The Issue The issues to be determined are whether Respondent is a licensed physician's assistant in Florida; whether he committed the allegations alleged in the Administrative Complaint, and if so, what penalty should be imposed?
Findings Of Fact Petitioner is the state agency charged with the licensing and regulation of health care professionals, including physicians assistants, pursuant to section 20.43 and chapters 456 and 458, Florida Statutes. At the time of the events giving rise to the Administrative Complaint, Respondent was licensed to practice as a physician's assistant in the State of Florida, having been issued license number PA9101556. Respondent received his license on January 16, 2001, and never renewed it. Under normal circumstances, his license would have expired on January 1, 2004. However, at the time of his licensure and until his discharge on April 1, 2008, Respondent was on active duty in the United States Air Force. On April 1, 2001, Respondent was involved in an automobile accident in which the driver of the other car involved was killed, along with her unborn child. Respondent was under the influence of alcohol at the time. As a result of the accident, on April 19, 2001, he was hospitalized and placed in military custody. Respondent's clinical privileges with the United States Air Force were placed in abeyance as of April 20, 2001, and on April 28, 2001, he was reassigned to Fort Stewart, Georgia, and placed in pre-trial confinement. On May 8, 2001, Respondent was notified that his clinical privileges in the Air Force were suspended pending the decision of his court martial, and that the action was taken "in response to your unprofessional conduct and three consecutive DUI arrests." The notice also stated that "[t]hese problems could potentially have adverse effects on patient care." On August 8, 2001, Respondent was convicted by court martial under Articles 111, 119, 133, and 134 of the Uniform Code of Military Justice. On October 3, 2001, an Arrest Warrant and Notice to Appear was filed in the Circuit Court for the Thirteenth Judicial Circuit in and for Hillsborough County, charging Respondent with D.U.I. manslaughter in violation of section 316.193(3), Florida Statutes (2001). On October 17, 2001, Respondent's clinical privileges in the Air Force were revoked, in response to his court martial conviction. As with the notice of suspension of his privileges, the notice of revocation stated: Depending on the outcome of this action, AFMOA/SGOC may report the matter to appropriate professional regulatory agencies. . . . Providers who separate, retire, are discharge [sic], end employment with the DoD, or permanently change station within the DoD while an adverse action review is taking place may be reported to the National Practitioner Data Bank and/state licensing agencies. . . . On January 2, 2002, an information was filed charging Respondent with two counts: one for D.U.I manslaughter, with regard to the death of the woman involved in the April 2001 accident; and one for vehicular homicide for the death of her viable fetus. On or about May 14, 2003, in State of Florida v. Joseph Frank Piotrowski, Case No. 01-CF-015207 (13th Judicial Circuit), Respondent was tried and found guilty of both counts charged and described in paragraph 7. On May 13, 2003, Respondent was sentenced to serve 15 years for each count, with credit for 376 days jail time served. The court ordered that his sentences run consecutively, and concurrently with his federal sentence. Respondent was discharged from the military on April 1, 2008. Respondent remains incarcerated, with an anticipated release date of January 15, 2029.
Recommendation Upon consideration of the facts found and conclusions of law reached, it is RECOMMENDED that the Florida Board of Medicine enter a Final Order finding that Respondent has violated section 458.331(1)(c) and section 456.072(1)(w), Florida Statutes (2002). It is further recommended that Respondent's license be revoked. DONE AND ENTERED this 4th day of November, 2011, in Tallahassee, Leon County, Florida. S Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 4th day of November, 2011. COPIES FURNISHED: Geoffrey Frederick Rice, Esquire Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Joseph Piotrowski, P.A., D11823 Cross City Correctional Institution 568 Northeast 225th Street Cross City, Florida 32628 Nicholas W. Romanello, Esquire Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1703 Joy A. Tootle, Executive Director Board of Medicine Department of Health 4052 Bald Cypress Way Tallahassee, Florida 32399
The Issue The central issue in this case is whether the Respondent violated Chapter 458 Florida Statutes as alleged in the Administrative Complaint dated July 11, 1986; and, if so, what penalty should be imposed.
Findings Of Fact Based upon the testimony of the witness and the documentary evidence received at the hearing, I make the following findings of fact: The Respondent, Maria I, Andrakovich, M.D., is a licensed physician in the State of Florida, having been issued license number MEOO2I436. On or about May 1, 1983, Respondent entered into a Service agreement with "The Doctor's Office, Inc." wherein Dr. Andrakovich agreed to provide medical services for the patients at 330 South Dixie Highway, Lake Worth, Florida. Respondent's employment with "The Doctor's Office, Inc." ended in March, 1984. On or about July 12, 1983, Respondent filed with the Board of Medical Examiners an Application for Certification for Physician's Assistant for Jean Eugene Raymond. On August 15, 1983, Mr. Raymond was certified to work under the supervision of Respondent pursuant to Chapter 458 Florida Statutes. On November 22, 1983, Mr. Raymond filed his Biennial Physician's Assistant Certification and reported a change of office address to 1177 Hypo1uxo Road, Lantana, Florida. Respondent executed the affidavit for this certification before a notary public. Respondent never worked at the Hypo1uxo, Road facility. Dr. Andrakovich remained at the prior office location which was approximately five miles from the Hypoluxo site. Prior to his move to the Hypoluxo facility, Mr. Raymond would confer, in person, with Dr. Andrakovich regarding each patient. After moving to the Hypoluxo facility, Mr. Raymond would confer with Dr. Andrakovich by telephone. Respondent relied on Mr. Raymond's judgment that this telephonic system of conferring about patients complied with any legal requirements of their relationship. Respondent did not know the regulations which govern physician's assistants. Many of the patients seen at the facilities on Hypoluxo and Dixie were elderly and suffered heart problems. Respondent's schedule required her to see one patient every fifteen minutes. This patient scheduling rate later increased to one patient every ten minutes. It was difficult for Respondent to confer with Mr. Raymond by telephone and meet the schedule. Respondent assumed Mr. Raymond would confer with the physicians at the Hypoluxo facility. No specific arrangement was made to require physicians at Hypoluxo to supervise Mr. Raymond nor did any physician there assume responsibility for Mr. Raymond's activities. During her employment with "The Doctor's Office, Inc." Respondent treated Norman Shapiro. Mr. Shapiro had a history of heart trouble, diabetes, and hypertension. During the fall of 1983, Mr. Shapiro had complained of increased pain which had resulted in Respondent doubling the strength of Mr. Shapiro's heart medication. Mr. Shapiro's medical record for this period suggested a deterioration in his heart condition. On November 21, 1983, Norman Shapiro went to the Hypoluxo facility and was seen by Mr. Raymond. Mr. Shapiro complained that he was constantly having to take his heart medication by handful amounts. Mr. Raymond recommended no coffee, tea, chocolates or smoking and that the patient should elevate his head 4-6 inches for sleeping. The only additional medication suggested was Maalox. The treatment recommended by Mr. Raymond was consistent with the diagnosis of a hiatal hernia but was inappropriate given the patient's history of heart disease. The minimally acceptable care within the medical community where "The Doctors' Office" was located would have required the patient Shapiro to be hospitalized. Mr. Raymond did not confer with Dr. Andrakovich regarding Mr. Shapiro's visit on November 21, 1983, until after the treatment had been recommended. Had Dr. Andrakovich seen Mr. Shapiro on that day, she would have put him in the hospital. Dr. Andrakovich believed Dr. Conti had treated Mr. Shapiro on November 21, 1983. On November 21, 1983, the electrocardiogram (EKG) for Mr. Shapiro was within normal limits. Despite the EKG, Mr. Shapiro's symptoms were cardiac- related and had a significant potential for morbidity and mortality. In fact, Mr. Shapiro died on November 22, 1983. Frank Colavecchio was president of the "The Doctor's Office Inc." and made all administrative decisions regarding the facilities on Dixie and Hypoluxo. Mr. Colavecchio administratively moved Mr. Raymond to the Hypoluxo office. On March 15, 1984, Dr. Andrahovich terminated employment with the "The Doctor's Office, Inc". Respondent did not notify the Board of Medical Examiners of this change and at no time advised the Board that she would no longer be supervising Mr. Raymond. It is inappropriate and contrary to standards of good medical practice for a physician's assistant to treat heart patients. Dr. Andrakovich knew or should have known that Mr. Raymond was treating heart patients.
Findings Of Fact Respondent, Alberto Correa (Correa) holds a Class "D" Security Officer License, Number D93-12073. On March 23, 1995, Correa was employed at the Pan American Hospital in Miami, Florida, in the capacities of maintenance man, electrician, and mechanic. On March 23, 1995, Rafael Burgos (Burgos) was an employee of Pan American Hospital. His duties included managing materials for the surgical department. On March 23, 1995, Burgos entered a computer request to Correa to put up a bulletin board in the surgical department. The board was needed to post the schedules for the surgical staff. Correa was the only mechanic on duty that day at the hospital. Correa had been assigned by his supervisor to perform tasks in the kitchen. After seeing the request on the computer, Correa telephoned the surgery room to determine if the request was an emergency. Correa determined that the work in the kitchen was a higher priority than the installation of a bulletin board. Correa continued to work in the kitchen. Later, he went to the surgery room to see what needed to be done. Burgos asked Correa to put up the bulletin board. Correa indicated that putting up the bulletin board was not an emergency which took precedence over the work in the kitchen. Correa refused to do the job and told Burgos that he would let his supervisor know that the bulletin board needed to be installed. Burgos asked Correa to give him some tools so that he could install the bulletin board himself since Correa was not going to do the job. Correa refused to give Burgos any tools and began to raise his voice at Burgos. At the time of the incident Correa was standing in the double-doorway leading into the surgical room. Correa asked Burgos to step out into the hallway. Burgos went to the double doors. When he got to the doorway he observed Correa with an open knife in his hand. Correa told Burgos not to come any closer or he would cut him to pieces. Correa lunged the knife at Burgos. Burgos never threatened Correa at any time before or during the incident. Burgos did not have a weapon at any time during the incident, and he made no threatening movements or gestures indicating that he was reaching for a concealed weapon. Correa contends that a fellow coworker told Burgos to shoot Correa and then Burgos got up and started coming towards Correa. Having judged the credibility of the witnesses, I find that a coworker did not tell Burgos to shoot Correa.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered finding that Gilberto Correa violated Section 493.6118(1)(j), Florida Statutes, and revoking his Class "D" Security Officer Licence. DONE AND ENTERED this 11th day of July, 1996, in Tallahassee, Leon County, Florida. SUSAN B. KIRKLAND 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 11th day of July, 1996. APPENDIX TO RECOMMENDED ORDER, CASE NO. 96-2019 To comply with the requirements of Section 120.59(2), Florida Statutes (1995), the following rulings are made on the parties' proposed findings of fact: Petitioner's Proposed Findings of Fact. 1. Paragraphs 1-22: Accepted in substance. COPIES FURNISHED: Douglas D. Sunshine Assistant General Counsel Department of State, Division of Licensing The Capitol, Mail Station 4 Tallahassee, Florida 32399-0250 Gilberto Correa 1441 Southwest 2nd Street, Number 4 Miami, Florida 33135 Honorable Sandra B. Mortham Secretary of State The Capitol Tallahassee, Florida 32399-0250 Don Bell, General Counsel Department of State The Capitol, PL-02 Tallahassee, Florida 32399-0450
The Issue Whether the Respondent's paramedic license should be disciplined based upon alleged violations of Sections 401.411(1)(a) and (k), Florida Statutes.
Findings Of Fact Petitioner, HRS, Office of Emergency Medical Services (EMS), is the state agency which certifies and disciplines emergency medical technicians (EMTs) and paramedics in Florida pursuant to Chapter 401, Florida Statutes (F.S.) and Chapter 10D-66, Florida Administrative Code (F.A.C.). Respondent, Joseph L. Riggall, was initially certified as a paramedic in Florida under Section 401.27 and Rule 10D-66.057, F.A.C., in 1990, and was last recertified by EMS for the biennial period December 1, 1992 through December 1, 1994 pursuant to an application he submitted to the department through its agent on October 25, 1992. Respondent Riggall has not filed for recertification as a paramedic in Florida subsequent to the automatic expiration of his certification on December 1, 1994. A paramedic is a medical paraprofessional authorized under Florida law and administrative rules to administer advanced life support treatment with respect to life-threatening medical emergencies. Florida law defines advanced life support to include the use of techniques such as endotracheal intubation, the administration of drugs or intravenous fluids, telemetry, cardiac monitoring and cardiac defibrillation. A paramedic is authorized to perform invasive techniques in order to help save lives threatened by medical emergencies or severe injuries. As a paramedic, Respondent has a responsibility to the public, HRS-EMS and his employer, Polk County Emergency Medical Services, to perform his patient care duties without being impaired by alcohol, habit forming drugs or controlled substances. Respondent was employed by Polk County Emergency Medical Services for a period of time, including March 1994. Respondent was arrested on March 14 1994 in Polk County, Florida, on charges of prescription forgery to obtain controlled substances. HRS-EMS began an investigation of Respondent on March 23, 1994 based upon a complaint. In early March, 1994, Respondent reported to his shift supervisor that on March 11, 1994, while he was on duty as a paramedic, all of the controlled substances (morphine and Valium) had been stolen and were missing from his ambulance stationed at Fort Meade, Polk County, Florida. Respondent's supervisor immediately requested that Respondent submit to a drug test at Polk General Hospital. Respondent complied. Respondent was drug tested at approximately 12:45 a.m., March 12, 1994 at Polk General Hospital. The results of the tests taken at Polk General Hospital, and submitted to Metpath Laboratory for testing on samples from Respondent's serum and blood revealed a very high level of morphine (opiates) in Respondent's bloodstream. The level of opiates in his blood was greater than 1,999 mcg/1 and confirmed by immunoassay by the testing laboratory. Respondent admitted to the use of prescription opiate medication on March 11 and 12, 1994 while on duty as a paramedic. As a result of the drug testing of Respondent conducted the evening of March 11 and continuing the morning of March 12, 1994, and Respondent's arrest on March 14, 1994 on other charges related to improperly obtaining controlled substances or prescription medications, the Polk County EMS Medical Director rescinded Respondent's ability to function under the medical director's medical license. Furthermore, Respondent's employer, Polk County EMS, suspended Respondent without pay from his position as a paramedic with Polk County. Subsequently, Polk County EMS discharged Respondent, after providing a pre- determination conference, on August 26, 1994. HRS-EMS issued an Administrative Complaint, dated July 18, 1994, charging Respondent with a violation of EMS statutes, in particular Section 401.411(1)(a) and (k), Florida Statutes by having tested positive to controlled substances while on duty as a paramedic for Polk County EMS, March 12, 1994. HRS-EMS has adopted an "impaired" EMTs or paramedics policy and program pursuant to Rule 10D-66.0571, F.A.C.. While the administrative complaint tracks the department's impaired practitioner's rule and provided notice to Respondent relative to the rule, Respondent failed to take advantage of this beneficial program. Under the impaired practitioner's rule of HRS-EMS, a paramedic who becomes impaired as a result of drug or alcohol use or addiction may avoid administrative sanction by performing voluntary activities including those listed in the department's administrative complaint against Respondent. Respondent reported for duty as a paramedic while taking a level of controlled substances which impaired his ability to safely provide care to patients.
Recommendation Based on the foregoing, it is RECOMMENDED as follows: 1. The paramedic certification of Respondent be revoked and an administrative fine of one thousand ($1,000) dollars for the violation of paramedic certification requirements be imposed. It is further RECOMMENDED that should Respondent reapply for certification as a paramedic or EMT in Florida, he be required to submit to, and successfully complete, the conditions set forth in Rule 10D-66.0571(2), Florida Administrative Code, and pay the administrative fine recommended above, prior to recertification. DONE and ENTERED this 15th day of February, 1995, in Tallahassee, Florida. DANIEL M. KILBRIDE 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 15th day of February, 1995. APPENDIX The following constitutes my specific rulings, in accordance with section 120.59, Florida Statutes, on proposed findings of fact submitted by the parties. Petitioner's proposed findings of fact. Accepted in substance: paragraphs 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 (in part), 19, 20, and 21. Rejected as subsumed or covered in the Preliminary Statement: paragraphs 12, 13, 14, 15, 16, 17, 18, and 22. Respondent has not submitted proposed findings of fact. COPIES FURNISHED: Robert L. Powell, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Kim Tucker, Esquire Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Robert P. Daniti, Esquire Emergency Medical Services Department of HRS 1317 Winewood Boulevard Tallahassee, Florida 32301 Joseph L. Riggall 13711 Hatchienha Road Haines City, Florida 33844
Findings Of Fact The Respondent, T. Hartley Davis, is a medical doctor holding license number ME 0001423. His address is 1309 Southeast 17th Street, Ocala, Florida 32670. On February 13, 1981, prior to this proceeding, an Administrative Complaint was filed against the Respondent alleging violations of Chapters 458 and 893, Florida Statutes. On September 25, 1981, the Board of Medical Examiners entered a Final Order adopting a stipulation between the Respondent and the Department of Professional Regulation. This stipulation provided, in pertinent parts, that the Respondent's license to practice medicine in the State of Florida would be limited to the evaluation and examination of individuals to determine their eligibility for life insurance. This limitation was to continue until the Respondent had completed a Board approved Clinical Training Program and submitted evidence of his ability to practice medicine with reasonable skill and safety to his patients. On May 5, 1952, the Administrative Complaint which is the subject of this proceeding was filed against the Respondent, alleging that he had violated the provisions of the Final Order of the Board of Medical Examiners entered on September 25, 1981. On approximately September 30, October 15, and November 5, 1981, the Respondent examined and treated Mr. Vernon E. Sowers as a patient in his office in Ocala, Florida, for neurodermatitis. The Respondent's examination and treatment of this patient was not in order to determine his eligibility for life insurance. On approximately October 2, October 22, and November 23, 1981, the Respondent examined Mr. Tommy L. Smith as a patient in his office in Ocala, Florida, after the amputation of his left leg and right arm. The Respondent's examination of Mr. Tommy L. Smith was not in order to determine his eligibility for life insurance. On approximately October 4, October 28, and November 23, 1981, the Respondent examined Mr. James W. Adams as a patient in his office in Ocala, Florida, for psychoneurosis. Respondent's examination of Mr. Adams was not in order to determine his eligibility for life insurance. On approximately September 27, September 30, October 7, October 20, November 2, November 12, November 19, November 27, and December 9, 1981, the Respondent examined and treated Mr. Oakley S. Walter as a patient in his office in Ocala, Florida, for multiple sclerosis. The Respondent's examination and treatment of Mr. Walter was not in order to determine his eligibility for life insurance. On approximately October 28, November 5, and November 16, 1981, the Respondent examined and treated Mr. James A. Swain as a patient in his office in Ocala, Florida, for arthritis and other problems. The Respondent's examination and treatment of Mr. Swain was not in order to determine his eligibility for life insurance. The Respondent prescribed A.P.C. tablets (containing aspirin, phenacitin and caffeine) for Mr. Swain, B-12 injections and an electric wheelchair for Mr. Walter, and topical corticosteriod ointment ("Halog") for Mr. Sowers. The Respondent submitted his statement of professional services rendered for each of the above patients to the Veterans Administration Medical Center in Bay Pines, Florida, for payment. The Veterans Administration paid the amounts of these statements for each of the above patients. Pursuant to the request or demand of the Veterans Administration for a refund from the Respondent of funds paid for professional services rendered to the above patients, for the reason that he was not eligible to write prescriptions, the Respondent refunded to the Veterans Administration the money he had been paid. There is no evidence that the medical license of the Respondent was placed on an inactive status by the Board, or that the Respondent's license had been either suspended or revoked by the Board, during the times he examined or treated the above patients. The Board's Order dated September 25, 1981, placed a limitation on the Respondent's license, precluding any medical practice except the evaluation and examination of individuals to determine their eligibility for life insurance, but no other sanction was imposed by the Board.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medical Examiners enter its Final Order finding the Respondent, T. Hartley Davis, M.D., guilty of five counts of violating Section 455.331(1)(x), Florida Statutes, and dismissing the remaining counts in the Administrative Complaint with prejudice. And it is further RECOMMENDED that the Board of Medical Examiners in its Final Order reimpose upon the Respondent, T. Hartley Davis, M.D., the limitations set forth in its Order dated September 25, 1981, restricting the medical practice of the Respondent to evaluating and examining individuals to determine their eligibility for life insurance, for a period of six (6) months. THIS RECOMMENDED ORDER entered this 11th day of October, 1983, in Tallahassee, Florida. WILLIAM B. THOMAS, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 11th day of October, 1983. COPIES FURNISHED: Barbara K. Hobbs, Esquire and Diane K. Kiesling, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Victor J. Musleh, Esquire Post Office Box 159 Ocala, Florida 32675 Dorothy Faircloth, Executive Director, Florida Board of Medical Examiners Old Courthouse Square Building 130 North Monroe Street Tallahassee, Florida 32301 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS DEPARTMENT OF PROFESSIONAL REGULATION, Petitioner, vs. CASE NO.: 82-1465 HARTLEY DAVIS, M.D., License No. 1423 Respondent. /
