The Issue Should discipline be imposed by the State of Florida, Board of Medicine (the Board), against Respondent's physician assistant's license for alleged inappropriate conduct in relation to Patient T.S.?
Findings Of Fact Stipulated Facts: Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. At all times material to this Complaint, Respondent was a licensed physician assistant within the State of Florida, having been issued license number PA 3346 on May 28, 1997. Respondent's address of record is 2608 Maywood Street, Eustis, Florida 32726-2063. Respondent is a physician assistant at Care First of Central Florida (hereinafter "Care First"), 15050 U.S. Highway 441, Eustis, Florida 32726. Patient T.S., (a.k.a. T.B.), and her daughters had been patients of Care First for several years for various family medical matters. On or about November 16, 2004, Patient T.S. met Respondent for the first time when Patient T.S. accompanied Patient R.P., her significant other, to Patient R.P.'s appointment with Respondent at Care First. During Patient R.P.'s appointment, Patient T.S. discussed a problem she was experiencing with fibromyalgia (a condition that causes widespread muscle and soft tissue pain and tenderness, especially in the trunk, neck, and shoulders). Respondent suggested Patient T.S. make an appointment with him for a checkup of her condition. Patient T.S. made the appointment for the following day, November 17, 2004, and attended her appointment accompanied by Patient R.P. Respondent thoroughly and appropriately examined Patient T.S. on November 17, 2004. On or about November 26, 2004, Patient T.S. presented herself unattended to Care First with complaints of coughing and chest congestion. Respondent met with Patient T.S. in an examination room with no other persons present. Respondent returned to the examination room, gave Patient T.S. some medication for her condition, and exited the room.1/ Prior Disciplinary History: There was no indication that Respondent had been accused of any prior wrongdoing involving his practice as a physician assistant.
Recommendation Upon consideration of the facts found and the conclusions of law reached, it is RECOMMENDED: That a final order be entered which dismisses the Administrative Complaint. DONE AND ENTERED this 11th day of August, 2006, in Tallahassee, Leon County, Florida. S CHARLES C. ADAMS 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 11th day of August, 2006.
Findings Of Fact Petitioner, Daniel J. Callahan, is a physician currently licensed to practice medicine in the State of Florida pursuant to Chapters 455 and 458, Florida Statutes. Respondent, Agency for Health Care Administration, Board of Medicine, (Board of Medicine), is the state agency charged with the duty and responsibility to administer Chapter 458, Florida Statutes. Petitioner is the subject of three disciplinary actions brought by the Board of Medicine which are now pending before the Division of Administrative Hearings, case Nos. 93-6020, 93-6021, and 94-3208. The Administrative Complaints filed in these cases set forth allegations of sexual misconduct against Petitioner. The Board of Medicine has filed a motion for official recognition of Rule 59R-9008, Florida Administrative Code, in the disciplinary actions against the Petitioner. Hearing in the disciplinary cases against Petitioner is currently scheduled to begin on March 29, 1995.
Findings Of Fact Based upon the stipulation filed in this cause, the testimony of the witnesses, and the documentary evidence received at the hearing, the following findings of fact are made: The Respondent, Randall E. Pitone, M.D., is a medical doctor licensed (license number ME 0029098) by the State of Florida since 1976. Respondent is a diplomate in psychiatry having received certification from the American Board of Psychiatry and Neurology. At all times material to the allegations of this case, Respondent was in the practice of psychiatry in the State of Florida. Respondent has been affiliated with or authorized to practice in a number of hospitals in the Pinellas County area. He enjoys a good reputation among the community of practicing psychiatrists and has covered for several of them during the course of his practice. The Respondent became Patient 1's treating psychiatrist in 1982 when the patient was almost 18 years of age. Patient 1 has a borderline personality disorder and other problems for which she required treatment. In order to more effectively provide treatment for borderline patients, Respondent attended at least two courses related to borderline personality disorder during the early 1980s. From September, 1982 through May, 1988, Respondent treated Patient 1 with individual psychotherapy. During this time, Patient 1 was hospitalized on several occasions and Respondent counseled with her within the hospital setting and at his office. Borderline patients are typically very needy, seductive, and manipulative in their approach to others. During her period of treatment Patient 1 frequently attempted to initiate a romantic relationship with Respondent who diplomatically refused her advances. On each of these occasions, Respondent explained to Patient 1 that he could not have a romantic relationship and continue therapy. Also during this period, Respondent was married and devoted to his family. In May, 1988, Respondent and Patient 1 ended their formal physician- patient relationship. Patient 1 was not sincerely pursuing therapy. Additionally, she had a new boyfriend with whom she seemed happy. Respondent encouraged her to seek therapy but she mistakenly believed that she did not need it. Although she would periodically drop by to visit with Respondent, she did not make appointments for therapy. Nor did she obtain therapy from another psychiatrist despite Respondent's encouragement for her to do so. Respondent's wife left him sometime in 1988. Her departure was very difficult for Respondent. The couple divorced in June, 1988, and Respondent's former wife remarried shortly thereafter and moved to Georgia. Respondent's children resided with him until sometime in 1989 when they moved to their mother's home. Subsequently, Respondent allowed Patient 1 to move into his home. She resided with him from June, 1989 until April, 1990. Throughout this period of cohabitation, Respondent included Patient 1 in his family activities. She went to his brother's home with him for Christmas and went on a cruise to Jamaica with his relatives. Respondent did not hide their relationship from his family or friends. During this period Respondent and Patient 1 engaged in sexual intercourse. Patient 1 has been hospitalized on several occasions since 1982. During one such hospitalization, on or about October 30, 1988 (after formal therapy had ended), Dr. Helm consulted with the Respondent regarding Patient 1's suspected drug abuse. Patient 1 has a serious addiction to alcohol, cocaine, and crack cocaine. This addiction dates at least as far back as the summer of 1989, and perhaps earlier. Respondent knew of Patient 1's addiction to cocaine and of her abuse of other substances. Respondent prescribed medications for Patient 1 in a misguided effort to wean her from street drugs. Whenever Respondent refused to give Patient 1 prescriptions, she would become outraged and destructive. On one such occasion, Patient 1 exited the car in which the couple was travelling and bolted in front of an oncoming truck. As a result Patient 1 was hospitalized with a broken pelvis. Between May, 1988, and March, 1990, Respondent wrote or authorized the prescriptions listed in attachment A for Patient 1. These prescriptions were given to Patient 1 despite the fact that she was no longer formally receiving psychotherapy from Respondent. Moreover, many of the prescriptions issued are not of the type generally associated with the treatment of psychiatric patients since they are more commonly associated with pain relief. Amitriptyline is a legend drug. Dalmane is a brand name of flurazepam, a legend drug and controlled substance. Valium is a brand name of diazepam, a legend drug and controlled substance. Xanax is a brand name of alprazolam, a legend drug and controlled substance. Darvocet is a brand name of a compound containing propoxyphene, a legend drug and controlled substance. Tylenol #3 and Tylenol #2 are brand names of acetaminophen or apap with codeine, legend drugs and controlled substances. Percodan is a brand name of oxycodone with aspirin, a legend drug and controlled substance. Percocet is a brand name of oxycodone with acetaminophen or apap, a legend drug and controlled substance. Legend drugs are required by federal or state law to be dispensed only on a prescription. Respondent inappropriately prescribed legend drugs/controlled substances to Patient 1. Respondent prescribed drugs for Patient 1 after they were living together and engaging in sexual relations. The types and quantities of prescriptions written by Respondent for Patient 1 were not justified by examinations and records maintained by the Respondent, were not issued in the course of medical practice, and were clearly excessive. By prescribing the drugs listed in attachment A, Respondent failed to provide Patient 1 with that level of care, skill and treatment, which a reasonably prudent similar physician recognizes as acceptable under the conditions and circumstances of this case. Respondent also failed to seek consultation in connection with his concerns over Patient 1. Instead, Respondent set himself up as her sole provider and savior. This action was medically inappropriate and further evidences Respondent's loss of objectivity in this instance. In effect, Respondent became a patient in need of treatment as a result of his erroneous and misguided efforts to assist Patient 1. On April 11, 1990, an order of emergency restriction of Respondent's license was issued by Larry Gonzalez, acting as Secretary of the Department. That order placed specific restrictions on the Respondent's license which include: -the prescription of controlled substances utilizing sequentially numbered triplicate prescriptions; -the review of each prescription by a supervisory physician; -the prohibition of providing medical services to Patient 1; and -the submission of monthly reports by a monitoring physician which includes specific information regarding Respondent's practice, any problems, a review of prescriptions and patient records. To date, Respondent has complied with the restrictions placed on his license. Additionally, Respondent has sought and obtained psychiatric counseling in connection with his errors in thinking related to his relationship with Patient 1. Respondent developed a rescue fantasy in which he perceived that he alone could assist Patient 1 recover from her illnesses. This was not a medically sound approach to the dilemma within which Respondent became embroiled. As Respondent fell in love with Patient 1, he lost his professional perspective and undertook this ill-fated rescue of her. An examination of Respondent's medical records does not suggest that the activities which gave rise to the allegations of this case have occurred regarding other patients. From the circumstances of this case, it is unlikely another incident or series of incidents of this type will recur. Sexual activity between a psychiatrist and his patient has detrimental effects on the patient. In this instance, that conduct had detrimental effects on both the Respondent and Patient 1. Since Respondent fell prey to Patient 1's manipulative nature, his judgment became impaired and she was able to orchestrate an inappropriate response from Respondent. It cannot be found, however, that Respondent used their relationship to induce Patient 1 to engage in sexual activity.
Recommendation Based on the foregoing, it is RECOMMENDED: That the Department of Professional Regulation, Board of Medicine enter a final order finding the Respondent guilty of violating Sections 458.331(1)(m), (q), and (t), Florida Statutes, and imposing the following penalties: suspension of the Respondent's license for a period of one year during which time the Respondent shall continue counseling, followed by a two year period of probation under the terms set forth in the emergency order issued April 11, 1990, together with an administrative fine in the amount of $5,000.00. DONE and ENTERED this 14 day of November, 1990, in Tallahassee, Leon County, Florida. Joyous D. Parrish Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 14 day of November, 1990. APPENDIX TO CASE NO. 90-3276 RULINGS ON THE PROPOSED FINDINGS OF FACT SUBMITTED BY THE DEPARTMENT: Paragraphs 1 through 20 are accepted. With regard to paragraph 21 it is accepted that Respondent provided the prescriptions as described, however, he had formally ended psychotherapy of Patient 1 in May, 1988. It was inappropriate for him to issue the prescriptions. Paragraphs 22A. and 22C. are accepted. Paragraph 22D. is rejected to the extent that it finds Respondent did not maintain appropriate records, otherwise, rejected as contrary to the weight of the credible evidence. Note: there is no paragraph 22B. Paragraph 23 is accepted. Paragraph 24A. is accepted. Paragraphs 24B. and 24C. are rejected as contrary to the weight of credible evidence. With regard to paragraph 25 it is accepted that Respondent prescribed substances for Patient 1 inappropriately and excessively, otherwise the paragraph is rejected as contrary to the weight of the evidence or a conclusion of law. Paragraphs 26, 27, 30 and 31 (because it allowed her to manipulate Respondent into prescribing inappropriately--he should have been the physician not a co-patient) are accepted. Paragraphs 28 and 29 are rejected as contrary to the weight of credible evidence. RULINGS ON THE PROPOSED FINDINGS OF FACT SUBMITTED BY THE RESPONDENT: Paragraphs 1 through 3 are accepted. To the extent addressed in findings paragraphs 3 through 7, Respondent's paragraphs 4 through 9 are accepted; otherwise rejected as irrelevant or a recitation of testimony. With the exception of the last sentence, paragraph 10 is accepted. The last sentence is rejected as speculative or conjecture--it is accepted that Respondent was in a stress-filled, emotional situation. Paragraphs 11 through 14 are accepted. Paragraph 15 is rejected as irrelevant. Paragraph 16 is accepted but is irrelevant. Paragraph 17 is accepted. Paragraphs 18 through 19 are accepted. Paragraphs 20 through 23 are rejected as recitation of testimony but see findings of fact paragraphs 27, 28, and 29. Paragraphs 24 through 28 are rejected as recitation of testimony. With regard to paragraph 29 it is accepted that the Respondent does not pose a threat to the public under his current circumstances. Otherwise, paragraph 29 is rejected as recitation of testimony or irrelevant. Paragraph 30 is accepted. Paragraph 31 is rejected as recitation of testimony. Paragraph 32 is accepted. Paragraph 33 is accepted. ATTACHMENT A Date Drug Prescribed 5/14/88 Dalmane 6/02/88 Valium 7/15/88 Percodan 7/20/88 Percodan 7/27/88 Xanax 7/27/88 Percodan 8/12/88 Percodan 9/06/88 Percodan 9/13/88 Zantac 9/23/88 Percodan 10/7/88 Darvocet N-100 10/29/88 Xanax 11/18/88 Percodan 01/6/89 Xanax 1 mg 01/09/89 Xanax 1 mg 01/10/89 Percodan 01/11/89 Xanax 01/16/89 Xanax 01/18/89 Xanax 01/21/89 Xanax 01/20/89 Tylenol 3 01/24/89 Tylenol 3 01/25/89 Tylenol 3 01/26/89 Xanax 01/31/89 Xanax 02/02/89 Percodan 02/04/89 Xanax 1mg 02/04/89 Percodan 02/04/89 Xanax 1mg 02/09/89 Percodan 02/10/89 Xanax 02/10/89 Percodan 03/03/89 Xanax 03/03/89 Percodan 03/13/89 Percodan 03/14/89 Xanax 1mg 03/17/89 Percodan 03/20/89 Xanax 03/24/89 Xanax 03/24/89 Percodan 03/27/89 Percodan 03/27/89 Xanax 03/29/89 Percodan 03/31/89 Percodan 04/07/89 Xanax 1mg 04/10/89 Percocet 5mg 04/11/89 Percodan 04/21/89 Percodan 04/24/89 Percodan 04/25/89 Percodan 04/25/89 Xanax 04/26/89 Percodan 04/28/89 Percodan 04/28/89 Xanax 04/29/89 Percodan 05/01/89 Xanax 05/02/89 Percodan 05/04/89 Percodan 05/05/89 Percodan 05/09/89 Xanax 05/11/89 Xanax 05/14/89 Xanax 1 mg 05/18/89 Xanax 1 mg 05/20/89 Xanax 1 mg 06/06/89 Xanax 1 mg 06/08/89 Percodan 06/09/89 Xanax 1 mg 06/09/89 Percodan 06/14/89 Xanax 1 mg 06/14/89 Percodan 06/16/89 Xanax 1 mg 06/23/89 Xanax 1mg 06/24/89 Percodan 06/26/89 Percodan 07/01/89 Xanax 07/07/89 Xanax 1 mg 07/07/89 Percodan 07/10/89 Percodan 07/15/89 Percodan 07/17/89 Percodan 07/20/89 Percodan 07/21/89 Valium 10 mg 07/21/89 Percodan 07/28/89 Percodan 07/30/89 Valium 07/31/89 Percodan 08/02/89 Percodan 08/04/89 Percodan 08/05/89 Valium 10 mg 08/07/89 Valium 10 mg 08/07/89 Percodan 08/09/89 Percodan 08/20/89 Valium 10 mg 09/01/89 Percodan 09/04/89 Valium 09/06/89 Percodan 09/19/89 Percodan 09/22/89 Valium 09/22/89 Percodan 09/28/89 Percodan 10/01/89 Percodan 10/02/89 Percodan 10/02/89 Valium 10 mg 10/04/89 Valium 10 mg 10/04/89 Percodan 10/05/89 Xanax 1 mg 10/06/89 Percodan 10/13/89 Darvocet-N. 100 10/13/89 Valium 10/13/89 Tylenol #2 10/17/89 Tylenol #2 10/19/89 Valium 5 mg 10/20/89 Tylenol #3 10/24/89 Tylenol #3 10/24/89 Valium 5 mg 10/25/89 Tylenol #3 10/26/89 Percocet 10/30/89 Percocet 10/30/89 Tylenol #4 10/30/89 Valium 10 mg 11/03/89 Percodan 11/17/89 Percodan 11/17/89 Valium 10 mg 11/24/89 Valium 10 mg 11/24/89 Percocet 11/27/89 Percocet 11/29/89 Percocet 01/02/90 Valium 10 mg 01/02/90 Percodan 01/12/90 Tylenol #3 01/12/90 Valium 10 mg 01/13/90 Xanax 1 mg 01/17/90 Tylenol #3 02/04/90 Xanax 1 mg 02/17/90 Percodan 02/20/90 Percodan 02/28/90 Percodan 03/10/90 Percodan 03/16/90 Percodan 03/17/90 Percodan COPIES FURNISHED: Bruce D. Lamb Chief Trial Attorney Department of Professional Regulation 730 Sterling Street, Ste. 201 Tampa, Florida 33609 Grover C. Freeman FREEMAN, LOPEZ & KELLY, P.A. 4600 West Cypress, Ste. 500 Tampa, Florida 33607 Dorothy Faircloth Executive Director Board of Medicine Department of Professional Regulation Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-0792 Kenneth E. Easley General Counsel Department of Professional Regulation Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-0792
The Issue The issues are whether Respondent committed the offenses set forth in the Administrative Complaint, and if so, what penalty should be imposed.
Findings Of Fact Respondent is and has been at all times material hereto a licensed physician in the State of Florida, having been issued license number ME 0066421. He is thirty-eight years old. He specializes in the practice of neurology. Respondent worked at a medical clinic in 1995 until July 31, 1995. While he was employed at the clinic, he became friends with Barrie Williamson who also worked at the clinic. Ms. Williamson was twenty or twenty-one years old. Respondent quit working for the medical clinic on July 31, 1995. Shortly thereafter, Ms. Williamson lost her job at the clinic. In August of 1995, Ms. Williamson invited Respondent to have dinner and watch a movie at the home of her twenty-two year old cousin, A.S. Ms. Williamson practically lived with A.S. and her boyfriend, Phillip McNutt. On the designated evening, Respondent took a bottle of wine to A.S.'s apartment. The nature of this get-together was strictly social. Sometime after the party, Respondent called Ms. Williamson at A.S.'s apartment. When A.S. answered the phone, Respondent identified himself as "Rastus the Nastus." A.S. made some sexual comments to the Respondent in jest. She did not realize to whom she was speaking until Respondent mentioned a bottle of wine. A.S. then gave the phone to Ms. Williamson. In August of 1995, A.S. and Phillip McNutt were planning to go to Australia. A.S. needed a physical examination in order to get a visa. She called Respondent and asked him if he would like to see her naked. When Respondent asked A.S. what she meant, she told him she needed a physical examination because she was moving to Australia. Respondent agreed to perform the physical examination. Respondent formed a physician/patient relationship with A.S. at that time. A.S. and Respondent planned on several occasions for A.S. to go to Respondent's home so he could perform the physical examination. Something came up on each occasion that prevented A.S. from going to Respondent's home. Respondent was aware that A.S. was coming to his house to get her exam done so she could get her Australian visa. He also thought she was coming on to him and wanted to fool around. On September 9, 1995, A.S. called Respondent and told him she would be at his house around 2:00 p.m. A.S. asked Respondent if there was anything she could take to him. Respondent told her to bring wine and chocolates. Next, A.S. and Ms. Williamson went to a wallpaper store and a fabric store. They also went to a paint store to buy paint because Ms. Williamson was moving into a new house. They met with a professional painter who had worked for Ms. Williamson's mother. The painter agreed to help Ms. Williamson paint the inside of her house. During this time, A.S. bought a six-pack of beer and drank two or three of them. She also bought a keg of beer because Ms. Williamson expected other people to show up for a "painting party." Initially, Ms. Williamson planned to accompany A.S. to Respondent's home on September 9, 1995. She decided not to do so because she did not want to leave the painter alone in her house. A.S. asked Ms. Williamson if it was safe to go to Respondent's home by herself. Ms. Williamson answered affirmatively. A.S. arrived at Respondent's home around 4:00 p.m. on September 9, 1995. She knocked on the door which was unlocked. When Respondent did not answer, she let her in. She was carrying a beer, a bottle of wine, and a box of chocolates. Her little dog was with her. Initially, A.S. and Respondent sat on the couch. A.S. showed Respondent the medical examination form that needed to be signed by a doctor in order for A.S. to obtain an Australian visa. During their conversation about the requirements of the medical examination, A.S. talked to Ms. Williamson on the phone. The first section of the medical form requires an applicant to give his or her name, address, gender and date of birth. The applicant must also attach a photograph. A medical examiner must certify in writing that the photographic image is a true likeness of the examinee. The form which is the subject of this proceeding does not have a photograph attached to it. While A.S. and Respondent were reviewing the form, A.S. called Mr. McNutt to ask about her passport photographs. The second section of the form is entitled applicant's declaration. A.S. completed this section in part while she was at Respondent's home. One question inquires whether the applicant consumes alcohol, and if so, how much. The subject form has a mark in the "no" box. The next section of the form is entitled examining doctor's findings and requires the physician's signature. This section of the subject form is not filled in except for a blood pressure reading: Systolic, 110; Distolic, 70. While Respondent and A.S. discussed the form, they drank some of the wine that she brought with her to Respondent's house. After reviewing the form, Respondent told A.S. that he could not do the exam at his home. He told her she needed to set up an appointment at Dr. McCoy's office where Respondent was occasionally seeing patients. A.S. smoked one of Respondent's cigarettes. Because it was his last one, A.S. and Respondent went to the local convenience store to buy more cigarettes. They drove in A.S.'s car. While they were at the store, Respondent cleaned the beer cans out of A.S.'s car. She introduced Respondent to a family friend. When they returned to Respondent's home, Respondent suggested that they go into another room. A.S. removed her cut-off overalls, went into the other room, and lay on the floor. She pulled the top of her body suit down and took off her bra. Respondent began to perform a breast examination on A.S. During this examination, he asked A.S. whether she ever checked her own breast. Respondent told A.S. how important breast examinations are and showed her how they should be done. No actual sexual activity occurred between A.S. and Respondent until he started stroking her breast in the role of a doctor during the physical examination. A.S. told Respondent she did not feel comfortable with her clothes off. Respondent asked her if she would be more comfortable if he took his shirt off. A.S. said she would. When he began undressing, A.S. told him she was only joking. After A.S. unsnapped the bottom of her body suit, Respondent checked the lymph nodes in A.S.'s groin area. When A.S. asked him what he was doing, Respondent explained that persons with HIV will sometimes have swollen lymph nodes. He also explained that she had lymph nodes under her arms and showed her where they were. During this activity, Respondent saw evidence that A.S. was wearing a tampon. He got up and sat down on the end of a weight-lifting bench which was in the room. A.S. also sat up. She asked him about a riding crop and bull whip that were in the room. He told her they were from a previous girlfriend. Thereafter, Respondent attempted to insert his penis in A.S.'s mouth. A.S. became resistive and told Respondent that they should not be doing this. Respondent did not take her seriously, and when he would not stop, A.S. bit his penis. Respondent pulled A.S.'s hair and told her to let go of his penis. When A.S. quit biting Respondent he became very angry. He threw A.S. down on the floor, and bit her on the neck leaving the imprint of his teeth. A.S. then pulled Respondent's hair. A struggle ensued in which A.S. received bruises to her neck, face, breasts, and abdomen. When the struggle was over, Respondent went into the living room. A.S. got dressed and when she entered the living room, she threw the Respondent's watch at him. He, in turn, gave her the medical form and told her to leave. A.S. left Respondent's home with her little dog. She went straight to Ms. Williamson's house. Before A.S. arrived at her cousin's house, Respondent called Ms. Williamson and asked her to tell A.S. that if she still needed her physical for Australia to give him a call. When A.S. arrived at Ms. Williamson's house, A.S. appeared upset. She eventually told her cousin what had happened. A.S. was crying and was sick to her stomach. Ms. Williamson saw bruises on A.S. that had not existed before her visit to Respondent's home. Ms. Williamson took A.S. to Mr. McNutt's apartment. From there A.S. went to the Tallahassee Police Station. As a result of Respondent's conduct on September 9, 1995, the Professional Recovery Network requested that he undergo a psychiatric examination in January of 1996. The examination revealed that Respondent has a personality disorder. A personality disorder is an enduring personality trait that causes dysfunction. A diagnosis of "personality disorder not otherwise specified" applies when a person has several enduring personality traits which cause problems but no single trait stands out as being prominent. Respondent suffers from "personality disorder not otherwise specified" with narcissistic, obsessive-compulsive, antisocial, and paranoid personality traits (DSM-IV, 301.9). These personality traits in Respondent are chronic and indicative of chronic maladjustment. Respondent shows his narcissistic personality traits by exhibiting a sense of entitlement, a lack of empathy, interpersonal exploitation for personal gratification, and arrogance. Respondent is a perfectionist who is inflexible and rigid. These are obsessive-compulsive personality traits. Respondent is impulsive. He is irritable and aggressive when he does not get his way. These are antisocial personality traits. Respondent's paranoid personality traits are evidenced by suspicions that others are exploiting, harming, or deceiving him. He sees that world as a threatening place. He perceives attacks on his character or reputation that are not apparent to others and reacts angrily. Respondent tends to distance himself from others because of his lack of ability to trust. He reads hidden, demeaning, or threatening messages into benign remarks or events. Respondent's personality disorder is responsible for: his chronic interpersonal difficulties; his fear of loss of control; his baseline anger and irritability; his over-reactivity; his sensitivity to criticism, his mild anxiety and depression; his difficulty in trusting others; and his defensive distancing of himself from other in a narcissistic fashion. Respondent's personality disturbance also explains his tendencies to impulsively act out in a physical or verbal manner, particularly under periods of stress. Because Respondent cares about how he appears to others, he is likely to be remorseful after an impulsive incident. Professional boundaries are the psychological and physical rules that protect not only the professional relationship but also the patient who is in a position of vulnerability due to the imbalance of power between doctor and patient. In this case, Respondent blurred the boundaries between his role as a physician and his role as a biological being when he agreed to perform a physical examination as doctor in his home on a female with whom he was intending to have sexual relations. Regardless of the mixed messages that A.S. may have been sending, Respondent crossed the professional boundary after A.S. arrived at his home. His conduct from that point on was below the level of care, skill and treatment which is recognized by reasonably prudent neurologists as being acceptable under similar conditions and circumstances. He completely failed to recognize the need for a clear boundary between his doctor/patient relationship with A.S. and his desire for personal gratification. There is clear and convincing evidence that Respondent violated the standard of care when he: (1) drank alcohol with a patient during an appointment for a physical examination; (2) participated in consensual or non- consensual sexual activities with a patient during an appointment for a physical examination; and (3) offered to remove his clothing during an appointment for a physical examination. Respondent is guilty of sexual misconduct because he used his physician-patient relationship with A.S. to engage her in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment. Respondent is guilty of exercising influence within a patient- physician relationship for purposes of engaging a patient in sexual activity. Respondent's personality disorder impairs his ability to practice medicine with reasonable skill and safety. Until Respondent receives appropriate treatment for his personality disorder, he should not be allowed to return to an unrestricted practice.
Recommendation Based upon the findings of fact and the conclusions of law, it is, recommended that Petitioner enter a Final Order finding Respondent guilty of all offenses as charged in the Amended Administrative Complaint and revoking his license to practice medicine. DONE and ENTERED this 13th day of August, 1996, in Tallahassee, Leon County, Florida. SUZANNE F. HOOD, Hearing Officer Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 13th day of August, 1996.
