The Issue The issue to be resolved in this proceeding concerns whether disciplinary action should be taken against the Respondent's medical license based on an alleged violation of section 458.331(1)(s), Florida Statutes, concerning his ability to practice medicine with reasonable skill and safety by reason of illness, substance abuse, or mental or physical condition.
Findings Of Fact The Petitioner is an agency of the State of Florida charged with regulating the practice of medicine as delineated in Chapter 458, Florida Statutes. The Board of Medicine is organized within the Agency and charged with determining and issuing final orders in disciplinary cases involving physicians within its jurisdiction. At all times pertinent to this proceeding, Dr. Murtha has been licensed to practice medicine in the State of Florida, holding license no. 0037467. As a licensed physician in the State of Florida, Dr. Murtha is subject to the licensure and medical practice regulatory jurisdiction of the Board of Medicine of the Agency of Health Care Administration. Dr. Murtha, at the time of the Agency's investigation, was approximately 42 years of age. He received his medical degree in 1978 from the University of Florida and completed his residency at the University of Tennessee. In 1981, he became board certified in internal medicine. He has been on the staff of St. Joseph's Hospital in Tampa, Florida for the ten years prior to the initiation of this action. In August 1995, the Agency filed a complaint against Dr. Murtha alleging that two episodes affected Dr. Murtha's ability to practice medicine with reasonable skill and safety to patients by reason of use of alcohol. The first episode related to a charge of driving under the influence. On May 2, 1994, Dr. Murtha was involved in a minor traffic accident and charged with driving under the influence (DUI). On August 24, 1994, Dr. Murtha pled no contest to the charge, and he received 12 months probation, six months revocation of his driver's license, a $250.00 fine, required attendance of DUI school, and court costs. 7/ The officer who investigated the May 2, 1994 accident and who also charged Dr. Murtha was not available for the hearing and did not testify. The second episode alleged by the Agency relates to the allegation that Dr. Murtha practiced medicine while intoxicated. Specifically, the Agency alleged that Dr. Murtha saw patients while intoxicated. Relating to the second factual allegation, Nurse Georgia Jacinta Paille testified that on January 30, 1995, she encountered Dr. Murtha visiting a patient at St. Joseph's Hospital. Ms. Paille is the day charge nurse at St. Joseph's Hospital in Tampa, and she appeared as the first witness for the Agency. Nurse Paille testified that on January 30, 1995, she encountered Dr. Murtha and that he had a strong odor of alcohol on his breath. She further testified that Dr. Murtha was acting angry and inappropriate and that he raised repetitive questions relating to care given to one of his patients. While Nurse Paille noticed the odor of alcohol, she did not notice if Dr. Murtha's speech or gait was affected by the alcohol. Furthermore, Nurse Paille could not testify that Dr. Murtha acted like someone who had been drinking. Nurse Paille reported her observations of Dr. Murtha to her manager, Margie Butler, who in turn made a report to Dr. Gilbert J. Pitisci, the Hospital Administrator. Gilbert J. Pitisci is a medical physician and the Senior Vice President for Medical Affairs at St. Joseph's Hospital in Tampa, Florida. In addition to various administrative duties, Dr. Pitisci is authorized to summarily suspend a physician's privileges at a hospital. On January 30, 1995, the same day that Nurse Paille observed Dr. Murtha, Dr. Pitisci encountered Dr. Murtha. Dr. Pitisci also noticed the odor of alcohol on Dr. Murtha's breath, and he noticed that Dr. Murtha had a slight slurring of his speech and that there was a slight tremor in his hands. Dr. Murtha declined Dr. Pitisci's invitation to discuss his condition in private. Rather, Dr. Murtha insisted that the discussion be held publicly at the nurses' station. Based on Dr. Murtha's physical appearance and based on the odor of alcohol on his breath, Dr. Pitisci summarily suspended Dr. Murtha as a potentially impaired physician and directed him to leave the hospital. Subsequently, Dr. Pitisci notified the state that it had a physician with a potential impairment with alcohol abuse. Other than detecting the odor of alcohol on Dr. Murtha's breath, Dr. Pitisci had no information as to the amount of alcohol consumed by Dr. Murtha. On or about March 24, 1995, the Agency received notification of Dr. Murtha's suspension from St. Joseph's Hospital. In response, the Agency opened an investigation that led to the filing of an order compelling physical and mental examination. Subsequently, Dr. Murtha received an order from the Agency compelling him to submit to both a physical and mental examination. The Agency chose the physician and directed Dr. Murtha when to appear for his appointment. On June 6, 1995, Dr. Murtha complied with the Agency order compelling his mental examination, and he was evaluated by Daniel J. Sprehe, M.D. Daniel J. Sprehe, M.D. is a psychiatrist licensed in the State of Florida. He has been qualified by various Florida courts as an expert in clinical and forensic psychiatry and was accepted as an expert in the area of psychiatry on behalf of the Agency. Dr. Sprehe's examination and testing of Dr. Murtha lasted approximately three hours. Dr. Sprehe obtained and prepared a detailed social and medical history of Dr. Murtha, administrated the Minnesota Multiphasic Personality Inventory Psychological Test (MMPI) and MMPI II, administered the Michigan Alcoholism Screening Test (MAST), and administered a Beck Depression Inventory. He also questioned Dr. Murtha and performed a mental status examination. The purpose of the evaluation was to determine Dr. Murtha's medical condition and to make any recommendations for treatment concerning his fitness to practice medicine. Dr. Sprehe completed a written evaluation, including a written opinion based on the evaluation. In addition to the aforementioned tests, Dr. Murtha was given a blood test that revealed no alcohol or drugs in his system. Dr. Sprehe's report indicated that Dr. Murtha scored rather low, a score of 7 (out of a possible 30), on the MAST test. He stated that the MAST is a self-reporting test and that a score of five or more places the subject in the range to be considered an alcoholic. Later, Dr. Sprehe indicated that based on the facts presented in other reports relating to Dr. Murtha, he would have modified Dr. Murtha's score to 9. Still later at the hearing, Dr. Sprehe again revised his scoring of Dr. Murtha's MAST test and concluded that he scored a 20. Dr. Sprehe surmised that Dr. Murtha did not answer the test questions candidly and that his score should have been higher. Dr. Sprehe also found that Dr. Murtha minimalized his abuse of alcohol. Based on the MAST test, Dr. Sprehe found that Dr. Murtha fell into the alcoholic range. For reasons fully stated in paragraphs 26, 27, and 41, the undersigned declines to adopt, as a finding of fact, any diagnosis of Dr. Murtha based on the MAST test. Dr. Sprehe explained the differences between the definitions of abuse and dependence. Subsequently, Dr. Sprehe opined, within a reasonable degree of medical certainty, that the Respondent was an alcohol abuser. Based on his opinion, Dr. Sprehe recommended that Dr. Murtha consider a diversionary program such as the Physicians Recovery Network. Dr. Sprehe also opined that Dr. Murtha suffered from narcissistic personality disorder, which can complicate the diagnosis of alcoholism. A person with narcissistic personality disorder tends to deny defects in themselves. Dr. Sprehe's diagnosis of narcissistic personality disorder was made after a one-hour examination of Dr. Murtha. Dr. Sprehe could not state with certainty that Dr. Murtha could not practice with reasonable skill and safety. Dr. Sprehe did opine, however, that "there is at least a question in my mind as to [Dr. Murtha's] ability to practice medicine with reasonable skill and safety." Dr. Sprehe opined that the results of the MAST test and the mental examination, coupled with Dr. Murtha's history, placed Dr. Murtha in the high risk category. No where in the written report to the Agency did Dr. Sprehe advise the Agency that Dr. Murtha was not able to practice medicine with skill and safety. Dr. Sprehe also opined, based on a hypothetical question, that Dr. Murtha "is not in a position to practice medicine safely to patients." The hypothetical question, however, was based on the testimony of Dr. Murtha's ex- wife which has been found to lack consistency. (See paragraphs 28-30). Therefore, for the reasons stated in paragraphs 28-30, the undersigned declines to adopt, as a finding of fact, Dr. Sprehe's opinion which was based on a factually deficient hypothetical question. On August 9, 1995, sixty-five days after Dr. Sprehe's examination and report, the Agency issued an Emergency Suspension Order against Dr. Murtha's license to practice medicine. Dr. Murtha called Mark Stuart Goldman, Ph.D. as his sole witness. Dr. Goldman is a clinical psychologist and distinguished Professor of Psychology at the University of South Florida. Dr. Goldman specializes in the area alcohol research and is currently the director of the Alcohol and Substance Abuse Institute at the University of South Florida. Dr. Goldman was accepted as an expert witness in the field of alcohol and alcoholism, and he testified on behalf of Dr. Murtha. Dr. Goldman testified to the issue of alcoholism and discussed in detail the Michigan Alcoholism Screening Test (MAST). As discussed earlier, Dr. Sprehe relied on the MAST to help make his diagnosis that Dr. Murtha is dependent on alcohol. Dr. Goldman testified that the MAST can be skewed and that the very accusation of alcohol abuse can result in the subject having points scored against him. Dr. Goldman stated that tests such as MAST are crude devices used for screening alcohol problems but are not designed for the purpose of making diagnosis. To make this point, Dr. Goldman cited the Handbook of Alcoholism Treatment Approaches, by Hester and Miller, for the purpose that screening tests such as MAST should not be used for the purpose of making a diagnosis and that to do so represents a violation of professional and ethical standards. The undersigned is persuaded by Dr. Goldman's position that tests such as MAST should be used as screening not diagnostic tools. As such, any opinions based on results from the MAST test are rejected as not supported by credible evidence. Dr. Goldman examined Dr. Murtha on two separate occasions. Dr. Goldman obtained and reviewed Dr. Sprehe's report, and he reviewed the results of the MMPI and the MAST. Based on his review of the materials generated by Dr. Sprehe and on his own examination of Dr. Murtha, Dr. Goldman could not offer an opinion as to whether Dr. Murtha is safe to practice medicine. In addition, Dr. Goldman felt the record was incomplete to offer an opinion as to whether the Respondent was dependent on alcohol. In summary, Dr. Goldman found that a conclusive diagnosis would take considerably more time and would involve additional examination techniques. The undersigned adopts Dr. Goldman's position that inadequate information was available to render an opinion regarding Dr. Murtha's ability to safely practice medicine. In addition to the expert testimony received at the hearing, the Agency also offered the testimony of Dr. Murtha's ex-wife, Donna Gail Murtha. Mrs. Murtha is a registered nurse employed at James A. Haley Veterans Administration Hospital, and she was married to Dr. Murtha for 23 years until their divorce in December of 1994. Mrs. Murtha was offered for the purpose of establishing that Dr. Murtha was an abuser of alcohol and that he regularly consumed alcohol while engaging in the practice of medicine. Mrs. Murtha offered conflicting testimony relating to the quantity of alcohol Dr. Murtha consumed during their marriage. At the hearing she stated that he consumed "at least a pint [of liquor] a day. During the discovery deposition, however, she stated that "she couldn't state an amount [of alcohol consumed]." She also denied ever stating that he [Dr. Murtha] drank a fifth a day. Mrs. Murtha offered additional conflicting testimony as it related to Dr. Murtha's use of alcohol while on call at the hospital. At the hearing she testified that Dr. Murtha consumed alcohol while on call. During the discovery deposition, however, she testified that she knew of no specific incident when Dr. Murtha used alcohol on call. She also stated that she could not recall any instance when Dr. Murtha went to the office after having consumed alcohol. Mrs. Murtha's testimony is rejected because it is inconsistent and it lacks reliability 8/ At no time during or prior to the Agency's investigation had any complaints been received against Dr. Murtha.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is: RECOMMENDED: That a final ordered be entered dismissing with prejudice the complaint filed against the Respondent in DOAH Case No. 96-0567. DONE and ENTERED this 20th day of June, 1996, in Tallahassee, Florida. WILLIAM A. BUZZETT, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 20th day of June, 1996.
The Issue Whether Respondent should be dismissed from his employment as an instructor at Chipola Junior College for alleged misconduct in office, incompetency, willful neglect of duties, and drunkenness, as set forth in the Complaint Recommending Dismissal, dated July 31, 1981. This proceeding commenced with the issuance of a Complaint Recommending Dismissal by the Interim President of Chipola Junior College alleging that Respondent James T. Sims, an instructor, should he dismissed for misconduct in office, incompetency, willful neglect of duty, and drunkenness. Respondent filed a petition for formal hearing pursuant to Section 120.57(1), Florida Statutes, on August 13, 1981. The matter thereafter was referred to this Division for the appointment of a Hearing Officer. At the hearing, Petitioner presented the testimony of Dr. Richard E. Morley, Interim President of Chipola Junior College; Dean James A. Lewis, Dean of Academic Studies; and Alice J. Story, Chairman of the Division of Natural Science and Mathematics. Respondent testified in his own behalf, and submitted the testimony of Dr. Jack Golden, Director of the Alcoholism Treatment Program at Capital Medical Center, Tallahassee, Florida. Four exhibits were received into evidence. The memorandum brief of Petitioner, and Respondent's memorandum have been fully considered and those portions thereof not adopted herein are considered to be either unnecessary, irrelevant, or unwarranted in fact or law.
Findings Of Fact Respondent James T. Sims has been an instructor at Chipola Junior College, Marianna, Florida, since 1959. In 1962, he entered into a continuing contract with the Beard of Public Instruction of Jackson County, Florida to continue in the capacity of a teacher at the college. At some undisclosed date, responsibility for the college became vested in a Board of Trustees at which time existing continuing contracts with the county Board of Public Instruction were apparently honored by the Board of Trustees without execution of new contracts. (Testimony of Respondent, Morley, Exhibit 1) Respondent's personnel file reflects that he was the subject of a number of memoranda from his supervisors commencing in 1975, concerning late or non-attendance of faculty meetings, early dismissal of classes, award of high grades to students who did not attend class, and unexcused absences. A "confidential" letter from Joiner Sims, Chairman, Division of Natural Science and Mathematics at the college, to Respondent, dated October 17, 1977, expressed concern over a "serious personal problem" that Respondent had had for several years which Sims had offered to help him solve, but stated that if he were found under the influence of alcohol on campus in the future, he would recommend Respondent's dismissal or return to annual contract. A memorandum from Chairman Joiner Sims to Respondent in March, 1978, recited that Respondent had been absent from classes on two occasions during the semester without advance notification. In September, 1979, President Raymond M. Deming met with Respondent, Dean of Academic Studies James A. Lewis, and Miss Josephine Story, then Chairman of the Division of Natural Science and Mathematics. A memorandum in Respondent's personnel file, dated September 10, 1979, of President Deming, reflects that during this conference Dean Lewis advised Respondent to quit drinking with the assistance of medicine, and that Respondent acknowledged that he liked to drink and had done quite a bit of drinking, but denied doing so on the college campus. The college officials offered to do anything they could to aid Respondent and he expressed appreciation for their consideration. (Testimony of Lewis, Story, Exhibit 1) A further memorandum from Dean Lewis to Miss Story on November 19, 1979, reviewed his concern about complaints from members of the community about Respondent's behavior off campus and his lessened effectiveness as an instructor over the past several months as a result of his "alcoholic problem," such as dismissing class early and absences from his office during office hours. By the memorandum, Dean Lewis requested that Miss Story direct Respondent to meet assigned classes for the full period, observe posted office hours, adhere to college rules, and insure that he understood that an immediate and permanent change in his performance was expected. Accordingly, by memorandum of November 20, 1979 to Respondent, Miss Story reviewed student complaints she had received concerning Respondent's late arrival at classes, assigning problems with little or no explanation, dismissing classes early, and coming to school sometimes smelling of alcohol. Miss Story had frequently failed to find Respondent in his office during office hours and she also noted this in her memorandum. The memorandum therefore directed Respondent specifically to cure the stated deficiencies. The memorandum had been preceded by a conference with Respondent on November 19th at which time Miss Story had reviewed Respondent's shortcomings, offered suggestions for improvement, and told him that if he found it impossible to abide by the conditions she had stated in her memorandum of November 20th, she would recommend that he be given the option of taking a semester's leave of absence to seek professional help. At the conference, Respondent assured her that he would take appropriate action to prevent further complaints. (Testimony of Story, Exhibit 1) Respondent's personnel file reflects that the President of the college Student Government Association wrote to President Deming on November 29, 1979, stating that Respondent had come to class several times unable to properly teach because of his "current problem of alcoholism" which prevented him from doing his job, that it was common knowledge to the students and faculty that he had a severe alcohol problem, and that his reputation would hurt the college greatly. In a letter to Miss Story dated December 12, 1979, Respondent denied the allegations. (Exhibit 1) In a letter dated December 17, 1979, President Deming informed Respondent that his image at the college and in the community should be a subject of great concern and that it may become necessary to request that Respondent submit himself to a physical examination if deemed necessary, and that if he ever came on the campus under the influence of alcohol he would be removed from the classroom and "immediate action would be taken." In another memorandum from Miss Story to Respondent dated June 3, 1980, she noted that although he had made a real effort toward improvement during the spring semester she had observed that several of his summer session classes had been dismissed before the end of the period, and cautioned him about maintaining class schedules. She explained the contents of her memorandum to Respondent in a conference on June 23rd and confirmed this with a memorandum dated June 25, 1980. In a further memorandum dated July 1, 1980, Dean Lewis reviewed past memoranda concerning Respondent that were contained in the latter's personnel file, and noted that "a pattern has developed that appears to be growing progressively worse." (Testimony of Story, Lewis, Exhibit 1) On March 31, 1981, Dean Lewis went to talk with Respondent during scheduled office hours but found that he had dismissed a class early and had not returned to his office. After searching around the campus, Lewis went to Respondent's home and, after no one answered his knocks at the door, went inside fearing that Respondent might be ill. He found Respondent watching television with a drink of some kind in his hand. Respondent told Lewis that he had gone home to take his medicine. Based on this incident, Dean Lewis sent a memorandum to President Deming with a copy to Respondent recommending that Respondent be given the opportunity to take off both 1981 summer sessions and the fall semester to seek professional help "with his problems" and that if he did not elect to do so, that either dismissal or some lesser action be taken against him. President Deming reprimanded Respondent in a letter dated April 10, 1981, wherein he again reviewed Respondent's past actions as reflected in memoranda in his file, restated the requirements that had previously been placed upon him as to his conduct, and stated that even one deviation from any of those directives would result in an immediate suspension and recommendation of dismissal. Respondent, by letter to President Deming, dated April 23rd defended his actions on March 31 by stating that he had been ill and attached copies of prescriptions for medicine issued on March 24 and 26 for throat pain. He claimed that he was only drinking a glass of water when Dean Lewis arrived at his home, and that his only dereliction was in failing to notify anyone that he was leaving the campus. (Testimony of Lewis, Exhibit 1) In another incident that occurred on June 15, 1981, during registration for the summer session, at which time Respondent was supposed to be counselling students, Dean Lewis observed that Respondent could not walk straight and did not appear rational. He appeared to be either sick or under the influence of alcohol, but Lewis could not smell anything on his breath. He felt that Respondent was in no condition to counsel students and carry out his duties. (Testimony of Lewis, Exhibit 1) On July 27, Miss Story recommended to Dean Lewis that Respondent be relieved of his teaching duties, and Lewis recommended to Dr. Morley, the Interim President, that Respondent be removed as a member of the faculty. Interim President Morley thereafter had a conference with Respondent at which he gave him the opportunity to resign or face dismissal action. Respondent declined to resign, and the Complaint Recommending Dismissal was issued by Morley on July 31, 1981. (Testimony of Morley, Lewis, Story, Exhibit 1) Miss Story and Respondent have philosophical differences regarding grading practices. Respondent uniformly gave high grades to his students and Miss Story felt that this was not in keeping with standard college practices. Respondent consistently received satisfactory evaluations of his performance regardless of his deficiencies, and both Dean Lewis and Miss Story justified this as an effort to encourage him to improve his performance. Neither questioned his knowledge of subject matter or teaching ability, but are of the opinion that his cumulative record establishes that his instructional ability has been impaired and he is a detriment to the institution. (Testimony of Lewis, Story, Exhibit 1) Respondent received treatment in the Alcoholism Treatment Program at Capital Medical Center, Tallahassee, Florida, in late August, 1981, for the program period of 28 days. The program involves psychotherapy which assists one suffering from the disease of alcoholism to regain his "self-concept," and learn about the addiction process and the person's own value and belief system. After the inpatient phase, the individual becomes involved in an aftercare program which includes a weekly meeting with counselors at the Medical Center, participation in Alcoholics Anonymous, and regular use of "Antabuse" to prevent lapses from abstention. A year is the normal recovery period. Since his discharge from Capital Medical Center in September, 1981, Respondent has been involved with the aftercare program. He has missed several of the meetings and on at least one occasion failed to take his Antabuse, became intoxicated, and was arrested for driving under the influence of alcohol in Marianna on October 21, 1981. Dr. Jack Golden, the Director of the Alcoholism Treatment Program, finds that it is not unusual for someone in Respondent's situation to not follow up completely with the aftercare treatment, or to experience at least one period of drinking during the first year of recovery. About 95 percent of his cases, including that of Respondent, involve the "denial process" for varying periods in which the individual cannot make sound judgments and refuses to recognize that he has a problem with alcohol. The disease, which has been recognized as treatable, is biological in nature in which the chemical system of a patient reacts differently to the drug of alcohol than does that of normal individuals. In most cases, persons will not seek assistance unless some crisis arises, or they are placed under coercion of some sort. In Respondent's case, the fact that he was being considered for dismissal prompted him to seek assistance. The treatment program has been experiencing about a 90 percent success rate if an individual remains in the program for one year with a six-months follow-up period thereafter. Although public intoxication has been decriminalized and alcoholism primarily placed in the health care system, it does not serve as an excuse for criminal activities. A state policy adopted in 1973 applicable to Career Service employees provides for termination of employment of persons suffering from alcoholism only if they refuse to seek treatment. (Testimony of Golden, Respondent) Respondent conceded at the hearing that he is an alcoholic and that he had committed himself to treatment which has benefited him to the point where he believes he can resume his normal career after successful completion of the treatment program. He admitted that he had dismissed classes early at various times and failed to keep proper office hours. However, he denied that he had ever been under the influence of alcohol while on the college campus and, in fact, had not consumed any alcohol for approximately six (6) months prior to the filing of the instant charges against him. He admitted that there was truth to the various other complaints that had been made against him over the years, but that some had been exaggerated to some extent. He did not take any initiative to reguest a leave of absence to seek treatment during the lengthy period because he was in what had been described as the "denial stage" of alcoholism. He produced a doctor's statement to the effect that he had had episodes of acute syncope, bradycardia, hypertension, cardiac arrhythmia, and fluid retention. The statement reflected that his "intermittent confusion, unstable gait and extreme weakness at times have probably been directly related to his electrolyte imbalance." Respondent also submitted a number of letters from various individuals, including students, attesting to his excellence as a mathematics instructor and to their lack of knowledge as to any problems with alcohol while on campus. (Testimony of Respondent, Exhibit 3, Composite Exhibit 4)
Recommendation That the Board of Trustees of Chipola Junior College dismiss Respondent, James T. Sims, from his employment as an instructor for incompetency and willful neglect of duty pursuant to Rule 6A-14.411(6), Florida Administrative Code. DONE and ENTERED this 29th day of December, 1981, in Tallahassee, Florida. THOMAS C. OLDHAM Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 29th day of December, 1981. COPIES FURNISHED: Richard Wayne Grant, Esquire 209 North Jefferson Street Post Office Box 209 Marianna, Florida 32446 Philip J. Padovano, Esquire Post Office Box 872 Tallahassee, Florida 32302 John E. Roberts, Esquire Post Office Box 854 Marianna, Florida 32446
Findings Of Fact Bell holds license no. ME 0008297 issued by the State of Florida. His license was active from January 7, 1959, until December 31, 1991, at which time Bell's license became inactive because of his failure to pay the renewal fee. Bell is a board certified child and adult psychiatrist. In addition to his practice of psychiatry, Bell practiced general medicine for a year in 1979, worked as a contract physician in several emergency room in Georgia during 1986 and 1987, and worked as a parts warehouseman for an automobile dealership between February and September, 1989. Bell has a long history of alcohol related problems, beginning in August, 1982, when Bell was charged in South Carolina with driving under the influence of alcohol and was later convicted of reckless driving, which Bell acknowledges to have been alcohol related. In 1987, Bell called Roger A. Goetz, M.D., Director of the Florida Physicians Recovery Network (PRN), because he could not find employment in Georgia. He told Goetz that he was an alcoholic and agreed to enter the South Miami Hospital's addiction treatment program. This was not the first alcohol treatment program from which Bell had received treatment. Lynn A. Hankes, M.D., evaluated and observed Bell during his treatment at South Miami Hospital. Dr. Hankes also saw Bell in August, 1988, for a reevaluation. When Bell entered South Miami Hospital, he gave an extensive history of alcohol abuse and he acknowledged that he was an alcoholic. Alcoholism is a primary disease characterized by continuous or periodic impaired control, drinking to excess, preoccupation with the drug of alcohol, the use of alcohol despite adverse consequences, and distortions in thinking, most notably, denial. The disease of alcoholism is progressive, causing multi- system impairment. The alcoholic is impaired and cannot predict or control when his drinking is going to be out of control. Denial is an integral part of the illness and a major obstacle to recovery. According to Dr. Hankes, at the time of his evaluations of Bell, Bell suffered from the disease of alcoholism. Despite the treatment and a period of abstinence after his release, Bell's attitude, awareness, and belief system, as manifested by his denial and lack of insight, indicated to Dr. Hankes that Bell would be unable to change his behavior, vis-a-vis alcohol. In his testimony, Dr. Hankes expressed an opinion that Bell is unable to practice with reasonable skill and safety due to his alcoholism and use of alcohol. However, Dr. Hankes' opinion was based only on his personal knowledge from 1988 and on his review of the reports of the other experts and the interviews with Bell. On August 23, 1988, Bell entered into a five-year contract with PRN in which he agreed to abstain from use of alcohol, to have Dr. Hankes as his monitoring physician, to attend AA three times per week, to attend aftercare, to notify PRN in case of a relapse, to contact PRN two times per month, to withdraw from practice on evaluation at the request of PRN, and to be reported to DPR by PRN if he failed to comply with the contract. Bell claims to have unilaterally "cancelled" his contract about two weeks after signing it, but he failed to advise PRN or anyone else about this cancellation. He cancelled the contract because Dr. Goetz did not find him a job which Bell believed Dr. Goetz had agreed to do if he went to treatment and signed a contract. PRN and Bell corresponded in 1989 and 1991 regarding the contract and Bell's alcohol usage. In August, 1991, Bell advised Dr. Goetz and PRN that he had no problem with alcohol. In May, 1991, Bell was arrested after an alcohol-related incident. The events leading up to this arrest involved a drinking binge Bell had with a lady friend who lived in a trailer next to him. Bell believed that the friend had stolen his carton of cigarettes and bottle of vodka while Bell was "asleep." He went to retrieve these items and entered the friend's trailer through the floor air duct. An altercation ensued involving a butcher knife. On August 22, 1991, Bell pled no contest to the charge of trespass in an occupied structure. At the time of the arrest, Bell's trailer was unkempt and strewn with empty liquor bottles. In December, 1991, at the request of DPR, Bell was examined by two physicians, John E. Perchalski, a family practitioner, and Ernest C. Miller, a psychiatrist and expert in addiction medicine. Bell reported to Dr. Perchalski and acknowledged at hearing that his average daily alcohol intake was 14.5 ounces and that his alcohol intake had remained at that level for many years. Dr. Perchalski assessed this information and determined that Bell had a history of chronic excessive alcohol intake. Additionally, Bell had a high corpuscular volume which can be indicative of excessive alcohol intake. According to Dr. Perchalski, while Bell has no physical disability that would prevent him from practicing medicine, his long history of maladaptive behavior and excessive, regular alcohol intake would make it very difficult for Bell to be able to perform in a completely rational and safe way in his care for his patients. Bell told Dr. Miller that he consumed an average of 14.5 ounces of alcohol per day and that he suffered from occasional blackouts and hangovers. Bell's further discussions with Dr. Miller supported Dr. Miller's opinion that Bell has no insight into his problem with dealing with, relating to, and controlling the use of alcohol and that treatment programs have thus far been unsuccessful. Bell's refusal to admit that he is an alcoholic is consistent with the level of Bell's denial regarding his problems with alcohol. The history given by Bell, the physical examination results, and the evaluation and assessment of Dr. Miller support Dr. Miller's diagnosis of chronic alcoholism, alcohol abuse, alcohol dependency, and gamma alcoholism. Dr. Miller's opinion is that in light of the progressive dysfunctional aspects of the disease, Bell will become incapable of sustaining an effective clinical role. As Bell drinks, which is inevitable without treatment, he will not function effectively and his functioning will become less effective as the disease asserts itself on the various aspects of Bell's being. While Dr. Miller acknowledges that Bell may be able to practice currently, the probability is that he will be or will become unable to practice safely until his disease of alcoholism and its disease process are successfully treated. Bell is not currently practicing so no immediate evidence of impaired practice exists. Additionally, Miller indicated that the ingestion of 14.5 ounces of alcohol would take 20 hours to dissipate from Bell's system and any work with patients before the alcohol dissipated would be affected. Bell maintains that he has no problem with alcohol and that at no time has there been any allegation that he treated any patient while under the influence of alcohol.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medicine enter a Final Order and therein: Suspend the medical license of Robert E. Bell, Jr., M.D., for a period of one year or until he appears before the Board of Medicine and demonstrates that he is able to resume the practice of medicine with reasonable skill and safety. If or when the terms of the suspension have been satisfied, place Dr. Bell on probation for five (5) years with terms and conditions to be set by the Board to insure his continued ability to practice with reasonable skill and safety. At a minimum, the demonstration of skill and safety should be supported by satisfactory mental and physical examinations by Board approved experts and by evidence of successful completion of an acceptable alcohol rehabilitation program. DONE and ENTERED this 26th day of August, 1992, in Tallahassee, Florida. DIANE K. KIESLING Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 26th day of August, 1992. APPENDIX TO THE RECOMMENDED ORDER IN CASE NO. 92-2204 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on the proposed findings of fact submitted by the parties in this case. Specific Rulings on Proposed Findings of Fact Submitted by Petitioner, Department of Professional Regulation Each of the following proposed findings of fact is adopted in substance as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed finding of fact: 1(1); 4(2); 5(3); 7(4); 8(12); 9(13); 10(16); 12(6); 13(5); 14(6 & 7); 15(7); 18(9 & 10); 20(15); 21(16); 22(18); 23(19); 24(19); 25(20); 26(21); and 27(23). Proposed findings of fact 2, 3, and 17 are unnecessary. Proposed findings of fact 6, 11, and 16 are subordinate to the facts actually found in this Recommended Order. Proposed finding of fact 19 is unsupported by the credible, competent and substantial evidence in that Goetz's opinions were based on the evaluations and opinions of other experts and have insufficient support to stand alone. Proposed finding of fact 28 is irrelevant. Specific Rulings on Proposed Findings of Fact Submitted by Respondent, Robert E. Bell, Jr., M.D. Proposed findings of fact 1a, 1b, 1d, 1e, 1f, 1g, 2a, and 2b are subordinate to the facts actually found in this Recommended Order. Proposed findings of fact 1c, 1h, and 1i are irrelevant. Proposed finding of fact 2c is unnecessary. COPIES FURNISHED: Larry G. McPherson, Jr. Barbara W. Makant Attorneys at Law Department of Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Robert E. Bell, Jr., M.D. Route 3, Box 503 Starke, FL 32091 Jack McRay, General Counsel Department of Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Dorothy Faircloth, Executive Director Board of Medicine Department of Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: Treatment resource personnel, as defined in the "Comprehensive Alcoholism Prevention, Control, and Treatment Act," Chapter 396, Florida statutes, are screened in order to establish their good moral character. A person found guilty of certain enumerated offenses is disqualified from employment at a treatment resource which serves unmarried clients under the age of 18 years. In 1979, the petitioner was found guilty of one of the disqualifying offenses listed in Section 396.0425(1), Florida statutes. She was convicted of lewd and lascivious behavior for removing her clothes at a bar. In connection with this offense, she was jailed and her daughter was removed from her custody and was placed in foster care. The Department of Health and Rehabilitative Services is authorized, in certain instances, to grant an exemption to a treatment resource personnel from disqualification from working with children or the developmentally disabled. Section 396.0425(3), Florida Statutes. The petitioner requested such an exemption and appeared before the Department's Exemption Review Committee in November of 1987. The Committee determined that an inconsistent pattern of rehabilitation existed in her case and denied her request for an exemption from disqualification. On or about June 11, 1987, the petitioner entered a plea of guilty to the offense of driving under the influence of alcohol and was placed on probation for a period of one year. Among the terms of her probation were that she refrain from the consumption and possession of alcoholic beverages. In September of 1987, petitioner was adjudicated guilty of trespass in a structure or conveyance, which offense occurred on June 27, 1987. She was ordered to pay restitution and court costs and was placed on probation for six months. Petitioner admits that she has had a problem with alcohol for twenty years. She has no recall of the offenses which occurred in June of 1987, and states that she was in a "total blackout" state on both occasions. In January of 1988, petitioner began attending Alcoholic Anonymous (AA) meetings, often going to two meetings a day. She also attends Junior College and aspires to be a school teacher some day. She states that she realizes that all of her prior problems were alcohol-related. She states that, as of the date of the hearing, March 14, 1988, she has been sober for 49 days. Her daughter confirmed that petitioner was not drinking now, and states that AA has become a big part of their lives.
Recommendation Based upon the findings of fact and conclusions of law recited herein, it is RECOMMENDED that petitioner's request for an exemption from disqualification as a treatment resource personnel be DENIED. Respectfully submitted and entered this 26th day of May, 1988, in Tallahassee, Florida. DIANE D. TREMOR Hearing Officer Division of Administrative Hearings The Oakland Building 2900 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 26th day of May , 1988. COPIES FURNISHED: E.J. Samuel C. Chavers, Esquire Department of HRS District 5 701 94th Avenue North St. Petersburg, Florida 33702 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Findings Of Fact In July, 1988, the Petitioner applied for renewal of dual annual licenses to operate both an alcoholism prevention and treatment program (APT) and a drug abuse treatment and prevention program (DATAP). On July 26, 1988, a representative of the Department, Aixa Reyes-Wajsman, made a site visit to Petitioner's facility to determine whether Petitioner was complying with the provisions of the Florida Administrative Code for the operation of an alcoholism prevention and treatment program (APT) and a drug abuse treatment and prevention program. The Department's representative found that the Petitioner was in violation of several administrative regulations, but the Petitioner took steps to comply with the regulations, and the Department renewed the Petitioner's regular annual DATAP license and regular annual APT license, authorizing the Petitioner to operate those programs through July 30, 1989. On June 27, 1989, a Department representative, Lorenzo Thomas, made a site visit to the Petitioner's facility to determine whether or not Petitioner was complying with regulations for the operation of an APT program. (The Petitioner requested renewal of the APT license only, not the DATAP license.) At the time, the Petitioner, primarily a small human development counseling service, had only two APT clients. By the time Mr. Thomas returned with his supervisor, Gail Potter, for a second site visit on July 27, 1989, the Petitioner had one additional APT client, who had just been accepted as a client. Although the Petitioner's client files included forms which would have allowed for the inclusion of initial and individualized treatment plans which identified target dates for completion of goals identified in the client's plan, the Petitioner did not utilize the forms so as to adequately describe the treatment plan or identify target dates. The Petitioner's client files did include progress notes. But the progress notes were incomplete and disorganized, some consisting of cryptic notes on pieces of scrap paper loose in the files, and did not adequately relate the progress of each client in accordance with the individual treatment plan. The Petitioner took the position that the notes were sketchy so as not to reveal client confidences in the event the records were required to be disclosed pursuant to a subpoena. One of the Petitioner's client files--the file on the new, third client--did not include a psychosocial assessment. The other two client files did include a partially completed psychosocial assessment, but neither was signed, credentialed and dated by the treating counselor. Since there had been no request for the release of client information on the Petitioner's three APT clients, there was no reason for the Petitioner's client files to include a client consent form for the release of confidential information. (The blank forms that the Petitioner had available for use in the event of a request for client information did not include a time limit for the release of such information.) The Petitioner's client files did not include evidence of the development and utilization of admission and discharge criteria or standards. The Petitioner distributed to its APT clients an information sheet upon admission, but the information sheet did not include admission criteria. The Petitioner also had available a questionnaire for new clients to complete. But the questionnaire was not used for the clients the Petitioner had at that time and, besides, did not indicate how the Petitioner would score, or evaluate, the client's answers. Based on the June 27 and July 27, 1989, site visits, HRS issued to the Petitioner an interim APT license from August 1, 1989, to October 29, 1989, instead of a regular annual APT license.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is recommended that the Respondent, the Department of Health and Rehabilitative Services, enter a final order affirming the Department's action in issuing to the Petitioner an interim alcoholism prevention and treatment program license instead of a regular license. DONE and ENTERED this 3rd day of April, 1990, in Tallahassee, Florida. J. LAWRENCE JOHNSTON Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 3rd day of April, 1990.
