The Issue An amended administrative complaint, dated July 31, 1989, alleges various violations of Chapter 459, F.S., by Respondent. Counts V, VI and VII, relating to Respondent's treatment of patient, R.C., were voluntarily dismissed by Petitioner at the commencement of the hearing. The following allegations are left at issue: That Respondent violated Section 459.015(1)(u), and (y), F.S., by prescribing Percodan and Ritalin, controlled substances, to his wife, G.I., inappropriately or in excessive quantities. That in the treatment of his wife, Respondent failed to practice osteopathic medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar osteopathic physician as being acceptable under similar conditions and circumstances, in violation of Section 459.015(1)(y), F.S. That Respondent violated Section 459.015(1)(p), F.S., by failing to keep medical records justifying the course of treatment of G.I.; and that of his mother, M.I., for whom he prescribed Demerol.
Findings Of Fact Respondent, Donald Iafornaro, D.O., is and has been at all times material to the allegations of the amended administrative complaint, a licensed physician in the State of Florida, with license number OS 0001794. Dr. Iafornaro has a limited osteopathic practice which he conducts from his home at 1802 North Lakemont, Winter Park, Florida. He has about fifty patients, and also treats his large family, including his wife, mother, eleven children and grandchildren. G.I. has been a patient of Dr. Iafornaro for approximately 25 years -- since 1973, as his wife, and prior to that, from 1964, along with the rest of her family in Cleveland, Ohio. Mrs. Iafornaro has had a demanding job caring for the Iafornaro children, her mother-in-law, the house and pets, and has recently been her husband's only staff in his practice. Between May 1985, and April 1987, her husband treated her for a variety of medical problems, including severe allergies, sleep apnea (a mechanical difficulty in breathing during deep sleep), depression, fatigue, a chronic fracture of the foot bone (a fracture which failed to heal), spinal stenosis, an unstable hip, ulcers, angina and various gynecological complaints Between May 1, 1985, and April 11, 1987, Dr. Iafornaro prescribed the following drugs, among others, to his wife: 2,720 tablets of Percodan 900 tablets of Ritalin Percodan is the product name for oxycodone hydrochloride, and Ritalin is the product name for methylphenidate hydrochloride. Both are Schedule II controlled substances and are legend drugs as defined in Section 465.003(7), F.S. With the concurrence of the parties, official recognition was taken of the Physician's Desk Reference (PDR) for the years 1984-1987. Petitioner also presented the testimony of two osteopathic physicians practicing in Dr. Iafornaro's community. The evidence from these authorities established that the prescriptions of Percodan and Ritalin for G.I. were inappropriate or in excessive quantities. Dr. Iafornaro felt that Ritalin was necessary to counteract the sedative effect of the antihistamines his wife had to take for her many allergies. He also prescribed the Ritalin for her depression. Ritalin is a mild central nervous system stimulant. It is indicated for attention deficit disorders (primarily in children) and narcolepsy. It should not be used for severe depression or for the prevention or treatment of normal fatigue. The PDR warns of drug dependence. Ritalin is also contraindicated in patients, such as G.I., who have exhibited anxiety, tension, depression and agitation. Ritalin may cause reactions such as skin rashes, a common complaint of this patient, but a problem which Dr. Iafornaro attributed to her multiple allergies. The Percodan was prescribed by Dr. Iafornaro for his wife's pain in her foot and for other pain in her low back and in her wrist. The PDR warns that Percodan may be habit forming. It contains aspirin, which can aggravate ulcers. It is indicated for relief of moderate to moderately severe pain; it is a depressant; it can cause apnea and respiratory depression in an overdose. Mrs. Iafornaro's statement that she used only about a half a tablet a day is inconsistent with the volume of the drugs prescribed for her over the relevant period. Dr. Iafornaro produced all of his medical records for G.I. for the relevant period. He claims they are incomplete because he also makes notes on odds and ends, writes on the back of a medical journal and keeps a lot of records in his head. (Iafornaro Deposition, p.15) The medical records produced by Dr. Iafornaro do not justify his course of treatment,for this patient, and particularly fail to explain the long-term volume of drugs that he was prescribing. Dr. Iafornaro claims that the probable cause panel previously reviewed his records and found them acceptable. The records were produced in response to charges that he had violated certain terms of an earlier disciplinary action. The issue was resolved with a "no probable cause" finding. That finding, in 1983, was for a different time period than the period at issue in this proceeding. Dr. Iafornaro provided records to the panel covering a limited period in 1983 when he was treating his wife for her foot fracture, a slip and fall accident and other acute conditions. The 1983 records, in contrast to those at issue here, describe the condition and his treatment. The later records provide copious listings of a variety of prescriptions, including the Percodan and Ritalin, with scant examination results, explanation of the condition being treated, or diagnoses of the complaints. Complete written medical records are an essential element of prudent osteopathic practice, particularly when, as here, the physician is treating his family and his objectivity may be questioned. Between January 5, 1987, and March 1, 1987, Dr. Iafornaro prescribed 200 50 mg Demerol tablets to his 84 year old mother, M.I. Demerol is a product name for meperidine hydrocloride, a Schedule II controlled substance, and a legend drug as defined in Section 465.003(7), F.S. The basis for the prescriptions was an episode of right upper quadrant pain felt to be of gallbladder origin. It is cheaper to purchase Demerol tablets by the 100. After M.I. took a few of the first prescription of 100, she lost the bottle and Dr. Iafornaro replaced it with another prescription. The medical records make no mention of the lost prescription, but they marginally justify the use of this drug for the limited period in issue and for the purpose intended. A previous disciplinary case involving allegations of Dr. Iafornaro's improper prescriptions and record-keeping practices was resolved with a stipulation for his one-year probation with conditions. The stipulation was approved by the Board of Osteopathic Medical Examiners in a Final Order entered on December 28, 1982. (DPR Cases #0010979, 0014467, and 0015303)
Recommendation Based on the foregoing, it is hereby, RECOMMENDED That the Department of Professional Regulation, Board of Osteopathic Medical Examiners enter a Final Order which finds Donald Iafornaro, D.O., guilty of having violated the provision of Subsection 459.015(i)(p), (u) and (y), F.S. and imposing the following penalties: Suspension of license for 90 days and until such time as he appears before the Board of Osteopathic Medical Examiners and establishes that he has taken and passed the examination conducted by the National Board of Examiners for Osteopathic Physicians and Surgeons or the Special Purpose Examination (SPEX) of the Federation of State Medical Boards, as designated by the Board of Osteopathic Medical Examiners in its final order; Upon reinstatement that his license be placed on probation for two years subject to such terms and conditions deemed appropriate by the Board, including, but not limited to, restriction of practice, direct or indirect supervision of practice or prescribing of controlled substances and required additional continuing education; That he be permanently restricted from prescribing controlled substances to family members, unless under direct supervision of another osteopathic physician; That a reprimand be imposed; That a fine of $2,000. be imposed. DONE AND RECOMMENDED this 23rd day of February, 1990, in Tallahassee, Leon County, Florida. MARY CLARK 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 23rd day of February, 1990. APPENDIX TO THE RECOMMENDED ORDER IN CASE NO. 88-5277 The following constitute specific rulings on the findings of fact proposed by the parties. Petitioner's Proposed Findings Rejected as unnecessary. Adopted in paragraph 1. 3.-5. Adopted in paragraph 5. Adopted in paragraphs 6, 8 and 10. Some blood pressure monitoring is found in the records however. Adopted in paragraph 6. Adopted as a conclusion of law and in paragraph 6. Adopted in paragraph 12. Adopted in paragraph 15. Adopted in paragraph 16. Rejected as contrary to the weight of evidence. Adopted in substance in paragraph 19. Respondent's Proposed Findings Rejected as unnecessary. Adopted in paragraph l. Adopted in part in paragraphs 7-10, otherwise rejected as unnecessary. 4.-6. Rejected as contrary to the weight of evidence. 7.&8. Adopted in paragraphs 15, 17 and 18. 9. Rejected as immaterial. COPIES FURNISHED: Bruce D. Lamb, Esquire Dept. of Professional Regulation 730 S. Sterling Street Tampa, FL 33609 Sam Murrell, Jr., Esquire P.O. Box 1749 Orlando, FL 32802 Kenneth D. Easley, General Counsel Dept. of Professional Regulation 1940 N. Monroe St., Suite 60 Tallahassee, FL 32399-0792 Rod Presnell Executive Director Osteopathic Medical Examiners Dept. of Professional Regulation 1940 N. Monroe St., Suite 60 Tallahassee, FL 32399-0792
Findings Of Fact At all times relevant hereto Lawrence D. Urban was a licensed osteopathic physician in Florida having been issued license number OS 001232. From January 1983 through at least March 17, 1984, Respondent maintained offices in Clearwater and Zephyrhills. He practiced in the Clearwater office on Monday, Wednesday and Friday of each week and in the Zephyrhills office on Tuesday, Thursday and Saturday. Respondent employed Wendell Bloom to work in the Zephyrhills office as a business manager and assistant to Respondent. Bloom had no medically related license such as physician's assistant, nurse, technician, etc. As an assistant to Respondent, Bloom drew blood, performed vascular analyses, mixed IV solutions, and administered IV solutions. He worked at the Zephyrhills office Monday through Friday. Bloom had standing orders from Respondent that if a new patient came in Bloom would draw a blood sample, send it to the lab for analysis and make an appointment for the patient to see Respondent when the results of the blood analysis was received. Respondent described his practice in Zephyrhills as holistic, involving nutrition, chelation, and cancer therapy using laetril. Chelation treatment involves the intravenous injections of solutions containing EDTA (Ethylenadiaminetetracetic acid), vitamins, including B12, B complex and C, and the minerals, calcium and magnesium. On many occasions Bloom commenced IV chelation injections containing EDTA before Respondent arrived at the office and completed some of these after Respondent had left the office. On at least five (5) occasions Bloom injected patients with IV solutions containing EDTA without Respondent being present any time during the procedure. Drawing blood without a doctor present in the office constitutes the practice of medicine. Injecting IV solutions in patients constitutes the practice of medicine without a doctor present. In the Zephyrhills office Respondent referred to Bloom as Dr. Bloom in the presence of patients. No sign or disclaimer was posted in the office that Bloom had no prior medical training and was not licensed in any medically related health professional field in Florida. Respondent knew that patients might believe Bloom to be a medical doctor. In administering an IV solution to a patient there is always a danger of an allergic reaction or an anaphylactic reaction, even if a patient has previously tolerated the treatment. Respondent acknowledged that serious side affects would result to a patient receiving an IV solution containing EDTA if the patient suffered kidney failure. Bloom also operated the vascular analyzer machine in the office. As described by Bloom, by attaching clips from the machine to the fingers and toes the machine will tell you if there is any kind of clotting or obstruction any place within the cardiovascular system. Further, by putting transmission gel on the clip and holding it over an artery, transmissions from the clip with the return echo is transformed onto a chart which will denote the elasticity of the artery. This machine is not universally accepted in the medical profession. By Final Order entered August 26, 1983 (Exhibit 1) the Florida Board of Osteopathic Medical Examiners found Respondent guilty of filing false reports, fee splitting, and abetting an unlicensed person to practice osteopathic medicine. He was sentenced to a reprimand, placed on probation for six (6) months and directed to report to the Board at the end of the probationary period. If, at this time, Respondent's report on the status of his practice satisfies the Board that the financial aspects of his practice is in accordance with the law, the reprimand will be withdrawn. Terms and conditions of the probation were not delineated. Respondent appeared before the Board at its March 17, 1984 meeting. After Respondent reported that the financial aspects of his practice were poor, but in conformity with the law, one of the Board members inquired if Respondent was working with any non-osteopathic physicians in his practice, which was one of the accusations for which he was reprimanded and placed on probation. At this point Respondent told the Board that he had a helper who was a "non- anything" who was drawing blood, doing vascular analyses of patients, giving IVs to patients undergoing chelation therapy and whatever Respondent told him to do. (Exhibit 2) After hearing these disturbing facts the Board voted to extend the Respondent's probation while an investigation of his practice was conducted. The charges considered at this hearing were those resulting from that investigation.
The Issue Whether the Respondent committed the violations set forth in the Amended Administrative Complaint dated November 19, 1998, and, if so, the penalty which should be imposed.
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 Board of Osteopathic Medicine is the entity responsible for imposing discipline on those licensed in Florida as osteopathic physicians. Section 459.015(2), Florida Statutes. The Department of Health is the state agency responsible for investigating and prosecuting disciplinary cases in which a probable cause panel of the Board of Osteopathic Medicine has found probable cause to support the filing of a formal complaint against a licensee. Section 455.621(4), Florida Statutes. Christopher Wayne, D.O., was at the times material to this proceeding, and is currently, a licensed osteopathic physician in the State of Florida, specializing in family practice and certified by the American Osteopathic Board of Family Physicians. Dr. Wayne operated at the times material to this proceeding, and currently operates, a primary care medical practice under the name of Dr. Christopher Wayne, D.O., Incorporated ("Company"). At the times material to this proceeding, the Company's office was located on the fifth floor in a building adjacent to the Mount Sinai Medical Center in Miami Beach, Florida. At the times material to this proceeding, Dr. Wayne and the physicians employed in his practice had staff privileges at several hospitals and medical centers in the Dade County area. However, at the times material to this proceeding, Dr. Wayne did not have staff privileges at Parkway Regional Medical Center ("Parkway"). At least one physician employed by the Company, Agustin Andrade, had staff privileges at Parkway. Dr. Wayne began discussions with Agustin Andrade with respect to his possible employment by the Company as a family practice physician in or around June 1995. Dr. Andrade is a medical doctor who completed a three-year residency in internal medicine and a two-year fellowship in endocrinology at the University of Miami, in Miami, Florida; he is board-certified in internal medicine and endocrinology. Dr. Andrade was also a citizen of Ecuador at the times material to this proceeding. On July 7, 1995, Dr. Andrade signed an Employment Agreement with the Company, and he began working for the Company in October 1996. The delay was attributable to Dr. Andrade's need to obtain legal residency and authority to work in this country. He obtained legal residency and authorization to work in this country in June 1996, and he obtained his green card, representing the permanent right to stay in this country, in February 1997. As part of the process for obtaining a green card, Dr. Andarde completed a HUD J-1 Visa Waiver Policy Affidavit and Agreement in which he agreed to the following conditions: I understand and agree that in consideration for a waiver, . . . I shall render primary medical services to patients, including the indigent, for a minimum of forty (40) hours per week within a USPHS designated HPSA. Such service . . . shall continue for a period of at least two (2) years. I agree to incorporate all the terms of this HUD J-1 Visa Waiver Affidavit and Agreement into any and all employment agreements I enter pursuant to paragraph 3 and to include in each such agreement a liquidated damages clause, of not less than $250,000 payable to the employer. This damages clause shall be activated by my termination of employment, initiated by me for any reason, only if my termination occurs before fulfilling the minimum two year service agreement. Soon after he began working for the Company, Dr. Andrade's professional relationship with Dr. Wayne deteriorated rapidly for a variety of reasons. After two weeks, Dr. Andrade told Dr. Wayne that he wanted a raise because he had learned that the other physician employed by the Company at the time was paid a higher salary than he was paid. Dr. Andrade also accused Dr. Wayne of forcing him to engage in what Dr. Andrade termed "illegalities," of forcing him to see too many patients at too many different hospitals, and of requiring him to see pediatric patients, which he did not feel he was qualified to treat. On January 7, 1997, Dr. Wayne and Dr. Andrade were the only physicians employed by the Company. On the evening of January 7, 1997, medical orders were given by telephone for three of Dr. Andrade's patients hospitalized at Parkway. The physician order forms indicate that the person giving the orders was Dr. Andrade. Dr. Andrade denies giving these orders, and he subsequently refused to accept responsibility for the orders by declining to sign them. At around 8:00 p.m. on January 9, 1997, Dr. Andrade went to Parkway and spoke with the nurses in Parkway's surgical intensive care unit, specifically Ann Bravi, a registered nurse who has been employed at Parkway for twenty-eight years. Dr. Andrade told Nurse Bravi that someone was impersonating him and giving telephone orders for his patients. While Dr. Andrade was standing beside her, Nurse Bravi called Dr. Andrade's answering service regarding one of his patients. The call was returned by someone who identified himself to Nurse Bravi as Dr. Andrade and who told her that there would be "[n]o orders for now." Nurse Bravi cannot recall whether she telephoned the answering service at Dr. Andrade's request or on her own initiative, nor could she recall whether she called the answering service number noted on the patient's chart or called a number that Dr. Andrade gave her. On Friday, January 10, 1997, Dr. Andrade terminated his employment with the Company, accusing Dr. Wayne of having breached the Employment Agreement by impersonating him with the staff at Parkway and by giving telephone orders on Dr. Andrade's patients at Parkway. On Monday, January 13, 1997, Dr. Andrade was distributing business cards indicating that he was practicing medicine with another physician, whose offices were located on the first floor of the building in which the Company's office was located. The Company has sued Dr. Andrade for damages resulting from breach of contract, and Dr. Andrade has sued Dr. Wayne for defamation. At the time of the final hearing, both lawsuits were pending in the Circuit Court of the 11th Judicial Circuit in and for Dade County, Florida. If an osteopathic physician gives medical orders by telephone for a patient who is not his patient and who is hospitalized in a facility at which he does not have medical staff privileges, then that physician has acted in a manner inconsistent with ethics and the standard of care practiced by an osteopathic family physician. The osteopathic physician has further acted in a manner inconsistent with ethics and the standard of care practiced by an osteopathic family physician if that physician gives telephone orders using the name of another physician. The evidence presented by the Department is insufficient to establish with the requisite degree of certainty that Dr. Wayne gave telephone orders for any of Dr. Andrade's patients at the Parkway Regional Medical Center or that he identified himself as Dr. Andrade in telephone conversations with staff at the Parkway Regional Medical Center.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Osteopathic Medicine enter a final order dismissing the Amended Administrative Complaint against Christopher Wayne, D.O. DONE AND ENTERED this 28th day of October, 1999, 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 28th day of October, 1999.
The Issue The issues in this case are whether Respondent's license or authority to practice osteopathic medicine was acted against by the licensing authority of another jurisdiction, in violation of section 459.015(1)(b), Florida Statutes (2016)1; and, if so, what penalty should be imposed.
Findings Of Fact The Department is the state agency charged with regulating the practice of osteopathic medicine and prosecuting disciplinary actions on the Board's behalf, pursuant to section 20.43 and chapters 456 and 459, Florida Statutes. 2 Respondent's Exhibits A through D were also initially offered into evidence and admitted. However, during the hearing, the parties noted that Respondent's Exhibits A through D duplicated Petitioner's Exhibits A, B, J, and M, except that Petitioner's versions of these exhibits contained redactions. After the hearing, the parties filed a joint motion to allow Respondent to adopt Petitioner's Exhibits A, B, J, and M and withdraw Respondent's Exhibits A through D. The joint motion was granted. Accordingly, the record does not include Respondent's withdrawn Exhibits A through D. 3 By agreeing to an extended deadline of more than ten days after the filing of the transcript for filing PROs, the parties waived the 30-day time period for issuing the Recommended Order. See Fla. Admin. Code R. 28-106.216. Respondent is licensed to practice osteopathic medicine in Florida, having been issued license number OS 10315 on or about March 4, 2008. Although Respondent has been licensed to practice osteopathic medicine in Florida since 2008, including at all times relevant to the Complaint, he testified that he did not practice osteopathic medicine in Florida until sometime after December 14, 2016. Currently, Respondent does not hold any other active licenses to practice osteopathic medicine in other states. Previously, he held licenses in Ohio, Missouri, and Kansas. The factual allegation in the Complaint that is the predicate for the charge against Respondent is as follows: On or about December 14, 2016, the State Medical Board of Ohio issued an Entry of Order permanently revoking the license of Respondent to practice osteopathic medicine and surgery in the State of Ohio. (Complaint at 2, ¶ 5). The parties stipulated that the Ohio Board is the licensing authority of the practice of osteopathic medicine in the state of Ohio. The parties also stipulated to the following: On December 14, 2016, in case number 16-CRF- 0055 and in accordance with chapter 119, Ohio Revised Code, the State Medical Board of Ohio entered an order which permanently revoked Respondent's certificate to practice osteopathic medicine and surgery in Ohio. (Amended Jt. Pre- hrg. Stip. Part E (Stipulated Facts), ¶ 10). Respondent disputed the Complaint's allegation quoted above, notwithstanding the stipulations, based on the argument that the word "license" in the Complaint is different from the word "certificate" in the stipulation. Respondent attempted to argue that the "certificate" that was permanently revoked was not a form of authority to practice osteopathic medicine and surgery. Respondent offered various possibilities, such as that the permanently revoked "certificate" must have been the "training certificate" that he believed he was given in 2004 to participate in a training program before licensure, or that it was some other kind of "certificate." Respondent's argument is not credible, is inconsistent with the words following "certificate"—"to practice osteopathic medicine and surgery"—and is wholly unsupported by the evidence. Ohio Licensure History In late December 2003, Respondent applied for osteopathic medical licensure in Ohio via an application for a Certificate to Practice Osteopathic Medicine and Surgery (Ohio Application) submitted to the Ohio Board.4 The application was not deemed officially received for processing until January 29, 2004, because Respondent's initial submission was not accompanied by the required $335.00 fee and he did not pay the fee until January 29, 2004. See Pet. Ex. 1, Bates p. 28, 3, and 18. The Ohio Application form asked whether the applicant was, or intended to be, in an accredited training program in Ohio. Respondent answered that he intended to be in an accredited training program. He identified the training program as Doctor's Hospital/Anesthesiology in Columbus, Ohio, with a planned start date of June 30, 2004. On January 30, 2004, the Ohio Board sent Respondent its "Acknowledgement of Application for Certificate to Practice Medicine and Surgery or Osteopathic Medicine and Surgery" (Acknowledgement), notifying Respondent that his application for a certificate to practice osteopathic medicine and surgery was received by the Board on January 29, 2004. The Acknowledgement also notified Respondent that he was authorized to 4 Respondent's entire licensure file, certified as complete by the Ohio Board, is in evidence, with Bates page numbers added in red. It is apparent that the pages representing Respondent's application for licensure to practice osteopathic medicine and surgery are not in order, perhaps because his initial submission in late December 2003 was incomplete and supplemented with various revised answers and additional documentation between 2004 and early 2005. participate in the training program identified in his application: "Please be advised that you are hereby authorized to begin participation in the training program to which you have been appointed … while your application is being processed." (Pet. Ex. 1, Bates p. 18). Respondent claimed that the Acknowledgement notified him that he was granted a "training certificate" so he could participate in the residency program while his application for a license to practice osteopathic medicine and surgery was being processed. The Acknowledgement says no such thing. Respondent's argument to the contrary is rejected. No evidence was offered to prove that a training certificate was ever issued to Respondent. Respondent's "training certificate" argument was part of his broader attempt to argue that in Ohio, the terms "certificate" and "license" refer to distinct items, and that a "license" is the form of authority to practice osteopathic medicine and surgery. Here too, Respondent's argument is contradicted by the record evidence and by Ohio law. Beginning with Respondent's initial submission, date-stamped by the Ohio Board on December 23, 2003, it is clear that the specific phrase used to describe the form of authority to practice osteopathic medicine and surgery in Ohio was a "certificate to practice osteopathic medicine and surgery," although the umbrella term "license" was frequently used interchangeably with "certificate."5 The interchangeable use of "license" and "certificate," prefacing the phrase "to practice osteopathic medicine and surgery," is replete throughout Respondent's Ohio licensure file. The interchangeable use of these terms is evident perhaps nowhere more clearly than in the Ohio Board's form "Affidavit and Release of Applicant [-] Medicine or Osteopathic 5 Pursuant to the Ohio Administrative Procedure Act, just as under the Florida Administrative Procedure Act, "license" is an umbrella term defined to mean "any license, permit, certificate, commission, or charter issued by any agency." § 119.01(b), Ohio Rev. Code; compare § 120.52(10), Fla. Stat. (defining "license" as "a franchise, permit, certification, registration, charger, or similar form of authorization required by law[.]"). Medicine"6 executed by Respondent and submitted as part of the Ohio Application bearing the Ohio Board's "received" stamp dated December 26, 2003. By the executed affidavit, Respondent certified under oath: that I am the person named in this application for a license to practice medicine or osteopathic medicine in the State of Ohio … and that all documents, forms or copies thereof furnished or to be furnished with respect to my application are strictly true in every respect. … I further understand that the issuance of a certificate to practice medicine or osteopathic medicine in Ohio will be considered based on the truth of the statements and documents contained herein or to be furnished[.] (Pet. Ex. 1, Bates p. 26, emphasis added). Respondent's Ohio Application contained multiple deficiencies and required several rounds of requests for omitted information/documentation followed by submissions that attempted to respond to the requests. This process, documented in Respondent's complete Ohio licensure file in evidence, spanned from early 2004 through early 2005. On April 13, 2005, the Ohio Board gave Respondent notice that it intended to determine whether to refuse to grant his certificate to practice osteopathic medicine and surgery, for reasons set forth in a detailed three- page letter. The gist of the reasons was that Respondent allegedly made false, fraudulent, deceptive, or misleading statements to the Acting Director of Medical Education for Respondent's residency program in Missouri pertaining to Respondent's failure to appear or respond to pages when he was on call. Respondent was informed of his right to a hearing. Respondent requested a hearing, which was held before a hearing examiner for the Ohio Board on August 24, 2005. The hearing examiner's report and recommendation in evidence sets forth a summary of the evidence 6 The title of this form is on two lines: the first line is "Affidavit and Release of Applicant"; the second line, immediately below the first, is "Medicine or Osteopathic Medicine." The dash has been inserted to denote separation between the two lines of the title, for clarity. (including Respondent's testimony at the hearing), findings of fact, and conclusions of law. (Pet. Ex. B, Bates p. 71-80). The findings were that Respondent had failed to report to work when he was scheduled to be the resident on call, and failed to respond to several pages from the emergency department. He met with the Acting Director, and after the meeting, a determination was made to terminate Respondent from the residency program for "grievous dereliction of duty and subsequent imminent risk to quality patient care." (Pet. Ex. B, Bates p. 77). Respondent appealed the termination. Shortly thereafter, upon questioning by the Acting Director, Respondent falsely reported that he had been at the hospital, on duty that night, and received no pages. Respondent said that he had been in the hospital library and had used the computer. The Acting Director asked Respondent three times if he had used the computer at the library, and Respondent said yes. But the Acting Director verified with library staff that the computers had remained inactive during the time in question. Caught in the lie, Respondent ultimately admitted to the Acting Director that he had failed to report to duty. Instead, he had taken cold medicine and slept the entire night at home. Respondent "admitted that he had used very poor judgment and had been dishonest." (Pet. Ex. B, Bates p. 77). Respondent's termination from the residency program was upheld on appeal. The hearing examiner concluded that Respondent's conduct violated section 4731.22(B)(5), Ohio Revised Code (making false, fraudulent, deceptive, or misleading statements in relation to the practice of osteopathic medicine and surgery), but did not demonstrate a current failure to prove good moral character. The hearing examiner elaborated on these conclusions: Dr. Hall issued a series of deceitful and self-serving misstatements during the course of his practice. Such conduct would justify permanent denial of his certificate to practice in this state. Nevertheless, Dr. Hall admitted his misconduct and deceit within a short time of their occurrence. Moreover, Dr. Hall was forthcoming in his application for licensure in Ohio. Therefore the evidence suggests that Dr. Hall has learned from his mistakes and will be more cautious and forthcoming in the future. (Pet. Ex. B, Bates p. 78, emphasis added). Based on the hearing examiner's findings and conclusions, her proposed order was that Respondent's application "for a certificate to practice osteopathic medicine and surgery" in Ohio be granted, "provided that he otherwise meets all statutory and regulatory requirements." If so, the "certificate" should be issued on the effective date of the order. However, the "certificate" should be immediately suspended for 30 days, then reinstated subject to a number of probationary terms for a period of at least two years. The hearing examiner's proposed order concluded with a provision addressing when the order would become effective: "This Order shall become effective thirty days after mailing of notification of approval by the Board." (Pet. Ex. B, Bates p. 78-80, emphasis added). At a meeting of the Ohio Board on December 14, 2005, the hearing examiner's proposed findings of fact, conclusions, and order were approved. A letter dated December 14, 2005, notifying Respondent that the Ohio Board had approved the hearing examiner's recommendations, bears a notation that it was mailed December 16, 2005. Respondent was required to update certain components of his licensure application. By letter dated December 29, 2005, Respondent was given notice as "a follow-up to your application for Ohio licensure" that he had to update his resume of activities from July 2004 forward; update the listing of licensure activity in other states; and execute another notarized Affidavit and Release of Applicant. (Pet. Ex. A, Bates p. 89, emphasis added). Respondent executed another Affidavit and Release on January 13, 2006; the form appears unchanged from the one he signed in 2003, continuing to use the terms "certificate" and "license" to practice osteopathic medicine and surgery interchangeably (Pet. Ex. A, Bates p. 25). Other updates to his application also were submitted on or shortly after January 13, 2006, including a letter from Doctors Hospital verifying that Respondent was in the anesthesia residency program, having begun February 2, 2004, and was anticipated to complete the program February 1, 2007. The submission of the required update items on or shortly after January 13, 2006, resulted in Respondent's certificate (a/k/a license) to practice osteopathic medicine and surgery being issued on January 17, 2006, two days after it otherwise could have been consistent with the provisions of the hearing examiner's proposed order. Also in accordance with the hearing examiner's proposed order, approved by the Ohio Board, Respondent's certificate to practice osteopathic medicine and surgery was immediately suspended for 30 days, which included the day that the certificate was issued. The 30-day suspension ran from January 17, 2006, through February 15, 2006. Respondent was permitted to practice osteopathic medicine pursuant to his certificate beginning February 16, 2006, subject to the terms of probation for at least two years. Less than six months after Respondent's first suspension was over, Respondent self-reported to the Ohio Board that he was terminated from the anesthesia residency program for diverting a drug he had prescribed to a patient for his own use. One month after the self-report, on August 30, 2006, Respondent signed a Step I Consent Agreement (Step I Agreement) with the Ohio Board. The Step I Agreement included the following stipulations and admissions: Dr. Hall admits that the Board ordered him to submit to a three-day examination at The Woods at Parkside [Parkside], a Board-approved treatment provider in Columbus Ohio, on or about July 31, 2006, based upon his self-report that he was terminated from his anesthesia residency program with Doctors Hospital in Columbus, Ohio, because he diverted for self-use Celestone, a corticosteroid, that he prescribed for a patient; and that he had diverted Kenalog, another corticosteroid, in the past. Dr. Hall further admits that during this examination, he was diagnosed with substance abuse and Bipolar Disorder with mixed anxiety and that he entered Parkside for further treatment, including 28-day residential treatment. Dr. Hall further admits that due to his substance abuse he currently is impaired in his ability to practice osteopathic medicine and surgery according to acceptable and prevailing standards of care because of habitual or excessive use or abuse of drugs, alcohol, or other substances that impair ability to practice and an inability to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness, including, but not limited to, physical deterioration that adversely affects cognitive, motor, or perceptive skills, due to his Bipolar Disorder with mixed anxiety. (Pet. Ex. B, Bates p. 57). The Step I Agreement provided that, based on the stipulations and admissions, Respondent's certificate to practice osteopathic medicine and surgery was suspended indefinitely. A series of requirements and conditions were imposed, which had to be met before the Ohio Board would "consider reinstatement of Dr. Hall's certificate to practice osteopathic medicine and surgery." (Pet. Ex. B, Bates p. 60). The Step I Agreement took effect September 13, 2006, when signed on behalf of the Ohio Board. (Pet. Ex. B, Bates p. 63). Six months later, on March 14, 2007, Respondent and the Ohio Board entered into the Step II Consent Agreement (Step II Agreement). Pursuant to the Step II Agreement, the indefinite suspension was lifted and Respondent's certificate to practice osteopathic medicine and surgery was conditionally reinstated under new probationary terms set forth in the Step II Agreement. The Step II Agreement contained additional stipulations and admissions agreed to by Respondent, including: C. Dr. Hall is applying for reinstatement of his license to practice osteopathic medicine and surgery in the state of Ohio, which was indefinitely suspended pursuant to the terms of the [Step I Agreement]. * * * E. Dr. Hall admits that he initially entered inpatient treatment for cortical steroid abuse, at the Woods at Parkside [Parkside], a Board- approved treatment provider in Columbus, Ohio, on or about July 31, 2006, that he transitioned to out- patient treatment on or about August 28, 2006, and that he was subsequently discharged, treatment complete, on or about September 5, 2006. Dr. Hall further admits that in addition to his abuse of corticosteroids, in the past he also self-medicated with Elavil and Ultram, and excessively consumed alcohol to the point of having blackout events. Dr. Hall further admits that during his treatment at Parkside, he received an additional diagnosis of Bipolar Disorder for which he was prescribed medication. * * * G. … Dr. Hall states … that Victoria Sanelli, M.D., a psychiatrist who was approved by the Board to provide an assessment of Dr. Hall, evaluated Dr. Hall and submitted a report to the Board … in which she stated that Dr. Hall's diagnoses include steroid dependence in early sustained remission, and that although Dr. Hall has been recently diagnosed with possible Bipolar Disorder, it was Dr. Sanelli's opinion as an addiction psychiatrist that it is extremely difficult to assign an Axis I diagnosis to someone who has recently been involved in substance abuse. … Dr. Sanelli further opined that Dr. Hall has a Mood Disorder, which may be depressed mood or Bipolar Disorder, and that Dr. Hall's ability to practice osteopathic medicine and surgery has been assessed, and he is capable of practicing according to acceptable and prevailing standards of care so long as certain treatment and monitoring requirements are in place. The Step II Agreement provided that reinstatement of Respondent's license would be subject to a probationary term of at least five years from March 14, 2007, with numerous conditions and limitations imposed, including the treatment and monitoring requirements deemed necessary to ensure Respondent remained capable of practicing according to acceptable standards of care. The terms of Respondent's probation included random drug and alcohol tests, evaluations, restrictions on travel outside the state, use of a monitoring physician to monitor Respondent's practice of osteopathic medicine and surgery, and submission of quarterly reports to the Ohio Board in which Respondent attested under oath to full compliance with all conditions of the Step II Agreement. Respondent testified that, at the beginning, he complied with the probationary terms he agreed to. For example, with regard to the travel restrictions, in 2007, when Respondent decided on the spur of the moment to travel to Alabama to visit a friend, he requested and obtained last-minute permission from the Ohio Board for the trip with the proviso that he continue to be subject to random screenings and go to meetings there. However, in or about September 2008, after the Step II Agreement had been in place for only a year and a half, Respondent decided he could no longer comply with the agreement he entered into. When his brothers, who lived in Florida, asked him to travel with them to Italy and Lebanon for a vacation, for which the brothers would pay, Respondent agreed. The brothers coordinated the travel dates to work with Respondent's schedule. Respondent testified that he could not recall how long the trip was, but it was more than one week and possibly less than two weeks. Even though this longer trip was planned, rather than spontaneous like the Alabama trip for which Respondent had obtained Ohio Board approval, this time Respondent did not request approval. This was no accident. Instead, Respondent schemed to leave "clean" urine samples and slips filled out to submit with the samples to the lab, and left them behind with an employee who kept the samples in a freezer and submitted one or more samples while Respondent was out of the country. Respondent devised this scheme to cover up his unauthorized travel, and to give the impression that the samples were being given contemporaneously with their submission to the lab. Instead, Respondent went unmonitored during his unauthorized trip abroad. This was a blatant and devious affront to the terms of the Step II Agreement Respondent promised to abide by. At the hearing, Respondent attempted to explain several different times why he carried out a scheme to circumvent the Step II Agreement's monitoring requirements and cover up his unauthorized travel: Because I had no control in my life. I was doing everything that the board had asked; I had gone to meetings, two, three, sometimes four times a week as required; I was doing random urine drug screens for almost two years; and I had done everything that was asked, and I felt I had no control of my life. I wasn't getting anywhere with this board program. I felt that they were completely inflexible and had a total lack of understanding. And I thought that the suspension—I'm sorry; the impairment diagnosis for basically prednisone, which is an anti-inflammatory drug, was cruel. … [W]hen the program in Ohio said that I had an [impairment], based on the use of drug that in literature is used for inflammatory conditions, it blew my mind. I was still being required to test like a drug addict for over two years and I was labeled a drug addict for two-plus years at that point, and the board didn't want to listen to my protest or my concerns. And there was just a total lack of understanding on the part of the board. And I—and I got—I got overwhelmed emotionally. And just said I had enough of being controlled by somebody who didn't—who didn't have any of my interests at heart. They only wanted to punish. (Tr. 135-136). * * * I was put in a vice like a grape and crushed. (Tr. 142). * * * I don't know that I thought it was okay [to circumvent the Step Two Agreement]. … At the time, like I said, I was under the impairment agreement; I was hoping there would be some benefits to asking for help for mental health issues, and like I said, rolling in the drug portion. But as time went on, there was no positive affect on my life. I couldn't travel to see family. Family is important. Family is who we turn to in times of stress. I couldn't see them without the board's approval. I couldn't find work because of the scarlet letter that was on me. I couldn't find work because I didn't finish the residency. You know, I think when we tell patients by the way, we have a treatment for your problem, but it's going to kill you, most people would say, well, screw that, I'm not going to do it. And you know, I don't think any of the downside was anticipated by me. (Tr. 144). I didn't foresee all of the negative repercussions that would come through in my life. And I was—I was adhering to everything they that they asked of me, meetings, urine drug screens. This—you know, when you have to do a urine drug screen, you have to basically strip for them and someone has to look at you. And it's intrusive. And I was doing that. I was more than willing to work within their system, and do back flips and front flips. If they said, you know, stand on one leg, I would have said yes, sir, for how long, sir? But at the same time, you could only get beaten and put into a corner for so long and say what in the hell is this program designed to do except excommunicate people from a profession? … And so I broke. After a certain amount of time, I broke. It was too much. I—I know I did something stupid. I know I did. And I regret it every day of my life. And I look at it and kick myself and wish I would have never done it. But all I can say is I'm sorry. … So, you know, that's all I can say. I know I screwed up and I took the punishment for it, and I'm here today to say, I am not that person from 12 years ago. (Tr. 145-146). * * * In 2008, like I said, I had been compliant with the board's ruling since '06, since August of '06. I think it was August of '06. And now we're looking at two years later and despite having done everything the board asked, I'm getting—I'm getting nowhere. I'm just feeling like I'm spinning my wheels and there's no end in sight to this—to this situation. And so I threw my hands up. (Tr. 149). No evidence was offered to substantiate Respondent's dramatic claims that the Ohio Board showed inflexibility, a lack of understanding, or an unwillingness to consider any protests or concerns submitted by Respondent. No evidence was offered to show that the Ohio Board ever denied a request by Respondent to travel; the only evidence was that Respondent's single last- minute request was granted and Respondent was allowed to meet his monitoring and treatment requirements while traveling. As Respondent acknowledged, the Step II Agreement that he signed was for a minimum of five years, beginning March 2007. Before March 2007, Respondent was subject to the Step I Agreement, which he also signed. These agreements included stipulations and admissions agreed to by Respondent, and imposed terms and conditions that he accepted. Respondent's characterization at the hearing of the terms he had agreed to as cruel, and his explanation at the hearing that he could not abide by the Step II Agreement because he decided he needed to take back control, after less than one-third of the five-year minimum term had passed, are very troubling current-day admissions. Respondent attempted to refute his admissions in the Step I and Step II Agreements, disputing the substance abuse characterizations and claiming that he admitted to them as a means to have his license reinstated. Without any evidentiary basis to contradict his own admissions in the Step I and Step II Agreements, it is sufficient for purposes of this proceeding to simply point out that Respondent's admissions speak for themselves, and Respondent is not painted in a favorable light, whether he admitted to facts he did not believe as a means to the end of having his suspended license reinstated or whether he admitted to facts that were true. Respondent's claims of oppression and torture (i.e., being put in a vice like a grape and crushed) to explain the backdrop to the Ohio Board's action permanently revoking his certificate to practice osteopathic medicine cause concern. Respondent overly dramatizes the simple fact that he chose to enter into the Step I and Step II Agreements, regardless of his rationalizations for having done so. Also of concern is that for all of his dramatic expressions at the hearing, Respondent ignored a troubling series of admissions. In the Step II Agreement, Respondent admitted to diverting the hospital's prescription medication that he had prescribed for a patient for his own use, and he also admitted to having diverted other medication for his own use in the past. His diversion of hospital medication that he prescribed for a patient for his own use instead was essentially theft, resulting in his termination from the hospital's residency program. Respondent admitted to drug diversion on more than one occasion, in addition to self-medicating, and those admissions were predicates for the conditions imposed by the Step II Agreement. At the hearing, Respondent never addressed this dishonest conduct. That makes Respondent's attempted explanation for why he could no longer abide by the Step II Agreement, with three and a half years left to the agreement he entered into, wholly unsatisfactory. Respondent seemingly has not recognized that these underlying dishonest dealings in medication played a part in his being "painted with a scarlet letter." Whether he recognized it or not, he certainly expressed no remorse. Respondent's scheme to violate the Step II Agreement and cover up his violation succeeded, initially, and for several years thereafter. Respondent made it to the end of his five-year probation, falsely representing under oath to the Ohio Board in quarterly reports that he complied with the terms the entire time. Respondent's probation was lifted under false presences, based on the false impression given by Respondent to the Ohio Board that as of March 14, 2012, he had complied with the Step II Agreement for the five-year probationary term. From then until April 1, 2013, Respondent's certificate to practice was active and unrestricted for the first time since it was issued. Respondent's scheme came to light after Respondent fired an employee and reported to police that the employee was discovered forging prescriptions to obtain prescription drugs. The employee reciprocated by reporting to the Ohio Board that Respondent had falsified his urine samples to cover up an unauthorized jaunt abroad, during which he evaded the required monitoring. Once again, Respondent's certificate to practice osteopathic medicine in Ohio was immediately and indefinitely suspended by the Ohio Board on April 1, 2013. Criminal charges were brought against Respondent in the fall of 2014, based on his scheme to have an employee submit "clean" urine samples that were kept in a freezer, with slips Respondent filled out ahead of time, to give the appearance that he was providing those samples while he was on his overseas trip. Respondent's Ohio certificate to practice osteopathic medicine was still under indefinite suspension when it came up for biennial renewal in 2014. Respondent chose not to renew the license, so the license became inactive on October 1, 2014, but remained under suspension. Respondent did not surrender his license/certificate to practice osteopathic medicine in 2014 or at any time thereafter. On March 2, 2016, Respondent pled guilty to, and was found guilty of, two felonies: attempted tampering with evidence, a fourth degree felony; and possession of criminal tools, a fifth degree felony. After the felony convictions, on April 13, 2016, the Ohio Board both vacated the summary suspension of his certificate and initiated the disciplinary action against Respondent's certificate, designated case number 16-CRF-0055, notwithstanding that Respondent's certificate was inactive. The notice mailed to Respondent on April 14, 2016, informed Respondent that the Ohio Board "intends to determine whether or not to limit, revoke, permanently revoke, suspend, refuse to register or reinstate your certificate to practice osteopathic medicine and surgery, or to reprimand you or place you on probation" for reasons enumerated in the notice. The reasons included the two felony convictions, Respondent's falsification of his quarterly reports to the Ohio Board attesting to full compliance with the Step II Agreement, and Respondent's violations of the limits placed on his certificate to practice pursuant to the terms of the Step II Agreement. Respondent was informed of his right to a hearing. Respondent asked for a hearing regarding the proposed disciplinary action against his certificate to practice osteopathic medicine and surgery in Ohio. Respondent testified at the hearing in this case that he pursued a hearing before the Ohio Board in the hope that he and his attorneys could persuade the Ohio Board to reinstate his inactive license. In his view, he had been punished enough and deserved something less than the most draconian punishment of permanent revocation. He believed that reinstating his license, likely subject to more conditions, was a possible outcome of the proceeding. Instead, the decision following an evidentiary hearing was to permanently revoke Respondent's certificate to practice osteopathic medicine and surgery in Ohio. The written decision reflects that the basis for the permanent revocation was, in part, Respondent's lack of remorse, downplaying his past crimes for which he pled guilty, and dishonesty displayed at the hearing. After setting forth proposed findings of fact and conclusions of law, the hearing examiner provided a summary to explain why the proposed order recommended permanent revocation: Dr. Hall was dismissed from a residency program at the University of Health Sciences in Independence, Missouri, for sleeping through a shift, then lied about his whereabouts in an effort to regain his position. Before this Board, he testified that he learned his lesson and had come to understand the importance of telling the truth. Yet while working at Doctors Hospital in Columbus, Ohio, he created a false patient record in order to obtain corticosteroids to treat his own pain. Then, in 2008, Dr. Hall devised and employed a scheme to deceive the Board that he remained in Ohio when in fact he was abroad, because he feared his request to travel might be refused. He caused specimens, provided in different times than he had indicated, to be submitted for drug testing, as part of that scheme. He has been under Board supervision his entire tenure in Ohio, up to 2012. It is indeed true that several years have passed since the 2008 conduct at issue in this hearing, and that there have been no proven instances of misconduct or non-compliance with monitoring for the five years between 2008 and 2013, when Dr. Hall's license was summarily suspended, or since early 2016 when Dr. Hall resumed practice in Florida. But his career up to that point in 2008 had consisted of a nearly unbroken chain of deceitful conduct, and for four of the five following years, Dr. Hall had remained under Board supervision on pain of revocation of his license. So the question now is whether Dr. Hall's pattern of lying "under pressure" was situational, caused by pain, depression, and perhaps frustration, the causes of which are largely in his past, or whether this conduct reflects an ingrained character trait. Given his history, if Dr. Hall wished to regain the Board's "trust" and demonstrate a character trait for truthfulness, it was incumbent upon Dr. Hall to testify with complete candor in the proceedings before this Hearing Examiner. This Hearing Examiner did not, however, find Dr. Hall's testimony to be particularly credible as a general matter, based on his demeanor and testimony. Three factors stand out in particular: Dr. Hall attempted to minimize his deceit to [the Acting Director of his Missouri residency program] … . But the Board's prior finding was that Dr. Hall's lie was premeditated; … Dr. Hall repeatedly attempted to minimize the character of his scheme to conceal from the Board his travel outside Ohio, and to submit urine specimens not given at the times indicated … . … Dr. Hall repeatedly resorted to pat phrases to describe, and in all likelihood exaggerate, the level of discomfort he experienced … . The evidence that Dr. Hall's persistent lack of candor is merely a result of past causes, no longer at play in his life, is less than convincing. Accordingly, this Hearing Examiner does not believe that the record reflects mitigating circumstances sufficient to support providing a pathway for Dr. Hall to regain licensure by this Board.[7] (Pet. Ex. B, Bates p. 27-28). 7 The hearing examiner's observation regarding whether mitigating circumstances supported providing a pathway for Respondent to regain licensure confirms Respondent's testimony that the reason he invested time and resources in this hearing was in the hope that the Ohio Board would consider mitigating circumstances, with the possibility of having his license reinstated subject to conditions. This would have been similar to the approach of the Step I and Step II Agreements, whereby in Step I, Respondent's certificate to practice was suspended, and would be considered for reinstatement only after Respondent complied with a series of requirements, followed by Step II, which was treated as an application for reinstatement, and was granted subject to limitations and conditions. This time, Respondent failed to convince the hearing examiner or the Ohio Board to allow another similar pathway. The Ohio Board entered an Order on December 14, 2016, attaching and incorporating the hearing examiner's report and recommendation and ordering as follows: "The certificate of Adam Patrick Hall, D.O., to practice osteopathic medicine and surgery in the State of Ohio shall be permanently revoked." (Pet. Ex. B, Bates p. 3). Just as Respondent's candor was found lacking in the Ohio proceeding, so, too, at the hearing in this case, Respondent was not credible, based on his demeanor and testimony. Instead, he was evasive, dramatizing his personal tribulations to which he attributed his past mistakes, while downplaying the extent and significance of his past wrongdoing. Several months after the Ohio Board permanently revoked Respondent's certificate to practice osteopathic medicine, Respondent's counsel, who had represented him since the Ohio proceedings in 2016, and worked with local Ohio counsel in the 2016 disciplinary proceeding, wrote the following on his behalf as a "self-report" to the Department on April 3, 2017: Please be advised that Adam Hall is represented by Chapman Law Group before the Florida Department of Health ("Department") and Board of Osteopathic Medicine ("Board"). … In November 2016, Dr. Hall submitted his response to the Department's Administrative Complaint. Subsequently, the Ohio Board of Osteopathic Medicine took action against his license. To wit, on December 15, 2016, by an order of the Board, Dr. Halls' [sic] Osteopathic medical license was permanently revoked. Such an order was based on convictions in the Court of Common Pleas of Lawrence County, Ohio in which Dr. Hall pled guilty to Attempted Tampering of Evidence, a fourth degree felony and Possession of Criminal Tools, a fifth degree felony. … Dr. Hall knows that pursuant to Florida Statute, his Ohio Board action constitutes grounds for disciplinary action, as specified in s. 456.072(2). To wit s. 456.015 [sic; 459.015(1)(b)] reads that: Having a license or the authority to practice osteopathic medicine revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of any jurisdiction, including its agencies or subdivisions. The licensing authority's acceptance of a physician's relinquishment of license, stipulation, consent order, or other settlement offered in response to or in anticipation of the filing of administrative charges against the physician shall be construed as action against the physician's license. Chapman Law Group respectfully submits that no action is needed on the part of either the Department or Board, because Dr. Hall reported this incident to the Department as required by law. (Pet. Ex. E, emphasis added). The letter was submitted on Respondent's behalf by attorneys Steven D. Brownlee and Ronald W. Chapman for the firm. Other Relevant Facts Respondent had a license to practice osteopathic medicine in Missouri at one time. He testified that "Missouri followed the action of Ohio, and I lost my license to practice in Missouri." (Tr. 148). Respondent did not provide specific details regarding the basis for the Missouri action to take away Respondent's license to practice in Missouri. Respondent had a license to practice osteopathic medicine in Kansas at one time. Respondent did not provide details regarding what happened to the Kansas license he held at one time. Respondent's Ohio licensure file contains a Kansas license verification form submitted as part of Respondent's application for a license (certificate) to practice osteopathic medicine and surgery in Ohio. The Kansas license verification form dated April 15, 2004, reports that Respondent's "original license date" was April 26, 2003; and the "expiration date" was September 30, 2003. The license status was reported as "cancelled." (Pet. Ex. A, Bates p. 31). No other evidence was offered regarding Respondent's Kansas licensure history, the reason for the short duration of his license, or why his license was "cancelled." As previously noted, Respondent has also been licensed to practice osteopathic medicine in Florida since 2008. However, he testified that he did not begin practicing in Florida until after the Ohio proceedings concluded with the Ohio Board's order of permanent revocation. There is no evidence of any blemishes on his track record practicing in Florida, but the tenure has been relatively short—three and a half years at the time of the hearing.8 Respondent is married, with three children. At the time of his hearing in Ohio that resulted in permanent revocation of his certificate to practice osteopathic medicine, his now-wife was his fiancée and they had a one- month-old child. Respondent testified that his wife is a lawyer. He credited her with coming up with the argument that the permanent revocation of his "certificate" to practice osteopathic medicine in Ohio was arguably something different than a permanent revocation of a "license" to practice osteopathic medicine in Ohio. Respondent noted that she raised this question before the Ohio disciplinary hearing, but the argument was not pursued there.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Osteopathic Medicine, enter a final order revoking Respondent, Adam Patrick Hall, D.O.'s, license to practice osteopathic medicine and assessing costs against him for the investigation and prosecution of this matter. DONE AND ENTERED this 15th day of October, 2020, in Tallahassee, Leon County, Florida. S ELIZABETH W. MCARTHUR Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 15th day of October, 2020. COPIES FURNISHED: Michael Jovane Williams, Esquire Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399 (eServed) Ronald W. Chapman, Esquire Chapman Law Group 6841 Energy Court Sarasota, Florida 34240 (eServed) Lauren Ashley Leikam, Esquire Chapman Law Group 6841 Energy Court Sarasota, Florida 34240 (eServed) Jamal Burk, Esquire Department of Health Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 (eServed) Kama Monroe, Executive Director Board of Osteopathic Medicine Department of Health Bin C-06 4052 Bald Cypress Way Tallahassee, Florida 32399-3257 (eServed) Louise St. Laurent, General Counsel Department of Health Bin C-65 4052 Bald Cypress Way Tallahassee, Florida 32399-3265 (eServed)
