The Issue Whether the Petitioner correctly answered questions 37, 44, 49, 83, and 206 of the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998.
Findings Of Fact Based on the oral and documentary evidence presented at the final hearing and on the entire record of this proceeding, the following findings of fact are made: The Department of Health is the state agency responsible for licensing and regulating physician assistants. Sections 455.574 and 458.347(7), Florida Statutes (1997). Mr. Molina sat for the Physician Assistant Examination administered on June 25 though 29, 1998. At the hearing, he disputed the Department's determination that the answers he gave to questions 37, 44, 49, 83, and 206 are incorrect. The questions that comprise the General Written Exam portion of the June 1998 Physician Assistant Examination were objective, multiple-choice questions. The questions were drawn from a bank of questions written by licensed physician assistants trained by a psychometrician employed by the Department. Prior to being included in the question bank, these questions were reviewed and field-tested to ensure that they were good, fair questions that adequately and reliably tested the applicant's ability to practice as a physician assistant with reasonable skill and safety. After the test questions for the June 1998 examination were selected from the question bank, the questions were reviewed before the examination and after the examination. The candidates taking the examination in June 1998 were directed in the instructions to the examination to choose the best answer from among four possible answers. This instruction was included in the examination booklet provided to each candidate, and the Department's normal procedure was to read the instructions aloud prior to the examination. According to the Department, the correct answer to question 37 is "C"; Mr. Molina chose answer "B." Although question 37 is, on its face, clear and unambiguous, the reference book relied upon by the Department to support its answer, although an authoritative source for physician assistants, does not, in fact, unambiguously support the Department's answer. Question 37 refers to the "entire anterior chest," and the answer to the question can be derived from the "Rule of Nines." The "Rule of Nines" is a standard rule used in the practice of medicine and is illustrated in an authoritative text entitled Current Medical Diagnosis and Treatment, which contains a chart showing the outline of the human body divided into sections, each representing approximately nine percent of the body's surface area. The chart shows, in pertinent part, the trunk of the human body divided into the "posterior" upper trunk and the "posterior" lower trunk, with a line drawn somewhat above the umbilicus to illustrate the division of the trunk into the upper and lower portions. The Department's expert testified, without explanation, that the "entire anterior chest" is composed of both the upper and the lower trunk. This conclusion cannot be drawn from the chart contained in the reference book relied upon by the Department, and Mr. Molina's answer to question 37 is as reasonable as the answer the Department considers correct. Accordingly, Mr. Molina should receive credit for his answer to question 37. According to the Department, the correct answer to question 44 is "D"; Mr. Molina chose answer "B." Question 44 asks for the "MOST likely diagnosis" based on the facts contained in the question. Question 44 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be derived from information included in the reference book entitled Ophthamology for the Primary Care Physician, which is considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 44 because the answer he gave is not the correct answer. 3/ According to the Department, the correct answer to question 49 is "A"; Mr. Molina chose answer "C." Question 49 asks for the "MOST likely" diagnosis based on the facts contained in the question. Question 49 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be found in volume 1 of Harrison's Principles of Internal Medicine, a reference book included in the list of recommended books sent to the candidates for the Physician Assistant Examination and considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 49 because the answer he gave is not the correct answer. According to the Department, the correct answer to question 83 is "D"; Mr. Molina chose answer "C." Question 83 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be found in volume 1 of Harrison's Principles of Internal Medicine, a reference book included in the list of recommended books sent to the candidates for the Physician Assistant Examination and considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 83 because the answer he gave is not the correct answer. According to the Department, the correct answer to question 206 is "C"; Mr. Molina chose answer "A." Question 206 asks for the "MOST common" presentation of a precancerous lesion. Question 206 is clear and unambiguous, and the correct answer is included among the choices provided. The correct answer can be found in volume 2 of Harrison's Principles of Internal Medicine, a reference book included in the list of recommended books sent to the candidates for the Physician Assistant Examination and considered an authoritative text by physician assistants. Mr. Molina should not receive credit for his answer to question 206 because the answer he gave is not the correct answer.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health enter a final order finding that Nigel Molina is entitled to credit for his answer to question 37 of the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998; finding that Mr. Molina is not entitled to credit for his answers to questions 44, 49, 83, and 206 of the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998; and recalculating Mr. Molina's score on the General Written Exam portion of the Physician Assistant Examination administered June 25 through June 29, 1998. DONE AND ENTERED this 8th day of February, 2000, in Tallahassee, Leon County, Florida. PATRICIA HART MALONO Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 8th day of February, 2000.
Findings Of Fact At all times material hereto Respondent has been a licensed physician in the State of Florida, having been issued license number ME-0008090. On December 12, 1983 Frank X. Curtis visited Respondent at his office, complaining of abdominal pain and constipation. Respondent advised Curtis that his symptoms could be indicative of cancer, ordered an upper G.I. series, and diagnosed his condition as a hiatal hernia. Respondent did not recommend any further treatment for Curtis. Because the abdominal pain and constipation continued, Curtis again saw Respondent on January 3, February 7, February 22 and March 1, 1984. During this time Curtis' weight dropped from 180 lbs. to 155 lbs., and Curtis became increasingly weak. On March 5, 1984 Respondent admitted Curtis to Community Hospital of New Port Richey with an admitting diagnosis of "partial intestinal obstruction." Curtis underwent a lower G.I. series which revealed a tumor in his intestine. Respondent performed surgery on March 9 to remove the tumor and his post-operative diagnosis of Curtis' condition was carcinoma of the sigmoid colon with metastasis to the liver and small intestine. Curtis was discharged from the hospital on March 18, 1984 but died on June 25, 1984 as a result of the spread of cancer in his body. According to expert testimony from Drs. Neufelder and Williams, Respondent failed to maintain proper medical records in the treatment of Curtis which would justify the course of treatment he provided. In their opinion, Respondent also failed to practice medicine in this case with reasonable care and skill, and in fact his treatment of Curtis was "far below acceptable standards." Specifically, Respondent's office records for this patient reveal no explanation of the reported symptoms of abdominal pain and constipation, and contain almost no patient history or record of any physical examination. A complete medical history and physical exam, as well as blood tests and follow-up should have been initially performed on this patient due to his reported symptoms. Respondent admits that his medical records in this case were inadequate, but contends that his treatment under the circumstances at the time, and not in hindsight, was adequate. However, considering all of the evidence presented, Respondent's treatment of Curtis from December 12, 1983 until he was hospitalized on March 5, 1984 was not adequate and did not demonstrate the level of skill and care reasonably expected of medical doctors in this state. The level of care and treatment provided while Curtis was hospitalized was adequate and met acceptable standards.
Recommendation Based upon the foregoing, it is recommended that Petitioner issue a Final Order suspending Respondent's license for a period of five (5) years. DONE and ENTERED this 28th day of October, 1985, at Tallahassee, Florida. DONALD D. CONN 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 28th day of October, 1985. APPENDIX Rulings on Petitioner's Proposed Findings of Fact: 1-3 Rejected as findings of fact but included in introductory material to this Recommended Order. 4 Adopted in Findings of Fact 2, 3, 4. 5-6 Adopted in Finding of Fact 5. 7 Adopted in Finding of Fact 6. COPIES FURNISHED: Joseph Shields, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Warren A. Clark, M.D. 94 Yellow Lake Road New Port Richey, Florida 33553 Fred Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Salvatore A. Carpino, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Dorothy Faircloth, Executive Director Board of Medical Examiners 130 North Monroe Street Tallahassee, Florida 32301
