Findings Of Fact At all times pertinent to the issues contained herein, the Respondent was a licensed medical doctor in Florida having been issued license number ME 0041256. Respondent was awarded his medical degree by the University of Tennessee in 1977. He came to southwest Florida in January, 1983 starting his practice in August of that year. He thereafter applied for and was granted privileges at Lee Memorial Hospital and practiced in Lee County until January, 1985 when he moved to Collier County. In January, 1985, Dr. Heiss notified Lee Memorial Hospital that he was moving his practice and that he no longer needed privileges at that facility. This was partly in response to a letter from the hospital asking him to resign which was, at least in part, based on his failure to keep his medical records current. He admits that prior to that time, he had received some notices involving incomplete records at the hospital and went in to work on them as best he could. However, due to his own medical problem which involved a prolonged throat infection that left him tired and weak, he could not accomplish much. This medical problem lasted for several months and when he was feeling better, he tried, to the best of his ability, he claims, during the summer of 1985, to complete the incomplete records. He went to the hospital and worked on some of them, but in late 1986, when he checked with clerical personnel in the medical records section, he was told his records were complete, and coincidentally, he stopped getting delinquency notices. Under the procedure in effect at Lee Memorial Hospital for correcting incomplete records in 1984, once a week, Ms. Lindahl, the assistant manager of the records section, would go through the files to determine which records were delinquent. If dictation was needed, the chart would be declared delinquent in 15 days. If only the signature was missing, the doctor was give 45 days to correct it. When the record was declared delinquent, medical records personnel would send a weekly reminder letter to the physician setting a one week suspense for correction and indicating that if the correction was not made, the doctor's hospital privileges could be suspended. These temporary suspensions, however, were not being enforced. According to Ms. Lindahl, in 1985, Dr. Heiss was identified and placed on the delinquent list 35 times. Because of this, he would have been sent 35 letters. In January, 1985, at the time Respondent left Lee Memorial Hospital, he left incomplete 84 charts. Because of the volume of incomplete records left by Respondent, the hospital Medical Records Committee, on May 2, 1985, authorized Ms. Lindahl to transfer these incomplete records to the permanent records section of the archives, a procedure that would not normally have been done with incomplete records. This transfer was accomplished in August, 1985. After Respondent left the hospital, in January, 1985, up to March, 1985, Ms. Lindahl contacted him both at home and at his new office both by phone and by letter on several occasions, and asked him to come in and complete his records. Each of the letters sent indicated those charts, by name, which needed completion. After the charts were transferred to permanent records in August, 1985, until February, 1987, Ms. Lindahl did not make any further effort to contact Dr. Heiss, nor did he contact her. However, she was informed by the Hospital Administrator that Dr. Heiss was to come in and work on the records. Therefore, she pulled these records for him and, in fact, the Respondent did, on some occasions, come in at night to work on them. Ms. Lindahl agreed to pull records for him as needed but advised him that she could not and would not pull all his incomplete records at one time. Charts are placed on microfilm after a period of years. Some of Respondent's charts were microfilmed before he completed them. However, the hospital made arrangements for him to complete these records as well in an effort to accommodate him. Once the records were placed on microfilm, it was more difficult for Dr. Heiss to complete them since, initially, there was no dictating equipment available in the microfilm reading area. However, it could have been done by Respondent taking notes from the film and thereafter dictating those notes in the records room where dictating equipment was available. However, that was not necessary, since the hospital set up a booth with dictating capability in it for him in the microfilm reading area. An Administrative Complaint was filed against Dr. Heiss in October, 1985, because of his incomplete files. The matter was referred to the Board of Medicine in February, 1987, after a stipulated settlement was reached between the Respondent and Counsel for the Board. On February 11, 1987, the Board of Medicine entered a Final Order which approved and adopted the stipulation entered into between Respondent and counsel for the Board on December 23, 1986. Paragraph 4 of the stipulated Disposition in this case provided that prior to the stipulation being presented to the Board, Respondent would complete all incomplete hospital records that he was responsible for at Lee Memorial Hospital. Dr. Heiss contends that at that time, he understood his medical records to be complete, based upon his inquiry to personnel in the medical records section at the hospital. He indicates he made several inquiries of at least two separate employees who told him they could find no record of any incomplete files charged to him. Once his incomplete records were transferred to permanent storage, they were deleted from the computer and a routine inquiry would not have disclosed them. However, Ms. Lindahl had in her possession a complete list of his still incomplete records and a simple inquiry to her, the person in charge, would have given him the correct information. Dr. Heiss did not check with Ms. Lindahl, who worked days even though he admits he may have been in the hospital for other reasons on several occasions during the day. He would usually come in during the evenings, and on one occasion, spoke with Mr. Shuler, the night records custodian, who checked the computer and found no record of the doctor's delinquency. Mr. Shuler, however, advised Dr. Heiss to check with Ms. Lindahl. Dr. Heiss states he believed that the Stipulation he worked out with counsel for the Board in response to the initial Complaint, took care of the problem. When he went before the Board in February, 1987, he had checked with medical records at the hospital and had been told his status was clear. This check was not with Ms. Lindahl, however. When he did so, he found he did have unfinished records. It was at that time, after the stipulation was signed, that he began to bring the records current. Dr. Heiss admits that during the period 1985 - 1986, believed there were some medical records that were incomplete but because they had been filed in the permanent records section, he believed his responsibility for them was fulfilled. As a practicing physician, he relies upon the medical records section to tell him what records need to be completed. When he was advised by that agency that he was no longer delinquent, he felt satisfied. This argument is specious and without merit. Respondent admits he did not make any attempt to work on the records from January to July, 1986. He contends that from July, 1986 to January, 1987, he called the hospital several times to check on his records but could get no indication he had files undone. It was not until after the Board meeting in February, 1987, when Mr. Shuler told him to speak with Ms. Lindahl, that he determined he did have some medical records incomplete. Notwithstanding, he knew he had some dictation that was incomplete and some matters were unsigned and in his opinion, it is more a question of semantics, (what the term, "incomplete" meant), and not knowing what he had to do. He contends he dealt in good faith with the hospital and with the Board of Medicine and was surprised to find out that he was not in good standing. This argument as well, is unbelievable. Dr. Heiss contends he relied on what he was told by the people at medical records but at no time until after he entered into the Stipulation with the Board of Medicine in 1987 did he contact Ms. Lindahl even though he knew she was the one who was in charge of delinquencies and was still employed by the hospital. It was incumbent upon him as the physician to contact the person in charge, especially in light of his suspicion that certain records were incomplete, and not rely on phone calls to anyone who answered. This does not constitute reasonably prudent action or the actions of a reasonable man. It cannot reasonably be claimed that Dr. Heiss' actions were based on an honest and reasonable mistake of fact. As a physician, he should have assumed that the Board wanted and required all records to be completed and it was his responsibility to insure that the records were, in fact completed. This he failed to do. On March 20, 1987, Respondent still had 53 charts incomplete of the 84 charts he had left incomplete when he departed the staff of Lee Memorial Hospital. These 53 charts were completed by November, 1987.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore: RECOMMENDED that the Respondent's license as a medical doctor in Florida be suspended for ninety days and that he pay an administrative fine of $1,000.00. RECOMMENDED this 29th day of January, 1988, at Tallahassee, Florida. ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 1st day of February, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-2674 The following constituted my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties in this case. BY THE PETITIONER 1 & 2. Accepted and incorporated herein. 3. Accepted 4 - 8 Accepted and incorporated herein. Accepted and incorporated herein. Rejected as contra to the evidence. 11 - 13. Accepted and incorporated herein. Accepted. Accepted and incorporated herein. Accepted and incorporated herein. 17 - 19. Accepted and incorporated herein. Accepted. Accepted. Accepted and incorporated herein. 23 & 24. Accepted and incorporated herein. 25. Argument rather than Finding of Fact. 26 & 27. Accepted and incorporated herein. BY THE RESPONDENT No submittal. COPIES FURNISHED: Dorothy Faircloth Executive Director DPR, Board of Medical Examiners 130 North Monroe Street Tallahassee, Florida 32399-0750 Susan Branson, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Dan E. Batchelor, Esquire Post Office Box 1899 Bonita Springs, Florida 33923
The Issue Whether Petitioner's application for licensure as a customer representative should be granted.
Findings Of Fact Based on the oral and documentary evidence adduced at the hearing, the following relevant findings of fact are made: Petitioner, Marie Ostrowski, submitted an application for licensure as a customer representative. The application was completed and executed by Petitioner on or about February 28, 2003. Chapter 626, Florida Statutes (2003), creates jurisdiction for Respondent, Department of Financial Services, to issue the license and regulate Petitioner in its use. was: One of the questions to be answered in the application Have you ever been charged, convicted, found guilty, or pled guilty or nolo contendere (no contest) to a crime under the laws of any municipality, county, state, territory or country, whether or not adjudication was withheld or a judgment of conviction was entered? Yes/No Petitioner typed or entered "N" in the space next to the question indicating "no" as the answer. Above the signature Petitioner placed on the application is language, which states in pertinent part: I do solemnly swear that all answers to the foregoing questions and statements are true and correct to the best of my knowledge and belief . . . * * * Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his/her official duty shall be guilty of a misdemeanor of the second degree. Under penalties of perjury I declare that I have read the foregoing application for license and that the facts stated in it are true. I understand that the misrepresentation of any fact required to be disclosed through this application is a violation of the Florida Insurance and Administrative Codes and may result in the denial of my application and/or the revocation of my insurance license. In reviewing and considering Petitioner's application, the Department conducted a background check of Petitioner. Based on its criminal background check, the Department determined that, contrary to the representations in the application in response to the question concerning Petitioner's criminal history, Petitioner had a criminal history. On July 15, 1992, in State of Florida vs. Marie Pallante [Petitioner], Circuit Court of Pinellas County, Florida, Criminal Division, Case No. CRC91-21372CFANO-C, Petitioner entered a plea of nolo contendere to "Issuing a Worthless Check." At the time of the criminal matter referenced herein, Petitioner's name was Marie Pallante. On July 15, 1992, the Court accepted the plea, and withheld adjudication, and ordered Petitioner to pay court costs of $100.00 within 60 days and to pay restitution in the amount of $100.00 within 60 days to Michael Pallante, who, at that time, was her estranged or former husband. The Clerk of the Circuit Court issued a Satisfaction of Judgment/Fine giving notice that the costs in the amount of $100.00 levied against Petitioner in Case No. CRC91-21372CFANO-C on July 15, 1992, was paid and satisfied in full on September 14, 1992. Petitioner also paid the restitution to her former or estranged husband as required by the Court in Case No. CRC91-21372CFANO-C. The underlying incident which led to the criminal charge being brought against Petitioner and resulted in her entering the nolo contendere plea, occurred on or about November 11, 1991, and involved a check written to a Publix Supermarket. At or near the time of the incident, Petitioner's estranged husband had her name removed from their previously joint checking account without her knowledge. This action was taken by Mr. Pallante soon after Petitioner filed for, and obtained, a restraining order against him. Prior to Petitioner's applying for the application, which is the subject of this proceeding, she mistakenly believed that based on her attorney's representations in the above- referenced 1992 criminal matter, the record in the matter was sealed and/or expunged. At all times relevant to this proceeding, Petitioner was employed by Mercury Insurance Company (Mercury). At the time Petitioner was employed by Mercury, she advised the appropriate personnel of the 1991 incident and the 1992 plea of nolo contendere. However, neither the criminal charge nor Petitioner's subsequent plea of nolo contendere was reflected in the background check done or procured by Mercury. Apparently, Petitioner answered the subject question on the application inappropriately based on her mistaken belief that her criminal record had been sealed and/or expunged. Petitioner's belief also seemed to be supported by the fact that no criminal record appeared in a previous criminal background check conducted by her employer, Mercury. The subject question, quoted in paragraph 3 above, was not ambiguous and contemplated that an applicant answer the question regarding any crime with which the applicant had been "charged, convicted, found guilty, or pled nolo contendere (no contest) . . . whether or not adjudication was withheld." In light of the clarity of the question, it is unreasonable to believe that Petitioner did not understand the question and appreciate that the answer to the question in the application was untruthful. By signing the application according to the instructions for the oath and by her signature, Petitioner acknowledged the consequences of her choice to provide the wrong answer about her criminal history as constituting a violation of the Florida Insurance Code. Prior to and subsequent to the 1992 criminal matter discussed above, Petitioner has not been involved in any other criminal activity or incident.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby: RECOMMENDED that the Department of Financial Services enter a final order denying Petitioner's application for a customer representative license. DONE AND ENTERED this 31st day of March, 2004, in Tallahassee, Leon County, Florida. S 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 31st day of March, 2004. COPIES FURNISHED: Ladasiah Jackson, Esquire Department of Financial Services 612 Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0333 Marie M. Ostrowski 8649 Hawbuck Street Trinity, Florida 34655 Honorable Tom Gallagher Chief Financial Officer Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Mark Casteel, General Counsel Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300
The Issue Whether the Petitioner, Juan Ramon Leal, is entitled to be licensed as resident legal expense sales representative.
Findings Of Fact At all times material to the allegations of this case, the Respondent is the state agency charged with the responsibility of regulating persons seeking licenses to become resident legal expense sales representatives. As such the Respondent appropriately received and considered the application for licensure submitted by the Petitioner on or about April 3, 2002. On June 27, 2002, the Respondent issued its decision regarding the Petitioner's application for licensure. Such decision denied Petitioner's request based upon his criminal history and the short amount of time that had elapsed between the alleged criminal activity and the application for licensure. On July 6, 2000, when he was 20 years of age, the Petitioner was arrested for possession of a controlled substance, unauthorized possession of a driver's license, and carrying a concealed weapon. As to the controlled substance charge, at the time of the arrest, the Petitioner was delivering to an individual, who was a confidential informant for the police, 400 tablets of a drug commonly known as ecstasy. The Petitioner knew that the package contained an illegal substance and that he was committing an illegal act. As to the charge of possessing an unauthorized driver's license, the Petitioner held fake identification so that when carded at dance clubs he could enter with his older girlfriend. There is no evidence that the fake license was used for any other purpose. As to the charge of possession of a concealed weapon, the Petitioner was arrested and his vehicle was thoroughly searched. The "concealed weapon" was a hunting knife under the seat or in the crack of the seats. The knife was not presented in the course of any of the activities cited by the police. In fact, the arresting officer described the Petitioner as "sincerely remorseful" and "cooperative." Subsequent to his arrest the Petitioner attempted to assist the police but proved unsuccessful. On May 10, 2001, the Petitioner pled nolo contendere to the possession charges. As he had no prior criminal record, adjudication of guilt was withheld and he was placed on probation. The Petitioner successfully completed all requirements of his probation. Thereafter, on March 14, 2002, the probation was terminated. On April 3, 2002, within the month of his probation being completed, Petitioner applied for the license at issue in this proceeding. Because the Department denied the license, the Petitioner sought the instant administrative review of the denial and sought relief from the criminal court having jurisdiction over his probation and record. To that end, Petitioner obtained an Order to Seal his criminal records. This order was entered on August 15, 2002. Had the Petitioner waited until after that date to apply for licensure, the pertinent criminal records would have been under seal and therefore unavailable for review. It is the Department's position that the Petitioner lacks fitness and trustworthiness to hold the license based upon the nature of the criminal activity and the recentness in time to the application for licensure. The Petitioner's employer, Nicolo Bonanno, testified that the Petitioner is a trustworthy employee, that he has had business dealings with the Petitioner for approximately 3 years, and that he has no hesitation in supporting his licensure. Mr. Bonanno is himself a licensee through the Department. The arresting officer expressed complimentary statements regarding the Petitioner including his demeanor during and subsequent to the arrest.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Insurance enter a final order granting the license sought by the Petitioner. DONE AND ENTERED this 23rd day of January, 2003, in Tallahassee, Leon County, Florida. ___________________________________ J. D. PARRISH 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 23rd day of January, 2003 COPIES FURNISHED: Honorable Tom Gallagher Chief Financial Officer Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Mark Casteel, General Counsel Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Eugene J. LaNeve, Esquire 717 Ponce de Leon Boulevard Suite 215 Coral Gables, Florida 33134 Ladasiah Jackson, Esquire Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-0333
The Issue An administrative complaint dated June 20, 1997, alleges that Respondent, Dr. Jeri-Lin Furlow Burton, committed various violations of Chapter 458, Florida Statutes, the Medical Practice Act. The issues in this proceeding are whether those violations occurred and, if so, what discipline is appropriate.
Findings Of Fact Respondent Dr. Burton is and has been at all material times a licensed medical physician in the State of Florida, having been issued license number ME: 0042559. Dr. Burton is a general practitioner and has been a physician for 21 years. At all relevant times she was practicing in Melbourne, Brevard County, Florida. The Department of Health (agency) is the state agency now charged with regulating the practice of medicine in Florida. Patient J.M. In 1996 J.M. lived in Melbourne, Florida, in an apartment complex frequented by Dr. Burton. Dr. Burton's former husband and a friend, L.V., both lived at the complex and she visited, provided some medical care to them, and sometimes brought them groceries. J.M. knew Dr. Burton was a physician. On February 15, 1996, J.M. awakened feeling awful. At the urging of her boyfriend, J.T., and accompanied by J.T., J.M. visited Dr. Burton at her office. According to Dr. Burton's treatment sheet notes, J.M. presented with complaints of a sore throat and migraine headaches associated with nausea and vomiting. Dr. Burton performed a brief physical examination, but not a neurological examination. J.M.'s temperature and blood pressure are documented, but not her pulse, weight, or respiration. Dr. Burton recorded that J.M. had a history of migraine headaches for years and was sometimes sick in bed for days. Dr. Burton performed a streptococcus screen, which was negative. For a first visit there should have been a more complete history in the records of this patient. Moreover, any complaint of serious headache, and especially a migraine headache, should have prompted Dr. Burton to perform and record a neurological examination. Dr. Burton diagnosed J.M.'s immediate problem as an upper respiratory infection with pharyngitis. Dr. Burton prescribed Inderal to prevent migraine headaches and Bactrim D.S., an antibiotic. Dr. Burton also gave J.M. some samples of Imitrex, which relieves migraine headaches. These prescriptions were appropriate and were justified by the medical record of the February 15, 1996, visit. There were subsequent prescriptions, however, that were not justified by Dr. Burton's medical notes for her patient, J.M. On March 12, 1996, Dr. Burton prescribed 30 Percocet for J.M.'s headache. The office note merely recites the date and the complaint that the headache was not getting relief from the Imitrex which usually produced good results. The next office note is dated March 21, 1996, and states only that patient needs refill of medications for headaches. "Again 'sick' headaches in bed. Written RX Percocet(30)." (Petitioner's Exhibit No. 7) On April 19, 1996, Dr. Burton again prescribed a refill of 30 Percocet for J.M. The office note merely reflects this fact. On May 10, 1996, Dr. Burton noted that she gave J.M. samples of Imitrex, 25 milligrams, No. 9. On none of the occasions noted after the initial visit in February 1996 was any examination described. Dr. Burton explained at the hearing that these were occasions when she saw J.M. at the apartment complex, generally in the evenings. Imitrex is a non-narcotic medication that works on progestagen. It is effective in approximately 90 percent of cases. When J.M. complained that it did not work, Dr. Burton did not pursue that complaint further with a neurological examination and detailed history; instead she simply prescribed Percocet, an inappropriate narcotic. (Roxicet, reflected in the pharmacy records for J.M., is a generic substitute for Percocet.) Inexplicably on the final occasion noted in J.M.'s chart, Dr. Burton switched back to Imitrex. The records by Dr. Burton are thoroughly void of any explanation for her course of treatment of J.M.'s headaches. Patient D.W. According to Dr. Burton, D.W., born March 5, 1953, was a long-standing patient, having first seen Dr. Burton in 1990 when Dr. Burton was employed by a walk-in clinic. The records of those visits are not part of the record in this case. The walk- in clinic has closed. The documented chronology of Dr. Burton's treatment of D.W. commences with D.W.'s visit to Dr. Burton's new private practice office in October 1995. D.W. presented to Dr. Burton's office on October 17, 1995, with complaints of Crohn's Disease (an autoimmune disease that affects the intestinal tract and causes severe abdominal pain, inflammation, bleeding, and in some instances infection and perforation of the intestinal tract), headache, and weight loss. There is no documentation of physical examination or an objective finding other than D.W. was in no acute distress (NAD). Dr. Burton prescribed three vials of Stadol NS (nasal spray) with two refills and one hundred tablets of Fioricet. On November 1, 1995, Dr. Turse, a gastroenterologist, evaluated D.W. Dr. Turse reviewed prior records from a Dr. Klein, which dated back to April 1995, revealing an extensive work-up including a normal upper gastro-intestinal endoscopy, bisopsies that were negative, an unremarkable colonoscopy, a normal abdominal and pelvic ultrasound, and a negative sigmoidoscopy. Dr. Turse noted that Dr. Klein suspected that the patient's problem might be psychogenic. Dr. Turse performed two studies, an endoscopy study, and a gastric emptying study. In a report dated November 16, 1995, Dr. Turse indicated that the EGD with mucosal biopsy revealed minimal findings and that he wanted to rule out gastroparesis/gastric motility disorder. Dr. Turse followed up with a gastric emptying study, which was normal. These studies allowed Dr. Turse to rule out Crohn's disease and gastroparesis in this patient. In a letter dated December 4, 1995, Dr. Turse advised Dr. Burton that the EGD was unremarkable and the gastric emptying study was normal, and despite an extensive work-up, there was no explanation for patient D.W.'s chronic recurrent vomiting. This doctor then indicated that his main impression was gastric motility disorder. On November 6, 1995, D.W. presented to Dr. Burton complaining of headaches. The medical records do not reflect a physical examination or that any lab studies were performed. Dr. Burton's "diagnoses" were a headache, Crohn's Disease, and nausea and vomiting. She prescribed Stadol NS No. 20 (twenty), Lortab 7.5 No. 100 (one hundred) and Fioricet No. 500 (five hundred). From December 5, 1995, through December 19, 1996, D.W. presented to Dr. Burton's office multiple times with various complaints of headache, diarrhea, nausea, and vomiting. Dr. Burton continued to diagnose gastroparesis and Crohn's disease without additional testing or consultation. At this time, it is clear that Dr. Burton had Dr. Turse's letter of December 4, 1995. While it was not inappropriate for her to continue with the diagnosis of Crohn's disease or gastroparesis, a general practitioner receiving a patient with Crohn's disease or gastroparesis would perform a physical examination with a minimum of a rectal exam. A stool test should also have been done to determine if the patient was experiencing blood, parasites, or infection in the intestines. These tests were not done. On December 27, 1995, D.W. presented to Dr. Burton with complaints of a headache. She was tearful, upset, and plucking her hair. Dr. Burton diagnosed Obsessive-Compulsive Disorder and prescribed one hundred tablets of Anafranil 5mg, and Buprenex. On March 8, 1996, D.W. presented to Dr. Burton with gastrointestinal complaints. She reported a history of two episodes of anorexia and Dr. Burton's diagnosis reflects "r/o (rule out) anorexia." On July 12, 1996, Dr. Burton prescribed Wellbutrin to D.W. She had already prescribed Prozac to D.W. on June 27, 1996. Documentation of numerous office visits from October 17, 1995, through December 19, 1996, for D.W. do not contain a complete history and physical examination, or physical findings and assessment. Several of the records, such as the July 12, 1996, record, contain no physical findings whatsoever; others contain merely a temperature reading. Dr. Burton continued to indicate Crohn's disease and gastroparesis as the working diagnoses. She continued to prescribe narcotics like Lortab in high doses for this patient and Donnatrol, Lomotil, and Bentyl, all of which will slow down the motility of the digestive tract. D.W. had a motility problem with her digestive tract. To prescribe medications that slow down the digestive tract further is contra-indicated and can make the patient subject to a perforation of the colon or a systemic infection called septicemia which can be life-threatening. Dr. Burton prescribed significant amounts of Lortab and Fioricet, which contain acetaminophen. Large doses of acetaminophen can be toxic to the liver. She did not perform any liver tests on D.W. Dr. Burton prescribed Xanax, a tranqulizer and Wellbutrin, an anti-depressant, to D.W. in a short period of time. It is not appropriate to prescribe a tranquilizer with an antidepressant in a depressed patient. Dr. Burton also prescribed Prozac and Wellbutrin in the same month. Wellbutrin and Prozac can lower the seizure threshold in people and the former can increase the effect of the latter. It is inappropriate to prescribe these drugs together so close in time. Dr. Burton failed to practice medicine within the acceptable level of care in that she failed to perform an adequate or complete history, physical examination, and assessment of D.W. related to multiple complaints. Dr. Burton failed to perform a rectal exam or a stool test; in addition, she failed to perform a liver test. She also fell below the acceptable standard of care by prescribing medications that slow down the digestive tract and are contra-indicated for a patient with either Crohn's disease or gastric motility disorder. She fell below the standard of care by prescribing Stadol, a narcotic antagonist, with the amount of narcotics prescribed for this patient. Dr. Burton failed to keep written records justifying the course of treatment in that she failed to document a detailed history, physical examination, assessment of physical findings, and plan of treatment for D.W. She consistently prescribed controlled substances for Patient D.W. without performing a complete physical assessment to determine need and she prescribed medications that had the potential to exacerbate some of D.W.'s previous known conditions. Patient C.W. C.W., born March 9, 1955, was D.W.'s husband and also a long-term patient of Dr. Burton. The records of his visit commence with his visit to Dr. Burton's office on October 26, 1995, with complaints of backache and headaches. Dr. Burton's records note a history of three back surgeries, one with insertion of Harrington rods (rods surgically placed along the spine to correct curvature) and recent epidural block. Dr. Burton's office records of C.W. do not contain reports of the surgeries, CTs, or Magnetic Resonance Imaging. There is no documentation of a physical examination or findings other than blood pressure. Dr. Burton diagnosed C.W. with headache, back pain, and depression and prescribed multiple medications including but not limited to: two hundred tablets of Lortab 7.5mg, one hundred tablets of Zoloft, one hundred tablets of Xanax 2mg, six units of Stadol NS, fifty tablets of Imitrex 50mg, ten units of injectable Imitrex, and 100 M.S. Contin 30mg, a narcotic. Prior to his visit with Respondent, C.W. was treated by a Dr. Weiss from December 3, 1992, through October 1995. Dr. Weiss' records, the majority of which were not obtained by Dr. Burton until shortly before the final hearing in this case, did substantiate the prior back surgeries and problems. Dr. Weiss also prescribed Lortab, a narcotic analgesic, for this patient. However, Dr. Weiss indicated in his reports that he either dropped the dosage on the Lortabs or he cancelled the prescriptions completely. As an example, in his report of August 31, 1993, it is noted that patient tried again for Lortab No. 60 but Dr. Weiss said it was too soon. Contained in Dr. Weiss' reports is a report from Dr. Hynes. Dr. Hynes treated C.W. on June 28, 1994, and commented that Patient C.W. was on Lortabs for three years and that the patient recognized that there probably was an addiction problem. This doctor strongly recommended an inpatient pain program. Dr. Burton did not have this record from Dr. Hynes or Dr. Weiss' records, other than a note giving C.W. a disability rating, when Dr. Burton treated him. A reasonably prudent physician would not prescribe the amount of narcotics that Dr. Burton has done in this case without documentation establishing the patient's history. During the period of about October 26, 1995, through December 9, 1996, C.W. presented to Dr. Burton on approximately sixteen occasions with complaints of back pain. Dr. Burton diagnosed chronic back pain and "failed back syndrome" and continued to prescribed Lortabs and other narcotics during this time period. There is no documentation of referral for orthopedic or neurological consultation, and inadequate documentation of physical assessment or clinical evaluation for treatment. There is no documentation concerning a referral to a pain management program. In her note of November 6, 1995, Dr. Burton indicated that C.W. took five tablets of MS Contin at once with no relief. Dr. Burton had indicated in her October 26, 1995, report, less than 2 weeks earlier, that she had warned the patient to take only one a day. Based on this history, C.W. was non-compliant with medication and Dr. Burton should have realized there may be a problem. On April 1, 1996, C.W. presented to Dr. Burton with complaints of weight loss and increased sleeping. Respondent prescribed several medications including Wellbutrin. From October 26, 1995, through December 9, 1996, C.W. received the following medications, among others, prescribed by Dr. Burton in the following approximate amounts: Lortab 7.5 1100 tablets Lortab 10 500 tablets Xanax 2mg 30 tablets Ritalin 20mg 10 tablets Imitrex 50mg 100 tablets Fioricet 900 tablets Duragesic 100mg 5 patches Methadone 10mg 40 Despiramine 25mg 30 Stadol NS 60 Vials Dr. Burton failed to practice medicine within the acceptable level of care in that she failed to perform an adequate or complete history, physical examination, and assessment of C.W. related to complaints of chronic back pain. Dr. Burton failed to practice medicine within the acceptable level of care when she failed to refer C.W. for neurological consultation and physical or pain management therapy of any kind. She failed to practice medicine within the acceptable standard of care for C.W. by consistently prescribing controlled substances in excessive quantities that are addictive without documenting the risks and by not attempting to decrease the dosage or detoxify the patient. Dr. Burton failed to maintain medical records documenting a detailed history, complete physical examinations, and assessments of physical findings of C.W. She failed to obtain records of prior surgeries or diagnostic evaluations to supplement C.W.'s record. Dr. Burton's medical records do not justify the course and scope of treatment of this patient. Weighing the Evidence The testimony of Drs. Rafool and Stein on behalf of the agency was competent and credible. Both reviewed all of the medical records provided by Dr. Burton to the agency and pharmacy records obtained independently by the agency. They also received some law enforcement records which have been excluded from this proceeding as hearsay. Both experts relied appropriately and substantially on Dr. Burton's medical records, or lack thereof, in rendering their opinions of her violations. Both experts explained their conclusions with specific examples and discussions of various office visits of the patients at issue. It is difficult to assess the credibility of Dr. Burton's expert witness, Dr. Centrone, a neurosurgeon. Like the other experts, he reviewed Dr. Burton's records, but he also reviewed detailed statements provided to him by Dr. Burton, which were prepared in the course of this proceeding and not contemporaneously with the office notes. Dr. Centrone, without detailing any basis, concluded that Dr. Burton properly treated the patients at issue. The testimony of J.M. regarding finding prescription bottles, in her name and provided by Dr. Burton, among the abandoned possessions of her former live-in boyfriend was unspecific and confusing and an inadequate basis for finding that Dr. Burton illegally provided drugs to the boyfriend, J.T., through prescriptions written to J.M. Likewise, J.M. never plainly contradicted Dr. Burton's explanation of her encounters with J.M. subsequent to the one office visit in February 1996. J.M. insists that she never returned to Dr. Burton's office, but Dr. Burton's notes do not state that she did return. Instead, as Dr. Burton explained, the notes reflect more casual encounters at the apartment complex and Dr. Burton's prescriptions for continued migraine complaints. Although the agency failed to prove alleged fraud by Dr. Burton, it did prove that Dr. Burton failed to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. For each patient at issue Dr. Burton consistently responded with prescriptions of controlled substances in inappropriate amounts or combinations. Her testimony that the patients had intractable pain, that she often provided free medical treatment to poor or uninsured patients, and that she had many patients, "nuts", that had been "dumped by every doctor in town," is not a valid defense. Moreover, the explanations in Dr. Burton's written statements offered at hearing and in her testimony regarding her treatment do not obviate the serious deficiencies in her medical records for J.M., D.W., and C.W. Those records provide a sketchy statement of complaint, diagnosis (often no more then "headaches," "back pain," or "failed back syndrome"), and a listing of medications prescribed (sometimes as many as 6 for a single visit). Rarely is there any evidence of an examination or any written justification for prescriptions. The agency's evidence, primarily Dr. Burton's own records, clearly establishes that she failed to keep written medical records justifying the course of treatment of the patients at issue. In a Final Order dated June 10, 1995, in DOAH Case No. 93-3096, Dr. Burton was disciplined by the Board of Medicine for failure to maintain appropriate medical records. In a consent order entered in Case No. 96-02493, Dr. Burton agreed to a fine and other conditions, after she was charged with violating the Board's order in the prior case.
Recommendation Based on the foregoing, it is hereby RECOMMENDED: that the Board of Medicine enter its final order finding that Respondent violated Sections 458.331(1)(m),(q), and (t), Florida Statutes (1995), and imposing discipline of a 2-year suspension, $2,000 fine and 2-year probation under appropriate conditions to be established by the Board. DONE AND ENTERED this 17th day of June, 1999, in Tallahassee, Leon County, Florida. MARY CLARK Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 17th day of June, 1999. COPIES FURNISHED: John E. Terrell, Senior Attorney Office of the General Counsel Department of Health Post Office Box 14229 Tallahassee, Florida 32317-4229 George Ollinger, Esquire 100 Rialto Place, Suite 700 Melbourne, Florida 32940 Tanya Williams, Executive Director Board of Medicine Department of Health Northwood Centre 1940 North Monroe Street Tallahassee, Florida 32399-0750 Angela T. Hall, Agency Clerk Department of Health 2020 Capital Circle, Southeast, Bin A023 Tallahassee, Florida 32399-1703 Pete Peterson, General Counsel Department of Health Bin A02 2020 Capital Circle, Southeast Tallahassee, Florida 32399-1701
The Issue The issue is whether Petitioner should be exempt from disqualification for employment in a position of trust, pursuant to section 435.07, Florida Statutes.1/
Findings Of Fact AHCA is authorized to conduct certain background screenings for employees providing specific types of services within health care facilities licensed by AHCA. See § 408.809(1)(a), Fla. Stat. (employees subject to screening); § 408.803(9), Fla. Stat. (definition of “licensee”). Petitioner was required to participate in Respondent’s background screening process because he sought employment in a position providing direct services to residents of a health care facility licensed by AHCA under chapter 400, Florida Statutes. Petitioner underwent the required background screening, which revealed: On or about May 6, 1996, in Case No. 1995MM007600, Petitioner was adjudicated guilty of Battery under section 784.03(1)(a)1., Florida Statutes. At the time of this offense, Petitioner and Teresa Poole, the alleged victim, resided together or shared the same dwelling. On or about May 15, 2002, in Case No. 2002CF000065, Petitioner pled no contest to Battery under section 784.03(1)(a)1., a misdemeanor. Adjudication was withheld. At the time of this offense, Petitioner was residing with or was sharing the same dwelling with Erica Goode, the alleged victim. On or about July 6, 2009, in Case No. 2009MM000294, Petitioner pled no contest to Battery under section 784.03(1)(a)1. Christine Crowley, the alleged victim, and Petitioner are related by blood and have previously resided together in the same dwelling. Christine Crowley is Petitioner’s biological sister. Each of the above-referenced battery charges constitutes Domestic Violence under section 741.28, Florida Statutes. Under sections 435.04(3) and 408.809(4)(e), Florida Statutes, the above-referenced criminal offenses disqualify Petitioner from providing services in a health care facility licensed by AHCA, unless AHCA grants Petitioner an exemption pursuant to section 435.07. In addition to his disqualifying offenses, Petitioner's background screening revealed: On or about September 18, 1998, in Case No. 1998CF000638, Petitioner was arrested for Aggravated Battery under section 784.045(1)(a)1. Although Petitioner was not ultimately convicted, at the time of this charged offense, Petitioner was residing with or had previously resided with the alleged victim, Christina McCullum, in the same dwelling. A conviction of this charge would constitute Domestic Violence under section 741.28. On or about September 21, 1998, in Case No. 1998CT003202, Petitioner pled no contest to Driving While License Suspended (With Knowledge) under section 322.34(2), Florida Statutes. Petitioner maintains that he did not actually have knowledge. On or about February 1, 1999, in Case No. 1999CT00187, Petitioner was adjudicated guilty of Driving While License Suspended (With Knowledge) under section 322.34(2). Petitioner maintains that he did not actually have knowledge. On or about February 24, 1999, in Case No. 1998CT004442, Petitioner was adjudicated guilty of Driving While License Suspended (With Knowledge) under section 322.34(2). Petitioner maintains that he did not actually have knowledge. On or about January 25, 1999, in Case No. 1999CF000264, Petitioner was arrested for Burglary under section 810.02(3)(b) and Battery under section 784.03(1)(a)1. At the time of these offenses, Petitioner had previously resided with the alleged victim, Christina McCullum, in the same dwelling. If convicted, this charge would constitute Domestic Violence under section 741.28. On or about April 14, 1999, in Case No. 1999MM000766, Petitioner was arrested for Assault under section 784.011. Petitioner was not ultimately convicted. On or about July 14, 1999, in Case No. 1999CF2483, Petitioner was arrested for Aggravated Battery under section 784.045. Petitioner was not ultimately convicted. At the time of this alleged offense, the Petitioner had previously resided with the alleged victim, Christina McCullum, in the same dwelling. If convicted, this charge would constitute Domestic Violence under section 741.28. On or about December 12, 1999, in Case No. 1999CF000727 (later transferred to 1999MM002249), Petitioner was arrested for Battery under section 784.03(1)(a)1. and Resisting without Violence under section 843.02. At the time, Petitioner had previously resided with the victim, Christina McCullum in the same dwelling. The battery charge constitutes Domestic Violence under section 741.28. Petitioner was adjudicated guilty of the above-referenced Resisting without Violence charge and sentenced to a year of probation with a special condition of completion of a Batterer’s Intervention Program. i. On or about July 30, 2002, in Case No. 2002MM007400, Petitioner was charged for giving a worthless check under section 832.05(2), but the charges were ultimately dismissed. On or about November 5, 2003, in Case No. 2003CF000692, Petitioner was charged with Aggravated Battery under section 784.045(1)(a)1. Petitioner was not ultimately convicted. On or about March 18, 2004, in Case No. 2004CF000185, Petitioner was charged with Dealing in Stolen Property, under section 812.019(1). Petitioner was not ultimately convicted. On or about June 3, 2009, in Case No. 2009CF000362, Petitioner was charged with Burglary under section 810.02(3)(c) and Petit Theft under section 812.014(3)(a), Florida Statutes. Petitioner was not ultimately convicted. At the time of the above- referenced charges, Petitioner was the former spouse of, and had previously resided with, the alleged victim, Erica Goode/Crowley in the same dwelling. On or about June 26, 2009, in Case No. 2009MM000678, Petitioner was arrested for Battery under section 784.03(1)(a)1. and Disorderly Conduct (Affray) under section 870.01(1). Petitioner was not ultimately convicted. On or about July 9, 2009, in Case No. 2009MM000721, Petitioner was charged with violating a No Contact Order issued by the first appearance judge in the case referenced above. Petitioner was not ultimately convicted. On or about August 21, 2009, in Case No. 2009MM000922, Petitioner was arrested for Battery under section 784.03(1)(a)1. Petitioner was not ultimately convicted. At the time of this arrest, Petitioner was residing in the same dwelling with the alleged victim, Michelle Vanhoose. On or about January 2011, in Case No. 2010CF000620, Petitioner was adjudicated guilty of Aggravated Stalking under section 784.048(3), Florida Statutes. Licensed professionals under the Department of Health may work at a facility licensed by AHCA, if granted an exemption by the Department of Health, but may only work within the scope of that professional license, unless AHCA itself grants the applicant an exemption. Petitioner does not have an active license or exemption from disqualification from the Department of Health. Petitioner does not dispute that he has disqualifying offenses and subsequent criminal history, but claims his application and entire file support his rehabilitation by clear and convincing evidence. AHCA received Petitioner’s application for exemption in accordance with sections 408.809 and 435.07, on or about June 15, 2017. AHCA conducted a telephonic hearing with Petitioner on August 2, 2017. During the telephonic hearing, in addition to discussing the results of Petitioner’s background screening, as evidence of his rehabilitation, Petitioner pointed out that he has been working, getting an education, and has not been arrested in six years. Petitioner also submitted several positive letters of recommendation from close friends and family. After the telephonic hearing, AHCA denied Petitioner’s request for an exemption and sent Petitioner the Denial Letter, signed by AHCA’s manager for the Background Screening Unit, Samantha Heyn, on behalf of AHCA. Although Ms. Heyn did not attend AHCA’s telephonic hearing with Petitioner, she previously spoke to Petitioner in a phone call about his exemption request. In making the decision to deny Petitioner’s application, Ms. Heyn and pertinent AHCA staff with the background screening unit considered Petitioner’s entire case file, including all submissions received from Petitioner and his explanations during the teleconferences. AHCA also considered the time elapsed since the offenses, the nature and harm to the victims, the circumstances surrounding the offenses, Petitioner’s history since the offenses, and all other supporting documentation provided by Petitioner before deciding to deny Petitioner's request for exemption from disqualification. Petitioner testified that he has ambitions to work as a licensed health care professional. During the administrative hearing, Petitioner testified that he is in his current predicament because of vindictive people falsely accusing him of crimes, and AHCA personnel who have labeled him a criminal. Similarly, during his earlier teleconference with AHCA, Petitioner stated that he was in his current situation due to racism, labeling, vindictive people out to destroy him, and other factors out of his control. Petitioner’s statements at the initial teleconference with AHCA were conflicting as to whether the courses he took for batterer’s intervention and anger management were court-ordered, conditions of a plea deal with prosecutors, or fully voluntary outside of the criminal justice system. Petitioner was arrested for violent and domestic crimes after taking each course. While Petitioner has stated that he takes full responsibility for his actions, his other statements at the teleconference and at the administrative hearing reflect a lack of candor and an unwillingness to accept responsibility for his past criminal episodes. While the letters of recommendation from close family and friends, successful educational pursuits, and a clean record for the last six years demonstrate progress toward rehabilitation, this fairly recent success does not annul Petitioner's extensive criminal history, lack of candor, and unwillingness to accept responsibility. The records of successful exemption applicants offered by Petitioner were not helpful to Petitioner’s case. The criminal backgrounds were not the same as Petitioner’s and the evidence was insufficient to permit a useful comparison between the facts and circumstances of those applicants with those of Petitioner. In view of all of the evidence, it is found that Petitioner failed to meet his burden to prove by clear and convincing evidence of rehabilitation when he presented his case to AHCA, and the evidence presented at the final hearing failed to demonstrate that AHCA abused its discretion in denying Petitioner’s request for exemption.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is recommended that Respondent enter a final order denying Petitioner’s request for an exemption from disqualification for employment. DONE AND ENTERED this 16th day of March, 2018, in Tallahassee, Leon County, Florida. S JAMES H. PETERSON, III 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 16th day of March, 2018.
The Issue The amount that Respondent, Florida Power and Light Company (FPL), is entitled to bill the electrical account for the property located at 3151 S.W. 84 Court, Miami, Florida, owned by Petitioner, Blanca Rodriguez, and her husband, Juan A. Rodriguez, for electricity used but not metered because of meter tampering, and the amount that Respondent is entitled to bill for the reasonable costs of its investigation.
Findings Of Fact On January 30, 1987, the FPL electric service account at 3151 S.W. 84 Court, Miami, Florida, was opened under account number 20770-66450 in the name of Juan A. Rodriguez. The account was in the name of Juan A. Rodriguez at all times pertinent to this proceeding. At the request of the Petitioner, the account was changed into her name on October 9, 1996. The residence located at 3151 S.W. 84 Court, Miami, Florida, has, at all times pertinent to this proceeding, been owned by Petitioner and her husband, Juan A. Rodriguez. At all times pertinent to this proceeding, Petitioner has lived in the subject residence and has received the benefit of FPL electrical service. Petitioner’s husband, Juan A. Rodriguez, lived in the residence from 1987 until he and Petitioner separated in 1994. Thereafter he moved back into the residence in February 1996, and he was living at the residence at the time of the formal hearing. In August 1995, FPL became suspicious that someone had tampered with the electrical meter for the subject residence. An investigation was instigated and assigned to Helen Lubert, a senior revenue protection investigator employed by FPL. Petitioner stipulated to the experience and expertise of Ms. Lubert. Based on that investigation, which included a review of the public records, spot checks of electrical usage during times there was no meter tampering, and an interview with Petitioner and her husband, Ms. Lubert projected the amounts of electricity that had been actually used at the subject residence. This projection made use of charts referred to as seasonal average percentage of usage charts. These charts and the methodology used by FPL have been approved by the Florida Public Service Commission. FPL’s records retention policy is to purge billing records that are more than six years old. When Ms. Lubert attempted in March 1996 to determine how long the meter tampering had been going on she could not locate the billing records for the subject property prior to April of 1990. In comparing the amounts that were billed with the amounts that she had projected had been actually used, Ms. Lubert found the amounts billed were substantially lower than the amounts she had projected had been used. Ms. Lubert reasonably determined that meter tampering had been occurring at the subject residence since at least April 1990. Ms. Lubert testified that the projected amount of electricity actually used was reasonable and that the amount of the billing for the electricity that had been used but not billed because of meter tampering was reasonable. She also testified that the billing for the investigative costs was reasonable. In forming her opinion that the projected amount of electricity actually used was reasonable, Ms. Lubert considered that the methodology used has been approved by the FPSC, the approximate size of the residence, the type water heater and appliances in the residence, the fact that there is a swimming pool with an electrical pump, the number of occupants in the residence, the manner in which Respondent reported she used air conditioning, and the fact that there was an apartment added to the house in 1994. Ms. Lubert calculated that since April 1990 and the date of the billing, the value of the unmetered electricity that had been used by the subject account was $7,453.12. This calculation is a reasonable estimate of the unmetered energy used. Ms. Lubert also calculated that the reasonable costs of the investigation was $349.38. This amount is reasonable. On April 5, 1996, FPL billed the subject account the sum of $7,802.50 based on Ms. Lubert’s calculations. Although her name was not on the account with FPL prior to October 1996, neither the FPSC or FPL has challenged her right to contest this billing.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Florida Public Service Commission enter a final order that denies Petitioner’s challenge to this billing, thereby upholding the billing to the subject account. DONE AND ENTERED this 21st day of May, 1997, in Tallahassee, Leon County, Florida. Hearings Hearings CLAUDE B. ARRINGTON Administrative Law Judge Division of Administrative The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative this 21st day of May, 1997 COPIES FURNISHED: Mrs. Blanca Rodriguez 3151 Southwest 84th Court Miami, Florida 33155 Mayra Trinchet, Esquire 42 Northwest 27th Avenue, Suite 323 Miami, Florida 33125 Robert E. Stone, Esquire Post Office Box 029100 Miami, Florida 33102 Vicki Johnson, Esquire Public Service Commission Division of Legal Services 2540 Shumard Oak Boulevard Tallahassee, Florida 32399-0850 Blanca Bayo, Director of Records Public Service Commission 2540 Shumard Oak Boulevard Tallahassee, Florida 32399-0850 Rob Vandiver, General Counsel Public Services Commission 2540 Shumard Oak Boulevard Tallahassee, Florida 32399-0850 William D. Talbott, Executive Director Public Services Commission 2540 Shumard Oak Boulevard Tallahassee, Florida 32399-0850
Findings Of Fact In July of 1984, Jo Ellen Dyer, submitted her resignation as a Personnel Specialist at St. Mary's Hospital, and St. Mary's placed an ad for her position. Petitioner submitted a resume to St. Mary's, with a cover letter seeking that position. St. Mary's contacted him for an interview, and he was interviewed by Gerald Gorman, Employee Relations Director, on July 25, 1984. As part of that interview Petitioner completed a St. Mary's Hospital employment application in which he represented that he did not have any physical handicaps or illnesses which in any way might hinder his ability to perform the job for which he had applied. Gorman was impressed with Petitioner. However, he contacted Petitioner shortly after the interview to explain that there was some question over whether Jo Ellen Dyer's position would be filled due to potential hospital cost reduction needs. Several weeks later Gorman contacted Petitioner to find out if Petitioner was still interested in the position. Upon ascertaining that Petitioner was, Gorman scheduled the next stage in the employment process, an interview with Gil Wright, the department head. On October 5, 1984, Petitioner was interviewed by Wright and then again by Gorman. At that time Petitioner was offered the position of Personnel Specialist subject to reference checks and a preemployment physical examination. It is the standard policy of St. Mary's to make employment contingent upon the passing of an initial employment physical that must be accomplished prior to employment and upon favorable reference checks. During the interview of October 5, 1984 Petitioner told Gorman that Petitioner wanted or needed to give two weeks' notice to his current employer, Job Service of Florida, if Petitioner was going to be selected for the Personnel Specialist position. Because of that requirement for two weeks' notice, Gorman and Petitioner agreed that Petitioner must be advised no later than October 19, 1984 that he would be hired, and November 5, 1984 was agreed to be Petitioner's starting date of employment at St. Mary's. They further agreed that Petitioner would be scheduled for his pre-employment activities the week of October 15, 1984. On October 9, 1984 Petitioner signed a form entitled "Condition of Employment" which advised him that his examination would include blood tests, urinalysis, chest x-ray, PPD, and an examination by a physician. On October 15, 1984 Petitioner came to the hospital to continue his pre-employment activities by completing various forms. Since Gorman had a scheduling conflict, he requested Personnel Specialist Andrew Thompson to assist Petitioner in completing the required paperwork. One of the forms was a personnel specialist position description which Petitioner read and then signed. That job description contained the statement "must be able to do a substantial amount of the [sic] walking throughout the hospital." On that same day Petitioner filled out a medical history form advising that he had arthritis in his neck, that he had sustained a neck injury, that he had been under a doctor's care during the past two years at the Veterans administration, that he had a VA disability, a medical discharge, and "myositis." He further indicated that he had lost no time from work during the past year. While Thompson and Petitioner were completing the paperwork, they were also engaging in conversation since they both expected to be working together as two of the three Personal Specialists at St. Mary's. Petitioner told Thompson that Petitioner, due to a spinal injury, would periodically, without warning, suffer loss of hand coordination which would sometimes result in him dropping items being carried. Petitioner also told Thompson that one of Petitioner's legs was subject to sporadic disfunction that caused him to periodically fall, without warning to himself or to others. He told Thompson that this occurred several times while he was at his place of employment and that his falling had caused humorous incidents. Thompson told Gorman on October 15 or 16, 1984, what Petitioner had said about his physical condition. On October 16, 1984, Gorman sent Petitioner a letter confirming the offer of employment made on October 5, confirming the November 5 effective date, and scheduling Petitioner's orientation for November 5. The offer contained in that letter again stated that it was "subject to satisfactory reference checks and the passing of pre-employment health requirements." On October 17, 1984, Petitioner was interviewed for a promotion that he had applied for at his current employer, Job Service of Florida. On October 18, 1984, Petitioner was given a physical examination by Dr. Amratlal M. Patel, the hospital's employee health physician. Dr. Patel reviewed Petitioner's medical history which caused him concern as to Petitioner's physical condition. He asked Petitioner, who had been lying on a table or stretcher, to walk. When Patel saw that Petitioner, attempting to walk without his cane, was only able to take several steps while holding on to the table and that he was wobbling, Dr. Patel told him to lie back down and asked him how he was able to walk. Petitioner replied that he could walk with a cane. Patel asked who had been treating him, and Petitioner advised that he had been receiving treatment at the Veterans Administration clinic and that his treating neurologist was a Dr. Wilson. Patel told Petitioner that he needed additional information before he could make a decision regarding Petitioner's employability. Patel ordered a lumbar spine x-ray taken of Petitioner and told Petitioner that he needed Petitioner's medical records from the Veterans Administration and a report or the medical records from Dr. Wilson, Petitioner's treating physician, in order to determine Petitioner's current medical condition and prognosis. Dr. Patel did not examine Petitioner in more depth than he would any other applicant for employment since he believed that the answers to Petitioner's condition would best come from a specialist who had been treating Petitioner, and Dr. Patel is not a neurologist. Dr. Patel did not request that Petitioner walk with his cane in order to observe Petitioner walk but merely took Petitioner's word for it that he would walk with a cane. Although Patel will sometime contact an applicant's doctors if he has questions and if he knows them, Patel did not contact Petitioner's doctors whom he did not know. He instead requested copies of the records and advised Gorman that he was requiring Petitioner to bring him copies of Petitioner's records from the Veterans Administration and from Dr. Wilson before he would make any determination of Petitioner's ability to perform the job requirements. Dr. Patel knew that the Personnel Specialist position required a good deal of "running around." After his physical examination, Petitioner called Dr. Wilson to request copies of his medical records, but Dr. Wilson was not in his office at the time that Petitioner called. Petitioner did not ask anyone else in Dr. Wilson's office to provide him with copies of his medical records and did not again attempt to contact Dr. Wilson to obtain a copy of those records. He did, however, go to the Veterans Administration Ambulatory Care Center where he picked up a copy of his most recent medical records. He then drove back to St. Mary's and gave the Veterans Administration's records to Gorman. Gorman reminded Petitioner that he must also supply a copy of Dr. Wilson's records, and Petitioner told Gorman that he needed to hear from Gorman by the following day as to what Dr. Patel had determined based upon Patel's review of the Veterans Administration's records. The Veterans Administration records revealed that during Petitioner's visits to the doctor there in June, July, and August, 1984, Petitioner was deteriorating more, that he had difficulty in getting out of chairs unassisted, with eating, with holding things in his hands, with letting go of things that he was holding, and with getting up off of the floor. On October 19, 1984, Dr. Patel reviewed the Veterans Administration's notes and concluded from that information that Petitioner's condition was more serious than Patel had thought, that there was very severe permanent central nervous system involvement, that Petitioner would not be able to physically move about the hospital as the personnel specialist job required, but that Dr. Patel still wanted the information from Dr. Wilson without which he felt he could not make a medical decision regarding Petitioner's employability. Dr. Patel informed Gorman of his conclusion after his review of the Veterans Administration's notes, telling Gorman that Petitioner had a lot of problems with his muscles and central nervous system, and that Dr. Patel could not make a decision based only on the medical information thus far provided by Petitioner. Because October 19 was the last day upon which two weeks' notice could have been given by Petitioner before his starting time at St. Mary's of November 5, 1984, and because of Petitioner's insistence that he be notified on October 19 of Dr. Patel's conclusion upon review of the Veterans Administration's records, Gorman contacted Petitioner on October 19. Gorman told Petitioner that Dr. Patel could not make a good medical decision based on the information contained in the Veterans Administration's records provided by Petitioner. Gorman told Petitioner that Dr. Patel did not know Petitioner's complete current medical condition and prognosis for the future without Dr. Wilson's records and that in view of the activities of the job Dr. Patel could not recommend Petitioner at that time. During that same telephone conversation Petitioner told Gorman that he was "flying a desk" at his present job and could not understand why he could not do the same at St. Mary's. Gorman explained that the position to be filled at St. Mary's was not one of "flying a desk" but required much more physical activity, as indicated in the job description signed and acknowledged by Petitioner. Gorman further told Petitioner that since he could not offer Petitioner the position on October 19 (the deadline set by Petitioner), that the hospital would continue to look for qualified candidates to fill the position. Gorman sent Petitioner a letter on that date confirming the substance of the telephone conversation between them. No time limit was imposed by anyone from St. Mary's hospital as to when the medical documentation requested of Petitioner was to be provided. Petitioner never did provide St. Mary's with any documentation from Dr. Wilson although he knew that it had been requested as a condition precedent to his approved employment. Petitioner did not request that Gorman extend the October 19th deadline established by Petitioner for his two-weeks' notice in order that he could bring Dr. Wilson's records to Dr. Patel for his review. Gorman's decision to look for other applicants due to Petitioner's failure to provide documentation from Dr. Wilson was influenced by Gorman's concern for Petitioner's safety and well-being, if employed at St. Mary's Hospital, and the safety and well-being of co-workers and patients of the hospital. The position for which Petitioner applied, the one being vacated by Jo Ellen Dyer, involved walking throughout the hospital a minimum of 70 percent of the work time. The hallways in the hospital are frequented by visitors, staff, and patients, and patients ambulate in the hallways with IVs attached. Further, persons on stretchers and in wheelchairs are frequently encountered in the hallways. Petitioner received the promotion he was applying for at his then place of employment in November of 1984. In November of 1984 St. Mary's Hospital's president issued instructions that new hirings of employees would be limited, and vacant positions should be filled prudently. The Personnel Specialist position for which Petitioner applied has never been filled and was eliminated, for practical purposes, in December of 1984. Although other persons have since been hired as Personnel Specialist at St. Mary's or have transferred from other departments into Personnel Specialist positions at St. Mary's, none of those persons have been hired for or transferred to the personnel Specialist position previously held by Jo Ellen Dyer, the one for which Petitioner had applied. The duties formerly performed by Jo Ellen Dyer were absorbed by Drew Thompson. St. Mary's Hospital does employ handicapped employees when the handicap does not interfere with the performance of their duties and a reasonable accommodation can be made for those individuals. St. Mary's Hospital's failure to hire Petitioner was due to Petitioner's failure to qualify for that employment by providing required medical information by the deadline that Petitioner had imposed in order that Petitioner could show that he was able to fulfill the job duties. A person using a cane could fulfill the job description so long as that was the only problem. At the time that St. Mary's was required by Petitioner to make its final decision on October 19, the information it had regarding Petitioner's current medical condition was the information that Petitioner had given to Drew Thompson about falling unexpectedly and dropping things unexpectedly and the information contained in the Veterans Administration's medical records Petitioner he had given to the physician at the Veterans Administration for purposes of obtaining medical treatment. Those who encountered him at St. Mary's Hospital, however, observed Petitioner having no difficulty walking with his cane. The partial medical information provided by Petitioner was inconclusive. Petitioner is not a handicapped person and does not consider himself to be one. Petitioner testified at the final hearing that he walks with no difficulty, that when he interviewed at St. Mary's Hospital he parked his car two and one-half blocks away and walked to the interview (rather than parking in a handicapped space), that he has never been physically unable to perform any of his job duties, that he suffers no limitations whatsoever on his ability to walk, to carry, to lift, to push, and that he is not precluded from doing anything. He testified that he writes with no difficulty and operates a computer daily despite the numbness in his hands. He lifts and moves furniture in his family's thrift store when he is there; he pushes his wife in a wheelchair; and he is a wood carver who uses knives, which requires fine finger manipulation.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED that a Final Order be entered finding Respondent not guilty of an unlawful employment practice regarding its failure to hire Petitioner and dismissing with prejudice the Petition for Relief filed in this cause. DONE and RECOMMENDED this 31st day of May, 1988, at Tallahassee, Florida. LINDA M. RIGOT, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 31st day of May, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-5116 Petitioner's proposed findings of fact numbered 1, 3, 4, 7-15, 18-22, 27, and 33 have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed findings of fact numbered 2, 34, and 40 have been rejected as being contrary to the weight of the credible evidence in this cause. Petitioner's proposed finding of fact numbered 6 has been rejected as not being supported by the weight of the credible evidence in this cause. Petitioner's proposed findings of fact numbered 35-39 have been rejected as being irrelevant Petitioner's proposed findings of fact numbered 5, 16, 17, 23-26, and 28-32 have been rejected as not constituting findings of fact but rather as constituting argument of counsel, conclusions of law, or recitations of the testimony. Respondent's proposed findings of fact numbered 1-32 have been adopted either verbatim or in substance in this Recommended Order. Respondent's proposed finding of fact numbered 33 has been rejected as not constituting a finding of fact but rather as constituting argument of counsel. COPIES FURNISHED: Donald A. Griffin, Executive Director Human Relations Commission 325 John Knox Road Building F, Suite 240 Tallahassee, Florida 32399-1925 Lynn E. Szymoniak, Esquire 1030 Lake Avenue Lake Worth, Florida 33460 Leo P. Rock, Jr., Esquire Post Office Box 3068 Orlando, Florida 32802 Dana Baird, General Counsel Human Relations Commission 325 John Knox Road Building F, Suite 240 Tallahassee, Florida 32399-1925 Sherry B. Rice, Clerk Human Relations Commission 325 John Knox Road Building F, Suite 240 Tallahassee, Florida 32399-1925
The Issue The issue is whether Petitioner’s request for exemption from disqualification should be granted.
Findings Of Fact Respondent is the state agency responsible for regulating the employment of persons in positions of special trust as direct service providers. Petitioner is seeking employment with Always Promoting Independence, LLC, and Supporting Independence/Honor Health Care Management, both service providers are regulated by Respondent. Petitioner wants to work as a direct service provider, which requires background screening. The results of Petitioner’s background screening revealed a history of criminal offenses. Respondent relies on the Department of Children and Families Background Screening Unit (“Department”) to initially receive exemption from disqualification requests and to compile documents related to such requests. On February 8, 2016, Petitioner submitted a Request for Exemption, Exemption Questionnaire (“Questionnaire”), various criminal records, character references, and other various documents (the “Exemption Packet”), to the Department seeking to demonstrate support for the granting of an exemption from employment disqualification. The Department subsequently forwarded the Exemption Packet to the Agency for review. To begin its exemption review, Respondent considered Petitioner’s disqualifying offense. In May 1991, Petitioner committed the disqualifying offense of “Fraudulent Use of Credit Card” (six counts). Petitioner pled nolo contendere to the disqualifying offense and adjudication was withheld. She was sentenced to 24 months’ probation and payment of fines and court costs. She completed her term of probation early. In its continued exemption review, Respondent considered the following non-disqualifying offenses, which Petitioner obtained subsequent to her May 1991 disqualifying offense: an arrest for “Aggravated Assault with a Firearm” in August 1997 (a violation of section 784.021, Florida Statutes); an arrest for “Driving While License Suspended with Knowledge” in October 2007 (a violation of section 322.34(2), Florida Statutes); an arrest for “Driving While License Suspended with Knowledge” in September 2008 (another violation of section 322.34(2)); an arrest for “Possession of Cannabis” in March 2012 (a violation of section 893.13(6)(b), Florida Statutes); and a conviction for “Possession of Drug Paraphernalia” in March 2012 (a violation of section 893.147(1)). Petitioner received notification by letters dated September 22, 2015, and January 12, 2016, from the Department, Respondent’s background screening entity, of her disqualification from employment due to criminal history. The specific disqualifying offense listed in both letters was “Fraud-Illegal Use of Credit Cards,” a violation of section 817.61, Florida Statutes. Petitioner provided details of the circumstances surrounding the disqualifying offense. In short, Petitioner indicated she gave three “associates” a ride to the mall in exchange for their promise to buy her a new pair of shoes. She left the Champs sports store with her shoes, expecting one of her companions to pay for them. She was in her car when her companions ran from the store with a security guard in pursuit. They told her to start the car which she refused because she believed she had not done anything wrong. Unfortunately for her, one of her companions had attempted to pay for her new shoes with a stolen credit card. She and her companions were arrested and charged with credit card fraud. Petitioner provided documentation of the charge, the disposition after her no contest plea, and the fact that her probation was terminated early. Petitioner provided explanations for all but one of the non-disqualifying offenses that ranged from the gun charge being at the end of a “bad relationship” (her then-girlfriend falsely accused her); to she was pulled over for a broken taillight, then charged with driving with a suspended license (she claimed she paid her tickets and the license was reinstated, although no records were provided on this point); to she was pulled over for having too dark a window tint in her car and cannabis was found (she testified it was not hers), but, since no one confessed to ownership, all were cited for possession; and finally to no explanation at all for the 2007 driving with a suspended license charge. Petitioner accepted little responsibility for her criminal offenses and concluded with the statement that she has no current involvement with any court system; she stated she is in “good standing.” Petitioner indicated on her Questionnaire that there was no harm to any victim or property, including damage or injury, in her past. Petitioner indicated on her Questionnaire that there were no stressors in her life at the time of the disqualifying offense. Regarding current stressors in her life, Petitioner testified she is unable to provide for her family and she is eager to obtain and keep steady employment. Petitioner listed her educational achievements as a diploma from Clearwater High School (1988), an Associate in Arts degree from Tampa Tech in computer engineering (1991), and an Associate in Science (“A.S.”) degree from St. Petersburg College in human services (2014). Petitioner indicated on her Questionnaire that she has received no counseling for any reason. Petitioner indicated on her Questionnaire that she has no history of alcohol and drug abuse. Petitioner indicated on her Questionnaire that she is involved with a community organization known as “Parents that Care.” As to expressing remorse or accepting responsibility for her actions, Petitioner testified she completed her probation early and that she no longer surrounds herself with negative influences and people. Petitioner’s recent work history has been stable. Her work history since 2009 indicates she has worked for two groups providing direct support/in-home support staff: Supporting Independence/Honor Health Care Management (2012-present) and Peaceful Dreams, Inc. (2009-2012). In addition to the criminal records submitted, Petitioner also offered affidavits of good moral character, written personal statements, IRS W-2 Forms, a copy of her A.S. degree from St. Petersburg College, and three letters of reference attesting to her character. The letters were written by people who have known Petitioner for many years and who believe her to be hard-working, reliable, and caring. Petitioner also submitted a copy of an exemption from disqualification she had received from the Agency for Health Care Administration (“AHCA”) dated May 27, 2014. Jeffrey Smith, regional operations manager for the Suncoast Region, testified that the Agency reviewed all the provided documentation provided by Petitioner, the information provided on the Exemption Questionnaire, the various records documenting Petitioner’s criminal history, her educational record, her character references, and her exemption from AHCA. Following a review of all the documentation included in the Exemption Packet, Agency Director Barbara Palmer advised Petitioner by a letter dated May 27, 2016, that her request for an exemption from her disqualifying offense was denied. The basis for the denial was that Petitioner failed to provide clear and convincing evidence of her rehabilitation. Mr. Smith testified the Agency considered all the documentation submitted by Petitioner in her Exemption Packet, as well as the additional documents provided prior to and at the hearing. He did not find that the documentation negated or refuted the official records of the disqualifying and non- disqualifying offenses. Further, the fact that the non-disqualifying offenses related to Petitioner’s driving is relevant to the position for which she seeks an exemption from disqualification. A direct service provider is often called upon to transport individuals entrusted to her care. Petitioner’s statement that her license was reinstated and that she received no more driving citations after the offenses described above was refuted by Mr. Smith, based upon subsequent driving records regarding Petitioner. Mr. Smith also noted two additional reports from the Department in which Petitioner was named the alleged perpetrator. One report showed some indicators of child abuse (cuts/punctures/bites/excessive corporal punishment), and the other report involved allegations of exploitation of a vulnerable adult, specifically, one with a developmental disability, but resulted in no official findings of exploitation. The Agency’s clients are a vulnerable population, consisting of individuals whose developmental disabilities are defined as intellectual disability, autism, spina bifida, Prader-Willi syndrome, cerebral palsy, Down syndrome, and/or Phelan-McDermid syndrome. Without the Agency’s services, these clients would require institutionalization. Petitioner testified passionately that she enjoys working with individuals with disabilities. Working in this field inspired her to return to school to earn a degree in human services. She testified that working with persons with disabilities is her long-term goal. She admitted she made some “foolish mistakes” when she was younger, but that she now accepts responsibility for her actions. She also testified that she believed her exemption should be granted because another agency, AHCA, had granted her an exemption from disqualification. Respondent countered with the fact that this vulnerable population requires being able to rely on the direct care provider’s good character and trustworthiness. Individuals entrusted with the care of the disabled are often called upon to make decisions of a financial, medical, and social nature. The Agency must weigh the benefit against the risk when considering granting an exemption. Petitioner’s history shows poor judgment on her part, and she provided testimony that was inconsistent with the documentation of her criminal history and the report and allegations of abuse or neglect from the Department. Petitioner admitted to use of a credit card of a vulnerable adult, which showed poor judgment on her part. Additionally, the close proximity of Petitioner’s most recent arrest (2012) to her request for exemption demonstrates her issues with the law are not limited to the distant past. Finally, Respondent, pursuant to section 435.07(5), Florida Statutes, considered the exemption given Petitioner by AHCA. The exemption from AHCA, however, is neither binding on the Agency nor does such exemption follow the same criteria or involve the same service population as the exemption sought from Respondent. The granting of an exemption from employment disqualification would allow Petitioner to be employed as a direct service provider to Agency clients. The undersigned appreciates Mr. Smith’s thoughtful and comprehensive assessment of Petitioner’s criminal history and fitness to hold a position of trust, and finds his testimony at hearing and reasons for recommending the denial to be credible and reasonable.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Persons with Disabilities enter a final order denying Petitioner’s request for an exemption from disqualification. DONE AND ENTERED this 19th day of October, 2016, in Tallahassee, Leon County, Florida. S ROBERT S. COHEN 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 19th day of October, 2016. COPIES FURNISHED: Rosemary Brinson 1010 Eldridge Street Clearwater, Florida 33755 Jeannette L. Estes, Esquire Agency for Persons with Disabilities 200 North Kentucky Avenue, Suite 422 Lakeland, Florida 33801 (eServed) Lori Oakley, Acting Agency Clerk Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 (eServed) Richard D. Tritschler, General Counsel Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 (eServed) Barbara Palmer, Director Agency for Persons with Disabilities 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 (eServed)
