Findings Of Fact At all times relevant thereto, Respondent, Anthony S. Coco, held chiropractic license number 0001508 issued by Petitioner, Department of Professional Regulation, Board of Chiropractic Examiners. He is authorized to practice chiropractic in the State of Florida and presently maintains an office at 65 Royal Palm Beach Boulevard, Vero Beach, Florida. In response to a newspaper advertisement, Thomas A. Murphy visited the office of Respondent on May 13, 1980, regarding treatment of low back pain, impotence, nervousness, headaches and general aches and pains. Murphy had a 100 percent service-connected disability and was already being treated by a medical physician for other undisclosed ailments. Murphy was given a complete examination by Coco, including neurological and orthopedic tests. Additionally, eight x-rays were taken of the patient. As a general practice, Coco does not record negative (or normal) results on the patient's records. Because all tests except the x-rays were negative, the results of the examination were not reflected on Murphy's patient records. However, a detailed record of his findings were prepared in a request for authorization to provide chiropractic treatment forwarded to the Veteran's Administration (VA) on May 15, 1980. The request was later denied by the VA, and Murphy terminated his relationship with Respondent. Murphy became involved in a dispute with a secretary in Coco's office and filed a complaint against him with Petitioner. Petitioner then retained the services of an outside consultant, Dr. Fred C. Blumenfeld, to examine Murphy's patient file. Blumenfeld was initially given an incomplete file to examine, and based upon his initial review of the incomplete file, concluded that Respondent failed to exercise reasonable care in his treatment of Murphy. That precipitated the instant proceeding. Prior to the final hearing, Blumenfeld gained access to the entire file, and upon examining the same, reached an opinion that no "malpractice" had occurred. Although he testified that he would have marked the x-rays differently, and would have noted all negative findings on Murphy's patient chart, he did not otherwise criticize Coco's treatment of Murphy, and saw no basis for the issuance of an administrative complaint. Three other experts, including a nationally recognized professor of chiropractic and a former member of the Board of Chiropractic Examiners, each concluded that Coco's treatment of Murphy was proper and consistent with generally recognized standards of skill and care of chiropractors in the community. They also concluded that Coco's diagnosis of Murphy's ailments, as reflected on his patient notes and letter of May 15, were consistent with the x- rays taken of Murphy. Although Mr. Murphy appeared at the final hearing, he did so reluctantly and had no complaint regarding his examination and the diagnosis rendered by Coco.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that all charges against Respondent be DISMISSED. DONE and ENTERED this 21st day of March, 1983, in Tallahassee, Florida. DONALD R. ALEXANDER 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 21st day of March, 1983.
The Issue Whether Respondent violated Section 460.413(1)(c), Florida Statutes; and if so, what penalty should be imposed.
Findings Of Fact Respondent, Joseph Forlizzo, is, and has been at all times material hereto, a chiropractor licensed in the State of Florida, having been issued license number CH-0003278. Petitioner, Department of Health, Board of Chiropractic, is the state agency that licenses and has regulatory jurisdiction of chiropractors. Section 20.43, Florida Statutes; Chapter 455, Part II, Florida Statutes; and Chapter 460, Florida Statutes. On September 3, 1996, in the United States District Court for the Middle District of Florida, Case No. 95-132-CR-T-24(E), Respondent was convicted of conspiracy to collect an extension of credit by extortionate means as defined in Title 18, United States Code, Section 891, from Michael Muzio and Wesley Earl Ball by express and implicit threats and acts of violence and other criminal means to cause harm to the person, property, and reputation of said Michael Muzio and Wesley Earl Ball. The conspiracy to commit extortion referred to in the conviction involved the contemplated use of actual or threatened force or violence against the person of another. The crime of which the Respondent was convicted, conspiracy to collect an extension of credit by extortionate means, is a felony. As a result of the subject conviction, Respondent was sentenced to imprisonment for a term of 51 months followed by supervised release for a term of 36 months and ordered to pay restitution of $100,000 to Michael Muzio. The subject conviction has not been overturned or vacated on appeal. Respondent was a co-owner in a business known as American Mobile Imaging (AMI) with Michael Muzio and others. AMI was in the business of providing medical testing or diagnostic services. The medical testing or diagnostic services provided by AMI included the use of a Magnetic Resonance Imaging (MRI) mobile unit. Chiropractic is a healing art. Dr. Butler's credible testimony was that, in his expert opinion, the practice of chiropractic has a foremost and formidable requirement for mental fitness and emotional stability on the part of practitioners. Moreover, Dr. Butler's credible testimony was that the crime of which Joseph Forlizzo was convicted shows a callous disregard for and lack of respect for human life and that respect for human life is the entire premise of health care providers. The crime of which Respondent was convicted is directly related to the practice of chiropractic medicine.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is: RECOMMENDED that the Department of Health, Board of Chiropractic Medicine, enter a final order finding that Respondent, Joseph Forlizzo, is guilty of conduct described in Section 460.413(1)(c), Florida Statutes, as alleged in the Administrative Complaint; and revoking Respondent's license to practice as a chiropractic physician. DONE AND ENTERED this 15th day of February, 2000, in Tallahassee, Leon County, Florida. CAROLYN S. HOLIFIELD 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 15th day of February, 2000. COPIES FURNISHED: James A.G. Davey, Jr., Esquire Agency for Health Care Administration 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308 Timothy E. Leahy, Esquire Leahy and Associates, P.A. 535 Central Avenue, Suite 300 St. Petersburg, Florida 33701 Eric G. Walker, Executive Director Department of Health Board of Chiropractic 1940 North Monroe Street Tallahassee, Florida 32399-0750 Angela T. Hall, Agency Clerk Department of Health 2020 Capital Circle, Southeast BIN A02 Tallahassee, Florida 32399-1701 Pete Peterson, General Counsel Department of Health 2020 Capital Circle, Southeast BIN A02 Tallahassee, Florida 32399-1701
The Issue Whether Respondent violated Subsections 460.413(1)(ff) and 456.072(1)(u), and Section 460.412, Florida Statutes (2002),1 and, if so, what discipline should be imposed.
Findings Of Fact At all times material to this proceeding, Dr. Hether was a licensed chiropractic physician within the State of Florida, having been issued license number CH 2601 on or about April 16, 1977. Other than the instant Administrative Complaint, Dr. Hether has had no disciplinary action taken against his license. In April 2003, Dr. Hether had two chiropractic offices, one in Port Orange, Florida, and one in Deland, Florida. On or about April 8, 2003, C.B., a 29-year-old female, presented herself to Dr. Hether's office in Port Orange, Florida, in order to receive chiropractic treatment for injuries she sustained in an automobile accident. C.B. began receiving treatments in the Port Orange Office, but switched her appointments to the Deland office on or about May 8, 2003. The remainder of her treatments was given at the Deland office. Her treatments included chiropractic adjustments and massages. The chiropractic adjustments were performed by Dr. Hether and other physicians who worked for Dr. Hether; however, the majority of the chiropractic adjustments were performed by Dr. Hether. Until C.B.'s visit on June 11, 2003, all the massages had been performed by licensed massage therapists who worked for Dr. Hether. From on or about April 8, 2003, up to June 11, 2003, C.B. received various chiropractic treatments at Dr. Hether's offices without incident. On June 11, 2003, C.B. presented herself to Dr. Hether's office to receive her usual chiropractic treatment, including a massage. Dr. Hether, his son, and another male were in the office. Dr. Hether offered to perform the massage on C.B. because the regular massage therapist was not present, and C.B. accepted. C.B. went into the massage room, undressed to her underwear, and lay face down on the table with a sheet draped over her. Dr. Hether came into the massage room and began to massage C.B. Dr. Hether and C.B. were the only persons in the room during the massage. While C.B. was lying face down, Dr. Hether slipped his hands under C.B.'s underwear on the left side of her buttocks and then placed his hand under her underwear on the right side of her buttocks. At Dr. Hether's instruction, C.B. turned over onto her back. Dr. Hether placed his hands under C.B.'s breast area and rubbed upward towards her cleavage. Dr. Hether then slid his hand down C.B.'s body toward her vaginal area, grabbed a part of C.B.'s vaginal area, and began to make grunting noises as if he were getting sexual pleasure from the touching. While Dr. Hether was touching C.B.'s vaginal area, Chase Hether, Dr. Hether's son and office manager, knocked on the door to the massage room. Dr. Hether briefly stopped the massage to speak to his son. The door was partially open, but Chase Hether could not see inside the massage room. After speaking to his son, Dr. Hether closed the door and walked back to the massage table, where he again placed his hand in C.B.'s vaginal area and slid his fingers back and forth. Dr. Hether then shoved his hand further down C.B.'s panties and repeatedly thumped C.B.'s vaginal area. While Dr. Hether was thumping her vaginal area with one hand, he grabbed C.B.'s ankle with the other hand, while using the full pressure of his body weight on her body. Dr. Hether resumed making the grunting sounds and continued to make the sounds for a while. C.B. had approximately 27 massages at Dr. Hether's offices from the time she began treatment in April 2003 until June 11, 2003. The massage therapists who gave her those massages did not touch C.B.'s pubic area or touch the areas around C.B. breasts. After the massage, C.B. got dressed and went into another room to receive a chiropractic adjustment from Dr. Hether. Dr. Hether gave the chiropractic adjustment without any further inappropriate touching. After he concluded the chiropractic treatment, he asked C.B. personal questions about her living arrangements and occupation. C.B. went into the reception area of the office to leave the building. She saw Chase Hether and another man in the reception area. C.B. did not tell either man what had happened nor did she tell them that she would not be back to Dr. Hether's office for treatment. While Dr. Hether was touching C.B. inappropriately, she did not cry out, tell him to stop, or attempt to leave. When Chase Hether came to the door of the massage room, C.B. did not tell him what Dr. Hether was doing. C.B. did not try to stop the massage, leave Dr. Hether's offices, or tell others at Dr. Hether's office about the inappropriate touching because she was afraid of Dr. Hether and did not know what else Dr. Hether might do to her. She felt like she was a "visitor in her own body" and had no control over what was being done to her. She did not report the incident to the police department because she felt that the police were ineffective. C.B. did not go back to Dr. Hether's offices for treatment after the incident on June 11, 2003. She sought treatment from another chiropractic physician, Dr. Kimberly Watson, whom C.B. saw on June 23, 2003. C.B. told Dr. Watson what had happened to her at Dr. Hether's office. Dr. Watson advised C.B. that she could file a complaint with the Department of Health. C.B. did send a complaint to the Department of Health in June 2003, but she sent it to the wrong address. She got the correct address from Dr. Watson and filed a complaint with the Department of Health in September 2003. A year passed, and she contacted the Department of Health, wanting to know the status of her complaint. C.B. was told to file another complaint, which she did. Dr. Hether's wife, Kathe Hether, testified that she was at Dr. Hether's office the day of the incident and that as C.B. was leaving the office she spoke to C.B. for several minutes concerning her publishing business and that C.B. told her that she was going to another chiropractor that was nearer to her home. Mrs. Hether's testimony is not credible. Her husband of 36 years did not advise her until two months before the final hearing, that an administrative complaint had been filed against him. It is inconceivable that two and one-half years after their conversation, Ms. Hether vividly remembers talking to C.B. when there had been no reason to remember the conversation. Additionally, Ms. Hether's explanation for C.B.'s failure to return to Dr. Hether for treatment because C.B. wanted to go to a chiropractor closer to her home is also not credible. C.B. chose to seek treatment from Dr. Watson, whose office was about the same distance from C.B.'s home as Dr. Hether's office. C.B. also told Dr. Watson about the incident with Dr. Hether, explaining the reason that she discontinued treatment with Dr. Hether. C.B. has not brought a civil action against Dr. Hether for the incident on June 11, 2003. She filed the complaint with the Department so that Dr. Hether would not touch other patients inappropriately.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered finding that James Hether, D.C., violated Subsection 460.413(1)(ff), Florida Statutes, by violating Subsection 456.072(1)(u) and Section 460.412, Florida Statutes; issuing a reprimand; imposing a $2,500 administrative fine; requiring a psychological evaluation by the professional resource network; and placing him on probation for two years, the terms of which would include a practice restriction prohibiting him from treating female patients without another certified health care professional in the room. DONE AND ENTERED this 28th day of July, 2006, in Tallahassee, Leon County, Florida. S SUSAN B. HARRELL 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 July, 2006.
Findings Of Fact Respondent, Richard Powers, was at all times material hereto a licensed chiropractor in the State of Florida, having been issued license number CH0003372. Respondent has routinely advertised his chiropractic practice in the Palm Beach Post. On July 8, 1984, July 15, 1984, and September 2, 1984, Respondent ran an advertisement in the Palm Beach Post which offered a free examination and which stated that the "usual value of this exam is $80. This includes X-rays if needed." The advertisement did not include the disclaimer mandated by Section 455.24, Florida Statutes. That statute, effective June 12, 1984, required that: In any advertisement for a free, discounted fee, or reduced fee service, examination, or treatment by a health care provider ... (such as Respondent) ... the following statement shall appear in capital letters clearly distinguishable from the rest of the text: THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT WHICH IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT. By memorandum dated September 30, 1984, the Department of Professional Regulation, Board of Chiropractic (Board), advised all licensees of the aforesaid amendment to section 455.24. Respondent asserts he had no knowledge of the amendment until his receipt of the Board's memorandum in October, 1984, and that he complied, or attempted to comply, with the amendment at all times thereafter. The evidence supports Respondent's assertions. The advertisements of July 8, 1984, and July 15, 1984, were captioned in bold type "ADVANCED APPLIED CHIROPRACTIC," listed Respondent as a diplomate of the National Board of Chiropractic, and concluded in bold type "A STANDARD OF EXCELLENCE." The advertisement of September 2, 1984, touted Respondent's clinic as "Advanced Applied Chiropractic and Comprehensive Pain Center." The generally accepted definition within the medical community of diplomate is an individual who has completed an extensive post graduate program and successfully passed the board's examination. This establishes superior qualifications in the individual's field of practice. Although the National Board of Chiropractic issues diplomate certification to those individuals who pass its examination, its examination is a basic licensing examination which establishes minimal competency, not excellence. Respondent's use of the phrase "Advanced Applied Chiropractic" to describe his clinic implies that he possesses skills superior to the average chiropractor. Respondent has registered the phrase "Advanced Applied Chiropractic" as a fictitious name. Respondent was, on one prior occasion, disciplined by the Board for an advertising violation.
The Issue Whether Respondent committed the offenses described in the administrative complaint filed against him? If so, what penalties should be imposed by the Board of Chiropractic?
Findings Of Fact Based upon the evidence received at hearing, the Hearing Officer makes the following findings of fact: Dr. Jordan Breslaw is now, and was in 1987, licensed to practice chiropractic in the State of Florida. Dr. Breslaw is the owner of Jordan Chiropractic Center. The Center is located in Margate, Florida. On or about November 11, 1987, Dr. Breslaw placed an advertisement in the Quad City News announcing that the Jordan Chiropractic Center would be hosting a "Community Appreciation Day" at its location in Margate on November 16, 1987. The advertisement contained the following representation: As an act of Community Service the Jordan Chiropractic Center will DONATE ALL SERVICES to anyone who wants to experience the benefits of Chiropractic. Everyone Welcome! [emphasis in original.] Appearing beneath this statement were drawings of gift- wrapped boxes and balloons. Next to these drawings were the following words in italics: "Entertainment," "Door Prizes," "Food and Refreshments," and "Meet The Merchants." The advertisement did not set forth the usual fees and charges for chiropractic services rendered at the Jordan Chiropractic Center; nor did it state that any patient or other person responsible for payment had the right to refuse to pay, cancel payment, or be reimbursed for payment for any service, examination, or treatment which was performed as a result of, and within 72 hours of responding to, the advertisement. Dr. Breslaw examined and treated patients at the Jordan Chiropractic Center on Monday, November 16, 1987. He charged these patients his usual fee for these services.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Board of Chiropractic enter a final order finding Dr. Jordan Breslaw guilty of the offenses charged in the administrative complaint and imposing an administrative fine of $1,000 and placing him on probation for three months, as described above, for his transgressions. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 30th day of June, 1989. STUART M. LERNER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 30th day of June, 1989. COPIES FURNISHED: Cynthia Shaw, Esquire Department of Professional Regulation 1940 North Monroe Street Suit 60 Tallahassee, Florida 32399-0792 Dr. Jordan Breslaw 201 North State Road 7 Margate, Florida 33063 Pat Guilford Executive Director Board of Chiropractic 1940 North Monroe Street Tallahassee, Florida 32399-0792
The Issue The issues in this case are whether Respondent engaged in sexual misconduct in the practice of chiropractic medicine, in violation of section 460.412, Florida Statutes, or whether Respondent engaged in sexual misconduct while acting as a health care professional in violation of section 456.072(1)(v), Florida Statutes; and, if so, what is the appropriate sanction.
Findings Of Fact The Florida Department of Health, Board of Chiropractic Medicine, is the state agency charged with regulating the practice of chiropractic medicine in the state of Florida, pursuant to section 20.43 and chapters 456 and 460, Florida Statutes. At all times material to this proceeding, Dr. Kian was a licensed chiropractic physician in the state of Florida, holding license number CH10343. He is subject to jurisdiction of the Board of Chiropractic Medicine. Dr. Kian has also been licensed to practice in the states of Kentucky and Kansas, and has practiced chiropractic medicine in Germany. Dr. Kian's current address of record is 901 West Indiantown Road, Suite 20, Jupiter, Florida 33458. He received his chiropractic degree in 2009 from Life University in Georgia. Dr. Kian operates a chiropractic clinic named Capstone Chiropractic, renting office space at that location to an acupuncturist named Kelvin Yu (Mr. Yu) and a massage therapist named Robert Lorezca (Rob). Dr. Kian has not previously been subject to disciplinary action by the Board of Chiropractic Medicine. Patient J.K. has been recently licensed as a registered nurse. At the time of the incidents alleged in this case, she was a licensed practical nurse. Patient J.K. had received chiropractic treatment from three or four different chiropractors on about 20 to 30 occasions prior to meeting Dr. Kian. Patient J.K. frequently receives treatment by Rob for muscle soreness. Rob was a friend of Patient J.K.'s family, and they have known each other for many years. Patient J.K. first met Dr. Kian after an appointment with Rob for a massage therapy session at Capstone Chiropractic. That meeting occurred months before the incident at issue. On that earlier occasion, Dr. Kian gave Patient J.K. a free chiropractic adjustment as a favor to Rob. The treatment was administered in an open area. On April 25, 2017, when Patient J.K. first entered Capstone Chiropractic, she had a brief conversation with Rob, Dr. Kian, and Mr. Yu, and they discussed that they could open a spa because they offered so many different treatment options. She discussed a chiropractic adjustment with Dr. Kian, and he indicated he would adjust her after her massage with Rob. She also had an appointment with Mr. Yu. After her massage, Dr. Kian took Patient J.K. to a table in the open room to adjust her. Although she had been undressed for the massage, she had put her clothes back on afterwards, and was fully clothed during the adjustment. Patient J.K. told Dr. Kian that she had pain in her lower back, as she frequently did, and that recently her right foot also had begun to hurt. Following the adjustment, Dr. Kian offered Patient J.K. an additional trigger point release treatment. This would involve a treatment of the hamstring and the psoas, a muscle which runs from the lumbar spine to the femur. To administer the trigger point release, Dr. Kian was to perform a deep massage of the affected areas. Patient J.K. asked Dr. Kian if the trigger point release massage required skin-on-skin contact, and Dr. Kian told her it did. She returned to the private massage room she had been in earlier with Rob. She undressed completely and lay face down on the massage table, covered by a sheet. When Dr. Kian returned, they were the only persons in the room. When Patient J.K. was on her stomach, Dr. Kian lifted the sheet to massage her hamstrings. Patient J.K. could feel that the sheet was "pulled all the way off," exposing her buttocks, so she pulled the sheet back to cover herself. Dr. Kian then readjusted the sheet "halfway" and proceeded to massage Patient J.K.'s hamstring. When massaging Patient J.K.'s hamstring, Dr. Kian gradually moved his hand between Patient J.K.'s legs, touching her labia. When Patient J.K. was touched, she flinched away, pulled the sheet down, and said "whoa." She initially thought this first touch might have been unintentional. Dr. Kian began to work on her right foot a while, and then asked Patient J.K. to flip on to her back so that he could treat her psoas muscle. She turned on to her back underneath the sheet. Dr. Kian then moved the sheet, exposing the lower half of Patient J.K.'s body. Patient J.K. again pulled the sheet back over to cover herself. Dr. Kian then readjusted the sheet, leaving Patient J.K.'s vaginal area partially exposed. Dr. Kian then began to massage the psoas muscle, working from the outside toward the inside of her body. Dr. Kian kept moving his hand toward the center, between Patient J.K.'s legs, and he again touched her labia. Patient J.K. immediately looked up to see Dr. Kian leaning very closely over her lower body. She pulled the sheet to cover herself and said "whoa." Patient J.K. knew at that point that his exposing her and touching her was intentional because it was the second time that it had happened, and she was shocked. Dr. Kian immediately straightened up and walked up toward Patient J.K.'s head, saying he wanted to do an adjustment. He started to massage her left shoulder area, moving toward her breast. Patient J.K. told him that was okay, that was enough, and that she needed to go. Dr. Kian said, "Well, let me adjust your back, lean forward." Patient J.K. pulled the sheet under her arms and leaned forward. She did not hear any popping and so again said that it was time for her to go. Patient J.K. testified she just wanted to get out of there. She turned her legs off of the bed to sit on its edge. As soon as she leaned forward, she testified that Dr. Kian was "literally right in my face." Patient J.K. believed that Dr. Kian intended to kiss her on the lips. She turned her head to the left, and he kissed her on the cheek. Patient J.K. testified that she believed Dr. Kian would have kissed her on the lips had she not turned her head. Dr. Kian exited the room, and Mr. Yu came in immediately. Even though her mother's dental appointment was actually later in the afternoon, Patient J.K. told Mr. Yu that she had to leave to go to it and would not have time for her acupuncture treatment. She just wanted to go. As soon as Mr. Yu left, Patient J.K. dressed herself and went to the counter where Dr. Kian, Rob, and Mr. Yu were standing. She said nothing about what had happened to either Rob or Mr. Yu. She paid Rob for her massage and Dr. Kian for the adjustment. Dr. Kian was surprised by the offer to pay, but Patient J.K. insisted that he accept payment. As Dr. Shreeve testified, the scope of practice for chiropractors requires that they do not intentionally expose any genital area or any part of a patient's body that does not need to be open to the doctor's skin-to-skin contact. In treating Patient J.K., there was no need to expose her buttocks or vaginal area. As Dr. Shreeve's testimony indicated, when properly treating the psoas muscle, a chiropractor's hands would not be near the vaginal area, and there was no justification for touching Patient J.K.'s labia in her treatment. Under all of the circumstances, it is clear that Dr. Kian used the chiropractor- patient relationship to engage in sexual activity outside of the scope of professional practice by intentionally exposing Patient J.K.'s buttocks and vaginal area and intentionally touching her labia. Following the incident, Patient J.K. drove from Jupiter to her home in Vero Beach, a drive of about an hour and a half. She reflected on what Dr. Kian had done. When she arrived in Vero Beach, Patient J.K. called her brother, who was a licensed chiropractor, and told him what had happened. She also called her Aunt Mary and a family friend, who was an attorney, and asked what she should do. He told her that she needed to go to the police. She tried a couple of times to contact Rob to discuss what had happened. She was unable to communicate with Rob and then decided not to try to contact him again about the incident. Patient J.K. decided to report Dr. Kian so that he could not sexually assault another patient. Patient J.K. drove to the Jupiter Police Department on April 27, 2017, and reported the incident. An interview was scheduled for May 4, 2017, and conducted by Detective Panczak. Detective Panczak subsequently contacted the Department of Health. Patient J.K.'s testimony was clear and convincing, and she was consistent in her recollection in all major respects. Minor differences in her accounts of events reflected that she was genuine in her efforts to tell her story as accurately as possible from her memory on each occasion and did not attempt to craft or memorize a single version of events. Patient J.K. did not struggle to remember the relevant facts. While her testimony that she believed Dr. Kian intended to kiss her on the lips following the trigger point release session was credible, it is possible that Dr. Kian might have intended to kiss her on the cheek for a more benign purpose; and under all of the circumstances, it was not clearly and convincingly shown that his action in kissing her on the cheek constituted sexual misconduct. Dr. Kian denied all allegations except kissing Patient J.K. on the cheek.1/ His assertions that she was never exposed, that his hands were never close to Patient J.K.'s vaginal area, and that her body shape and positioning would have prevented exposure of her vaginal area and prevented him from touching her labia were not credible and are rejected. Revocation of Dr. Kian's professional license would have a very great effect upon his livelihood.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Florida Department of Health, Board of Chiropractic Medicine, enter a final order finding Dr. Hamed Kian in violation of sections 456.072(1)(v) and 460.412, Florida Statutes; revoking his license to practice chiropractic medicine; and imposing costs of investigation and prosecution. DONE AND ENTERED this 27th day of July, 2018, in Tallahassee, Leon County, Florida. S F. SCOTT BOYD 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 27th day of July, 2018.
The Issue The issue for consideration in this matter is whether the Respondent's license as a chiropractic physician in Florida should be disciplined because of the matters alleged in the Administrative Complaint filed herein.
Findings Of Fact At all times relevant hereto, Joseph S. Maddox was licensed by the Board of Chiropractic to practice chiropractic in Florida. His Florida license number is CH0003204 (Exhibit 10). C.G. was a patient of Respondent during the period 1984-1988. In 1984, she presented to Respondent with pain in the coccyx. When external manipulation was unsuccessful in restoring the alignment in the tail bone, Respondent performed the adjustment through the vagina. Six months later, another internal coccyx adjustment was made, this time rectally. Both of these internal adjustments are accepted chiropractic techniques for coccyx realignment, but the rectal procedure is preferred because of fewer layers of tissue between inserted finger and coccyx and proximity to the coccyx. With respect to C.G., it is alleged that, for the purpose of attempting to engage the patient in sexual activity outside the scope of practice or examination, Respondent manually penetrated C.G.'s vagina, penetrated C.G.'s vagina with a vibrator device, manipulated C.G.'s breasts, asked the patient questions regarding her sex life and activities, and these activities occurred when Respondent was in a closed room with C.G. In 1986, C.G. had mammo-plasty reduction surgery. Before this surgery, she asked Respondent if the operation would alleviate her back pain. Respondent then examined her breasts and manipulated them. No evidence was presented that Respondent ever suggested having sex with C.B. Following this surgery there was some seepage from the wound, and while undergoing chiropractic treatment by Respondent, C.G. asked him to look at the wound. This is the occasion Respondent is alleged to have manipulated C.G.'s breasts. On several occasions, Respondent used a vibrator when giving chiropractic treatment to C.G. The vibrator was described by all witnesses as a portable machine with two handles and a rectangular vibrator pad approximately 10 inches by 4 inches. Although the Administrative Complaint alleges Respondent used the vibrator inside the patient's vagina, C.G. testified that during the course of the vibrator treatment Respondent allowed the vibrator to rest on her vaginal area, and he moved the vibrator over the vaginal area. C.G. also testified that Respondent used the vibrator for too long a period which was painful at the time and left her sore after the treatment was over. Between August 1987 and April 1988, C.G. leased space in Respondent's office facility in which she conducted her mental health counseling. During this period, she became close friends with Sara Chasse' who worked in Respondent's office for some three years before she was dismissed by Respondent. While occupying space at Respondent's office, C.G. used Respondent's staff to make appointments, answer the phone and perform other clerical services. C.G. is also an accredited professional astrologer (Exhibit 2) and prepared natal charts for Ms. Chasse' and Respondent's wife. K.T. first came to Respondent for an adjustment in late 1984. She has gone to chiropractors for thoracic problems dating back to childhood. In fact, K.T. has worked in a chiropractic setting for some 17 years and had formed her own company, Chiro Girls, to provide trained personnel to be employed by chiropractic clinics. At her first visit to Respondent's clinic, K.T. discussed with Respondent her ideas of how a chiropractic clinic should be run. K.T. was then employed to conduct a time motion study of the clinic operations and thereafter was employed under contract with Respondent as clinic director. K.T. considered her function at the clinic was to educate and motivate the clinic's staff. Friction developed between K.T. other employees and patients; and the contract was mutually dissolved some eight months later and well short of the year for which the contract was entered into. K.T. related a long history of menstrual cramps to Respondent which he treated with a vibrator. Respondent also queried K.T. regarding her sex life. Although K.T. deemed such questions inappropriate, a sexual history is appropriate to ascertain when treating female patients presenting symptoms of low back pain and dysmenorrhea (Exhibit 12). Further, use of a vibrator is appropriate when treating trigger points that can greatly intensify dysmenorrhea (Exhibit 13). Although K.T. testified that Respondent used a small, hand-held vibrator which he moved over her vaginal area and inserted in her vagina to induce her to climax, Respondent emphatically denies this; and nearly all other witnesses testified that the only vibrator used in the clinic was the large vibrator described in Exhibit 6. K.T.'s testimony that the vibrator treatment was very painful is more consistent with the use of the standard vibrator than with a smaller vibrator that could be inserted in a vagina. Accordingly, I find Respondent did not insert a vibrator into K.T.'s vagina. A.M.T. was treated by Respondent in 1980 when she was 15 years old. Initially she had back problems which were treated by adjustment and spine realignment. Between June and September 1980, A.M.T. worked in Respondent's clinic part-time. During this period A.M.T. developed coccygeal pain, and realignment of the coccyx was accomplished internally through the rectum. A.M.T. testified that Respondent rubbed her clitoris to relax her and discussed sexual techniques with her. She also testified Respondent's wife was in the treatment room while she was receiving therapy. A.M.T. thought the treatment she received was normal until she came in contact with a social services counselor in 1986 and then decided she had been abused by Respondent. When school started in September 1980, A.M.T. was unable to work at Respondent's clinic and get to school on time. Her need for treatment ended when she stopped working at the clinic. Respondent denies he rubbed A.M.T.'s clitoris or engaged in any unethical treatment of A.M.T; however, Respondent testified that he discussed sex with A.M.T. and her boyfriend at the request of A.M.T.'s mother. The mother denies asking for such a consultation with her daughter, and the boyfriend (now husband of A.M.T.) denies ever attending such a meeting. Since this alleged incident occurred approximately 10 years ago it is likely that none of the participants precisely recall what happened, but is more likely that Respondent's version of the sexual conversation with A.M.T. is inaccurate. However, Respondent's and his wife's attempts to justify sexual discussion with A.M.T. on the totally discredited basis that such discussion was requested by A.M.T.'s mother, leads to the conclusion that these discussions and treatments failed to comply with generally accepted standards of chiropractic treatment. Respondent treated M.W. with usual Chiropractic techniques for approximately one year for pain associated with muscular skeletal chassis stemming from a work-related back injury. At this time, Respondent's wife, Marty, was enrolled in massage school. After a discussion among the involved parties, it was agreed that Marty would practice massage on M.W. with Respondent present to point out the muscular skeletal anatomy. These treatments took place in Respondent's clinic in the evening well after the clinic had closed and were given at no cost to M.W. M.W. told Respondent that she experienced pain while having sex with her husband. He suggested vibrator treatment would help in this regard, and M.W. purchased a vibrator. M.W. testified that the massage therapy started on her neck and moved down her back and legs while she lay nude on the table. It is undisputed that the last evening M.W. received a massage she was alone in the clinic with Respondent. Marty was delayed and did not get to the clinic, so the massage was started by Respondent. During this massage a hand-held vibrator was used. M.W. testified Respondent moved it over her vaginal area and inserted the vibrator in her vagina. Respondent contends that M.W. requested he so use the vibrator on her. Both indicate that the other was the aggressor. Respondent acknowledged that he became sexually excited and testified M.W. put her hand on his penis. M.W. testified that Respondent put her hand on the front of his pants, and when he did so she got off the table, dressed and departed, never to return. Respondent testified that when M.W. grabbed him he realized the situation was getting out of hand and he left the room. When he returned, M.W. was dressed and was leaving. Even if Respondent's version of the incident is accepted as true, he voluntarily (if not intentionally) placed himself in an indefensible position and a factual situation that can lead only to the conclusion that he attempted to engage M.W. in sexual activity outside the scope of the practice of chiropractic. T.P. worked in Respondent's clinic for three months some five years ago and received chiropractic treatment from him. While undergoing activator adjustment the vibrator treatment approached the vaginal area, but T.P. inferred no sexual overtones in the procedure. When treated by Respondent she wore undergarments and considered his treatment similar to the other four or five chiropractors with whom she has worked. Sara Chasse' was a patient of Respondent for two years before being employed by him in 1984-1985 and again in 1986 until discharged in 1989. During her employment, she also received chiropractic treatment from Respondent. Chasse' was the back office assistant and was supposed to be in the room with Respondent when he was treating female patients. As the back office assistant she overheard the Respondent ask female patients questions about their sex life. No allegations were made in the Administrative Complaint regarding unprofessional or unethical treatment of Chasse' by Respondent; accordingly, most of her testimony regarding such treatment is irrelevant. Chasse' was a close friend of C.G. and M.W. and knew K.T. and T.P. She discussed with them the treatment they received from Respondent. Chasse' filed a complaint with the Department of Professional Regulation against Respondent and provided a list of patients treated by Respondent which included those who testified in these proceedings. All of the complaining witnesses testified that Respondent had them stand in front of a full length mirror clad only in bra and panties so he could demonstrate to them the results of the adjustments made during their treatment. They also testified that while they were in the room alone with Respondent the door was closed and sometimes locked. Other witnesses denied the door leading into an examination room was ever locked. Petitioner's expert witness opined that menstrual cycle problems are best left for treatment by an obstetrician/gynecologist; the use of a vibrator is not appropriate to relieve menstrual cramps; that it is not relevant to chiropractic when female patients last had intercourse; and that using a vibrator over and in the vagina, rubbing patient's clitoris, discussing your own sexual activities with patients, and having patients stand nude before a full length mirror constitutes a failure to practice chiropractic at a level of care, skill and treatment which is recognized by a reasonable prudent chiropractic physician as being acceptable under similar circumstances and/or constitutes an attempt to engage the patient in sexual activity outside the scope or practice or the scope of generally accepted examination or treatment of the patient. Respondent's expert witness opined that when a female patient presents with low back pain, a reasonable inquiry by the chiropractic physician would be the sexual practices of the patient; that the questions shown in Exhibit 12 are appropriate; and it is appropriate for a chiropractor to treat dysmenorrhea pain, and Exhibit 13 accurately depicts the trigger points; that use of vibrator is appropriate to treat the lower abdominal area of the patient; that there is no fixed standard in the practice of chiropractic whether the door to the examining room is open or closed (but not locked), nor is there a fixed standard of practice regarding the chiropractor having some staff member present when a patient is being examined. Both expert witnesses agreed that prudence demands the chiropractic physician have a staff member present in the examining room when sensitive area's of the patient are being manipulated and that neither intervaginal massage nor clitoral stimulation is an appropriate chiropractic procedure.
Recommendation It is recommended that Joseph S. Maddox be found guilty of Counts II, III and V, and not guilty of all other charges. It is further recommended that his license be suspended for a period of six (6) months, that he pay an administrative fine of $5000 and, upon completion of the suspension, be placed on probation under such terms and conditions as the Board deems appropriate, for a period of two years. ENTERED this 7th day of August, 1990, in Tallahassee, Florida. K. N. AYERS Hearing Officer Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 7th day of August, 1990. APPENDIX Proposed findings submitted by the parties are generally accepted. Those not included in H.O.'s findings or not rejected as noted below, were deemed immaterial or unnecessary to the conclusions reached. Petitioner's Proposed Findings Rejected 10. Rejected. 12. Proposed finding that door was locked is rejected. 15. First sentence rejected as irrelevant to the charges. 21-24. Accepted as the testimony of K.T. insofar as inconsistent with H.O.'s 12, those findings are rejected. 27. Same as 15. 30. Rejected insofar as inconsistent with H.O. #17. Same as 15. Rejected as irrelevant. 40-41. Accepted only insofar as consistent with H.O. #20. 58. Rejected as irrelevant. 59-73. Are generally rejected as irrelevant and hearsay, insofar as inconsistent with H.O. #21 and not merely corroborating testimony of other witnesses whose treatments by Respondent were alleged to violate prescribed chiropractic standards. Respondent's Proposed Findings Rejected 6. Last sentence rejected. Other witnesses testified to use of small hand held vibrators. First sentence rejected. See H.O. #9. Rejected. K.T. testified that a small hand held vibrator was used on her the one time she was treated with a vibrator. She also testified that the treatment was very painful which would lead one to believe the large (10"x4") vibrator was used on pressure points. Rejected insofar as the improper touching of A.M.T.'s vaginal area is concerned. Rejected insofar as inconsistent with H.O. #16. Rejected. Rejected only insofar as it concludes that the uncalled for discussion of sexual techniques with a 15-year old female patient does not constiti1ite an attempt to engage the patient in sexual activity or malpractice. Last sentence is rejected. COPIES FURNISHED: Elizabeth R. Alsobrook, Esquire Department of Professional Regulation Northwood Centre 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792 Grover Freeman, Esquire Suite 500, 4600 Cypress Street Tampa, FL 33607 Patricia Guilford Executive Director Board of Chiropractic Department of Professional Regulation Northwood Centre 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792 Kenneth D. Easley General Counsel Department of Professional Regulation Northwood Centre 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792
