of Pharmacy. -Clerkship only General Hospital of Managua, Social Security Hospital, and Mental Health Hospital. After private medicine all time. You are harassing to me, intimidateing and abuseing of my civil rights and I will have to go at the Judge; You are having to me damage. 4/ On November 14, 1991, the Section sent Petitioner a letter advising him that his application was still incomplete and repeating the requests made in numbered paragraphs 1, 5, 6 and 7 of its October 15, 1991, letter to Petitioner. The letter, like the previous letters the Section had sent him, was unsigned. Petitioner responded by letter dated November 18, 1991, in which he stated the following: I have full my file by Physician Assistant and please, I don't want "nobody else" your anonymous letter, without signature and full of bureaucratic harassment. My rights I will debate it in the instance of Law that it concern. At the bottom of the letter, under Petitioner's signature, was a "Postscript," dated November 20, 1991, which read as follows: I send you fotocopy of Immigration and Naturalization service; "fast" you will have original from Immigration by mail. You don't have jurisdiction on matter of Immigration and your hostility is it "abuse of authority" and also is illegal. You infringe my civil rights. "We have to avoid the risorgimento of the Nazism and the Ku Klux Klan (KKK) in all the sectors," this involve: Racialism, Prepotency, irrationality, intolerance, perversion, terrorism, intimidation . . . etc. and it is crime of hate (Law by crime of hate F.S. 1989) The Section next communicated with Petitioner by letter dated December 17, 1991. The letter advised Petitioner that he needed to do the following to complete his application: Translation of medical school diploma, prepared as instructed: The translation of the diploma is a copy and is not notarized as stated above; the translation does not indicate that it was done by a certified translator. Translations must be done by a certified translator and bear his seal or statement of certification. Please provide the translator with a copy of criteria for translation (enclosed). Translations or transcripts, prepared as instructed: The notary did not affix the seal to the translation of the transcripts. The translation is a copy and as such must be notarized as is stated above. On page 2 of the application under Medical Education your dates of attendance at the University of Nicaragua do not agree with your previous application, (exile file #88). PA Application: Med School: 4/1/52-1/30/58 Exile File #88: " " 4/1/52-1/30/53 and 4/1/58-1/30/59 Please clarify these discrepancies in affidavit form. Please resubmit pages 8 and 9 of the application to indicate your core clinical clerkships only. List specific date(s), type of rotation, and name and location of hospital, institution or individual where clerkship was performed or supervised. List affiliate University/College. An accounting of your activities for the following period(s) of time: 12/31/61 to 11/1/72. List all practice experience and/or employment, do not leave out any period of time. The Aids certificate submitted does not indicate AMA approved category I. Please submit proof of AMA Category I approved training, or request in affidavit form a 6 month extension in order to obtain AMA approved Category I course. Petitioner responded by affidavit dated December 31, 1991, to which he appended various documents, including a revised version of pages 8 and 9 of his Application as requested in numbered paragraph 4 of the Section's December 17, 1991, letter. In the affidavit, Petitioner stated the following: Translation of medical school diploma, prepared as instructed: notarized, the translation was done by a certified translator and it has or bear his seal and statement of certification. There are in Exile file No. 88 and my file for Certification as a Physician Assistant in each one, respective translation of the diploma "full criteria of law for translation." Translations was prepared by a Certified translator of Professional Traslating Services, Inc.- Suite 540, Courthouse Tower Building.- 44 West Flaguer Street.- Miami, Florida 33130 Phone: (305) 371-7887 I ask for please, send to me fotocopy of each one, file No. 88 and PA application, in order to delimitate responsibility. Translations of transcripts, prepared as instructed: The notary affixed the seal to the translation of the transcripts and it was notarized. Please, send to me fotocopy of each one, file No. 88 and PA application to delimitate responsibility. The discrepancies of dates under Medical Education of attendance at the University of Nicaragua was clarified on letter notarized January 19, 1990 in reply letter of December 1, 1989 by William R. Flynn, Senior Clerk, Department of Professional Regulation Board of Medicine, paragraph No. 1 file No. 88 (attached fotocopy) and affidavit of the 7th day of August, 1991 in reply your letter of the august 2, 1991 paragraph No. 1, that have your OK on the left margin (to see attached fotocopy). Confirmation Date: Med. School, April 1, 1952 to December 31, 1958.- Application Physician Assistant Section. These discrepancies are result of mistake in the transcription and dates and numbers at the remote time and distance and it was in opportune moment clarified. But it is more important to appoint that the application for certification as a Physician Assistant of the 21 day of June, 1991 page 2 and 10 they are with its correct dates and that your letter 12/17/91 paragraph 3 are free Objections I am incorporating as pages 3 and 4 in this affidavit the corresponding pages 8 and 9 of the application to indicate my core clinical clerkships; really this question was formulate with confused and ambiguous terms. My application is concrete and certain, page "8" application for certification as Physician Assistant. From 12/31/61 to 11/1/72 own private medicine; See affidavit of the 7th day of August, 1991, attached fotocopy. The AIDS certificate of Miami Dade Community Dade, Medical Center Campus for Allied Health Professions. Attached program; You will receive direct information of the Miami-Dade Community College Med. Center Campus. Petitioner, after receiving the Section's December 17, 1991, letter, also sent a letter to Vytas Urba, an assistant general counsel with the Department of Professional Regulation. In his letter, he accused the Section of acting with "madness and hatred" and claimed that he was the victim of a "conspiracy" to violate his civil rights that had resulted in damages of $99,999.99. By affidavit dated January 14, 1992, Petitioner requested that the Section give him a "6 month extension in order to obtain an AMA, AIDS certificate approved Category I course." Among the documents appended to the affidavit was a translation of his "Medical School Diploma." On January 28, 1992, the Section sent Petitioner a letter, which indicated that "the following [was] necessary to complete [his] application:" While you have stated on several occasions that you have not practiced medicine since arriving in the United States, you have not responded to questions regarding your activity or employment. It is not enough to merely state that you are not practicing medicine, you must account for your activities from 3/10/88 until the present. You have previously stated that you are a correspondent for Nicaraguan newspaper and radio station but have not substantiated this employment with any information. This will be the THIRD REQUEST for you to account for your activities from 3/10/88 until the present. Please complete the enclosed page 3 of the application as instructed. You must identify, by address and location the names of all employers, or state in affidavit form that you have not been employed in any way since 3/10/88. You have previously stated that in the period from 12/61 to 11/72 that you had a private practice in Managua. You have not identified what type of practice this was. What specialty, or field of medicine did you practice during this time. Your affidavit of 7 August 1991 states that you attended for 5 years the Universidad Centro-Americana, and that you received a degree of "Psichologist" from this school. Please provide the location of this school and the dates of your attendance. Your previous response that this information is "irrelevant" is not acceptable. You have voluntarily submitted this affidavit, which conflicts with other statements that you have made regarding your activities and you must verify the location of the school and dates of attendance. The translation of your diploma recently submitted is returned; this document is obviously a copy. Any copy must be notarized as is stated above. Your previous application does not contain a copy of this translation that is notarized as required. Please resubmit a translation of your diploma that is either an original document or properly notarized. The translation of your transcripts was also a copy that was not notarized however there was an acceptable copy in your previous application. With regard to HIV/AIDS training your request for a six month extension is accepted. The instructions provided with the application clearly state that this training must be AMA Category I approved training. This information should be requested of the provider prior to taking any HIV/AIDS course. You may enquire of Miami Dade Community College as to whether they are authorized to provide AMA Category I training. If they can provide you with verification of this course being AMA Category I approved, the training will be accepted upon receipt of this verification. Petitioner responded by affidavit dated February 10, 1992, in which he stated the following: There are in file No. 88 letter January 19, 90 . . . . notarized DOCUMENTS with my activities from 3/10/88 until the present, question 1 and the period from 12/61 to 11/72 my private practice in Managua, question 2 (attached); also affidavit 22th day of August, 1990 and notarized letter January 19, 1990 (attached fotocopy) over-marked on green. Next page I ratify and complement question number 1 and I state that in the period from 12/61 to 11/72 I practiced Familiar Medicine, question number 2. I attended for 5 years at the Universidad Centro-Americana, - from 1969 to 1972, this University in Managua, Nicaragua, C.A. (Re: question number 3). - Psichology School. I resubmit (THIRD TIME) my diploma notarized as required; please send me two previous documents submitted. I requested at the Florida Board of Medicine, Physician Assistant Section through Cecilia Abrahansem (Director) . . . to eliminate the unlawful monopoly with HIV/AIDS AMA Category I course. I am foreign journalist for "El Momento" Nicaraguan news agency, Radioperiodico El Momento, RADIO MUNDIAL, Managua, Nicaragua. This activity until the present. (From 1/30/88 to present) Among the documents appended to the affidavit was a revised version of page 3 of Petitioner's Application, which reflected, in addition to his previously disclosed employment with the "White Cross" as its "Director of Familiar Medicine" from November 11, 1972, to February 20, 1998, his employment as a "Foreign Journalist" with "El Momemto Nicaraguan news agency" from "1/30/88 To: the present." By letter dated June 4, 1992, Petitioner was directed to appear before the Physician Assistant Committee of the Board (hereinafter referred to as the "Committee") at its June 12, 1992, meeting. Petitioner appeared before the Committee at its June 12, 1992, meeting as directed. Inasmuch as he has substantial difficulty understanding, and communicating effectively in, English, the Committee provided Petitioner with the services of an interpreter. Members of the Committee asked Petitioner various questions. The questions were asked in English and translated to Spanish, Petitioner's native language, by the interpreter. Petitioner responded in Spanish. The interpreter translated his responses to English for the benefit of the Committee. Asked when he had arrived in the United States, Petitioner responded, "March 10, 1988." He was then asked when he had last practiced medicine. His initial response was, "in Managua, Nicaragua." After the question was repeated, however, he answered, "before this time." In response to the question of whether he had had any exposure to the practice of medicine since his arrival in the United States, Petitioner stated, "never here in the States." Petitioner told the Committee, in response to their inquiry regarding the matter, that since his arrival in the United States he had been "a writer and a reporter." Petitioner responded in the affirmative when asked if his only exposure to medicine since he had been in the United States was the intensive review course he had taken at the University of Miami from February to November, 1990. Petitioner was asked whether he had gone to law school. After responding in the affirmative, he was asked when he had gone to law school. Petitioner answered that he was unable to give an "exact date," but it had been "about five years before he [had] left the country." He added that he had gone to law school at night. Asked whether he had received a law degree, Petitioner responded that he "couldn't" because it "wasn't possible . . . politically." At no time in responding to the Committee's questions or during any other phase of the application process did Petitioner knowingly provide false information or withhold pertinent information with the intent to mislead or deceive those evaluating his Application about his qualifications to be certified as a physician assistant. Any inaccuracies or omissions in the information he provided was the product of, not an intentional effort to defraud, but rather either inadvertence, carelessness, faulty or limited recall, misunderstanding, limited English language comprehension and communication skills, 5/ or a good faith belief that the information in question was not germane. After questioning Petitioner, the Committee voted to deny Petitioner's Application. On August 15, 1992, the Board issued a written order denying the Application on the following grounds: Your failure to submit a properly completed application. You have demonstrated a lack of good moral character based upon your testimony and inconsistent and evasive answers. The Board has also determined that based upon review of your application and documentation, and due to the extended length of time since you last worked in the field of medicine, and because of the length of time since any significant medical education or training has taken place, you have not established that you are currently able to practice as a physician assistant with reasonable skill and safety to the public. Petitioner's Other Activities Since His Arrival in the U.S. As he attempted to make clear during the application process, Petitioner has not engaged in the practice of medicine in the United States since his arrival in this country. He has studied medicine on his own, as well as performed medical- related research in connection with several books he has written, however. He has also done volunteer work for the Red Cross. Petitioner has continued to direct and administer from the United States the operations of the "White Cross" clinic. Recently, he has started to again visit the clinic on a fairly regular basis and treat patients. The first of these post-March 10, 1988, visits occurred sometime in 1992. Since 1988, Petitioner has not received any compensation for the work he has performed for the clinic. In addition to the foregoing activities, Petitioner has worked as a journalist since coming to the United States as he indicated on the revised version of page 3 of his Application. Petitioner has not lost the ability he demonstrated throughout his many years of practice in Nicaragua before immigrating to the United States to treat patients in a safe and effective manner. He is currently able to practice as a physician assistant with reasonable skill and safety to the public, notwithstanding that he may have had some difficulty in following the instructions he was given (in English) by the Section during the application process and providing the Section with the information he desired. 6/ Furthermore, Petitioner is of good moral character.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Board enter a final order certifying that Petitioner is eligible to take the examination for certification as a physician assistant pursuant to Section 458.347(7)(b), Florida Statutes, and granting him temporary certification pursuant to Section 458.347(7)(b)2., Florida Statutes, pending the results of the examination. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 3rd day of June, 1993. STUART M. LERNER 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 3rd day of June, 1993.
