Findings Of Fact Petitioner is the prevailing party in charges of medical malpractice initiated against him by Respondent herein. (Stipulation) Petitioner is a small business party as defined in Section 57.111, Florida Statutes. (Stipulation) No special circumstances exist which would make the award of fees and costs unjust. (Stipulation) Reasonable attorney's fees and costs exceed the maximum of $15,000 authorized to be awarded in these proceedings. (Stipulation) The initiation of the proceedings which resulted in an administrative complaint being filed naming Eric Grosch, M.D., as a party respondent followed disciplinary action instituted against Dr. Grosch by the Peer Review Committee at Humana Hospital, St. Petersburg, Florida, following the hospital death of a 74-year old female patient of Dr. Grosch. The investigator assigned to this case interviewed numerous witnesses at Humana Hospital, notified Dr. Grosch of his inquiry, and submitted an investigative report to the Department of Professional Regulation (DPR) with medical records. On the basis of this investigative report and medical records, an administrative complaint was prepared by DPR, and the investigative report with medical records was forwarded to the members of the Probable Cause Panel (PCP) with a recommendation to obtain an expert opinion on the standard of care issue. This panel met on January 19, 1990. At this meeting of the PCP, the panel members voted to refer the records to an expert who would submit his opinion on whether the evidence supported malpractice on the part of Dr. Grosch. By letter dated January 23, 1990, the hospital records and uniform complaint form were forwarded to Dr. Braunstein, who is board certified in the field of internal medicine, for his review and opinion as to whether Dr. Grosch failed to treat the patient 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. By letter dated April 13, 1990, Dr. Braunstein submitted his opinion that in the treatment of the subject patient, Dr. Grosch failed to adhere to the requisite standard of care. The investigative file, medical records and Dr. Braunstein's opinion were referred to a different PCP on June 2, 1991, for a determination if probable cause existed to file an administrative complaint. After having reviewed the evidence presented, this panel voted to proceed with the charges in the administrative complaint. During the meeting of this PCP, one of the members raised the question as to whether the administrative complaint addressed an issue relative to the alteration of some medical records by Dr. Grosch. DPR staff members at the PCP meeting agreed to look into the altering records issue and, if found warranted, to refer this issue back to the PCP. The administrative complaint and records were forwarded to Bruce Lamb, the DPR attorney assigned to prosecute the case. After reading the investigative report and interrogating the various witnesses named in the investigative report, Mr. Lamb found a conflict in the medical records discharge summary and the observations of witnesses regarding the administration of a sedative to the patient during the intubation process. The witnesses recalled the sedative being proposed after the intubation started, while the Respondent's discharge summary stated the sedation was given before the intubation was started. As a result of this discrepancy in the medical records and witnesses' versions of the sequence of events, Mr. Lamb prepared a proposed Amended Administrative Complaint adding factual paragraphs 20 and 21 and Counts 3 and 4 charging the filing of a report known to be false and making deceptive, untrue or false representations related to the practice of medicine. This Amended Administrative Complaint with investigative report, medical records and expert opinion was presented to a third PCP on October 12, 1990, and the panel voted to amend the original administrative complaint to include the additional counts shown in the proposed Amended Administrative Complaint. At the hearing on November 6, 1990, DOAH Case No. 90-4808, Dr. Grosch, Respondent, admitted factual allegations 20 and 21 in the Amended Administrative Complaint, and witnesses to testify to these facts were not called.
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part II, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The Election of Rights form advised of the right to an administrative hearing. 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED: 4. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 5. The Respondent shall pay the Agency $1,000.00. If full payment has already been made, the cancelled check is your receipt and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the “Agency for Health Care Administration” and containing the AHCA case number should be sent to: Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration 2727 Mahan Drive, MS 14 Tallahassee, Florida 32308 Filed February 4, 2013 2:17 PM Division of Adminitrative Hearings ORDERED at Tallahassee, Florida, on this 3¢_ day of a, a , 20 1% Elizabeth{Dudek, Secr Agency {for Health Care Administration
Other Judicial Opinions A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct copy of this Final Order was served on the below-named persons by the method designated on this ( 3) day of my , 2012. Richard Shgop, Agency G ; cae Agency fr Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Facilities Intake Unit Agency for Health Care Administration (Electronic Mail) Warren J. Bird, Assistant General Counsel Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Office of Finance and Accounting Revenue Management Unit Agency for Health Care Administration (Electronic Mail) Theodore E. Mack, Esquire Powell & Mack, P.A 3700 Bellwood Drive Tallahassee, Florida 32303 (U.S. Mail) |W. David Watkins Administrative Law Judge Division of Administrative Hearings (Electronic Mail) — VES IDsEVIE 11.460 sOvvMuuVIVY Newent BAe weve reve vw STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINIST TION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. AHCA No. 2011008176 COOPER-SOLICE, INC., d/b/a ASBURY PLACE, Respondent. COMES NOW the Petitioner, State of Florida, Agency for (Health Care Administration (“the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Cooper-Solice, Inc., d/b/a Asbury Place (“the Respondent”), pirsuant to sections 120.569, and 120.57, Florida Statutes (2011), and alleges ag follows: NATURE OF THE ACTION This is an action to revoke the Respondent's assisted living jlity license and to impose an administrative fine of $5,000.00 and a survey fee of $500,00 against the Respondent based upon one class II violation. PARTIES 1. The Agency is the licensing and regulatory authority| that oversees assisted living facilities in Florida. Ch. 408, Part II, and Ch. 429, Fla, Stet, (201 3);|Ch. 59A-35, Ch. 58A-5, Fla. Admin, Code, The Agency may deny, revoke, and suspend any license issued to an assisted living facility and impose an administrative fine for a violation of the Health Care Licensing Procedures Act, the authorizing statutes or applicable rules. §§ 408.813, 408.815, 429.14, Received Time Apr. 16. 2012 4:20PM No. 7557 Filed July 19, 2012 12:36 PM Division of Administrative Hearings EXHIBIT 1 AODUNTRLALE #4826 PF. 008/015 429,19, Fla. Stat. (2011), In addition to licensure denial, revocation or suspension, or any administrative fine imposed, the Agency may assess a survey fee against an assisted living facility. § 429.19(7), Fla. Stat. (2011). 2. The Respondent was issued a license by the Agency fo operate an assisted living facility (License No. AL 9099), located at 4916 Mobile Highway, Pe sacola, Florida 32506, and was at all times material required to comply with the applicable jstate statutes and mules. § 429.11, Fla. Stat. (2011). “assisted living facility” means any building or buildings, section or distinct part of a building, private home, boarding home, home for the aged, or other residential facility, whether operated for profit or not, which under-takes through its ownership or management to provide housing, meals, and one or more perspnal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator. § 429.02(5), Fla. Stat. (2011). Those residential facilities are intended to be a less costly alternative to the more restrictive, institutional settings for individuals who meet the minimum criteria in order to be admitted to such a facility and do not require 24-hour nursing supervision. Assisted living facilities are regulated in a manner so as to encourage dignity, individuality, and choice for residents, while providing them a reasonable assurance] for their health, safety and welfare. Generally, these facilities, through its staff, provide resident supervision, the assistance with personal care and supportive services, as well as the assistance with, or the administration of, medications to residents who require such services. 3. As the holder of such a license, the Respondent is allicensee. “Licensee” means “an individual, corporation, partnership, firm, association, or governmental entity that is issued a permit, registration, certificate, or license by the Agency.” § 408.808(9), Fla. Stat. (2011). “The licensee is legally responsible for all aspects of the provider operation.” Id, “Provider” means Received Time Apr. 16, 2012 {1:20PM No, 7557 ves ierevieg 11.60 pouveuovive MODUN EFL ALT #40 r.uussy £0 “Vig “any activity, service, agency, or facility regulated by the Agency an listed in Section 408.802,” Florida Statutes (2011). § 408.803(11), Fla. Stat. (2011). Assisted living facilities are regulated by the Agency under Chapter 429, Part I, Florida Statutes (2011), listed in Section 408.802, Florida Statutes (2011). § 408.802(14), Fla. Stat. (2011). Assisted] living facility residents are thus clients. “Client” means “any person receiving services from a ptovider.” § 408.803(6), Fla. Stat. (2011). CQUNTI Financial Exploitation of Residents 4. Under Florida law, in addition to the requirements of Part Il of Chapter 408, Florida Statutes, the Agency may deny, revoke, and suspend any likense issued under this part and impose an administrative fine in the manner provided in Chapter 120, Florida Stamtes, against a licensee for a violation of any provision of this part, Part I! of Chapter 408, Florida Statutes, or applicable rules, or for any of the following actions by a licensee, for the actions of any person subject to level 2 background screening under Section 408.809, or for the actions of any facility employee: ... (c) Misappropriation or conversion of the property of a resident of the facility. § 429.14, Fla. Stat. (2011). 5. In addition to the grounds provided in authorizing statutes, grounds that may be used by the Agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: . . . .| (c) A violation of this part, authorizing statutes, or applicable rules. § 408.815(1)(c), Fla, Stat. (2011). 6. Under Florida law, no resident of an assisted living facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, thé Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility. Every resident of a facility shall havé the right to: (a) Live in a safe and decent living environment, free from abuse Received Time Apr. 16, 2012 1: 200M No. 7557 von ruspevig Lt,eu pe veruuVvivY AODUNIFLAUC #40ebo r.vvosut ‘ . i) : and neglect. (b) Be treated with consideration and respect and with Bue recognition of personal dignity, individuality, and the need for privacy. (c) Retain and usehis or her own clothes and other personal property in his or her immediate living quarters, so 49 to maintain individuality and personal dignity, except when the facility can demonstrate that such would be unsafe, impractical, or an infringement upon the rights of other residents. |.. (f) Manage his or her financial affairs unless the resident or, if applicable, the resident/s representative, designee, surrogate, guardian, or attorney in fact authorizes the administrator o: the facility to provide safe- keeping for funds as provided in Section 429.27, Florida Statutes. | § 429.28(1)(a)-(c), (f, Fla. Stat. (2011). 7. The Agency conducted a complaint survey of the Respondent from July 17-20, 2011. 8. Based upon the survey, the Agency found that fiv facility residents had been exploited as follows: Resident #1 9. A record review of Resident #1’s health assessment dated 3/23/11 indicated an admission on 9/11/10 with a diagnosis of depression, anxiety, Parkinson's disease, and combative behavior. The Agency surveyor attempted to interview the Resident, but her comments were not clear. 10. A review of the Resident's contract dated 9/11/10 indicated that the Resident was to pay $1,200.00 a month for room and board. ‘I. During an interview with Adult Protective Services}on 7/18/11 at 2:00 pm, the APS investigator stated she was investigating an allegation related|to a missing social security card, The allegation indicated the social security card was missing and had been given to the Received Time Apr. 16, 2012 1:20PM No. 7557 vor eres . , Pa qveuntruauc #4020 Fr. uuDsUID - Respondent’s former Administrator to make payments for room and board monthly. The APS investigator stated that the Resident received a social security payment of $1,321.00 per month, and that the facility rent was $1,200.00, leaving a difference of $121.00 a month. 12, The APS investigator further stated the facility was hot able to show where the $121.00 difference went. 13. Areview of the facility records indicated that from 10/2010 to 3/2011, $1,200.00, the rent was paid in cash. 14, During an interview on 7/18/1) at 3:00 pm with an ide/Assistant Administrator, the Assistant Administrator stated that she’ knew that the ve daughter had given the former Administrator the social security card to pay the rent. 15. The Assistant Administrator stated that the former [Administrator gave her the social security card and the Resident’s personal identification number (PIN) to get cash from Wal-Mart and bring it back to the former Administrator. 16. The Assistant Administrator stated she would add th¢ Resident's name to the hair dresser list, but the Resident did not get her hair done and the money would go to the former Administrator. . 17. The Assistant Administrator stated that the former Administrator would pay her ‘ money at times and paid her house payment and her power bill. Resident #4 18. A record review for Resident #4 indicated that the Resident was admitted to the Respondent’s assisted living facility on 6/ 11/08 and later expired on 5/10/11. 19, Resident #4 had a diagnosis of Dementia and confusion. 20, The Resident's contract dated 5/1/09 indicated that he or she was to pay $2,100,00 Received Time Apr. 16. 2012 1:20PM No. 7557 vrs rusevig 11,41 tVuvsuoViVY MepunIrEAyEe #4020 6 ‘ C -VUTFVID a month for rent. 21, A review of the facility records dated 10/10-5/11 shows that the rent was paid in the amount of $2,100.00. ‘ 22. During an interview and record review with the Respondent’s Owner on 7/18/11 at 10:00 am, the Owner indicated that the former Administrator wduld create fake invoices for personal items and send them to the Resident's guardian. - 23, The guardian would send the payment to the forme Administrator, who would pocket the money. 24, She claimed from $300.00 - $400.00 a month for perspnal items. 25, During an interview with the Assistant Administratof on 7/18/11 at 3:00 pm, she stated that the former Administrator would create receipts for personal items, tu them in for reimbursement, and then keep the money. , 26. The Assistant Administrator stated that she witnessed the former Administrator sign the Resident’s name on his checks. ident 27. A record review for Resident #5 indicated that the Resident was admitted to the Respondent’s facility on 10/22/ 10 and later expired on 7/1/11. 28. The Resident had a diagnosis of Schizophrenia and chronic obstructive pulmonary disease (“COPD”) and was assessed to be alert and oriented. 29, The Resident's contract, dated 4/4/11, indicated that the Resident was to pay $2,100.00 per month for rent. 30. A-review of the facility records dated 10/10-7/1/11 show payment.of $1,900.00 a month, Received Time Apr. 16. 2012 1:20PM No. 7557 Neeu ee WWURY Levey avvurve 31. During the interview with the Assistant Administrator on 7/18/11 at 3:00 pm, she stated that the former Administrator stated the Resident gave the former Administrator his check book for handling and that the former Administrator would write out his check each month for rent and forge his name. 32. The former Administrator would forge the Resident's name on checks for personal items that the Resident did not receive. 33. The former Administrator would give the Assistant inistrator money and tell her that she did not need to pay her back. This went on for about 3-4/years. 34, During an interview with the Owner on 7/18/11 at 10:00 am, the Owner said that the Resident was alert and oriented. She further stated that the former Administrator had his checkbook and would pay his rent and make out checks to herself. id 6 35. A record review for Resident #6 indicated that the Resident was admitted to the Respondent’s facility on 3/26/08 and left the facility on 1/11, 36. The Resident had a diagnosis of Dementia. 37. The Resident's contract, dated 5/1/09, indicated alpayment of $2,450.00 per month for rent. 38. A review of the facility records, dated 10/10-1/11, show a payment of $2,350.00 per month. 39. During an interview with the Assistant Administratoy on 7/18/11 at 3:00 pm, she stated that a check would go to the facility in the name of the facility) for rent. 40. Another check would come in the former Administrator's name for personal items and resident lunches, which did not happen. Received Time Apr. 16 2012 1:20PM No. 7557 vey losevlg 14,21 1OuYRZOVIVY ASDUNTTL AUG w4oeu veo 7 ‘ ry fuss 41. During an interview with the Owner on 7/18/11 at 4400 pm, she stated that the facility had nothing to do with this. 42. This was between the former Administrator and the Resident's family. Resident #7 43. During an interview with the Owner on W18/11 at} 10:00 am, she stated that Resident-#7 has been living at the facility for about 3-4 years and "I idn't know it." 44, Resident #7 was never placed on the facility’s role or jn the facility’s system. 45, The facility had no records or contract for this resident. 46. There was a note dated 11/27/09 stating that the rent js $1,850.00, hair is $60.00, toiletries are $74.54, sodas and snacks are $44.50 and incontine supplies are $162.87, per month. 47. There was another note, dated 7/30/10, stating that rent is $1,850.00, toiletries are $86.40, incontinent supplies are $174.45, hair is $60.00 and spendin: money is $60.00. 48. A review of the facility records does not indicate the Resident’s name or show any rent received and money for personal items from 10/2010 to 3/2011, 49. During an interview with the Assistant Administratoy on 7/18/11 at 3:00 pm, she stated that the former Administrator was receiving rent for the Resi 50. The rent was paid in the name of the former Administrator. 51. | This Resident was not on the books and the Owner did not know that she lived at the facility. 52. The Resident lived there for about 3-4 years. 53, The former Administrator would have Resident MORs and medications from the medication cart removed when the state came to survey. Received Time Apr. 16. 2012 1:20PM No, 7557 luvuwuvive AoOUNnTrLAUG 4#40¢ebo Fevliusulo 54, During an interview with the Owner on 7/18/11 at 10:00 am, she stated that she terminated the former Administrator for stealing money from residents that went on for 3-4 years, 55, The former Administrator was let go on 3/7/11. 56. The Owner further stated that she called the police far some of the residents. It "was not clear in interview which residents were called to the police. 57. The Owner stated that she notified Adult Protective Services for some of the thefts against the residents. 58. It was not clear during the interview which residents were called to Adult Protective Services. 59, Further interview indicated the Owner did not comple € oF send in day | or day 15 adverse incident report for all residents involved in exploitation. 60, Further interview with the Owner indicated she had|not completed an audit for any other resident records to ensure exploitation had not occurred, 61. | The Owner stated that the Assistant Administrator during this time, who was the person who removed the medications and MOR from the medicatidn cart while state surveyors were in the building and who cashed the checks at her own bank and brought the money back to her, is still working at the Facility as an aide. 62. The Respondent's actions and/or inactions constituted a class II violation. 63. Class "II" violations are those conditions or occurrences related to the operation and maintenance of a facility or to the personal care of residents which the agency determines directly threaten the physical or emotional health, safety, or security of the facility residents, other than class I violations. § 429.19(2)(b), Fla. Stat, (2011). Received Time Apr. 16, 2012 1:20PM No. 7557 ve ree ew te Perey reve ivy AOOUNITLAVG #40¢2b FLULIZVIO 64. The Agency shall impose an administrative fine for a gited class Il violation in an amount not tess than $1,000 and nat exceeding $5,000 for each violation. A fine shall be levied notwithstanding the correction of the violation. § 429.1 9(2)(b), Fla. Stat. (2011). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, seeks to revoke the Respondent’s license to operate this assisted living facility and impose an administrative fine against the Respondent in the amount of $5,000.00. Survey Fee 65. The Agency re-alleges and incorporates by reference Count 1. 66. The Agency received a complaint about the Respondent. 67. In response to the complaint, the Agency conducted a complaint survey of the Respondent. 68. As aresult of the complaint survey, the Respondent was cited for violations. 69. The basis forthe violations alleged in this Administrative Complaint relates to the complaints made against the Respondent. 70. Under Florida taw, in addition to any administrative fines imposed, the Agency may assess a survey fee, equal to the lesser of one half of the facility's biennial license and bed fee or $500, to cover the cost of conducting initial complaint invéstigations that result in the finding of a violation that was the subject of the complaint or moniforing visits conducted under Section 429.28(3)(c), Florida Statutes, to verify the correction of the|violations. § 429.19(7), Fla. Stat. (2011). 71. ‘In this instance, the Agency is entitled to assess as WHEREFORE, the Petitioner, State of Florida, Agency for [Health Care Administration, seeks a survey fee against the Respondent of $500.00. 10 Received Time Apr. 16. 2012 1:20PM No, 7557 new verenee #4026 F.UTZ/UI9 CLAIM FOR RELIEF intends to impose a final order that: — A: — Makes findings of fact and conclusions of law as set farth above. B. Enters the relief set forth above. Respectfully submitted this 4 day of April, 2012. 2727 Mahan Drive, MS+3 Tallahassee, FL 32308 Telephone 850-412-3630 Facsimile 850-921-0159 NOTICE The Respondent is notified of the right-to request an administrative hearing pursuant to Sections 120.569 and 120.87, Florida Statutes. The Respondent has the right to hire and be represented by an attorney in this matter. Specific options for allministrative action are set out in the attached Election of Rights form. The Respondent is further notified if the Election of Rights férm is not received by the Agency for Health Care Administration within twenty-one (21 days of the receipt of this Administrative Complaint, a fina) order wil} be entered. The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Adwministration, 2727 Mahan Drive; Building 3, Mail Stop 3, Tallahassee, FL_ 32308; Telephone (850) 412-3630, iv Received Time Apr. 16. 2012 1:20PM No, 7557 . . OSDUNITLAUL 78626 F.013/015 . CERTIFICATE OF SERVICE THEREBY CERTIFY that a true and correct copy of the Ad inistrative Complaint and Election or Rights form were served to Rose Creighton Cooper, Administrator, Cooper-Solice, Inc. d/b/a Asbury Place, 4916 Mobile Highway, Pensacola, Florida 32506, by U.S Certified Mail, Return Receipt No. 7009 0960 0000 3709 5577, on this a day of April, 2012. 2727 Mahan Drive, MS}3 Tallahassee, FL 32308 Telephone 850-412-36310 Facsimile 850-921-0159 Received Time Apr. 16, 2012 1:20PM No. 7557 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, y. AHCA No. 2011008176 DOAH Case No. 12-2498 COOPER-SOLICE, INC. d/b/a License No. AL9099 ASBURY PLACE, Facility Type: Assisted Living Facility Respondent. / SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Respondent, Cooper-Solice, Inc. d/b/a Asbury Place (hereinafter “Respondent”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, the Respondent is a licensee and operates an Assisted Living Facility pursuant to Chapters 408, Part IL, and 429, Part J, Florida Statutes and Chapter 584-5, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure of Respondent; and WHEREAS, the Agency served the Respondent with an Administrative Complaint dated April 9, 2012, notifying the Respondent of the Agency’s intent to revoke its license and to EXHIBIT 2 impose an administrative fine in the amount of $5,000.00 for a Class II deficiency and a survey fee of $500.00 against the Respondent; and WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and WHEREAS, the parties stipulate to the adequacy of consideration exchanged; and WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement of this proceeding; NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 3. Upon full execution of this Agreement, Respondent agrees to waive any and all proceedings and appeals to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), a formal proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction; and further agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled, provided however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement. 4. Upon full execution of this Agreement, the parties agree to the following: a. The Agency withdraws its intent to revoke Respondent’s license and reduces the Class II deficiency to a Class Ill deficiency. b. The Respondent shall remit to the Agency, within thirty (30) days of the entry of a Final Order adopting this agreement, an Administrative Fine in the sum of five hundred dollars ($500) for a Class Tl deficiency and a five hundred dollar ($500) survey fee. c. The Administrative Complaint is deemed superseded by this agreement. d. The Respondent has voluntarily withdrawn its request for a formal proceeding. 5. Venue for any action brought to interpret, challenge or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Circuit Court in Leon County, Florida. 6. By executing this Agreement, the Respondent neither admits nor denies the allegations raised in the Administrative Complaint referenced herein. 7. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case(s). 8. Each party shall bear its own costs and attorney’s fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 10. The Respondent for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the Agency and its agents, representatives, and attorneys of all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency’s actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this Agreement, by or on behalf of the Respondent or related or resulting organizations, 11. | This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph of this Agreement. 12. Inthe event that Respondent is or was a Medicaid provider, this settlement does not prevent the Agency from seeking Medicaid overpayments or from imposing any sanctions pursuant to Rule $9G-9.070, Florida Administrative Code. This agreement does not prohibit the Agency from taking action regarding Respondent’s Medicaid provider status, conditions, requirements or contract. 13. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. The Respondent fully understands that counsel for the Agency represents solely the Agency and Agency counsel has not provided legal advice to or influenced the Respondent in its decision to enter into this Agreement. 14, This Agreement contains the entire understandings and agreements of the parties. 15. This Agreement supersedes any prior oral or written agreements between the parties, This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 16. All parties agree that a facsimile signature suffices for an original signature. 17. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Theodore E. Mack, Esquire é Powell & Mack, P.A Agency for Health Care Administration 3700 Bellwood Drive 2727 Mahan Drive, Bldg #3 Tallahassee, Florida 32303 Tallahassee, Florida 32308 Counsel to Cooper-Solice, Inc., dba Asbury Place DATED: {/30// DATED: L2/ o/ 12 Stuart F. Williams GO nena Counsel Agency for Health Care Administration Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Tallahassee, Florida 32308 DATED: _| pf2iler— DATED: 12) [2017+
The Issue The issue is whether Respondent's request for a substantial interests hearing under section 120.57(1), Florida Statutes (2017),1/ should be dismissed as untimely.
Findings Of Fact The Department is the agency of the state of Florida charged with regulating the practice of CNAs pursuant to section 20.43, chapter 456, and chapter 464, Florida Statutes. Ms. Williams holds Department certificate number CNA20004. As a CNA, she is subject to regulation by the Department. A copy of the Department's filed Administrative Complaint was served on Ms. Williams, via certified mail, on January 5, 2018.2/ Attached to the Administrative Complaint was a Notice of Rights which included the following language: A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. The copy of the Administrative Complaint, Notice of Rights, and Election of Rights form gave Ms. Williams written notice of intended agency action that affected her substantial interests. As Ms. Williams credibly testified, she completed the Election of Rights form requesting a hearing at her attorney's office and signed that form on January 18, 2018. Ms. Williams testified that her attorney's secretary put the request for hearing form in the mail to the Department, but admitted she did not actually see the secretary do so. There was no testimony at the hearing from a secretary or other person as to when or how the document was placed into the mail, or even as to the usual procedures for mailing similar documents. There was no evidence as to the date the request for hearing was actually mailed. It was undisputed that Ms. Williams's counsel did not send an Election of Rights form to counsel for the Department via e-mail on January 18, 2018. It was also undisputed that Ms. Williams's counsel did not send a document entitled "The Respondent, Daphne Williams Answer to Petitioner's Complaint" to counsel for the Department via e-mail on January 18, 2018, despite the certificate of service on the document purporting to show service by Ms. Williams's counsel on counsel for the Department via e-mail on January 18, 2018. Ms. Carraway and Mr. Thomas testified convincingly from their personal knowledge as to their usual procedures in receiving and stamping the incoming mail at the Department. Mr. Thomas stated that he worked in the mail room and delivered mail to 12 different locations at the Department (three separate locations in each of four different buildings) on the same day that it arrived from the mail carriers. Ms. Carraway testified that she opened mail delivered to her location from the mail room and stamped it with the date and time on the same day she received it. Neither witness gave any credible testimony regarding Ms. Williams's specific request for hearing. There was no indication that either witness remembered that particular piece of mail, or remembered the day upon which it arrived at the Department. However, it is a reasonable inference that Ms. Williams's request was date-stamped on the date it was received. It is undisputed that the date stamp on Ms. Williams's request for hearing is January 29, 2018. Ms. Williams's request for hearing was received by the Department on January 29, 2018.
Recommendation In view of the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Ms. Daphney D. Williams's request for a substantial interests hearing under section 120.57(1) should be dismissed as untimely. DONE AND ENTERED this 6th day of September, 2018, in Tallahassee, Leon County, Florida. S F. SCOTT BOYD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 6th day of September, 2018.
The Issue The issue is whether Petitioner had just cause to discipline Respondent by suspending his employment without pay as a tenured professor for six months, by prohibiting him from engaging in any activities with outside businesses, and by withdrawing existing outside activities exemptions or approvals.
Findings Of Fact Respondent is a Board Certified medical doctor. Respondent specializes in neurology and clinical neurophysiology. He has special expertise in epilepsy and clinical neurophysiology. Respondent has performed research in the area of epilepsy. At all times material to this case, UFBOT employed Respondent. Respondent also worked for the Malcolm Randall Veterans Administration (VA). Respondent had a laboratory at the McKnight Brain Institute on the University of Florida campus. He was a tenured professor on the faculty of the Biomedical Engineering Department. He also held joint appointments as Professor of Neurology and Professor of Psychiatry, as well as an affiliate appointment as Professor of Neuroscience. Respondent was a member of the University of Florida's Graduate Faculty. An Institutional Review Board (IRB) is an internal review board that has the obligation to provide oversight for all research activities involving human subjects. IRB-01 is one of four review boards affiliated with the University of Florida. IRB-01 is responsible for oversight of research at the Health Science Center. IRBs are charged with the responsibility of complying with federal regulation for the protection of human subjects found in 45 C.F.R. Part 46, Protection of Human Subjects. This regulation is known as the "Common Rule." Beginning in 1993, Respondent was the principal investigator (PI) on a research protocol entitled "Dynamical Studies in Temporal Lobe Epilepsy," hereinafter referred to as Protocol 447-1993. IRB-01 approved Protocol 447-1993. Pursuant to Protocol 447-1993, data in the form of video-taped EEGs and clinical records were collected from 18 patients with intractable epilepsy. Some of the data was called "scalp" data, because it was collected via electrodes attached to the patients' scalps. The rest of the data was called "depth" data, because it was collected during surgical procedures. The informed consents in Protocol 447-1993 informed the subjects that researchers would be reviewing their medical records to gather information about their epilepsy. According to the informed consents, researchers would analyze brain wave recordings that were performed on the patients as part of the diagnostic evaluation, store the recordings on a computer, and analyze the recordings with new mathematical techniques. The informed consents also advised the subjects that their personal information would not appear in print or be presented in a manner that could identify them. The informed consents for subjects enrolled in Protocol 447-1993 provided that the University of Florida and the VA Medical Center would protect the confidentiality of the subjects' records to the extent provided by law. Subjects were also informed that the National Institutes of Health (NIH) as the Study Sponsor, the Food and Drug Administration (FDA), and IRB-01 had the right to review the records. Protocol 447-1993 continued with IRB-01 approval for several years. The protocol expired in May 2002. It is not permissible for a researcher to use data from an expired protocol in a later protocol without additional approval from the IRB. In 2001, Respondent applied for and received approval from IRB-01 for a research protocol entitled "Bioengineering Research Partnership," identified as Protocol 430-2001 (BRP Protocol). Respondent was the PI for the new protocol. The proposal for the protocol described the research procedures as a plan to develop and test automated computer-based algorithms for analyzing the spatiotemporal dynamical properties of multi- channel EEG recordings to determine the probability of an epileptic seizure. The computer algorithms were to be tested and evaluated on three (3) data sets. The first dataset was comprised of a group of long-term EEG recordings that were obtained for clinical purposes in patients with medically intractable epilepsy. By memorandum dated September 18, 2001, Respondent informed the IRB-01 Vice Chairman that the study under which the EEGs were collected for the BRP Protocol was another IRB-01 approved protocol, identified as Protocol 22-2000. Protocol 22- 2000 did not include data from Protocol 447-1993. Respondent did not reference data from Protocol 447-1993 in his September 18, 2001, memorandum. Further, there is nothing in the BRP Protocol that informs the IRB-01 that data from Protocol 447-1993 would be included in the new research project. If there is a change in a protocol, no matter how slight, the change must be approved by the IRB. If Respondent wished to include data from Protocol 447-1993 in the BRP Protocol, he needed to make a request to include that specific data. The IRB never gave Respondent approval to use the data from Protocol 447-1993 in the BRP Protocol. The IRB approved the BRP Protocol as an exempt Category IV study pursuant to the Common Rule. An exempt Category IV study is "[r]esearch involving the collection or study of existing data, documents, records, pathological or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects." See 45 C.F.R. § 46.101(b)(4). NIH grants funded the BRP Protocol and Protocol 447- 1993. In 2003, the privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) were implemented at the University of Florida. In order to enforce those provisions, the University of Florida created the Privacy Office at the Health Science Center. Respondent and all of his staff were required to take privacy training provided by the Privacy Office. According to HIPAA, protected health information (PHI) about a patient may be used or disclosed to others only in certain circumstances or under certain conditions. Information about a patient can be de-identified under two alternative procedures set forth at 45 C.F.R. Section 164.514(b). The first procedure requires that a qualified person applying accepted statistical and scientific principals determines that the risk is very small that the information could be used, alone or in combination with other reasonably available information, by an anticipated recipient to identify an individual who is a subject of the information. The qualified person must document the methods and results of the analysis that justify such a determination. The second procedure is the removal of all identifiers set forth in 45 C.F.R. Section 164.514(b)(2)(i) from a given patient data set. The identifiers include any unique identifying number, characteristic, or code. Additionally, the covered entity may not have actual knowledge that the remaining information can be used alone or in combination with other information to identify the patient. If a data set is properly de-identified, it is not PHI and is not governed by HIPAA. Furthermore, it does not fall within the definition of human subject research under the Common Rule. Properly de-identified data does not require subject consent or IRB approval for disclosure. Pursuant to the policies and procedures of the IRB-01, only the IRB can make the determination that the research does not include human subjects. BioNeuronics (formerly Neurobionics) is a start-up medical technology company that Respondent and others formed for the purpose of translating an invention developed by Respondent and his colleagues at the University of Florida and Arizona State University into medical devices for the treatment of patients with epilepsy. The University of Florida Research Foundation (UFRF) and Arizona State University owned the patent. BioNeuronics entered into a licensing agreement with the two institutions, permitting the company to develop the patented technology. The University of Florida's Office of Technology Licensing (OTL) was established to work with inventors to facilitate the transfer of technologies created at the university to the commercial sector for public benefit. It is not uncommon for both inventors and the UFRF to be given stock in start-up companies. The OTL encourages inventors to maintain an advisory relationship with the licensee. Pursuant to the licensing agreement, the UFRF was to provide "test data" to BioNeuronics. The licensing agreement does not identify the test data to be provided. The licensing agreement did not contain any provision that test data from Protocol 447-1993 was to be provided to BioNeuronics. At all times material to this case, Respondent owned stock in BioNeuronics, as does the UFRF. Respondent was paid $2000 per month as a consultant for the company. The University of Florida approved the terms of Respondent's participation in BioNeuronics. The UFBOT employs Michael Mahoney as the IRB-01 Coordinator. He is responsible for management of the IRB-01 office. He sits as an alternate member of the IRB-01 Board. The IRB-01 Executive Committee is composed of the Chairman, the Vice-Chairman, the QA Coordinator, the Assistant Director for IRBs, and Mr. Mahoney. Mr. Mahoney's duties involve more than just office management. He also acts as a resource for investigators and research team members on general regulatory information. He provides guidance with IRB-01 forms and assistance with the preparation of submissions for IRB review. In January 2006, Respondent sent an e-mail to Mr. Mahoney, informing him that Respondent had been acquiring and storing long-term EEG and video records of patients with medically intractable seizures. Respondent's e-mail stated that there was an international effort to establish a shared database so that researchers in participating institutions could share datasets. Respondent requested information as to the requirements to share this data with persons outside the university. On February 1, 2006, Mr. Mahoney responded to Respondent, informing him that he needed IRB approval before doing anything new with the data, including releasing it to others. Mr. Mahoney concluded his message by stating that Respondent would have to submit something to the IRB before using or sharing old datasets for different research purposes. At all times material here, Deng Shan Shiau, Ph.D., held a faculty position as a Research Assistant Professor of Biomedical Engineering. Dr. Shiau was in charge of Respondent's laboratory. Dr. Shiau and another research assistant, Dr. Iasemidis, supervised the work of graduate engineering students who recorded, stored, and analyzed data in Respondent's laboratory. Drs. Iasemidis and Shiau brought technical experience and engineering expertise to Respondent's research projects. Daniel J. DiLorenzo, M.D., Ph.D., M.B.A, is an official with BioNeuronics. On February 8, 2006, Respondent forwarded to Dr. DiLorenzo a copy of Respondent's January 2006 e-mail and Mr. Mahoney's February 1, 2006, response. In his transmittal, Respondent stated that he would ask a new assistant, Jessica Martin, to work with Dr. Shiau to obtain copies of consents signed by patients in the depth electrode database to see if the consents would allow the sharing of the de-identified data. Respondent stated that if the consents were inadequate, he would request permission from IRB. Respondent contends that his January e-mail to Mr. Mahoney and Mr. Mahoney's response was not intended to refer to the release of data to BioNeuronics. Instead, he claims that he was inquiring about the release of data to an international symposium of scientists. Respondent's February 8, 2006, e-mail to Dr. DiLorenzo is persuasive evidence to the contrary. On March 7, 2006, Jessica Stevens, an employee in Respondent's laboratory also wrote an e-mail to Mr. Mahoney. Ms. Stevens wanted to know what needed to be done to hand over pre-existing data to others. Ms Stevens wrote a subsequent e-mail to Mr. Mahoney, clarifying that the data Respondent would be handing over was gathered from 1994 to 1997, and that the data would be furnished to BioNeuronics. Mr. Mahoney responded to Ms. Stevens the next day. Mr. Mahoney stated that Ms. Stevens' question was fairly similar to the one he had previously answered directly to Respondent. Mr. Mahoney informed Ms. Stevens that releasing data originally obtained for research purposes is a tricky proposition at best. Mr. Mahoney wanted to know whether the subjects originally consented to share their data, regardless of whether it was de-identified. Mr. Mahoney questioned whether Respondent wanted to release identifiable data and whether Respondent had any conflict of interest issues with the receiving entity. Mr. Mahoney informed Ms. Stevens that her e-mail did not give him enough details to assist her, and that she might want to meet with him to ensure that nothing inappropriate occurred. Ms. Stevens read Mr. Mahoney's response to Respondent, who responded, "Don't listen to him." Respondent told Ms. Stevens that Mr. Mahoney did not know what he was talking about. Mr. Mahoney's advice to Respondent about the release of old data to persons outside the University of Florida was not an official directive of the IRB. However, if Respondent did not believe Mr. Mahoney was qualified to give advice regarding the release of data, there would have been no reason for Respondent to contact Mr. Mahoney in the first place. On March 8, 2006, Dr. DiLorenzo sent an e-mail to Respondent. The message thanked Respondent for agreeing to transfer de-identified continuous EEG data to BioNeuronics. Dr. DiLorenzo stated that all were in agreement that de- identified data would not require IRB approval. Dr. DiLorenzo also related that Dr. Shiau mentioned that he could provide copies of Epilepsy Monitoring Unit (EMU) reports and a spreadsheet with the timing of seizure events for each patient. Respondent did not respond to this message from Dr. DiLorenzo. Respondent subsequently asked Dr. Shiau to put data from Protocol 447-1993 on an external hard drive to send to BioNeuronics. Dr. Shiau sent the external hard drive to BioNeuronics on or about March 14, 2006. On March 16, 2006, Respondent sent an e-mail to Dr. DiLorenzo, asking whether he had any questions about the data format, location of seizures, seizure types, et cetera. Respondent admits that Dr. DiLorenzo would not have been able to determine the seizure type with just the EEG data. Respondent's testimony that he did not intend to send BioNeuronics the patients' clinical records or Excel spreadsheets is not persuasive. The patient information from Protocol 447-1993 consisted of the following computer files: (a) an EEG file with an associated "tag" file; (b) and EMU report consisting of a clinical encounter record, saved in .pdf format; and (c)an Excel spreadsheet with the timing of seizure events for each patient. Respondent knew or should have known that BioNeuronics needed this information to test its algorithm and that the company could not succeed using just the EEG files. Each patient from Protocol 447-1993 was identified by a research subject number such as P171 or P267. Dr. Shiau kept a list of the codes with the associated patient name in a locked file cabinet to which only he had access. Each of the computer files on a given patient included the research subject number as part of the file name. For example, one of the EEG files for P171 was named P17101.eeg. The associated tag file for that EEG file was named P17101.tag. The EMU clinical record for that patient was named P171.pdf. The corresponding Excel spreadsheet was named P171.xls. Respondent originally recorded the Protocol 447-1993 data on VHS tapes. In a second study, the pre-recorded data was transferred from VHS to a digitized form using a proprietary Nicolet Biomedical software program utilized to read the EEGs. The tag files were also generated by the Nicolet reader. The contents of the tag file did not appear on the computer screen when viewing the EEG files, but they could be opened using a word processing program such as WordPad. Neither Respondent nor Dr. Shiau was aware that six of the tag files had patient last names imbedded within the binary codes. The data sent to BioNeuronics was gathered prior to the implementation of HIPAA. At some point in time, an effort had been made to de-identify the clinical records by removing the patients' names, birthdates, and other personal information on the top half of the first page. There is no evidence that anyone specifically checked the data to determine if the records were de-identified pursuant to the new HIPAA standards. Therefore, Respondent's testimony that he did not seek IRB approval prior to sending the data to BioNeuronics because he had a reasonable belief that the data from Protocol 447-1993 was de-identified and related to the BRP Protocol is not credible. On March 18, 2006, an anonymous letter was sent to various entities, including the Office of Civil Rights, the Department of Veteran Affairs, the FDA, the Florida Board of Medicine, the Office of the Attorney General of Florida, the Office for Human Research Protections, the College of Medicine of the University of Florida, the Office of Research Affairs of the University of Florida School [sic] of Medicine, and the NIH. The letter alleged that Respondent had committed an intentional and willful HIPPA [sic] research protocol violation. The letter alleged that the violation involved the release of PHI to BioNeuronics on external hard drives. On March 21, 2006, Linda Dance, an assistant in Respondent's laboratory, wrote a letter to Susan Blair, the Privacy Officer for the University of Florida. In the letter, Ms. Dance reported what she believed was a HIPPA [sic] violation. Ms. Dance identified the violation as the release of patient data to BioNeuronics, a company in which Respondent owned stock and from which he received monthly consulting fees. The Office of Human Research Protections (OHRP) is a federal agency of the United States Department of Health and Human Services. The OHRP wrote to the University of Florida and the VA based on the anonymous letter. The OHRP requested both institutions to investigate the alleged non-compliance, and forward to OHRP a written report. The OHRP also required the university and the VA to provide a description of any corrective actions taken to prevent noncompliance in the future. Ms. Blair undertook an investigation of the matter, interviewing all of the persons involved. She also contacted BioNeuronics to inform the company of a potential disclosure of PHI. The University of Florida Police Department was also involved in the investigation. BioNeuronics immediately returned the external hard drive. The company's president, John Harris, attested that BioNeuronics had erased any data from the hard drive that had been put onto their computer systems. He also attested that to his knowledge, no one at the company had viewed any PHI. The Security Office of the Health Science Center received the hard drive. The office then made a forensic copy of the drive, which contained 18 patient files, including EEG files, tag files, clinical records, and Excel spreadsheets. The Privacy Office made hard copies of the computer files to determine whether they contained any PHI. An employee of Shands Hospitals, who was not connected with the Privacy Office, but who had full access to confidential hospital patient records, was able to identify all 18 patients within a very short time. For at least one of the patients, the clinical record reflects that it is a record of Shands Hospital at the University of Florida. It also contains a room number, a date of service, the name and signature of the doctor, the medications prescribed, the types of procedures involved, and a diagnosis and detailed description of the patient's seizure activity. In the body of the narrative, the clinical record contains the last name of the patient. Access to patient records at Shands Hospitals and Clinics is restricted to persons having a verified and legitimate need to know. Unauthorized access for the purpose of identifying a patient is a violation of law. However, it makes no difference whether an average citizen has access to the information necessary to re-identify a patient. Rather, if identification is possible, the information is PHI. Respondent and Dr. Shiau were placed on administrative leave as of March 31, 2006, pending the outcome of the investigation. Ms. Blair concluded her investigation and issued a report dated April 30, 2006. William Ditto, Ph.D., the Chairman of the Department of Biomedical Engineering, in consultation with the Dean of the College of Engineering and the Provost of the University of Florida, determined that in lieu of dismissal, Respondent would be suspended without pay for six months, commencing August 16, 2006, through February 7, 2007. Dr. Shiau was given a written reprimand. Dr. Ditto sent Respondent a letter dated August 2, 2006. The letter advised Respondent of the six-month suspension. The letter also noted that Respondent was prohibited from engaging in any outside activities with businesses outside the university. The letter stated that Respondent's current outside activities, exemptions, or approvals were withdrawn, including those with BioNeuronics, Inc. and Optima Neuroscience, Inc. The revocation of Respondent's waiver to participate in outside activities would have required him to abandon investors who licensed his technology at Optima Neuroscience and give up hope of ever seeing his work come to fruition. Therefore, Respondent did not divest himself of his interest in BioNeuronics or Optima Neuroscience. Respondent did discontinue all outside activities with those companies during this period and his stock in Optima Neuroscience was held in escrow. Respondent appealed the disciplinary action. The UFBOT referred the appeal to the Division of Administrative Hearings. UFBOT denied Respondent's request to be reinstated to his position with the university during the appeal in accordance with Florida Administrative Code Rule 6C1-7.048(2)(c). UFBOT stopped paying Respondent at the end of the spring semester 2006. Ordinarily, UFBOT would have paid him during the summer from funds generated by this grants. Due to his involuntary administrative leave, Respondent could not do any work under his grant during the summer because the UFBOT refused to continue Respondent in pay status pending his appeal. Prior to the end of his disciplinary suspension, the university relinquished Respondent's major funding source, the On Line, Real Time Seizure Prediction Grant, worth 2.4 million dollars to the NHI. Since research was the primary basis of Respondent's employment, Respondent assumed there was no job for him to return to after his defacto suspension was over. On February 16, 2007, Respondent voluntarily resigned from his tenured professorship at the University of Florida.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That Petitioner enters a final order finding just cause to discipline Respondent, who is entitled to back pay from August 16, 2006, to February 16, 2007. DONE AND ENTERED this 6th day of December, 2007, in Tallahassee, Leon County, Florida. S SUZANNE F. HOOD 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 6th day of December, 2007. COPIES FURNISHED: Carla D. Franklin, Esquire Carla D. Franklin, P.A. 4809 Southwest 91st Terrace Gainesville, Florida 32608 Susan M. Seigle, Esquire Dell Graham, P.A. Post Office Box 850 Gainesville, Florida 32602 B. Dianne Farb, Esquire Assistant General Counsel University of Florida Post Office Box 100215 Gainesville, Florida 32610-0215 Deborah K. Kearney, Esquire General Counsel Department of Education Turlington Building, Suite 1214 325 West Gaines Street Tallahassee, Florida 32399-0400 Jeanine Blomberg Interim Commissioner of Education Department of Education Turlington Building, Suite 1514 325 West Gaines Street Tallahassee, Florida 32399-0400
The Issue The issues to be determined are whether Respondent has been convicted of crimes related to the practice or the ability to practice medicine in violation of section 456.072(1)(c), Florida Statutes (2013), by virtue of being found guilty of traveling to meet a minor to engage in sexual contact; unlawful use of a two- way communications device to facilitate the commission of a felony; and using a computer to facilitate or solicit the sexual conduct of a child; and if so, what penalty should be imposed.
Findings Of Fact The Department is the state agency charged with the licensing and regulation of physicians pursuant to section 20.43 and chapters 456 and 458, Florida Statutes. The Board of Medicine is the professional licensing board charged with final agency action with respect to physicians licensed pursuant to chapter 458. At all times relevant to these proceedings, Respondent was licensed as a physician by the State of Florida, and holds license number ME 79663. Respondent is an internist in Perdido Key, where he practices as a solo practitioner. Respondent considers himself to be an “old fashioned physician” who spends 30-45 minutes with each patient. This pace necessitates that he see fewer patients per day than the apparent norm. In mid-to-late 2013, Respondent had reached a cross- roads in his life. He was in the midst of a drawn-out divorce proceeding, and was coming to terms with his sexuality as a gay man. He felt like he was drowning in the paperwork associated with his practice, and was in debt. He was also mildly depressed about his life. While Respondent had come to terms with his homosexuality, he had not told his family and friends and was unsure of their response. Respondent does not drink or smoke, and does not go to bars, so his venues for meeting other men with whom to build any kind of relationship were limited. He decided to post ads on Craig’s List in the “Casual Encounter Section.” One of his ads read in part, “I prefer younger Men. Under 30 is a big plus . . . . No reciprocation required if you come to me, are fit and under 25.” On December 22, 2013, Respondent received a response from a person identified as “Matt.” Respondent corresponded by e-mail with Matt over the next couple of weeks. From the very beginning, Matt described himself as “kinda young.” Respondent responded by saying, “I like young,” to which Matt revealed he was not yet 18. The following day, Matt stated that he had just turned 14 and was inexperienced. Respondent wrote that he would love to meet Matt and “show [him] a few things,” and stated that “I love inexperienced guys that I can take my time with and see them experience the joy of sex for their first time.” Many of the e-mails are quite graphic and reciting their contents would serve no purpose. These e-mails lasted from December 23, 2013, through January 2, 2014. In reality, the person responding to the ad and identified as Matt was not a 14-year-old boy. Matt was actually Zach Ward, an undercover police officer. During Respondent’s e-mail communications with Detective Ward, he offered to meet Matt eight separate times. He was aware that his conduct had criminal implications and noted this fact several times. For example, he advised Matt not to save a photo that he sent to Matt and not to save any of their messages “in case anyone gets ahold of your phone,” and he advised Matt to “be careful what they text,” but that there is “nothing illegal with us kissing and making out.” Respondent even attempted to justify his actions in an e-mail, stating: I have rationalized that it is morally ok if you are the one who instigates it. Clearly doesn’t make it legal. But I think it is almost preferable for a young guy to be able to experiment and play safe and learn from an older person as opposed to playing with a girl your age and ending up getting her pregnant. Yet that is somehow socially accepted but older with younger is not . . . . I have given this much consideration. I feel if the opportunity came knocking at my door, I wouldn’t chase it away. Respondent also spoke to Matt about his practice as a physician. He told Matt that he was a family doctor, and communicated with him by e-mail between seeing patients. He discussed a 16-year-old patient with Matt, identifying the patient by first name; stating that he had seen the patient naked; that he thought the patient was “cute”; and that he wished the patient was gay. In talking about this patient, Respondent told Matt he always asks teenagers about their sexual preference, and also stated: Some people make jokes about pedophiles becoming doctors and teachers. But, as long as they don’t act on their desires and don’t make advances and seduce their patients, I don’t see any harm in it. I think it actually makes me a better doctor. I screen teens for issues like depression, drug use, sexual activity and orientation. I spend a little more time with them than most doctors. But I treat them like a person and don’t just push them out the door. To me, a sexual predator uses their influence to coerce a child into sexual acts. I would never do that . . . . Eventually, Matt and Respondent agreed to meet at a bowling alley near Matt’s purported home. On January 2, 2014, Respondent left his office and traveled to the pre-arranged meeting location at a bowling alley. Upon his arrival, Respondent was arrested. On April 25, 2014, the State Attorney for Escambia County filed a three-count Information against Respondent. The Information alleged that on January 2, 2014, Respondent knowingly traveled within the state to engage in unlawful sexual conduct with a person Respondent believed to be a child less than 18 years old, in violation of section 847.0135(4)(a), Florida Statutes (2013); that between December 23, 2013, and January 1, 2014, Respondent knowingly used a cell phone or two-way communication device to facilitate or further the commission of a felony, i.e., traveling to meet a minor to engage in sexual conduct, in violation of section 934.215, Florida Statutes (2013); and that between December 22, 2013 and January 1, 2014, Respondent knowingly used a computer or internet service to attempt to seduce or solicit another person Respondent believed to be a child less than 18 years old to engage in unlawful sexual conduct, in violation of section 847.0135(3)(a). The Information was filed in Escambia County Circuit Court and docketed as Case No. 1714CF000027A. For some reason that has not been explained, the documents also bear docket no. 2014-CF-000027. Respondent was tried before a jury on January 12, 14, and 15, 2015. Respondent testified on his own behalf during the criminal trial, and claimed that he was aware that Matt was not a young boy, but was in fact an undercover police officer posing as an underage male. He felt law enforcement was targeting homosexuals, and he wanted to use the opportunity presented to him to bring attention to this social issue that he felt needed to be addressed. He also claimed that he was aware there was a good chance that he would be arrested, but viewed it as a way to deal with his growing dissatisfaction with his practice and his need to admit to his family and friends his decision in terms of his sexuality. By its finding of guilt, the jury clearly did not find his claim to be credible. Respondent wrote a letter to his housekeeper the day before the pre-arranged meeting with Matt, telling her that he expected to be arrested and that he believed that Matt was an undercover police officer. The housekeeper found the letter and turned it over to defense counsel. While the letter was not admitted into evidence in the criminal proceeding, it was admitted in this disciplinary case. While Respondent believes that the letter shows that he did not believe Matt to be underage, this disciplinary proceeding is not an opportunity to retry the criminal action. Moreover, Respondent’s claim that he knew Matt was not an underage boy, but rather a police officer, is rejected as not credible. Respondent’s letter to his housekeeper could be just as easily interpreted as an attempt to provide a defense for Respondent should he get caught. Even assuming, for the sake of argument, that Respondent did in fact know Matt was an undercover officer, a finding which the undersigned does not make, his actions are not transformed into a selfless act. Both Respondent’s testimony at hearing and the letter he wrote to his housekeeper evidence a total disregard of the consequences his actions could bring and what effect those actions could have on the continued vitality of his practice and the well-being of his patients. On January 15, 2015, the jury found Respondent guilty of all counts charged. At his sentencing hearing on February 23, 2015, several patients, employees, and a family member testified on his behalf. The circuit court judge withheld adjudication, and sentenced Respondent to two years of community control, followed by 13 years of probation. This sentence represents a downward departure from the criminal sentencing guidelines. Respondent was designated as a lifetime Sex Offender; required to enroll and complete Sex Offender Counseling and any recommended treatment; prohibited from caring for or treating minors without notifying the minor’s parents of his Sex Offender status, and having another staff member present; prohibited from any other contact with those under the age of 18; and prohibited from using a computer unless required for the treatment of patients. Among the many conditions of probation is the requirement that Respondent must work “diligently at a lawful occupation, advise [his] employer of [his] probation status, and support any dependents to the best of [his] ability, as directed by [his] officer.” Respondent’s conditions of community control require check-ins with his Community Control Officer approximately three times weekly, and that he keep his Community Control Officer apprised of his whereabouts at all times. Any travel outside his work schedule must be approved in writing, and Respondent must notify his Community Control Officer in advance of any travel to address a patient emergency. Respondent only has one part-time staff member, a receptionist, available to be present during examination and treatment of minor patients. His receptionist is not licensed by the Department. At hearing, he testified that he no longer sees minor patients. Respondent asserts that his conviction is not related to the practice or the ability to practice medicine, because he had no intent to harm any minor. However, the evidence indicates that he went to the bowling alley for the meeting knowing that his actions would in all likelihood get him arrested. The evidence, taken as a whole, suggests that the encounter was worth the risks to him. This fact alone shows a disregard for the well-being of his patients and their continued care. Moreover, the conditions of his criminal sentence place specific restrictions on his medical practice by requiring the parents of any minor patient to be informed of his Sex Offender status, and requiring the presence of another staff person in the office during any treatment of minors. Further, as noted by Dr. Libert’s testimony, Respondent is prohibited from having contact with minors outside the supervised care of underaged patients. Having a staff member available, even part-time, for supervised patient visits does not address the very real probability of children being present in his office that are related to his patients. Clearly, these restrictions that have been imposed as a result of his convictions are related to the Respondent’s ability to practice medicine. The personal qualities essential to the sound practice of medicine include integrity, respect for the public trust, good judgment, and respect for the well-being of others. Respondent’s actions reflect extremely poor judgment and a violation of both the trust of his patients and the trust society places in physicians. His Sex Offender status undermines the confidence that the public is entitled to have in the judgment and integrity of a health care professional licensed in this state. Patients should not have to check the Sex Offender Registry before placing themselves into the care of a licensed physician. Respondent’s convictions for the crimes charged in the Information are convictions of crimes related to the practice or the ability to practice medicine in the State of Florida.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medicine enter a final order finding that Respondent has violated section 456.072(1)(c), Florida Statutes, and revoking his license to practice medicine. DONE AND ENTERED this 2nd day of December, 2015, in Tallahassee, Leon County, Florida. S LISA SHEARER NELSON 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 2nd day of December, 2015. COPIES FURNISHED: Brian Mitchell Lee, M.D. 13020 Sorrento Road Pensacola, Florida 32507 Louise Wilhite-St. Laurent, Esquire Prosecution Services Unit Department of Health 4052 Bald Cypress Way, Bin C65 Tallahassee, Florida 32399 (eServed) Brynna J. Ross, Esquire Prosecution Services Unit Department of Health 4052 Bald Cypress Way, Bin C65 Tallahassee, Florida 32399-3265 (eServed) Andre Ourso, Executive Director Board of Medicine Department of Health 4052 Bald Cypress Way, Bin C03 Tallahassee, Florida 32399-3253 (eServed) Nichole Geary, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 (eServed)
The Issue The issue in this case is whether Respondent, Peter N. Brawn, M.D., committed violations of Chapter 458, Florida Statutes, as alleged in an Administrative Complaint filed by Petitioner, the Department of Health, on January 21, 2004, in DOH Case Number 2002-15991; and, if so, what disciplinary action should be taken against his license to practice medicine in the State of Florida.
Findings Of Fact Petitioner, the Department of Health (hereinafter referred to as the "Department"), is the agency of the State of Florida charged with the responsibility for the investigation and prosecution of complaints involving physicians licensed to practice medicine in Florida. § 20.43 and Chs. 456 and 458, Fla. Stat. (2005). Respondent, Peter N. Brawn, M.D., is, and was at the times material to this matter, a physician licensed to practice medicine in Florida, having been issued license number ME 75202. Dr. Brawn is board-certified in pathology. Dr. Brawn has not previously been the subject of a disciplinary proceeding in Florida. Dr. Brawn's address at the times relevant to this proceeding was 525 Caroline Street, Key West, Florida 33040. His telephone number was (305) 292-1917. Dr. Brawn's Prescription Dispensing Log of May 14, 2002. Dr. Brawn's prescription dispensing log for May 14, 2002, indicates that Carisoprodol was dispensed to an individual whose initials are J.T. This individual's name is identical, except for the last letter of his last name, to Patient J.T., the patient at issue in the Administrative Complaint. The last letter of the individual listed in the log is "r" (hereinafter referred to as "J.Tr"), while the last letter of the patient in the Administrative Complaint is a "z" (hereinafter referred to as "J.Tz"). The Events of May 17, 2002. On or about May 17, 2002, Douglas Lee Howard, a police officer with the police department of the City of Tustin, Orange County, California, was serving as a resource officer at Tustin High School. Officer Howard was summoned to the assistant principal's office at approximately noon. When he arrived, he observed a student, J.Tz, who had been removed from his classroom, leaning against the wall, falling asleep. J.Tz is the same individual identified in the Administrative Complaint as Patient J.T. J.Tz was 16 years of age at the time of this incident. Officer Howard told J.Tz to go into the assistant principal's office and sit down. J.Tz complied, running into a lobby counter and the office doorjamb on the way. When he attempted to sit, he sat on the arm of the chair, nearly tipping the chair over. When asked if he had taken any drugs, J.Tz produced a white plastic medicine bottle (hereinafter referred to as the "Medicine Bottle"), from his pants pocket. The permanent manufacturer's label on the Medicine Bottle indicates that it contained 100 350 mg tablets of Carisoprodol, commonly referred to as "soma." This is the same medication which Dr. Brawn dispensed on May 14, 2002, to J.Tr. Carisoprodol is a legend drug which acts as a muscle relaxer and is used for muscle strains. Physiologically, it causes drowsiness, dizziness, and loss of coordination or ataxia, all symptoms that were exhibited by J.Tz on May 17, 2002. The Medicine Bottle also contained a printed label (hereinafter referred to as the "Added Label") which had been pasted onto it which included the following information: Peter Nelson Brawn, M.D. 525 Caroline St. Key West Florida 33040 305.292-1917 1-888-491-4545 Patient Name J[] T[] Date Dispensed 5/14/02 Name & Strength of Drug Directions for Use 1 tablet 4X/day The "Patient Name," "Date Dispensed," and "Directions for Use" had been written in ink on the Added Label. The last name of the patient name written on the Added Label can be read as either J.Tz or J.Tr. Officer Howard confiscated the Medicine Bottle from J.Tz. Officer Howard and a school nurse counted 84 pills remaining in the Medicine Bottle. Officer Howard, after asking J.Tz where he had obtained the pills, called the toll-free telephone number listed on the Added Label, a number listed next to Dr. Brawn's name and his address and phone number of record. He spoke to an individual who identified himself as Peter Brawn. The individual he spoke with indicated that, while he had no record of dispensing any medication to J.Tz, he did have a record of having dispensed Carisoprodol to J.Tr on the date in question. The individual Officer Howard spoke with also indicated that J.Tr had reported his age to be 18. The information disclosed to Officer Howard was medical information which would not have been generally known by anyone other than Dr. Brawn. Officer Howard had never spoken to Dr. Brawn and, therefore, could not have identified the individual he spoke to as Dr. Brawn through voice recognition. Based upon the fact that the phone number Officer Howard called was listed on the Added Label next to Dr. Brawn's name, address, and phone number, the fact that the individual identified himself as "Dr. Peter Brawn," and the fact that the individual disclosed medical information which Dr. Brawn was privy to, it is found that the individual Officer Howard spoke to was in fact Dr. Brawn. Dr. Brawn explained to Officer Howard that he had prescribed the Carisoprodol to J.Tr after being contacted by him through two e-mails. Dr. Brawn admitted that he had not spoken to J.Tr and that he had not confirmed any medical history. Having not spoken to J.Tr, it is found that he also did not perform any physical examination of J.Tr. Finally, given the foregoing, it is found that J.Tr and J.Tz are the same individual. It is, therefore, concluded that the J.Tr Dr. Brawn dispensed Carisoprodol to on May 14, 2002, is the Patient J.T. of the Administrative Complaint. Medical Records. Based upon the admissions against interest made by Dr. Brawn to Officer Howard during the May 17, 2002, telephone conversation Officer Howard testified about, it is found that Dr. Brawn, not having taken any medical history of J.Tr and not having given him an examination, did not make any medical record to support his dispensing Carisoprodol to Patient J.T. Without Dr. Brawn's admissions against interest, the evidence failed to prove that Dr. Brawn did not have medical records relating to the medications he provided to J.Tr. No direct evidence, other than phone conversation, was presented that would support a finding that such records do not exist. On or about February 27, 2003, the Department had served a subpoena on Dr. Brawn, through counsel, requesting the following: All medical records and reports for J[] T[z], DOB . . . including but not limited to, patient histories, examination results, treatments, x-rays, test results, records of drugs prescribed, dispensed, or administered, and reports of consultations and hospitalizations. In the "Application Affidavit for Patient Records Subpoena Without Patient Release" which was used to get permission for serving the subpoena on Dr. Brawn, J.Tz is also referred to as "a/k/a Tr." Despite the Department's awareness of the possibility that J.Tz and J.Tr were the same individuals, the subpoena actually served on Dr. Brawn did not request any medical records or other information relating to J.Tr. By letter dated March 12, 2003, Dr. Brawn, through counsel, informed the Department that he had "no medical records responsive to th[e] subpoena." The Standard of Care. Keith Fisher, M.D., accepted as an expert, testified convincingly and credibly that a reasonably prudent physician, similarly situated to Dr. Brawn, would, before dispensing Carisoprodol, a legend drug: (a) obtain a complete medical history of the patient; (b) make a diagnosis, prepare a treatment plan for the patient, and keep a medical record for the patient; and (c) perform a physical examination of the patient to determine that the patient was truly in need of Carisoprodol. Dr. Brawn failed to take any of the steps Dr. Fisher opined were necessary before dispensing Carisoprodol. Dr. Brawn dispensed the Carisoprodol to Patient J.T. based upon two e-mails he received. He did not conduct any examination of Patient J.T. and he did not obtain a medical history of Patient J.T. These findings, again, are based upon the telephone conversation between Dr. Brawn and Officer Howard. Without those admissions, the evidence in this case failed to prove, however, that Dr. Brawn did not carry out the responsibilities described by Dr. Fisher when he dispensed Carisoprodol to who he believed was J.Tr, but was actually Patient J.T. The Admissibility of Officer Howard's Deposition. Officer Howard's deposition, Petitioner's Exhibit 1, was taken by telephone on July 12, 2002, just over two weeks before the final hearing. Officer Howard's deposition was taken by telephone because he works and resides in California. No order was obtained from this forum or any court to take the deposition by telephone. The Notice of Taking Deposition sent to Dr. Brawn scheduling Officer Howard's deposition indicates that it was to be taken by telephone. It also put counsel for Dr. Brawn on notice of the following: "This deposition is being taken for purposes of discovery, for use at an administrative hearing, or any other purpose for which it may be used under applicable laws of the State of Florida." [Emphasis added]. At no time before or during the deposition was any objection made by counsel for Dr. Brawn to the manner in which the deposition was taken. In particular, no objection was made to taking the deposition by telephone. By his silence, Dr. Brawn gave tacit agreement to the taking of Officer Howard's deposition by telephone. In addition to the foregoing, the Joint Pre-Hearing Stipulation filed by the parties only two days after Officer Howard's deposition was taken does not list Officer Howard as a witness, and the transcript of Officer Howard's deposition is listed as a potential Petitioner's exhibit. Given these facts and the fact that Dr. Brawn was aware that Officer Howard works and resides in California, it is inferred that Dr. Brawn knew or should have known that the deposition would be offered in lieu of Officer Howard's appearance and testimony at hearing. Yet, counsel for Dr. Brawn waited until hearing to raise any objection to the admissibility of Officer Howard's deposition testimony. While part of Officer Howard's testimony constitutes hearsay testimony, in particular, comments made to him by J.Tz, no finding of fact has been based upon such testimony. For example, while Officer Howard testified that J.Tz told him who he obtained the pills from and how, that testimony has not been relied upon to make a finding as to how J.Tz got the pills. During Officer Howard's testimony, he referred to seven photographs which he had taken of the Medicine Bottle. Those photographs were taken by Officer Howard on May 17, 2002. While Dr. Brawn objected during the deposition to their admissibility, he did not state the basis of his objection. At hearing, Dr. Brawn objected to the admissibility of not only the photographs, but also to the entire deposition, suggesting that he had not been able to effectively cross examine Officer Howard about the photographs because he did not have them before him while the deposition was being taken. Officer Howard, however, used the photographs to refresh his memory and described adequately what they depicted. His testimony alone, without regard to any consideration of the photographs, supports the findings made herein. Additionally, the Department's file on Dr. Brawn, which had been provided to Dr. Brawn, contained a single-page copy of an e-mail with all the photographs testified to by Officer Howard. Those smaller photographs, which were available during the deposition, and Officer Howard's description of the Medicine Bottle and its labels, were adequate to eliminate any prejudice to Dr. Brawn.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the a final order be entered by the Board of Medicine finding that Peter N. Brawn, M.D., has violated Section 458.331(1)(m), (q), and (t), Florida Statutes (2001), as described in this Recommended Order; suspending his license for a period of two years from the date of the final order; and requiring that he pay an administrative fine of $15,000.00. DONE AND ENTERED this 2nd day of September, 2005, in Tallahassee, Leon County, Florida. LARRY J. SARTIN 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 2nd day of September, 2005. COPIES FURNISHED: Patrick L. Butler Ephraim D. Livingston Assistants General Counsel Prosecution Services Unit Office of General Counsel Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Sean M. Ellsworth, Esquire Ellsworth Law Firm, P.A. 404 Washington Avenue, Suite 750 Miami Beach, Florida 33139 Larry McPherson, Executive Director Board of Medicine Department of Health 4052 Bald Cypress Way Tallahassee, Florida 32399-1701 R. S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 Timothy M. Cerio, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 Dr. John O. Agwunobi, Secretary Department of Health 4052 Bald Cypress Way, Bin A00 Tallahassee, Florida 32399-1701
