The Issue Whether Respondent violated a rule of the Board of Medicine or the Department by advertising in a deceptive or misleading manner, thereby violating a provision of Chapter 458, Florida Statutes, which makes a licensee subject to disciplinary action if found guilty of violating a rule of the Board or Department.
Findings Of Fact Respondent has been licensed as a physician by the Florida Board of Medicine since 1976 and holds license number ME0026906. He has completed a residency program in his speciality of orthopedics but has not been Board certified in this speciality by a member board of the American Board of Medical Specialists. Respondent identifies himself as a diplomate of the Academy of Neurological and Orthopedic Surgeons on letterhead on correspondence mailed from his office. He has been so designated by this Academy since 1980. Respondent also identified himself as a diplomate of the Academy of Neurological and Orthopedic Surgeons on various correspondence disseminated to Associated Insurance Brokers Claims Management in regard to patient E.S. Although Respondent contends that he did not intend his identification on his letterhead as a diplomate to be advertising, he did acknowledge that such designation enhances his stature as an orthopedic surgeon. Many insurance carriers approve for payment higher patient charges assessed by various specialists. Respondent testified that in order to be designated as a diplomate of the American Academy of Neurological and Orthopedic Surgeons he had to pass a rigorous examination; however, no evidence was submitted from which a comparison could be made between this designation and a similar designation from a Board approved by the American Board of Medical Specialists (ABMS). The American Academy of Neurological and Orthopedic Surgeons is not now and never has been a member of the American Board of Medical Specialties. Nor has it ever pertitioned the Florida Board of Medicine for recognition as a speciality board. The American Federation of Medical Accreditation, which recognizes the American Academy of Neurological and Orthopedic Surgeons, has never been a member board of the American Board of Medical Specialists; nor has the Federation ever petitioned the Florida Board of Medicine for approval as a recognizing agency for medical specialties.
Recommendation Based on the foregoing, it is, hereby, RECOMMENDED: That a final order be entered finding Edward Neil Feldman guilty of violation of Sections 458.331(1)(d) and (x), Florida Statutes; and that he be given an official reprimand and fined $2,000.00. DONE AND RECOMMENDED this 20th day of December, 1993, in Tallahassee, Leon County, Florida. K. N. AYERS 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 Hearing this 20th day of December, 1993. APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-3804 Proposed findings submitted by Petitioner are accepted. Proposed findings submitted by Respondent are accepted except as noted below: Accepted as testimony of Dr. Feldman. However, no evidence was submitted comparing this test to the test given by a speciality board approved by the ABMS. Second sentence rejected. By stating he is a diplomate, Respondent implies certain recognition. Rejected as irrelevant. Rejected as irrelevant. Rejected as irrelevant. Rejected as irrelevant. Rejected. See Hearing Officer #5 and #6. See Hearing Officer #5 and #6. Rejected as irrelevant. 15. Respondent's attempt to equate the notice on letterhead that Respondent was a diplomate to an entry in a curriculum vitae (c.v.) is misplaced. A c.v. is similar to a professional life history and is totally inapt for advertising. The same cannot be said when the achievement is placed on a letterhead. 18. Rejected. COPIES FURNISHED: Britt Thomas, Esquire Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Thomas Saieva, Esquire SAIEVA & WALSH, P.A. 800 West DeLeon Street Tampa, Florida 33606-2722 Jack McRay, Acting General Counsel Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Dr. Marm Harris, Executive Director Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792
Findings Of Fact On November 12, 1981, Cindy Patton (Brown) (Romines) (hereinafter called Cindy) went to the Manatee Dental Center to have a filling that had fallen out replaced. At this time Respondents Greenberg, Schmidt, and Hutchinson owned the clinic; Respondents Quirk, Esclangon, and Shawn were salaried employees of the clinic; and all were licensed by Petitioner as dentists of Florida. Upon arrival at the clinic, Cindy was referred to Respondent Quirk, who examined her and concluded that tooth No. 19 could not be repaired by simply filling the cavity, but that root canal therapy (RCT) followed by a crown was required. He so advised Cindy, who responded that she was not prepared to pay for the RCT at that time. Quirk agreed to commence the RCT and have Cindy return when she was ready to have the work completed. Quirk opened the tooth and located three canals which he reamed out to 40 mm. Medication was placed in the opening, the opening was temporarily sealed and Cindy was discharged to return at a later date. Four days later, on November 16, 1983, a small part of the temporary filling fell out and Cindy returned to the clinic to have the RCT completed and crowned. Upon her arrival she was assigned to Respondent Esclangon, who completed the RCT. For reasons not fully explained at the hearing, this RCT was not successful although Esclangon worked on Cindy several hours before closing the hole. The same afternoon Cindy returned to the clinic in considerable pain and was again treated by Esclangon, who reopened the cavity, rereamed the canal, and resealed the tooth. He made notations on Exhibit 1 that patient was due back the following day, 11/17/81. Upon her return on November 17, Cindy, who was nervous, upset, and in pain, was referred to Respondent Shawn, who examined her and concluded the RCT was a "failed" one and the only solution was to extract tooth No. 19 and replace it with a partial bridge. Since the failure of the RCT was responsible for the extraction and bridge, Respondent Shawn advised Cindy that there would be no additional charge (over the cost of the RCT and crown) for the extraction and bridge. On November 17, 1981, after anesthesizing the area, Shawn extracted tooth No. 19, prepared teeth 18 and 20 for the bridge, immediately took impressions to have a permanent partial bridge constructed, fabricated a temporary bridge, and placed the temporary bridge in Cindy's mouth. At this time Cindy's mouth was still anesthesized, her gums were swollen and sore from the "failed" RCT and extraction, and, when the temporary bridge was -installed, she was not capable of enough sensation in the mouth to say the bridge fit or not. Shawn testified he used articulating paper to check the occlusion and it appeared all right. Cindy was rescheduled to return for the permanent bridge to be installed on November 27, 1981. On November 18 Cindy was called to reschedule her appointment to December 1. On November 17 Cindy returned to the clinic complaining of soreness and that the temporary bridge was digging into her gums. She was seen on this visit by Respondent Hutchinson, who prescribed she rinse frequently with a warm solution one-half saline and one-half peroxide, and he gave her a prescription for Percodan. Although Cindy testified she did not return to the clinic again despite her mouth not improving, Exhibit 1 indicates she went to the clinic on November 25, 1981, to pick up the X-rays taken of her mouth. On November 25, 1981, Cindy went to see Dr. Steinberg complaining of discomfort and exhibiting swollen gums and pain when biting on the bridge. Steinberg checked the temporary bridge, found the occlusion too high, and filed it down. He also found the temporary bridge poorly contoured and unpolished. He recontoured the temporary bridge and polished it. While the bridge was out he examined the jaw where tooth No. 19 had been extracted and found a dry socket which he treated and corrected. Immediately after the dry socket was treated and the temporary bridge adjusted, Cindy's discomfort was alleviated. Dry sockets, when they occur, usually appear within three to four days after a tooth is extracted. Shawn saw Cindy only on November 17, when he extracted the tooth and performed the other work noted above. In explanation of his decision to take the impression for the permanent bridge immediately after the tooth was extracted and while the gum was inflamed, Respondent Shawn testified the reason for departing from the normal practice of taking an impression several days after an extraction, which will allow the gums to shrink to a more stable state and to heal, was to "better serve her." Cindy had been through an arduous but unsuccessful RCT the previous day, was tense, upset, and had a sore mouth. Respondent Shawn further testified the technique used is described in the textbook by Tylman as a technique for fabricating immediate permanent replacement dentures. However, excerpts from Tylman produced at the hearing indicate this technique calls for taking the impression before the tooth is extracted, is generally used where anterior teeth are involved with the cosmetic effect more important than where posterior teeth are involved, and where no secondary infection exists. Cindy had been prescribed penicillin the previous day either for an infection she may have had or to inhibit an infection from starting as the result of the dental work. The patient records of Manatee Dental Center identify the dentists working on the patient by a numerical code. Dentists and the number identifying each dentist are listed in Exhibit 3. No specific notation is made on the patient's record that "Dr. " is the dentist of record, yet these records identify each dentist who performs work on the patient. William Kimball went to the Manatee Dental Center on June 18, 1982, complaining of a toothache. He was referred to Respondent Epps, who extracted tooth No. 18. Epps prescribed penicillin and noted patient "needs teeth cleaned and scaled." Kimball did not have the prescription for penicillin filled. He returned to the clinic on June 25, was referred to Respondent Esclangon, and complained of soreness in the area of the extraction, of inability to open his mouth, and of difficulty in swallowing. He was advised to take penicillin for the infection that was developing and was given another prescription for penicillin. Kimball returned to the clinic on June 28 and was referred to Respondent Epps. He was still complaining of pain in the area of the extraction and had difficulty opening his mouth and swallowing. Epps made an adjustment of the occlusion to correct an overbite and prescribed Demerol for the pain. That prescription was filled June 28. On June 30 Kimball returned to the clinic still complaining of pain and was referred to Respondent Shawn. Upon examination Shawn observed (Exhibit 2) that Kimball could barely open his mouth, the side of his face was swollen, and his throat was sore. Shawn recorded "Pt. had pterygoid mandibular infection." Kimball was told to drink a lot of liquids and return on Friday (July 2). When he returned July 2, 1982, Kimball's condition had not improved. He was again seen by Shawn, who lanced the gum in the vicinity of the extraction but only a little pus drained out. Kimball was told to stay on his medication and was given prescriptions for Keflex and Percodan. By July 3 (Saturday) Kimball was in such bad shape that he had to be driven to the clinic by his brother. He could not open his mouth or swallow and exhibited evidence of a massive infection in his mouth. He was examined by a dentist on duty, Dr. Cole, who sent him to an oral surgeon as an emergency patient. This oral surgeon, Dr. Kropp, was reached on his paging service and had Kimball sent to his office. Upon arrival Kropp found a very ill patient who could not open his mouth and had difficulty swallowing and breathing. Kropp concluded the situation was acute and he lanced the jaw and removed an estimated 150 cc. of very foul-smelling purulent solution. The pain immediately subsided and the other symptoms of swelling, difficulty breathing, and swallowing, moderated. By the time Kimball was referred to Kropp on July 3, 1982, the infection had spread to the parapharyngeal space and Kropp feared it would spread to the media thynum. Pus in that area could prove fatal. Kropp described Kimball on July 3 as moribund, indicating a very ill patient. When Kropp lanced the abscess he lanced in a completely different area than was lanced by Shawn. Infection in the parapharyngeal space will cause the patient difficulty in swallowing. Kropp opined the treatment given Kimball up through June 30 was proper, but the results from the July 2 treatment demonstrated a little incompetence and a little bad luck. Kropp acknowledged it was very rare to have an infection in the submandibular space and Kimball's infection had spread from the submandibular space to the parapharyngeal space where it had become life-threatening. Respondent's expert witness, Richard M. Rose, M.D., who specializes in respiratory infections, reviewed the X-rays and dental records of Kimball, and listened to the testimony respecting Kimball's diagnosis and treatment. Among his conclusions is that Kimball is a poor host for infections and is not as likely to respond to treatment for these infections as are most people. He opined that from the information available on June 30, the infection was not ready for drainage and could only be treated with antibiotics and hot soaks to increase blood flow and localize the infection; on July 2 there was some indication the infection was localized and surgical drainage was the primary treatment for infection; the dramatic change in Kimball's condition between July 2 and July 3 simply means the infection had progressed to the next stage and not necessarily that the infection was worse; and that the treatment rendered on July 2 was proper for the symptoms presented.
The Issue The central issue in this case is whether Richard Koenig, D.P.M., should be licensed as a podiatrist in the State of Florida. More specifically, this case must determine these issues: whether Richard Koenig, D.P.M., has practiced podiatry in the past at an acceptable standard of care as required by Section 461.013(1)(s), Florida Statutes; whether he fraudulently misrepresented material facts on his application for licensure as a podiatrist in violation of Section 461.013(1)(a), Florida Statutes; and whether his application to become licensed as a podiatrist is barred on grounds of administrative res judicata because of the Board of Podiatry's denial of his application in 1994-1995.
Findings Of Fact Dr. Koenig is an applicant for licensure as a podiatrist in the State of Florida. He is presently licensed to practice podiatry in the State of Missouri and was previously licensed in Illinois and Florida. Both of the latter licenses have expired. Dr. Koenig meets all criteria for licensure in Florida other than the grounds for denial cited by the Board in its Notice of Intent to Deny and described in the Statement of the Issues, above. The Board is responsible for certifying individuals who are qualified to become licensed as podiatrists and the Department of Health is responsible for issuing the licenses after the Board's certification. Dr. Koenig permitted his Florida license to lapse while he practiced in Missouri. He initially sought to be licensed again in this state in 1994. At that time, his application to sit for the examination, and thereafter to be licensed, was denied by the Board. Dr. Koenig requested a hearing on the denial before the Division of Administrative Hearings (DOAH) and a case was opened as DOAH Case No. 95-0570. Dr. Koenig later dismissed his petition and the DOAH file was closed. The earlier denial thus became final. Dr. Koenig reapplied for licensure in 1997. It is this application which is the subject of the instant proceeding. Dr. Koenig has already taken and passed the national podiatric licensure examination in Louisiana in 1997, thus meeting the examination requirement. Dr. Koenig was involved in approximately eleven podiatric malpractice cases during his practice in Missouri in the 1980's and early 1990's. Eight of the cases were settled by his insurance carrier. Three additional cases were pending at the time of Dr. Koenig's initial application in 1994. Of these three, Dr. Koenig prevailed at trial in two cases. The third case has been voluntarily dismissed by the plaintiff and has not been refiled. Dr. Koenig has not been engaged in the practice of podiatry as his primary professional activity since 1993-1994. He occasionally provides podiatric services as part of his commitment to the U.S. Navy, but he has primarily been engaged in developing and marketing two devices for use in podiatric and related services and has been teaching. Dr. Koenig received and reviewed the 1994 Board Notice of Intent to Deny Application for Examination and Licensure prior to filing his 1997 licensure application. In addition, he was aware that he had dismissed his petition to review that decision and the Board's decision was thus final. Nevertheless when called upon to state in the 1997 application whether he had ever been denied licensure as a podiatrist, Dr. Koenig answered "No." (Petitioner's Exhibit No. 1) This answer was false. Question five of the application for podiatry licensure reads: "Has any podiatry license held by you ever been acted upon, suspended or revoked, or have you ever been denied licensure?" Dr. Koenig's explanation concerning his negative answer to this question was that he thought he was being denied the right to take the examination, which was a condition required before he could be licensed. His understanding is supported by a reading of the minutes of the Board meeting at which the decision was made: "Dr. Simmonds moved to deny Dr. Koenig from taking the examination based on not having the ability to practice Podiatric Medicine at a level of care and safety." (Petitioner's Exhibit No. 1) However, the Board sent, and Dr. Koenig received, a Notice of Intent to Deny Application for Examination and Licensure. While that document plainly states that he was both being denied the right to take the examination and the right to be licensed, he did not focus on the second point--the right to be licensed. Dr. Koenig offered his explanation to the Board at its meeting on July 25, 1997, and when asked about the application question, he stated, "Because it is a misunderstanding. I make a differentiation between being denied a license and being denied the opportunity to sit for a license, and I may be wrong, and I stand corrected if I am, but that's what my intention was." (Petitioner's Exhibit No. 1, Transcript pp. 21-22). He understood that the Board was denying him the right to take the examination, an essential element of his application process. Dr. Koenig's explanation has been consistent throughout this proceeding, both before the Board and in the formal hearing. Although Dr. Koenig did answer the question incorrectly, his explanation that he did so without any fraudulent intent is entirely credible. Had there been an intent to defraud the Board regarding his application, Dr. Koenig might have avoided disclosing the malpractice suits which resulted in the Board's earlier decision to deny him licensure. Those malpractice suits are no longer an appropriate basis to deny licensure. Dr. Koenig is a Board-certified podiatrist and is a Fellow of the American College of Foot and Ankle Surgeons. One becomes Board-certified by taking an examination, by meeting practice requirements, and by submitting a number of medical cases to the Board for evaluation. Only about 10 percent of all podiatrists are Board-certified. Dr. Koenig's specialty is foot surgery and he has operated more often than a podiatrist in standard practice. Dr. Koenig has written several articles in peer- reviewed journals, and has spoken widely in the United States and elsewhere at various continuing medical education seminars. A frequent topic of his speeches involves the use of an implant which he developed to replace the big toe joint. This implant is patented, approved as a safe device by the FDA, and is covered by Medicare and Medicaid. Dr. Koenig has developed and marketed a special shoe for patients who have had foot surgery. There have been no Medicare or Medicaid complaints brought against Dr. Koenig and he maintains Medicare and Medicaid provided numbers. The two lawsuits which went to a jury verdict were decided in his favor and there are no lawsuits pending now. The multiple claims of malpractice occurred when he was actively engaged in foot surgery practice in Missouri. His insurance carrier, without consulting him, settled those claims. After he changed carriers and contested the claims, he has prevailed. The Board in this proceeding presented no evidence that Dr. Koenig has practiced below the standard of care. Nor did it refute his credible testimony.
Recommendation Based on the foregoing, it is hereby RECOMMENDED: that a Final Order be entered granting Dr. Koenig's license to practice podiatry in the State of Florida. DONE AND ENTERED this 24th day of April, 1998, in Tallahassee, Leon County, Florida. MARY CLARK Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 24th day of April, 1998. COPIES FURNISHED: John J. Rimes, III Office of Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050 Eric B. Tilton Gustafson, Tilton, Henning & Metzger, P.A. Suite 200 204 South Monroe Street Tallahassee, Florida 32301 Angela T. Hall, Agency Clerk Department of Health Building 6 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 Eric G. Walker, Executive Director Board of Podiatry Department of Health 1940 North Monroe Street Tallahassee, Florida 32399-0792
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency issued the attached Administrative Complaint to the Respondent to revoke its health care clinic license due to Respondent’s principal being ineligible for licensure or exemption from disqualification from licensure pursuant to Section 435.07, F.S.. (Ex. 1) The Respondent filed a Petition for Formal Hearing and the case was referred to the Division of Administrative Hearings. During the proceedings, the Agency filed a Motion to Relinquish Jurisdiction based upon the lack of any material facts in dispute. In response, the Administrative Law Judge issued an Order to Show Cause to Respondent, followed by an Order Closing File and Relinquishing Jurisdiction stating that the Agency was authorized to enter a Final Order against the Respondent. (Ex. 2) Based upon the foregoing, it is ORDERED: 2. The Administrative Complaint is UPHELD and the Respondent’s health care clinic license is REVOKED. 3. In accordance with Florida law, the Respondent is responsible for retaining and appropriately distributing all client records within the timeframes prescribed in the authorizing statutes and applicable administrative code provisions. The Respondent is advised of Section 408.810, Florida Statutes. 4. In accordance with Florida law, the Respondent is responsible for any refunds that may have to be made to the clients. 5. The Respondent is given notice of Florida law regarding unlicensed activity. The Respondent is advised of Section 408.804 and Section 408.812, Florida Statutes. The Respondent should also consult the applicable authorizing statutes and administrative code provisions. The Respondent is notified that the cancellation of an Agency license may have ramifications potentially affecting accrediting, third party billing including but not limited to the Florida Medicaid program, and private contracts. 1 Filed July 23, 2013 10:20 AM Division of Administrative Hearings ORDERED at Tallahassee, Florida, on this 727 ~day of key , 2013. Elizabeth Dudek, Secretary Agency for Hegith Care Administration NOTICE OF RIGHT TO JUDICIAL REVIEW. A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and this 2 7A of this Final Order_was | was served on the below-named persons by the method designated on this ~ Jad a, » 2013. Richard Shoop, Agency Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Facilities Intake Unit Agency for Health Care Administration (Electronic Mail) Thomas Jones, Unit Manager Health Care Clinic Unit Agency for Health Care Administration (Electronic Mail) Finance & Accounting Revenue Management Unit Agency for Health Care Administration (Electronic Mail) Robert Dickson, Field Office Manager Local Field Office Agency for Health Care Administration (Electronic Mail) Katrina Derico-Harris Medicaid Accounts Receivable Agency for Health Care Administration (Electronic Mail) Warren J. Bird, Senior Attorney Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Shawn McCauley Harry Vassilakis, Registered Agent Medicaid Contract Management All Care Chiropractic & Wellness, Inc. Agency for Health Care Administration 505 Deltona Boulevard, Suite #103 (Electronic Mail) Deltona Florida 32725 (U.S. Mail) E. Gary Early Harry Vassilakis, Unit Manager Administrative Law Judge All Care Chiropractic & Wellness, Inc. Division of Administrative Hearings 807 Beville Road (Electronic Mail) South Daytona, Florida 32119 (U.S. Mail) NOTICE OF FLORIDA LAW 408.804 License required; display.-- (1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. (2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued. 408.812 Unlicensed activity. -- (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency.
The Issue The following issues of fact were considered: Did the Respondent aid, assist, procure, or advise an unlicensed person to practice medicine? Did the Respondent delegate professional responsibilities to persons when he knew or had reason to know that said persons were not qualified by licensure to perform them? Did the Respondent presign prescription forms? Both parties submitted posthearing findings of fact, which were read and considered. Those findings not incorporated herein are found to be either subordinate, cumulative, immaterial, unnecessary, or not supported by the evidence.
Findings Of Fact The Respondent, Albert P. Oteiza, is licensed to practice medicine and surgery in the State of Florida and has been so licensed at all times relating to the charges in the Administrative Complaint. The Respondent was president and director of the Union Latina Association, Inc. (the Association), located at 1313 Southwest First Street, Miami, Florida. The Respondent was paid by the Association, which provided medical services to patients who were members of the Association. The Respondent practiced at Clinical Union Latina (the Clinic), located at 1313 Southwest First Street, Miami, Florida, and was the medical director of the Clinic. The Respondent was not an officer or director of the Clinic. The president of the Clinic was Rigoberto Garcia, and the business manager was Christian Carmona. Florencio Sanchez-Lopez was employed as a physician's assistant at the Clinic by Christian Carmona, who assigned Sanchez-Lopez's duties. Sanchez-Lopez was not a licensed physician and was not a certified physician's assistant. Sanchez-Lopez admitted seeing and treating patients at the Clinic. Sanchez- Lopez saw those patients who were in serious condition in the presence of the Respondent. Those patients who were not in serious condition, Sanchez-Lopez saw without the Respondent being present, and Sanchez-Lopez prescribed treatment and medications for these patients. Sanchez-Lopez examined and prescribed medications and treatment for Ralph Nunez, an investigator for the Board of Medical Examiners, in the manner Sanchez-Lopez had admitted to examining and prescribing for other patients. Valerio Matta was employed as a physician's assistant at the Clinic by Carmona, who assigned Matta's general duties. Matta was not a licensed physician or a certified physician's assistant. Matta saw patients at the Clinic, examining them and prescribing medications and treatment for them without the presence of a licensed physician, as he did with Georgina Jorge, an investigator with the Department of Professional Regulation. Matta also admitted that he had performed minor surgery on patients, but only when the Respondent was present in the Clinic. Carlos Manuel Rodriguez-Murgia was employed as a physician's assistant at the Clinic by Carmona, who assigned Rodriguez-Murgia his general duties. Rodriguez-Murgia was not a licensed physician or certified physician's assistant. Rodriguez- Murgia saw patients at the Clinic, examining and prescribing medications and treatment for them without the presence of a licensed physician, as he did with Georgina Jorge, an investigator with the Department of Professional Regulation. The acts performed by Sanchez-Lopez, Matta, and Rodriguez-Murgia all constituted the practice of medicine. However, these acts did not exceed the acts which could have been performed by a physician's assistant. The Respondent was aware or should have been aware that Sanchez-Lopez, Matta, and Rodriguez-Murgia were engaged in seeing patients at the Clinic and performing acts which constituted the practice of medicine. Carmona was deceased at the time of the hearing. Garcia, president of the Clinic, outlined Carmona's duties. Carmona was responsible for having Sanchez-Lopez, Matta, and Rodriguez-Murgia certified as physician's assistants. All three men confirmed that Carmona represented to them they would be licensed and they were "legal" to perform their duties. Sanchez-Lopez, Matta, and Rodriguez-Murgia could not swear that it was the Respondent's signature on the prescriptions they used or that they had seen the Respondent sign the prescriptions. There were other licensed physicians who worked at the Clinic.
Recommendation Having found the Respondent guilty of three counts of violating Section 458.331(1)(w), Florida Statutes, as alleged in the Administrative Complaint, it is recommended that the Board of Medical Examiners suspend the license of the Respondent, Albert P. Oteiza, for a period of 12 months and assess a civil penalty against him of 3,000. DONE and RECOMMENDED this 17th day of October, 1983, in Tallahassee, Leon County, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 17th day of October, 1983. COPIES FURNISHED: Joseph W. Lawrence, II, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Blas E. Padrino, Esquire 2355 Salzedo, Suite 309 Coral Gables, Florida 33134 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Dorothy Faircloth, Executive Director Board of Medical Examiners 130 North Monroe Street Tallahassee, Florida 32301 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS DEPARTMENT OF PROFESSIONAL REGULATION Petitioner, vs. Case No. 83-122 ALBERT P. OTEIZA, M.D., License No. 20879 Respondent. /
