Findings Of Fact The Petitioner was employed by the Respondent as an Accountant II on December 1, 1987 and in December of 1993, was promoted to Tax Auditor II. In September of 1991, the Respondent received a complaint regarding Petitioner from a taxpayer. The taxpayer alleged that the Petitioner had accused the taxpayer of attempting to sabotage the Petitioner's van. When questioned about the complaint, the Petitioner stated that the taxpayer had attempted to damage his van because the Petitioner had denied the taxpayer's refund claim. The Petitioner's supervisor investigated Petitioner's claims, counseled him and suggested that the Petitioner participate in the Employee Assistance Program (EAP). The Petitioner declined assistance. In October and November of 1992, the Petitioner began making bizarre allegations about his co-workers and supervisors engaging in outrageous and deviant sexual conduct and activities, and began to behave strangely. The Petitioner told his supervisors that his co-workers were engaging in sex with his mother, aunt, uncle and other members of his family. According to the Petitioner, these sexual activities were taking place in the office. The Petitioner was upset particularly at one co-worker, who Petitioner stated had moved in next door to him or into his neighborhood in order to spy on Petitioner. In addition, Petitioner stated that the "sex police" were observing him at Walmart. The police would get on top of his van to spy on him according to Petitioner. During this time, the Petitioner filed a "sexual harassment" complaint with the Respondent's Inspector General. Petitioner's statement to the investigators repeated the bizarre accusations outlined above regarding his co- workers. After investigating the Petitioner's claim, the Respondent's Inspector General found no evidence to substantiate these allegations and statements. Because the Petitioner's increasingly bizarre behavior, the Respondent became concerned about the Petitioner's ability to perform his duties as a Tax Auditor I. Therefore, the Respondent requested that the Petitioner go to a psychiatrist for an evaluation. The Petitioner agreed and went to the Apalachee Center for Human Services, where he was examined by Dr. Terence Leland, a psychologist and Dr. Inez Bragado-Spence, a psychiatrist. The evaluation consisted of three, one- hour interviews and various written tests. It was understood that the results of this examination would be shared with Respondent. Dr. Leland reported to the Respondent that the Petitioner had made delusional statements of the type made to and investigated by the Inspector General and found to be baseless. The Petitioner reported that co-workers and others were spying on him. The Petitioner reported alleged sexual liaisons at the office between various employees and supervisors. The Petitioner reported plots against him by various conspirators and "hit men" of the Respondent. Dr. Leland's diagnosis was that the Petitioner suffered from a delusional (paranoid) disorder, persecutory type. It was Dr. Leland's opinion that the Petitioner clearly needed treatment. Dr. Leland felt that the Petitioner could not perform his duties without treatment, and recommended requiring treatment as a condition of the Petitioner's continued employment. During this period, the Petitioner's job performance suffered. Based upon Dr. Leland's reports, the Respondent required that the Petitioner obtain treatment as a condition of continued employment. The Petitioner and the Respondent entered into an agreement which required the following as a condition of continued employment: Seeking psychiatric treatment within 40 days. Furnishing documentation that treat- ment had commenced and was continuing for as long as treatment was recommended. Following the prescribed treatment so long as it was recommended. The Petitioner commenced treatment in June of 1993, Dr. Prasad, a psychiatrist, prescribed medication for the control of Petitioner's illness and Suzan Taylor, a counselor associated with Dr. Prasad, held regular counseling sessions with Petitioner. As a result of his treatment, the Petitioner was asymptomatic, his work improved, and he was promoted to Tax Auditor II in December of 1993. In the summer of 1994, approximately one year after commencing treatment, Dr. Prasad and Suzan Taylor began to suspect that the Petitioner was no longer taking his medication when he again began making delusional statements. At the same time, the Petitioner's supervisor began to notice the reoccurrence of Petitioner's prior conduct. When confronted by his doctors in November of 1994 about the failure to take his medication, the Petitioner stated that he had quit taking it. He was given the option of getting shots of the same medication on a regular basis, but he declined. On November 18, 1994, the Petitioner had an altercation with a co- worker and received a one-day suspension. Dr. Prasad had diagnosed the Petitioner as having major depression with psychotic features of persecution and delusion. Dr. Prasad's opinion was that the Petitioner could not perform his essential job functions without treatment. On or about November 21, 1994, the Petitioner told his supervisor that his last visit to Dr. Prasad was on November 16, 1994. Dr. Prasad was contacted by Petitioner's employer, and Dr. Prasad issued a final report dated November 23, 1994, in which she stated that the Petitioner refused to take any further medication or follow her directions; therefore, there was nothing further she could do to help him if he refused her recommended treatment. She did not release Petitioner from treatment. The Respondent issued its proposed letter of termination based upon the Petitioner's refusal to continue treatment contrary to his agreement and the Petitioner's behavior on the job. In a response to the letter of termination, the Petitioner made bizarre statements about the co-worker with whom he had had the altercation with on November 18, 1994. At a pre-determination conference conducted by William Fritchman, the Respondent's Chief of Personnel and Training (at the time), it was suggested that the Petitioner go to another doctor for evaluation and treatment, if necessary. The Petitioner stated that he would not seek further medical help and stated that he would not take any drugs. The Respondent had real concerns about the Petitioner's ability to perform his job duties, his interaction with taxpayers, and potential harm to fellow employees. Based upon Dr. Prasad's diagnosis and opinion that Petitioner required continuing treatment and Petitioner's declining job performance, Mr. Fritchman issued the Final Action Letter of Termination citing the Petitioner's breach of the conditions of employment, as agreed in the letter of April 30, 1993, which constituted insubordination. Petitioner offered no evidence showing he was sexually harassed.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Petitioner's claim be dismissed. DONE AND ENTERED this 28th day of October, 1996, in Tallahassee, Florida. STEPHEN F. DEAN Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 28th day of October, 1996. COPIES FURNISHED: Jack E. Franklin Post Office Box 572 Tallahassee, Florida 32302-0572 Gene T. Sellers, Esquire Department of Revenue Post Office Box 6668 Tallahassee, Florida 32311-6668 Sharon Moultry, Clerk Human Relations Commission Building F, Suite 240 325 John Knox Road Tallahassee, Florida 32303-4149 Dana Baird, Esquire Human Relations Commission Building F, Suite 240 325 John Knox Road Tallahassee, Florida 32303-4149
The Issue Whether Petitioner's application for medical licensure by endorsement has expired and Respondent is therefore without authority to act on the application, as Petitioner claims? If not, whether the application should be denied on the grounds that Petitioner is guilty of violating Section 458.331(1)(a) and (gg), Florida Statutes,1 as Respondent has preliminarily determined.
Findings Of Fact Based on the evidence adduced at hearing, and the record as a whole, the following findings of fact are made to supplement and clarify the factual stipulations set forth in the parties' December 8, 2005, Prehearing Stipulation3: Petitioner is now, and has been since 1998, a Napperville, Illinois anesthesiologist licensed to practice medicine in the State of Illinois. At no time has she resided in Florida or used a Florida mailing address. "[A]t the end of 2002," Petitioner hired US Medical Licensing (USML) to help her obtain licenses to practice medicine in Florida, California, and Nevada, including "put[ting] together the application[s for such licensure] for [her]." In making these arrangements with USML, Petitioner dealt with USML's Melinda Hilterbrand, with whom she spoke over the telephone. Petitioner paid USML by credit card. USML first "charged [Petitioner's] credit card in January" of 2003 (using the credit card number Petitioner had given Ms. Hilterbrand during their telephone conversation). Petitioner provided USML, at USML's request, information and documentation (including a "standard credentialing application [she used in] Illinois") for USML to utilize in "put[ing] together [her Florida, California, and Nevada] application[s]." None of the information and documentation Petitioner provided was, to her knowledge, false or inaccurate. USML "put together the application[s]," as it had agreed to do. It then submitted them to the Florida, California, and Nevada medical licensing agencies without Petitioner's review, approval, or signature, notwithstanding that Petitioner had not given USML authorization to make such submissions. On June 16, 2003, Respondent received the Florida application that USML had "put together" for Petitioner (Petitioner's Florida Application) using the appropriate Respondent-developed form . Petitioner's Florida Application gave Petitioner's mailing address as "5631 Ballybunion Drive, Pace, Florida" (Pace, Florida Address). This was actually USML's mailing address, not Petitioner's. Petitioner's Florida Application gave Petitioner's telephone number as "(850) 994-4646." This was actually USML's telephone number, not Petitioner's. 10. Items 12, 12a., 12b., 15a., and 19b. on the application form on which Petitioner's Florida Application was submitted (Florida Application Form) asked the following questions: 12. Was attendance in Medical school for a period other then the normal curriculum? (If "yes," explain on a separate sheet providing accurate details.) 12a. Did you take a leave of absence during medical school? (If "yes," explain on a separate sheet providing accurate details.) 12b. Were you required to repeat any of your medical education? (If "yes," explain on a separate sheet providing accurate details.) 15a. Have you ever been dropped, suspended, placed on probation, expelled or requested to resign from a postgraduate training program? (If "yes," explain on a separate sheet providing accurate details.) 19b. Have you ever applied for, taken an examination for, or failed to receive specialty board certification or recertification for any reason?" (If "yes," explain on a separate sheet, providing full details). Each of these questions was incorrectly answered "no" on Petitioner's Florida Application. Item 15 on the Florida Application Form asked the applicant to "[l]ist in chronological order from date of graduation from Medical school, to present, all professional/postgraduate training (Internship/Residency/ Fellowship)." In response to this request, Petitioner's Florida Application listed her participation (following graduation from medical school) in programs at the University Medical Center in Las Vegas, Nevada, at the Medical College of Ohio in Toledo, Ohio, at the Advocate Illinois Masonic Medical Center in Chicago, Illinois, and at St. Anthony's Hospital in Chicago, Illinois. No other post-graduate programs were listed, notwithstanding that Petitioner had also received post-graduate training at the Vanderbilt University Medical Center. At the time, Petitioner did not even know that her Florida Application had been submitted, much less that it contained any erroneous information, inasmuch as she had not seen it or been made aware of its contents. As will be discussed in more detail below, it was not until approximately three months later that she first learned of her Florida Application’s submission, and it was even later, at her July 24, 2004, appearance before Respondent’s Credentials Committee, that she first became aware "that there was any incorrect information on [her] application." No one from USML had ever contacted Petitioner and asked her for her responses to items 12, 12a., 12b., 15, 15a., 19b. or any other item on the Florida Application Form. Item 18 on the Florida Application Form was an Affidavit of Applicant, which read, in pertinent part, as follows: I affirm that these statements are true and correct and recognize that providing false information [ma]y result in disciplinary action against my license or criminal penalties pursuant to Sections 456.067, 775.083 and 775.084, Florida Statutes. I hereby authorize all hospitals, institutions, my references, personal physicians, employers (past and present) and all governmental agencies and instrumentalities (local, state, federal or foreign) to release to the Florida Board of Medicine information which is material to my application for licensure. I have carefully read the questions in the foregoing application and have answered them completely, without reservations of any kind, and I declare under penalty of perjury that my answers and all statements made by me herein are true and correct. Should I furnish any false information in this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice Medicine in the State of Florida. * * * Date of Expiration (Signature of Applicant required) 4 (Date Signed required) The Affidavit of Applicant in Petitioner's Florida Application contained what purported to be, but was not, Petitioner's signature. It was dated May 30, 2003. Petitioner had not authorized USML to sign her Florida Application on her behalf or otherwise "submit documents using [her] signature," nor was she "aware that [USML was] going to do [so]." On July 14, 2003, Respondent prepared and sent to the Pace, Florida Address (which, as noted above, was USML’s, not Petitioner’s, mailing address) a notice advising that Petitioner's Florida Application was "deficient" and explaining what needed to be done in order for the application to be considered "complete" (July 14, 2003, Deficiency Notice). The July 14, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). A letter has been sent to St. George's University to confirm you left the medical school in good standing. Your file has been submitted in for advisement regarding your examination score reports submitted to the board office. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? A letter has been sent to the Medical College of Ohio to retrieve[] further information on your performance. Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit two current letters of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). We await licensure verification from the Illinois State Medical Board. The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800)767-6732. The AMA Physician Profile sheet has not been received. You may contact the AMA at (312) 484-5199. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -University Medical Center, regarding your Internship, from 6/92 to 6/93 -Medical College of Ohio, regarding your Residency, from 4/94 to 5/96 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 -Valley Ambulatory Surgery Center, verifying your staff privileges and good standing. * * * On August 15, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (August 15, 2003, Deficiency Notice). The August 15, 2003 Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). We are in receipt of the evaluation form submitted by Valley Ambulatory Surgery Center. They indicate you did not perform competently and you were not regularly appointed. Please submit a written explanation. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit two current letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile sheet has not been received. You may contact the AMA at (312) 484-5199. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -University Medical Center, regarding your Internship, from 6/92 to 6/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * It was not until sometime in or around September of 2003, during a telephone conversation (she had initiated) with USML's Ken Carroll, that Petitioner first learned that her Florida Application had been submitted to Respondent. Petitioner was "very surprised" when Mr. Carroll told her about the application's submission because she had thought that she was "going to get to look at the application" and "go over it" before it was sent to Respondent and she had not been given this opportunity. Nonetheless, she did not voice any objections to Mr. Carroll during her telephone conversation with him. Rather, "[she merely] asked him if there were any problems with [the application], and he said that everything was okay." Petitioner assumed, erroneously, that USML had completed the application accurately. She did not, at that time, request a copy of the application to verify the application's accuracy, nor did she do anything to indicate that she did not want Respondent to treat the application as hers. Indeed, until becoming aware of the actual contents of the application, it was her desire that Respondent act on the application and grant her licensure, and her actions were consistent with such a desire. On September 17, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application remained "deficient" and explaining what needed to be done in order for the application to be considered "complete" (September 17, 2003, Deficiency Notice). The September 17, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of medical school transcripts from St. George's University Medical School and Ross University Medical School. It appears you transferred to Ross University after your third year. The transcript received from Ross University indicates your third year of medical school was repeated. Please submit a written explanation regarding attend[ing] two medical schools and why you answer[ed] no to question 12 (Was attendance in Medical School for a period other than the normal curriculum?) and 12b (Were you required to repeat any of your medical education?). We are in receipt of the evaluation form submitted by Valley Ambulatory Surgery Center. They indicate you did not perform competently and you were not regularly appointed. Please submit a written explanation. It appears question 1 of your licensure application was left blank. However, you should apply by endorsement. Enclosed is a copy of page 1, please check the appropriate box. On page 3, question 10 needs to list the date your medical degree was granted. On page 3, question 15 needs to list the specialty area of training. Please complete the enclosed copy of page 4. Explain why you switched training programs from Medical College of Ohio to Advocate Illinois Masonic Medical Center. Did you leave the program in good standing? Were you offered a contract to continue and complete the program? Submit a written explanation on why you started your training programs with Medical College of Ohio and Advocate Illinois Masonic Medical Center off cycle. Please complete the enclosed fingerprint card. Submit a written account of your employment/non-employment activities from 1/89 to 6/92 and 6/93 to 4/94, and 5/96 to 1/97, and 11/98 to 2/99, and 11/02 to Present. Submit a copy of your legal name change document. Explain in writing why the name "Randa Mariana Prochazka" appears on your supporting documentation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. Submit one current letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 464-5199. The AMA Physician Profile submitted to the board office indicates you had training with Vanderbilt University in Anesthesiology from 7/93 to 11/93. However, this training is not listed on question 15 of your licensure application. Please submit a written explanation. Also, a training evaluation form will have to be completed. A letter has been sent to the training program to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board office indicates your training with Medical College of Ohio is incomplete. Please provide a written explanation. A letter has been sent to the program to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to . . . our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On September 26, 2003, Respondent received a letter, dated September 23, 2003, that was addressed to one of its employees, Lakeisha Henderson, and purported to be, but was not, from Petitioner and signed by her (September 26, 2003, Letter). The September 26, Letter, of which Petitioner had no knowledge, read as follows: In answer to your questions in the letter you sent me 9/17/03 [sic], I am providing these answers: I left St. George's because of the war in Grenada. I waited till I was sure the situation was stable and I also took a leave to study for my ECFMG. I was not satisfied with the situation at the school so I transferred/moved to Ross. One course prior to the start of my clinicals was required at Ross before I could start there in the clinical phase. This was a repeat from St. George[']s, but the only one. During this period, I had numerous child care and child health issues with my children which caused me to not be available for work and surgery. Page one is attached. Page three is attached. Page 4 is attached. In answer to question #7, there was a change at Medical College of Ohio. The Program Director left due to illness and subsequently the program started changing, so I finished my second year and then did my third year at another program. I left in good standing, getting credit for everything. I could have continued if I had elected to do so but I declined. In question 8, I started my third year based on what was needed to complete and where the class was. I was having a child and was allowed to start off cycle. Non-Employment Dates: 01/89-6/92-Child Birth and child care, studied for tests. 05/96-01/97-Unemployed 11/98-02/99-Moving and vacation 11/02-04/03-Unemployed 05/03-Present @ Surgical Center of Downers Grove, IL I thought the fingerprint card had been sent to your office (Question #9) Item #11 has been requested. Question #12. I was married for a short period of time and while married took the last name of husband Prochazka. When we divorced I retained my maiden name. Question #18- The program was overfilled with Residents and I elected to leave with no credit as I only attended for a short period of time. Question #19- I was given full credit for my training there, so I do not understand the question. I have attached my diploma. All other items have been requested and will be sent directly to you. On September 30, 2003, Respondent received another letter, also dated September 23, 2003, that was addressed to Ms. Henderson and purported to be, but was not, from Petitioner and signed by her (September 30, 2003, Letter). The September 30, 2003, Letter, of which Petitioner had no knowledge, read as follows: I am sorry I forgot to include the fact that I was arrested for disturbing the peace. I have included all those documents. I forgot till Ken Carroll asked. I thought it was not needed as it was over 10 years ago, sorry to cause any issues. I have also included my divorce papers. Among the documents that were "included" with the September 30, 2003, Letter to Ms. Henderson was a statement in Petitioner’s handwriting, dated June 10, 1996, which provided an explanation of the circumstances surrounding Petitioner’s arrest. This handwritten statement was among the materials that Petitioner had furnished USML for use in the application preparation process. On October 16, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (October 16, 2003, Deficiency Notice). The October 16, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the letter dated September 23, 2003, [in which] you indicate employment with Surgical Center of Downers [Grove]. Do you hold staff privileges with this hospital? If so, an evaluation form will have to be completed. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. Submit a written account of your employment/non-employment activities from 6/93 to 4/94. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. We are in receipt of the letter of recommendation from Dr. Kianoosh Jafari. Please submit an additional letter of recommendation, addressed to the Florida Board of Medicine. "To Whom It May Concern" is not acceptable. Recommendation letter(s) must be current, original, personable and from physician(s). The National Practitioner Data Bank, self-query has not been received. You may contact the NPDB at (800) 767-6732. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. 19. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * Respondent received, in response to the October 16, 2003, Deficiency Notice, a letter that purported to be, but was not, from Petitioner and signed by her. The letter, of which Petitioner had no knowledge, read as follows: Question #5 from letter of 10/13/03 [sic] I left [the] program after one year to move closer to my husband at the time wh[o] was in the Midwest. I spent the time from 7-93 till 4-94 looking for a program and applying to programs. Petitioner was not married during the time period referenced in the letter. To the extent that the letter suggests otherwise, it is inaccurate. In or around the end of October of 2003, Petitioner received a letter from the Nevada State Board of Medical Examiners (Nevada Board) concerning an application for licensure that USML had submitted to the Nevada Board on her behalf. The letter, which was dated October 28, 2003, read as follows: Dear Dr. Sawan: Please find enclosed a new application for medical licensure for the State of Nevada. You will be required to complete this application without the assistance of a credentialing service. The Nevada State Board of Medical Examiners does not accept any documentation from the credentialing company U.S. Medical Licensing and Credentialing. After receiving this letter, Petitioner telephoned Mr. Carroll and asked him why "this Nevada licensure application . . . was not accepted." Mr. Carroll, in response to Petitioner’s inquiry, explained that "there were some other doctors that did not get their licenses and they were upset with [USML]" and had complained to the Nevada Board. Having received this response to her inquiry, Petitioner "did not dig anymore" into the matter. Petitioner subsequently completed the application form she had been sent by the Nevada Board and then returned it. Approximately, four and a-half months later she received her Nevada medical license On November 17, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (November 17, 2003, Deficiency Notice). The November 17, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the letter dated September 23, 2003, [in which] you indicate employment with Surgical Center of Downers [Grove]. Do you hold staff privileges with this hospital? If so, an evaluation form will have to be completed. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. The copy of your valid ECFMG certificate submitted to the board office is unreadable. The valid through area is not readable. Please resubmit a copy to the board office. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * Respondent received, in response to the November 17, 2003, Deficiency Notice, a letter that purported to be, but was not, from Petitioner and signed by her. The letter, of which Petitioner had no knowledge, read as follows: Question #2 from letter of 11/14/03 [sic] Downers Grover Surgical Center is an out patient center. Not a hospital. Question #5 A copy of my ECFMG is enclosed. On December 19, 2003, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (December 19, 2003, Deficiency Notice). The December 19, 2003, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * The December 19, 2003, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (December 19, 2003, Deficiency Letter), which read as follows: Your application remains incomplete. Please review the attached update [the December 19, 2003, Deficiency Notice] outlining the remaining deficiencies. Please be advised previous malpractice, criminal charges, discipline, addictions/impairment, unfavorable evaluations, etc. may require that you appear before the Credentials Committee for determination of eligibility for licensure. If your appearance is required, you will be notified in writing once your file is complete. Any information received by this office may require additional explanation and/or documentation to be requested in order to further determine licensure eligibility. After all requested documentation is received, your file will be submitted for a standard supervisory review. Should additional information be required, you will be notified. Once your file is determined complete, it will be presented to the Board for consideration at the next scheduled meeting. As documentation is received in our office, an updated list of deficiencies will be mailed to you. Your application will remain incomplete until all deficiencies are completed. In addition, notify the Board office immediately in writing of any occurrence(s) that would in any way change or affect any answer given in the application or an answer provided in response to any of our direct questions to you. If I can be of any assistance, please contact me at (850) 245-4131 extension 3512 or e-mail me at Lakeisha_Henderson @doah.state.fl.us. On January 22, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (January 22, 2004, Deficiency Notice). The January 22, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. On page 3, question 10 needs to list the date your medical degree was granted. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On February 24, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (February 24, 2004, Deficiency Notice). The February 24, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * On March 24, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (March 24, 2004, Deficiency Notice). The March 24, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter has been sent to the Medical College of Ohio to confirm your written explanation. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board office list[s] your graduation year incorrectly. Please have the AMA [Physician Profile] corrected. You may contact the AMA at (312) 484-5199. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to inquiry/evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 -Advocate Illinois Masonic Medical Center, regarding your Residency, from 1/97 to 11/98 * * * The March 24, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (March 24, 2004, Deficiency Letter). The body of the March 24, 2004, Deficiency Letter was identical to the body of the December 19, 2003, Deficiency Letter. On March 31, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (March 31, 2004, Deficiency Notice). The March 31, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION'S EXPIRATION DATE IS: June 15, 2004 APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. We are in receipt of the training evaluation form from Valley Ambulatory Surgery Center. The evaluation form indicates you resigned and your staff privileges were terminated. It appears you should have answered yes to question 18c. Please submit a written explanation as well [as] explain the no answer given for question 18c. A letter has been sent to Valley Ambulatory Surgery Center to retrieve[] further information. Enclosed for your review is a copy of the evaluation form. A letter will be sent to each training program requesting a copy of your training file. A letter has been sent to the Medical College of Ohio requesting further clarification on the letter submitted from them dated July 22, 2003. A letter has been sent to Vanderbilt University Medical Center to retrieve[] further information on your performance. We await verification of ECFMG examination results, direct from ECFMG, which must be requested by the applicant. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. We await responses to evaluation forms, which were mailed from our office to the following: -Vanderbilt University Medical Center, Department of Anesthesiology, regarding your Residency, from 7/93 to 11/93 * * * The March 31, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson, addressed to Petitioner at the Pace, Florida Address (March 31, 2004, Deficiency Letter). The body of the March 31, 2004, Deficiency Letter was identical to the bodies of the December 19, 2003, and March 24, 2004, Deficiency Letters. In or around March of 2004, during a telephone conversation with Mr. Carroll, Petitioner inquired as to whether her "talk[ing]" to Respondent "could help expedite" the processing of her Florida Application. Mr. Carroll, in turn, gave Petitioner Ms. Henderson’s name and telephone number and suggested Petitioner call Ms. Henderson. Petitioner followed Mr. Carroll’s suggestion and spoke with Ms. Henderson. Petitioner asked Ms. Henderson "if there [was] any problem with the application" and offered to provide "anything extra that [Ms. Henderson] may need." Ms. Henderson "did not say that there were any problems," but she did indicate "that she would like additional information," which she described for Petitioner. After speaking with Ms. Henderson, Petitioner prepared a handwritten letter, which she sent to Ms. Henderson by facsimile transmission on April 9, 2004. The letter read as follows: You requested an explanation for why staff privileges at Valley Ambulatory Surgery Center were terminated. It has been my understanding from their contract agreement that once I stop working there (resign), the staff privileges are automatically terminated. The following day, April 10, 2004, Petitioner sent to Ms. Henderson by facsimile transmission a handwritten list of references, as well as letters of recommendation (from others about her). Ms. Henderson had not asked Petitioner to provide these materials, but Petitioner sent them anyway, thinking that Ms. Henderson "might like to have them." On May 4, 2004, Respondent prepared and sent to the Pace, Florida Address a notice advising that Petitioner's Florida Application was still "deficient" and explaining what needed to be done in order for the application to be considered "complete" (May 4, 2004, Deficiency Notice). The May 4, 2004, Deficiency Notice read, in pertinent part, as follows: We will consider no application complete for licensure until we receive all requested documentation by the board. The applicant must ensure that the board receives all requested documentation. Verbal responses are inadmissible. * * * YOUR APPLICATION EXPIRATION DATE IS: June 15, 2004. APPLICATION SUBMITTED REMAINS DEFICIENT FOR LACK OF THE FOLLOWING: We are in receipt of the evaluation form from Advocate Illinois Medical Center. The evaluation form indicates they recommend you with some reservation. Please review the enclosed copy of the evaluation and provide a written response. Also, a letter has been sent to Advocate Illinois Medical Center to retrieve[] further information. A letter will be sent to each training program requesting a copy of your training file. A letter has been sent to Medical College of Ohio requesting further clarification on the letter submitted from them dated July 22, 2003. The AMA Physician Profile submitted to the board indicates you have an inactive resident license in Nevada. Please have the Nevada State Medical Board send a license verification letter to our office. * * * The May 4, 2004, Deficiency Notice was accompanied by a letter from Ms. Henderson addressed to Petitioner at the Pace, Florida Address (May 4, 2004, Deficiency Letter). The body of the May 4, 2004, Deficiency Letter was identical to the bodies of the December 19, 2003, March 24, 2004, and March 31, 2004, Deficiency Letters. Petitioner never received the May 4, 2004, Deficiency Notice or the May 4, 2004, Deficiency Letter; nor had she ever received any of the previous deficiency notices and letters. On June 15, 2004, Petitioner’s Florida Application was still incomplete inasmuch as Respondent had not received all of the information it had requested in the May 4, 2004, Deficiency Notice (including the letter from Petitioner requested in item 1 of the notice, the training files from University Medical Center in Las Vegas, Nevada, and Vanderbilt University Medical Center requested in item 2 of the notice, and the "license verification letter" requested in item 4 of the notice, which were all materials that were reasonable for Respondent to have asked for as part of the application review process). On June 28, 2004, Chandra Prine, Respondent’s Program Operations Administrator (and Ms. Henderson’s supervisor), prepared and sent to the Pace, Florida Address a letter addressed to Petitioner (June 28, 2004, Letter) advising her that she was required to make a personal appearance before the Credentials Committee on July 24, 2004, to discuss: Your medical education and your failure to answer yes to questions numbers 12, 12a & 12b on the licensure application. Failure to list your training at Vanderbilt from 7/93-11/93 and your failure to answer yes to question number 15a on the licensure application. In addition, the Committee may inquire into any other issues relating to your application and eligibility for licensure. Petitioner did not receive this letter. In July of 2004, Petitioner telephoned Ms. Henderson to inquire about the status of Petitioner’s Florida Application. She was unable to speak with Ms. Henderson, so she left a message asking Ms. Henderson to return the call. Petitioner subsequently received a telephone message from Ms. Henderson. In her message, Ms. Henderson stated that she thought Petitioner "was going to be going to a hearing" on her Florida Application, but suggested that Petitioner telephone Ms. Prine "just to be sure." Ms. Henderson did not say anything about there being "questions that were answered incorrectly on [the] application." After receiving Ms. Henderson’s message, Petitioner telephoned Ms. Prine and spoke with her. Petitioner told Ms. Prine that Ms. Henderson had left a message about an upcoming hearing concerning Petitioner’s Florida Application and had suggested that Petitioner contact Ms. Prine regarding the matter. Ms. Prine responded, "Yes, we sent you a letter saying you have to show up for this hearing," referring to the June 28, 2004, Letter. Petitioner replied that she had "not received any letter" from Respondent. Ms. Prine then "gave [Petitioner] the address" to which the June 28, Letter had been mailed. Petitioner informed Ms. Prine that this address (the Pace, Florida Address) was not hers. She then "gave [Ms. Prine] her home address for [Ms. Prine] to send [her] another letter." Petitioner asked Ms. Prine during their telephone conversation "what the hearing was going to be about." Ms. Prine's response was that Petitioner should be prepared to answer questions at the hearing regarding certain specific items on her Florida Application, which Ms. Prine identified by number. Petitioner told Ms. Prine that she "had never seen the application," to which Ms. Prine retorted, "Oh, but you signed it." Petitioner insisted that she "didn’t remember signing anything" and asked Ms. Prine to send her, along with the letter concerning the hearing, "a copy of whatever [she supposedly] signed." At no time during the telephone conversation did Ms. Prine tell Petitioner that her Florida Application contained any incorrect information, nor did she reveal to Petitioner anything about those items on the application that Petitioner would be questioned on at the hearing other than what their numbers were and that they pertained to her "schooling and training." It did not come as surprise to Petitioner that the Credentials Committee "wanted to hear from [her]" about her "schooling and training" given the difficulties she had encountered in these areas. Petitioner did not ask Ms. Prine to elaborate any further on what the Credentials Committee would inquire about at the hearing. Two days after her telephone conversation with Ms. Prine, Petitioner received a letter dated July 14, 2004, from Ms. Prine (July 14, 2004, Letter). The July 14, 2004, Letter was addressed to Petitioner at her Naperville, Illinois address and read as follows: This is in further reference to your application for licensure by endorsement. Please be advised that you are required to make a personal appearance before the Credentials Committee of the Board of Medicine to discuss the following: Your medical education and your failure to answer yes to questions numbers 12, 12a & 12b on the licensure application. Failure to list your training at Vanderbilt from 7/93-11/93 and your failure to answer yes to question number 15a on the licensure application. In addition, the Committee may inquire into any other issues relating to your application and eligibility for licensure. Date: Saturday, July 24, 2004 Time: 8:00 a.m. Location: Radisson Hotel 415 N. Monroe St. Tallahassee, FL 32301 (850) 224-6000 The meeting room will be posted in the lobby of the Hotel. Additionally, the Committee's recommendation on your application will be presented to the Board of Medicine, August 6-7, 2004 for final action. Thank you for your continued cooperation. Should you have any question regarding this matter, please feel free to contact me. Along with the July 14, 2004, Letter, Petitioner received from Ms. Prine the signature page of the September 26, 2003, Letter. After reviewing the latter, Petitioner telephoned Ms. Prine and left a message advising Ms. Prine that the signature on that document was not hers. The July 14, 2004, Letter was not accompanied by a copy of Petitioner’s Florida Application. Petitioner made a "personal appearance" before the Credentials Committee on July 24, 2004, as scheduled. As noted above, it was during this appearance that she first learned that her Florida Application contained information that was incorrect. In response to questioning, Petitioner truthfully told the Credentials Committee that she had not "even seen the application" and that it was "not [her] signature" that was on the application in that she did not sign it. The Credentials Committee voted to recommend the denial of Petitioner’s Florida Application, a recommendation that Respondent subsequently followed. On August 2, 2004, following her appearance before the Credentials Committee, Petitioner prepared and sent a letter to Ms. Prine formally requesting, for the first time, a "complete copy of [her] application for the Florida medical license [be] mailed to [her]" at her Napperville, Illinois address. On August 10, 2004, Petitioner prepared and sent to Ms. Prine another letter, which read as follows: I am writing to ask that you do not accept any communication from the USML agency regarding my application. I am not working through them anymore. Please call me directly at (773) 405-3718, or send all mail to: RANDA SAWAN M.D. 1304 Dunrabin Road Naperville, IL 60540 Your assistance with this matter will be greatly appreciated. Thank you. After Petitioner had made several post-Credential Committee hearing requests to Mr. Carroll that he send her copies of "anything [he had] involving [her] application," Petitioner received the following letter, dated September 23, 2004, from Mr. Carroll: I am sorry to inform you but your files along with several hundred other physicians' files were destroyed while in our storage area due to Hurricane Ivan which made a direct hit on Pensacola. Our Pensacola office is operating but has limited phone and no internet or cable. Again I apologize for this inconvenience. Petitioner never received any of the documents she had requested from Mr. Carroll.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that Respondent issue a final order finding that Petitioner's Florida Application expired, without being acted on, one year after it was filed and that it is therefore too late for Respondent to either approve or deny the application. DONE AND ENTERED this 7th day of March, 2006, in Tallahassee, Leon County, Florida. S STUART M. LERNER 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 7th day of March, 2006.
The Issue The central issue in this case is whether Richard Koenig, D.P.M., should be licensed as a podiatrist in the State of Florida. More specifically, this case must determine these issues: whether Richard Koenig, D.P.M., has practiced podiatry in the past at an acceptable standard of care as required by Section 461.013(1)(s), Florida Statutes; whether he fraudulently misrepresented material facts on his application for licensure as a podiatrist in violation of Section 461.013(1)(a), Florida Statutes; and whether his application to become licensed as a podiatrist is barred on grounds of administrative res judicata because of the Board of Podiatry's denial of his application in 1994-1995.
Findings Of Fact Dr. Koenig is an applicant for licensure as a podiatrist in the State of Florida. He is presently licensed to practice podiatry in the State of Missouri and was previously licensed in Illinois and Florida. Both of the latter licenses have expired. Dr. Koenig meets all criteria for licensure in Florida other than the grounds for denial cited by the Board in its Notice of Intent to Deny and described in the Statement of the Issues, above. The Board is responsible for certifying individuals who are qualified to become licensed as podiatrists and the Department of Health is responsible for issuing the licenses after the Board's certification. Dr. Koenig permitted his Florida license to lapse while he practiced in Missouri. He initially sought to be licensed again in this state in 1994. At that time, his application to sit for the examination, and thereafter to be licensed, was denied by the Board. Dr. Koenig requested a hearing on the denial before the Division of Administrative Hearings (DOAH) and a case was opened as DOAH Case No. 95-0570. Dr. Koenig later dismissed his petition and the DOAH file was closed. The earlier denial thus became final. Dr. Koenig reapplied for licensure in 1997. It is this application which is the subject of the instant proceeding. Dr. Koenig has already taken and passed the national podiatric licensure examination in Louisiana in 1997, thus meeting the examination requirement. Dr. Koenig was involved in approximately eleven podiatric malpractice cases during his practice in Missouri in the 1980's and early 1990's. Eight of the cases were settled by his insurance carrier. Three additional cases were pending at the time of Dr. Koenig's initial application in 1994. Of these three, Dr. Koenig prevailed at trial in two cases. The third case has been voluntarily dismissed by the plaintiff and has not been refiled. Dr. Koenig has not been engaged in the practice of podiatry as his primary professional activity since 1993-1994. He occasionally provides podiatric services as part of his commitment to the U.S. Navy, but he has primarily been engaged in developing and marketing two devices for use in podiatric and related services and has been teaching. Dr. Koenig received and reviewed the 1994 Board Notice of Intent to Deny Application for Examination and Licensure prior to filing his 1997 licensure application. In addition, he was aware that he had dismissed his petition to review that decision and the Board's decision was thus final. Nevertheless when called upon to state in the 1997 application whether he had ever been denied licensure as a podiatrist, Dr. Koenig answered "No." (Petitioner's Exhibit No. 1) This answer was false. Question five of the application for podiatry licensure reads: "Has any podiatry license held by you ever been acted upon, suspended or revoked, or have you ever been denied licensure?" Dr. Koenig's explanation concerning his negative answer to this question was that he thought he was being denied the right to take the examination, which was a condition required before he could be licensed. His understanding is supported by a reading of the minutes of the Board meeting at which the decision was made: "Dr. Simmonds moved to deny Dr. Koenig from taking the examination based on not having the ability to practice Podiatric Medicine at a level of care and safety." (Petitioner's Exhibit No. 1) However, the Board sent, and Dr. Koenig received, a Notice of Intent to Deny Application for Examination and Licensure. While that document plainly states that he was both being denied the right to take the examination and the right to be licensed, he did not focus on the second point--the right to be licensed. Dr. Koenig offered his explanation to the Board at its meeting on July 25, 1997, and when asked about the application question, he stated, "Because it is a misunderstanding. I make a differentiation between being denied a license and being denied the opportunity to sit for a license, and I may be wrong, and I stand corrected if I am, but that's what my intention was." (Petitioner's Exhibit No. 1, Transcript pp. 21-22). He understood that the Board was denying him the right to take the examination, an essential element of his application process. Dr. Koenig's explanation has been consistent throughout this proceeding, both before the Board and in the formal hearing. Although Dr. Koenig did answer the question incorrectly, his explanation that he did so without any fraudulent intent is entirely credible. Had there been an intent to defraud the Board regarding his application, Dr. Koenig might have avoided disclosing the malpractice suits which resulted in the Board's earlier decision to deny him licensure. Those malpractice suits are no longer an appropriate basis to deny licensure. Dr. Koenig is a Board-certified podiatrist and is a Fellow of the American College of Foot and Ankle Surgeons. One becomes Board-certified by taking an examination, by meeting practice requirements, and by submitting a number of medical cases to the Board for evaluation. Only about 10 percent of all podiatrists are Board-certified. Dr. Koenig's specialty is foot surgery and he has operated more often than a podiatrist in standard practice. Dr. Koenig has written several articles in peer- reviewed journals, and has spoken widely in the United States and elsewhere at various continuing medical education seminars. A frequent topic of his speeches involves the use of an implant which he developed to replace the big toe joint. This implant is patented, approved as a safe device by the FDA, and is covered by Medicare and Medicaid. Dr. Koenig has developed and marketed a special shoe for patients who have had foot surgery. There have been no Medicare or Medicaid complaints brought against Dr. Koenig and he maintains Medicare and Medicaid provided numbers. The two lawsuits which went to a jury verdict were decided in his favor and there are no lawsuits pending now. The multiple claims of malpractice occurred when he was actively engaged in foot surgery practice in Missouri. His insurance carrier, without consulting him, settled those claims. After he changed carriers and contested the claims, he has prevailed. The Board in this proceeding presented no evidence that Dr. Koenig has practiced below the standard of care. Nor did it refute his credible testimony.
Recommendation Based on the foregoing, it is hereby RECOMMENDED: that a Final Order be entered granting Dr. Koenig's license to practice podiatry in the State of Florida. DONE AND ENTERED this 24th day of April, 1998, in Tallahassee, Leon County, Florida. MARY CLARK Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 24th day of April, 1998. COPIES FURNISHED: John J. Rimes, III Office of Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050 Eric B. Tilton Gustafson, Tilton, Henning & Metzger, P.A. Suite 200 204 South Monroe Street Tallahassee, Florida 32301 Angela T. Hall, Agency Clerk Department of Health Building 6 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 Eric G. Walker, Executive Director Board of Podiatry Department of Health 1940 North Monroe Street Tallahassee, Florida 32399-0792
The Issue The issues in the case are whether the allegations of the Administrative Complaint are correct, and, if so, what penalty should be imposed.
Findings Of Fact The Petitioner is the State of Florida agency responsible for regulating the practice of medicine pursuant to Section 20.43 and Chapters 456 and 458, Florida Statutes (2004). As set forth herein, the Respondent was a physician licensed to practice medicine in the area of critical need (ACN), and holding Florida license number ACN144. A physician holding an ACN licensed must practice in a facility that meets certain statutory requirements or which is designated by the State Health Officer as an entity providing health care to an indigent population, and must submit documentation establishing employment at an ACN-designated facility for licensing. The secretary of the Florida Department of Health is the state health officer. Prior to the events at issue in this proceeding, the Respondent practiced medicine as medical director at "Mariner's Medical Center" (Mariner's), which closed in October 2002. Mariner's was an approved ACN facility. After the closure of the Mariner's facility, the Respondent accepted a position in Miami at Jackson Memorial Hospital (Jackson) in October 2002; however, prior to commencing his employment, circumstances at Jackson changed and the Respondent's position at Jackson was eliminated. The Respondent's employment contract at Jackson was terminated and, he received payment under the terms of the agreement. The Respondent subsequently returned to central Florida, apparently intent on opening a medical practice. By letter to "Sandy Condo," from the Respondent dated July 17, 2003, the Respondent sought responsibility for Mariner's medical records. The letter did not further identify Sandy Condo, but the address was that of the Petitioner. The letter, which identified the practice as an entity called "Boriquen Healthcare Plus," stated as follows: This is to certify my desire for the responsibility of the medical records of Mariner's Medical Center, where I was the Medical Director until October 24, 2002. I am willing to be the custodian of these medical records and I would like the computer data base (sic) be transferred to my care. I intend to follow up on the care of all these patients. In August 2003, the Respondent opened a private practice at 931 West Oak Street, Suite 103, Kissimmee, Florida, and began treating patients. The practice was initially named "Boriquen Health Care" (reflecting the historical name for Puerto Rico), but within a few days of opening was renamed "Physician's Health Care Plus." Towards the end of August 2003, the Respondent made efforts to acquire the ACN designation for his practice. Materials seeking the designation were submitted by Glenda E. Gonzalez-Cortes, M.D., the Medical Director for Physician's Healthcare Plus, to the Board of Medicine (Board). Although the materials were received by the Board, the Board was not the agency responsible for ACN facility designations. It is unclear whether the Board forwarded the materials to the appropriate office within the Department of Health for processing. It is likewise unclear whether the Respondent understood the distinction between the "Department of Health" and the "Department of Health, Board of Medicine." In any event, the fact that materials were submitted seeking ACN designation for the practice clearly establishes that the Respondent was aware that the practice was not designated as an ACN facility. A memo dated October 2, 2003, from Melinda K. Gray, Regulatory Supervisor of the Board of Medicine, to Larry McPherson, Jr., Executive Director of the Board of Medicine, stated as follows: Attached please find a letter dated July 17, 2003, from Dr. Jose A. Gutierrez, expressing his desire to take responsibility for the medical records of Mariner's Medical Center. Based on my conversation today with Dr. Gutierrez, he again expressed his desire to take responsibility of the medical records and to follow-up on the care of these patients who received medical treatment at Mariner's Medical Center Please be advised of the following: Mariner's Medical Center is closed. Mariner's Medical Center is owned by a non-health care licensee. The medical records located at Mariner's Medical Center are currently inaccessible and are being maintained by a leasing company. Dr. Gutierrez or the patients do not have access to these medical records. Dr. Gutierrez is willing to take custody of these records, which are located on a computer hard drive, and paper records. The hard drive is necessary to be able to link between the patient's name and patient identification numbers. Dr. Gutierrez indicated he intends to follow the care of these patients. Dr. Gutierrez holds a clear active medical license in the area of critical need in the state of Florida and reflects no prior discipline. Dr. Gutierrez indicated that either the leasing company or the owner of Mariner's Medical Center would not release these records to him until the Board of Medicine reviews his request to take custody of the records and the Board grants his request. Dr. Gutierrez agrees, accepts and acknowledges the responsibility to maintain the medical records and follow-up patient care of the patients who received medical treatment at Mariner's Medical Center, beginning July 17, 2003. By letter dated October 7, 2003, from the executive director of the Board of Medicine, the custodial request was approved. The letter stated as follows: It is my pleasure to advise you that, pursuant to your request, the Board of Medicine voted on October 4, 2003, to permanently appoint you as the Custodian of Records for the former Mariner's Medical Center. This appointment is pursuant to Section 456.057(19), Florida Statutes, which authorizes the Board of Medicine to permanently appoint a person as a custodian of medical records in the event of the death of a practitioner, the mental or physical incapacitation of the practitioner, or the abandonment of medical records by a practitioner. The custodian appointed shall comply with all provisions of this section, including the release of patient records. The Respondent suggests that the release of the records to his custody constituted approval of his July 17 request to provide treatment; however, the October 7 letter clearly did not address issues regarding provision of patient care. The statutory citation referenced in the letter addresses only custody, maintenance, and use of medical records. There is no credible evidence that the ongoing dialogue between the Respondent and representatives of the Petitioner constituted approval of the Respondent's request to provide medical care to Mariner's patients. Further, there is no evidence that the Respondent's practice at "Boriquen Health Care" or "Physician's Health Care Plus" was limited solely to patients who had received care at Mariner's. By letter dated November 25, 2003, to Kimberly Rivers, Regulatory Supervisor for the Department of Health, Board of Medicine, the Respondent referenced a conversation of November 21, 2003, wherein a discussion allegedly occurred regarding the requirements for ACN designation. The letter clearly establishes that the Respondent was aware that the practice had not yet received the ACN designation. The Respondent's ACN license was due to expire on January 31, 2004. On January 30, 2004, the Respondent submitted his ACN re-licensure application. Because he was not practicing at an ACN facility as of the expiration date, the ACN license was not automatically renewed. By letter dated February 5, 2004, the Petitioner notified the Respondent that his ACN license renewal could not be completed until submission of a letter from "your employer in an area of critical need." The letter referenced an enclosure that allegedly identified the ACN-designated facilities. An email dated February 16, 2004, from Joanne Davis-Trexler to the Respondent references a prior conversation and advises that the Respondent's license can not be renewed without "proof of employment in a facility approved as an Area of Critical Need." The email further advises that the Respondent's license is "delinquent" and that "practice with a delinquent license is a violation of Florida Statutes." An exchange of email between the parties indicates that subsequent to February 16, 2004, additional information, including Medicaid/Medicare billing records, was submitted by the Respondent to the Petitioner to document the patient population being served by the Respondent. On March 8, 2004, the secretary of the Department of Health, acting as the state health officer, approved Physician's Health Care Plus as an ACN-designated facility based on the staff's recommendation. On March 24, 2004, following the facility's ACN designation, the Respondent's ACN licensure was renewed. Between August 2003 (when the Respondent's practice began operating absent the ACN designation) and March 8, 2004, the Respondent failed to comply with licensure requirements limiting his practice to ACN-designated facilities. Between February 1 and March 24, 2004, the Respondent failed to comply with requirements related to timely renewal of his ACN licensure. The Respondent has moved to Texas, is no longer practicing medicine in Florida, and has placed his Florida license into a "retired" status.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Medicine, enter a final order issuing a letter of concern to the Respondent related to the licensing violations cited herein. DONE AND ENTERED this 12th day of May, 2006, in Tallahassee, Leon County, Florida. S WILLIAM F. QUATTLEBAUM 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 12th day of May, 2006. COPIES FURNISHED: Patrick L. Butler, Esquire Katharine B. Heyward, Esquire Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 George F. Indest, III, Esquire Joanne Kenna, Esquire The Health Law Firm 220 East Central Parkway, Suite 2030 Altamonte Springs, Florida 32701 Timothy M. Cerio, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 Larry McPherson, Executive Director Board of Medicine Department of Health 4052 Bald Cypress Way Tallahassee, Florida 32399-1701
Findings Of Fact At all times material hereto, Respondent has been licensed in the State of Florida as a life and health insurance agent. His licensure as a life and variable annuity contracts agent occurred on April 5, 1993. On September 9, 1994, Respondent pled nolo contendere to criminal charges pending before the Circuit Court of the Seventeenth Judicial Circuit, in and for Broward County, Florida. The charges were third degree grand theft, a felony, and practicing law while his license was suspended, a misdemeanor. Upon entry of his plea, adjudication was withheld, and Respondent was placed on probation for two years and ordered to make restitution in the amount of $400. Respondent did not notify Petitioner in writing within 30 days after pleading nolo contendere to that felony. Respondent's plea and criminal charges related to a fee in the amount of $l,000 which Respondent collected from a client to perform legal services at a time when Respondent's license to practice law was suspended. Although Respondent refunded $600 of that fee to the client, Respondent determined that the client had received $400 worth of services and refused to refund that amount until after the client filed litigation and obtained a civil judgment against Respondent. On or about October 20, 1995, the Florida Department of Corrections filed with the Broward County Circuit Court an affidavit alleging that Respondent had violated the Circuit Court's Order of Probation in a number of different ways. Based upon that affidavit, the Circuit Court issued a Warrant for Respondent's arrest on October 24, 1995. On January 11, 1996, Respondent was disbarred, effective immediately, by the Supreme Court of Florida. At the time of the final hearing in this cause, Respondent was not actively engaged in the insurance business. Rather, Respondent had been employed at the Miami Market for approximately 1-1 years, taking inventory and supervising crews.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered finding Respondent guilty of the allegations contained in the First Amended Administrative Complaint filed against him and revoking his licenses and his eligibility for licensure as an insurance agent. DONE and ENTERED this 5th day of March, 1996, at Tallahassee, Leon County, Florida. LINDA M. RIGOT, 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 5th day of March, 1996. APPENDIX TO RECOMMENDED DOAH CASE NO. 95-4700 Petitioner's proposed findings of fact numbered 1, 4-12, and 15 have been adopted either verbatim or in substance in this Recommended Order. Petitioner's proposed finding of fact numbered 2 has been rejected as not constituting a finding of fact but rather as constituting a conclusion of law. Petitioner's proposed finding of fact numbered 3 has been rejected as not being supported by the weight of the competent evidence in this cause. Petitioner's proposed finding of fact numbered 13 has been rejected as being irrelevant to the issues under consideration in this cause. Petitioner's proposed finding of fact numbered 14 has been rejected as being subordinate to the issues herein. COPIES FURNISHED: Ross S. Burnaman, Esquire Department of Insurance Division of Legal Services 200 East Gaines Street Tallahassee, Florida 32399-0333 Mr. David Felix Monaco Apartment 207E 7610 Stirling Road Hollywood, Florida 33024 Bill Nelson State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, Florida 32399-0300
The Issue Whether disciplinary action should be taken against Respondent's license to practice as a physician.
Findings Of Fact The Agency is that state agency charged with regulating the practice of medicine pursuant to Section 20.42, Florida Statutes; Chapter 455, Florida Statutes; and Chapter 458, Florida Statutes. Respondent is a physician licensed to practice medicine in the State of Florida. Respondent holds license number ME 0055126. The State of Michigan Department of Commerce Board of Medicine is the licensing authority for the State of Michigan. On or about April 18, 1994, the State of Michigan Board of Medicine issued a letter of reprimand to Respondent, and ordered that Respondent pay a fine in the amount of $1,500.00 within ninety days of the Order for prescribing anabolic steroids for the purpose of improving body-building or weightlifting. Respondent is guilty of having action taken against his license to practice medicine by the licensing authority of the State of Michigan. The State of Michigan notified the agency of its action against the Respondent. A search of the agency's records revealed he had not notified the agency of the action taken by Michigan against him. On or about September 5, 1995, an attempt was made to notify Respondent about the information the agency had received. This letter was subsequently returned unclaimed with a forwarding address in Dallas, Texas. On or about November 9, 1995, a second attempt was made to notify Respondent of the complaint. The letter was sent to Post Office Box 12131, Dallas, Texas 75225, which is the Respondent's current address.1 The Respondent returned the election of rights form and a letter requesting a formal hearing. Respondent failed to notify the Florida Board of Medicine within thirty days of the action taken against his medical license in Michigan. The Respondent failed to notify the Board of his change of address. The Respondent was preciously disciplined by the Board of Medicine by Final Order number AHCA96-00464. The Respondent's license was suspended until he appeared and demonstrated that he could practice with skill and safety.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law set forth herein, it is, RECOMMENDED: That Respondent the Agency enter its Final Order finding the violation of Section 458.331(1)(b), Section 458.331(x) and 458.331(1)(kk) and, Florida Statutes, and revoking the Respondent's license to practice medicine in Florida. DONE and ENTERED this 28th day of February, 1997, in Tallahassee, Florida. STEPHEN F. DEAN Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 28th day of February, 1997.
The Issue The issue is whether Petitioner's application for reinstatement of his license as a general contractor should be granted or denied.
Findings Of Fact Stipulated Facts Petitioner was previously issued Certified General Contractor's License number CGC42026. His license was active in the 2004 renewal cycle, became delinquent-active in the 2006 renewal cycle, and null and void at the start of the 2008 renewal cycle. Due to an executive order of the Governor relating to tropical storms, Petitioner's license became null and void on October 2, 2008. Petitioner was required to pay a renewal fee and report continuing education credit hours in order to renew his license prior to the start of the 2008 renewal cycle to avoid the license becoming null and void. Petitioner timely paid the renewal fee ($518) to renew his license. Petitioner completed and reported two continuing education hours for the reporting period ending August 31, 2008. Petitioner completed and reported 44 continuing education hours through July 5, 2011, and is currently up to date with all of his required continuing education credit hours. While Petitioner completed and reported a portion of his required continuing education hours, he did not complete and report all of his required continuing education hours to renew his license during the 2008 renewal period. This was due to financial difficulty and an inability to pay for continuing education credit hours. At present, the total hours Petitioner completed and reported would fulfill his 2006, 2008, and 2010 continuing education requirements. A license becomes null and void if it is not renewed within two years of the renewal date. Petitioner filed his application pursuant to section 455.271(6), Florida Statutes, to reinstate his Certified General Contractor's License number CGC42026. The Department entered its Notice of Intent to Deny the application. Following the Board's issuance of a Corrected Notice of Intent to Deny, Petitioner filed an Amended Petition for Formal Administrative Proceedings. The Corrected Notice stated that Petitioner's license expired due to non receipt of continuing education credits for renewal and, following the delinquency period, became null and void. The reasons for the denial set forth in the corrected notice were as follows: Applicant failed to present evidence of a good faith effort to comply with the license renewal statutes and rules and failed to present evidence that rises to the level of illness or unusual hardship that would justify the failure to renew the license. The Board approved the application of Alberto Munoz to reinstate his Certified Pool/Spa Contractor's License pursuant to section 455.271(6) at the July 14, 2011, meeting of the Board. The application filed by Mr. Munoz stated that his license had gone null and void because he failed to pay the required license renewal fee due to undue due to undue financial hardship. The Board approved the application of Edwin W. Steffen to reinstate his Certified Plumbing Contractor's License pursuant to section 455.271(6) at the August 11, 2011, meeting of the Board. The application filed by Mr. Steffen stated that his license had gone null and void because his "two cycle inactive status expired in August 2010." Further, Mr. Steffen cited financial difficulties following the "2009 market crash that hurt [him] significantly," leading him to "go back into the workforce." Neither the Department nor the Board has adopted any rules pertaining to applications to reinstate licensees pursuant to section 455.271(6) other than a Department approved application form. Facts based upon evidence of record Petitioner's Certified General Contractor's (CGC) license was active during the 2004 renewal cycle, and became delinquent-active in the 2006 renewal cycle. Petitioner was required to pay a renewal fee and report continuing education credit hours in order to renew his CGC license prior to the start of the 2008 renewal cycle to avoid the license becoming null and void. During the 2006 and 2008 renewal cycles, Petitioner worked as a construction foreman in remote encampments in Puerto Rico and in the U.S. Virgin Islands. Although these jobs were full-time, he earned very little money on these projects. During this time, Petitioner's wife and three children remained at home in Puerto Rico. He earned only enough during this time for his family to subsist. Although working in remote locations in Puerto Rico and in the U.S. Virgin Islands during this time, Petitioner insists that he always intended to return to Florida and was actively seeking work here. He did not finish working in the remote encampments until 2009. While working in the remote locations, he had no access to the Internet and relied on phone calls to friends in an attempt to find appropriate yet affordable continuing education courses. The courses he learned of were expensive at a time when he was earning little money and trying to support his family. Petitioner's testimony in this regard is deemed credible and is accepted as fact. When Petitioner submitted his application for reinstatement of his license, he included a money order for $100 as required. During this period of time, Petitioner paid his renewal fee and completed two continuing education credit hours, but was unable to afford the required number of authorized continuing education credits, and was not in a place from which he could travel to attend live courses. Petitioner made a good-faith effort to comply with the license renewal statutes and rules. He paid the renewal fee and has since completed the necessary continuing education requirements.
Recommendation Upon consideration of the facts found and the conclusions of law reached, it is RECOMMENDED: That the Construction Industry Licensing Board enter a final order granting Petitioner's application for reinstatement of his license as a general contractor. DONE AND ENTERED this 13th day of January, 2012, in Tallahassee, Leon County, Florida. S BARBARA J. STAROS 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 13th day of January, 2012.
Findings Of Fact The following facts were stipulated by the parties and required no proof at hearing: Petitioner, University Hospital, Ltd., is a Florida limited partnership and is the licensee of University Hospital and University Pavilion Hospital, both located on North University Drive, Tamarac, Florida. Petitioner Sebastian Hospital, Inc., is a Florida corporation, and is the licensee of Sebastian Hospital and SandyPines Hospital. Both hospitals are located on separate premises. Petitioner Haines City HMA, Inc., is a Florida corporation, and is the licensee of Heart of Florida Hospital, Inc. and Palmview Hospital. Both hospitals are located on separate premises. Petitioners timely filed their respective Petitions to determine the invalidity of the proposed rules at issue. Petitioners would be regulated by the proposed rules and are substantially affected parties with standing to challenge the proposed rules at issue. No proof is necessary to prove the standing of these Petitioners. Prior Rule 59C-1.004(2)(i) (the "License Consolidation Rule") required CON application and approval for license consolidations pursuant to Section 395.003, F.S. It was declared invalid in University Hospital, Ltd., et al. v. AHCA, 16 F.A.L.R. 3312 (final order dated July 22, 1994). [This decision is referenced throughout as University Hospital.] Prior to invalidation of the License Consolidation Rule, six CON applicants sought issuance of a single, or consolidated, license to replace former separate licenses held by the same licensee for facilities located on separate premises. Each of these six prior applicants involved a general acute care hospital and a specialty psychiatric hospital. Those applicants resulted in an issuance of CON numbers 7303, 6954, 7712, 7311, 7167, and 7047. Each of those six applications was ulti- mately approved in the form of a single license. When the single licenses were issued, no restrictions were placed on the licensees regarding eligibility for Medicaid reimbursement. As reflected in the respective SAARS, a significant result of approval of each of these applications was that the formerly separately licensed psychiatric hospital became eligible for Medicaid reimbursement for treatment of Medicaid patients. All of these prior applicants had licenses issued and became eligible for Medicaid. Such Medicaid reimbursement was not available to the separately licensed psychiatric facilities prior to issuance of a single, or consolidated, license. Aside from the rules under challenge, there has been no change in pertinent state statutes or rules subsequent to the final order in University Hospital Ltd., v. AHCA 16 F.A.L.R. 3312. After invalidation of the Consolidated License Rule, AHCA's interpretation is that issuance of a single, or consolidated, license for a general acute care hospital and a psychiatric hospital does not result in Medicaid eligibility. Petitioners did not participate in any of the rule workshops conducted on June 22, July 7, and November 2, 1994 or the public hearing held on February 13, 1995. Petitioners did not send in any written comments, questions, or materials, or request an economic impact statement. A holding of the Final Order in University Hospital, was that a Certificate of Need was not required prior to the issuance of a single consol- idated license for multiple premises. University Hospital, 16 F.A.L.R. at 3321. The Agency has no discretion regarding rule- making pursuant to Section 120.535. (Joint Prehearing Stipulation, filed 3/14/95) Approximately eighteen months ago and well before the University Hospital decision, the Agency for Health Care Administration (AHCA) commenced a major rewrite of the hospital license rules that had been promulgated by its predecessor agency, the Department of Health and Rehabilitative Services (HRS). After a series of public workshops, the revisions were noticed in the January 20, 1995, Florida Administrative Weekly. These substantial revisions of rule chapter 59A-3 comprise about fifty pages of the Florida Administrative Weekly. The challenged portions comprise only several paragraphs of the revisions. The challenged portions of the proposed rules are: 59A-3.203 Licensure Procedure. (2) All persons requesting licensure for the operation of a hospital under the provisions of Chapter 395, F.S., shall make application to the Agency, on forms provided, AHCA Form 3130- 8003-January 1995, and AHCA Form 3130-8001-January 1995, and shall receive a regular or provisional license prior to the acceptance of patients for care or treatment. * * * (e) An application for the addition of beds or off-site outpatient facilities to a hospital's license must include: A valid certificate of need or letter of exemption as required by ss. 488.041 - 408.045, F.S., and Approval from the Agency's Office of Plans and Construction. * * * (i) A single license will be issued to a licensee for facilities located on separate premises, upon request of the applicant. The license will specifically state the location of the facilities, their services, and the licensed beds available on each separate premises. Such a license shall also specifically identify the general or specialty classification of hospitals located on separate premises. (6) Each license shall specifically state the name of the licensed operator of the hospital, the class of hospital, and the name and location of the hospital. Any beds in the hospital which are regulated under the certificate of need program, as specified in Chapter 59C-1, F.A.C., shall be listed, including the number of licensed beds by type. The license for hospitals having facilities on more than one premises shall specifically state the location of each facility, their general or specialty classification, their services, and the licensed beds available on each separate premises. * * * Specific Authority 395.003, 395.004, 455.239, F.S. Law Implemented, 395.001, 395.003, 395.004, 395.1005, 408.035, 408.036, 455.239, F.S. History New. (emphasis added) Prior to the decision in the University Hospital case in July 1994, the proposed revisions did not include the requirement that the license for facilities on separate premises identify separately the general or specialty classification of each. That provision was added by the agency because it concluded that when it could no longer require a CON for "consolidated" licenses, then general acute care beds and free-standing psychiatric beds could not be "consolidated" on a single license. It is uncontroverted that the substantial effect of the requirement that each facility retain its prior classification is that a facility classified as a class III (specialty) facility is not eligible for Medicaid reimbursement. The agency agrees that proposed rule is based on, and is compelled by section 395.003(2)(d), F.S., which provides as follows: (d) The Agency shall, at the request of a licensee, issue a single license to a licensee for facilities located on separate premises. Such a license shall specifically state the location of the facilities, the services, and the licensed beds available on each separate premises. If a licensee requests a single license, the licensee shall designate which facility or office is responsible for receipt of information, payment of fees, service of process, and all other activities necessary for the Agency to carry out the provision of this part. (Emphasis supplied). It is immediately obvious from a comparison of the text of the proposed rule and the text of the law implemented that the law does not require that the license state the general or specialty classification for the separate facilities. This distinction was not lost on the agency since it included in its legislative package for the 1995 legislative session a proposed amendment to section 395.003(2)(d), F.S. that would cure the inconsistency by adding the proposed rule language to the statute. (Petitioner's exhibit number 16, p. 25) There is a statute which restricts Medicaid reimbursement for treatment in free-standing psychiatric hospitals. The agency argues that the proposed rules give effect to that statute, section 409.905(5), F.S., which provides, in pertinent part: . . . A licensed hospital maintained primarily for the care and treatment of patients having mental disorders or mental diseases is not eligible to participate in the hospital inpatient portion of the Medicaid program except as provided in federal law. . . . (emphasis supplied). Reliance on Section 409.905(5) is misplaced, however, because it is nowhere cited in the proposed rules as authority or law implemented. Moreover, evidence presented at hearing describes federal policy that when two hospitals are consolidated under one license and have a total capacity that is less than 50 percent psychiatric in nature, the premises are both eligible for Medicaid reimbursement, even though one remains primarily for the treatment of mental disorders. (Petitioners' exhibits number 20-22) The federal policy on Medicaid reimbursement was in effect in 1993, prior to the University Hospital decision and prior to the current version of the proposed rules. Section 409.905(5), F.S. has been in effect since 1991, before the six consolidated licenses referenced in paragraph 1, above, were issued. Section 395.003(2)(d), F.S. has been in effect in its current form at all times material. Nothing in the law has changed to support the agency's contention that, after the University Hospital decision, it can no longer issue a single license with a single license classification for separate premises. No evidence nor specific argument was presented with regard to the alleged invalidity of proposed rule 59A-3.203(2)(e), which on its face relates to the addition of beds or an outpatient facility to a hospital's license. Issues related to that portion of the proposed rule are not the issues invoked in this proceeding with regard to Petitioner's facilities. (See Petitioners' exhibit 26, p. 71, deposition of Tanya Williams)
The Issue The issue for determination is whether Respondent, a licensed physician, committed violations of Chapter 458, Florida Statutes, as alleged in the Administrative Complaint, sufficient to justify the imposition of disciplinary sanctions against his license.
Findings Of Fact Respondent is Michael A. Fuentes, M.D., a licensed physician at all times pertinent to these proceedings, holding medical license number ME 0044461. Respondent's last known address is 311 Akron Avenue, Pittsburgh, Pennsylvania 15216. Petitioner is the state agency charged with regulating the practice of medicine pursuant to Chapter 458, Florida Statutes. The Pennsylvania State Board of Medicine is the licensing authority for the State of Pennsylvania. The Connecticut Board of Medicine is the disciplining body for the State of Connecticut. On or about July 27, 1994, the Pennsylvania State Board of Medicine indefinitely suspended Respondent’s license to practice medicine and then stayed that suspension while placing Respondent on five year's probation. The Board found Respondent to be an impaired physician who had been non-compliant with treatment recommendations. On or about August 26, 1996, the Pennsylvania State Board of Medicine, reviewed its earlier decision and shortened the probationary period to three years. Respondent did not report the Pennsylvania State Board of Medicine’s action in either instance to Petitioner’s representatives in the State of Florida. On October 19, 1993, the Connecticut Board of Medicine summarily suspended Respondent’s license to practice medicine due to his mental impairment and failure to undergo a complete psychiatric evaluation. Subsequently, on or about June 20, 1995, the Board revoked Respondent’s license to practice medicine in Connecticut. Respondent did not report the Connecticut State Board of Medicine's action in either instance to Petitioner's representatives in the State of Florida. Respondent is guilty of having action taken against his license to practice medicine by the licensing authorities of the State of Pennsylvania and the State of Connecticut, violations of Section 458.331(1)(b), Florida Statutes. Additionally, Respondent did not notify the Florida Board of Medicine within 30 days of the license disciplinary actions taken by either the State of Pennsylvania or the State of Connecticut against his license, notifications required by Section 458.331(1)(kk), Florida Statutes.
Recommendation Based on the foregoing, it is hereby RECOMMENDED that a Final Order be entered finding Respondent guilty of the charges set forth in the Administrative Complaint and revoking his license to practice medicine in the State of Florida. DONE AND ENTERED this 22nd day of September, 1997, in Tallahassee, Leon County, Florida. DON W. DAVIS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 22nd day of September, 1997. COPIES FURNISHED: Carol Lanfri, Esquire Agency for Health Care Administration Post Office Box 14229 Tallahassee, Florida 32317-4229 Stephen M. Chizmadia, Esquire 125 Sun Dance Road Stamford, Connecticut 06905 Michael A. Fuentes 32 Lake Drive Darien, Connecticut 06820 Michael A. Fuentes c/o The Royal Inn Route 219, Boot Jack Summit Ridgway, Pennsylvania 15853 Marm Harris, Executive Director Agency for Health Care Administration 1940 North Monroe Street Tallahassee, Florida 32399-0770 Pete Peterson, Esquire Department of Health Building 6, Room 102-E 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 Angela T. Hall, Agency Clerk Department of Health Building 6 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 James Howell, Secretary Department of Health Building 6, Room 306 1317 Winewood Boulevard Tallahassee, Florida 32399-0700
