00-005098PL Department Of Health, Board Of Medicine vs. Babu V. Mangilipidi, M.D. Status: Closed Recommended Order on Tuesday, August 14, 2001.

Summary: The Board presented sufficient evidence to establish facts to show Respondent to be guilty of conduct to justify revocation.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD OF )

MEDICINE , )

)

Petitioner , )

)

vs. ) Case No. 00-5098PL

)

BABU V. MANGILIPUDI, M.D. , )

)

Respondent. )

_________________________________)

RECOMMENDED ORDER

Upon due notice, William R. Cave, an Administrative Law

Judge for the Division of Administrative Hearings (Division),

held a formal hearing in this matter on April 24, 2001, in

Lakeland, Florida.

APPEARANCES

For Petitioner : Kim M. Kluck, Esquire

Agency for Health Care Administration

Post Office Box 14229

Tallahassee, Florida 32317-4229

For Respondent : Jack T. Edmund, Esquire

1125 East Main Street

Bartow, Florida 33830-5004

STATEMENT OF THE ISSUE

Did the Respondent commit the violations alleged in the

Administrative Complaint dated May 16, 2000, and if so, what

penalty should be imposed?

PRELIMINARY STATEMENT

By an Administrative Complaint dated May 16, 2000, and fi led

with the Division on December 18, 2000, the Department of Health,

Board of Medicine (Board) is seeking to revoke, suspend, or

otherwise discipline Respondent's license to practice medicine in

the State of Florida.

As grounds therefor, the Board alleges that Respondent

violated Section 458.331 (1)(j)(m)(q)(t) and (x), Florida

Statutes, in that Respondent: (a) exercised influence within a

patient-physician relationship for the purpose of engaging

patient S. M. in sexual activity in violation of Section

458.331(1)(j), Florida Statutes; (b) failed to keep legible

medical records in violation of Section 458.331(1)(m), Florida

Statutes; (c) prescribed, dispensed, administered, mixed, or

otherwise prepared a legend drug, including any controlled

substance, other than in the course of Respondent's professional

practice in violation of Section 458.331(1)(q), Florida Statutes;

(d) failed to practice medicine with that level of care, skill,

and treatment which is recognized by a reasonably prudent similar

physician as being acceptable under similar conditions and

circumstances in violation of Section 458.331(1)(t), Florida

Statutes; and (e) engaged in sexual misconduct with patient S. M.

in violation of an express prohibition against sexual misconduct

stated in Section 458.329, Florida Statutes, and Rule 64B8-9.008,

Florida Administrative Code, which violates Section

458.331(1)(x), Florida Statutes.

By an Election of Rights dated December 6, 2000, and filed

with the Board, Respondent, Babu V. Mangilipudi, M.D. (Dr.

Mangilipudi), denied the allegations in the Administrative

Complaint and requested a formal administrative hearing.

By letter dated December 18, 2000, the Board referred this

matter to the Division for the assignment of an Administrative

Law Judge and for the conduct of a formal hearing.

At the hearing, the Board presented the testimonies of

Terri Smith, Miguel A. Soler, and Sherry Doty. The Board also

presented the transcripts of the depositions of Patient, S. M.

and Gordon J. Rafool, M.D., in lieu of their live testimonies at

the hearing. The Board's Exhibits 1-9 were admitted in evidence.

Dr. Mangilipudi testified on his own behalf and presented the

testimony of Richard Carino, M.D. Dr. Mangilipudi did not offer

any documentary evidence. Sections 458.329, 458.331, 20.43,

Florida Statutes; Rule 64B8-8001, Florida Administrative Code;

and the Final Order, Consent Agreement, and Administrative

Complaint in Department of Health vs. Mangilipudi V. Babu, a.k.a.

Babu V. Mangilupudi, M.D. , Case No. 91-02874, Final Order No.

AHCA-95-00213, were officially recognized.

At the conclusion of the hearing, the parties requested 30

days from the date the transcript was filed with the Division to

file their proposed findings of fact and conclusions of law. The

parties' request was granted with the understanding that any time

constraint imposed under Rule 28-106.216(1), Florida

Administrative Code, was waived in accordance with

Rule 28-106.216(2), Florida Administrative Code. The Transcript

of this proceeding was filed with the Division on May 14, 2001.

Subsequent to the filing of the Transcript, Dr. Mangilipudi filed

an unopposed Motion for Extension of Time for Filing the

Respondent's Recommended Order, which was granted with the

understanding that any time constraint imposed under

Rule 28-106.216(1), Florida Statutes, was waived in accordance

with Rule 28-106.216(2), Florida Administrative Code. The

parties timely filed their proposed findings of fact and

conclusions of law under the extended time frame.

FINDINGS OF FACT

Upon consideration of the oral and documentary evidence

adduced at the hearing, the following relevant findings of fact

are made:

1. The Board is the agency charged with regulating the

practice of medicine in the State of Florida.

2. Dr. Mangilipudi is and, at all times material hereto,

has been licensed to practice medicine in the State of Florida ,

having been issued license number ME 0049229.

3. Sometime during 1994, Patient, S. M. (S. M.), was

involved in a serious car accident, in which S. M.'s neck was

broken. As a result of the broken neck, S. M. was required to

wear a halo brace on her head and neck.

4. The record is not clear if S. M. was under the care of a

physician at the time she presented to Dr. Mangilipudi on

December 23, 1996.

5. On December 23, 1996, when S. M. presented to

Dr. Mangilipudi at his office, she was complaining of neck pains,

headaches, and nerve damage, which cause her hands to tingle, as

a result of the car accident. In the Registration Information

form that S. M. filled out on December 23, 1996, in

Dr. Mangilipudi’s office, S. M. indicated that she was not taking

any medications.

6. An assistant took S. M.'s vital signs.

Dr. Mangilipudi performed a limited physical examination and

prescribed Soma to relax her muscles and Lorcet for the pain and

to relax her muscles. Due to the seriousness of her injury,

Dr. Mangilipudi advised S. M. to take larger dosages of the

prescribed medication than would be indicated on the prescription

bottle. Dr. Mangilipudi wrote the dosages of medication he

wanted S. M. to take on a pad of paper.

7. Lorcet is the brand name for Hydrocodone, a Schedule II

substance, as listed in Section 893.03(2)(a )1,j., Florida

Statutes.

8. S. M. attempted to tak e the larger dosages of the

prescribed medication as suggested by Dr. Mangilipudi. However,

the medication made her nauseous. During a subsequent

appointment, S. M. advised Dr. Mangilipudi that the suggested

dosage of medication was making her nauseous. Dr. Mangilipudi

advised S. M. that unless she took the suggested dosage the

nerves in her hands would tighten up and her hands would become

deformed and crippled and there would be no help for her.

Subsequently, S. M. began taking the larger dosages of medication

as suggested by Dr. Mangilipudi. At first, the larger dosage of

medication made S. M. feel sick. However, after a month, the

larger dosage began to make S. M. light-headed and intoxicated.

Eventually, S. M. stopped taking the medication because it made

her feel "drugged-up." When S. M. stopped taking the medication,

she became very sick, with vomiting, diarrhea, cold sweats, hot

sweats, fever, and chills, which lasted two days. These symptoms

are consistent with those experienced during withdrawal.

However, at the time, S. M. thought she had the flu.

9. Subsequently, S. M. scheduled an appointment with

Dr. Mangilipudi to evaluate her symptoms. During this

appointment, S. M. advised Dr. Mangilipudi that she had stopped

taking the medication. Dr. Mangilipudi advised S. M. that she

did not have flu as she suspected but that she was "hooked" on

the pain medicine and there was nothing that could be done about

it. Dr. Mangilipudi further advised S. M. she would have to take

these drugs for the rest of her life. At this point

Dr. Mangilipudi gave S. M. a dose of Lorcet, and within 15

minutes, S. M. felt as though she had never been sick.

10. Sometime around S. M.'s third visit, Dr. Mangilipudi

had S. M. bring her prescription bottles with her so that he

could determine if she was taking the larger prescribed dosage.

11. Over time, S. M. increased the number of pills that she

was taking in order to achieve the same effect. At one point,

S. M. was consuming approximately 30 pills a day. When S. M. ran

out of the Lorcet pills, she would "flip out" and become angry,

irritable, and desperate. S. M. would then go to

Dr. Mangilipudi's office, and he would give her another

prescription.

12. Sometime after S. M.'s treatmen t began, S. M. and

Dr. Mangilipudi established a mutual sexual relationship .

Although Dr. Mangilipudi did furnish S. M. with prescriptions for

drugs, and money at times to have the prescriptions filled, there

is insufficient evidence to establish facts to show that S. M.

was forced; induced, but not forced, into this sexual

relationship in order to obtain the prescriptions or money,

notwithstanding the testimony of S. M. to the contrary. By her

own admission, S. M. agreed to pay back the money once she

secured a job. Likewise, there is insufficient evidence to

establish facts to show that Dr. Mangilipudi was coerced into

this sexual relationship. By his own admission, Dr. Mangilipudi

was attracted to S. M. In fact, and again by his own admission,

Dr. Mangilipudi would respond favorably to any attention given to

him by an attractive young woman.

13. S. M.'s testimony that she had oral sex with

Dr. Mangilipudi in the examining room is just not credible,

considering the circumstances that existed in the office at that

time.

14. The sexual encounters between S. M. and

Dr. Mangilipudi were numerous (more than two times) and occurred

outside of the office in different motels in Lakeland, Florida,

when Dr. Mangilipudi could find time to meet S. M. during his

busy schedule. During this time when Dr. Mangilipudi and S. M.

were meeting at motels, Dr. Mangilipudi would write prescriptions

for the pain medicine and give them to S. M. to be filled.

15. In order to avoid detection for excessive prescribing

the drugs for S. M., Dr. Mangilipudi wrote prescriptions for the

drugs in the names of different members of S. M.'s family. These

family members were as follows : Janie Lukancich, Michelle

Lukancich, Laura Norton, Laura Van Buren, Laura Lukancich,

Jessica Koch and Johnny Moon. S. M. would present these

prescriptions at different pharmacies to be filled. Most of the

prescriptions were filed by pharmacies in Tampa, Florida.

However, some of the prescriptions were filled in Lakeland,

Florida, at the Jewett Pharmacy.

16. By an agreement dated November 11, 1997, S. M.

agreed not to send any of her friends or family to

Dr. Mangilipudi’s office for prescriptions or money, provided he

supply S. M. with Lorcet and Zanax for one year by calling in

prescriptions to a certain number in Tampa, Florida, every tenth

of the month for one year. It appears that Dr. Mangilipudi

complied with this agreement for a short period of time.

17. Eventually, S. M. broke off her sexual relationship

with Dr. Mangilipudi. However, by this time she had become

addicted to the pain medicine and proceeded to harass

Dr. Mangilipudi by threatening to tell his wife about their

sexual relationship and to report him to the Board for having

excessively prescribed pain medicine for her. S. M. demanded

that Dr. Mangilipudi help her pay for drug rehabilitation.

Eventually, their respective attorneys became involved and a

settlement was reached in the amount of $7,000.00.

Dr. Mangilipudi, through his attorney, paid S. M. the agreed-upon

amount of $7,000.00. However, S. M. continued to harass

Dr. Mangilipudi. S. M. eventually told Dr. Mangilipudi's wife

about the sexual relationship with Dr. Mangilipudi. S. M.

continued to harass Dr. Mangilipudi about money and drugs.

However, by this time, Dr. Mangilipudi decided that enough was

enough. Subsequently, Dr. Mangilipudi was forced into having

S. M. and her husband removed from his office by law enforcement.

S. M. continued to harass Dr. Mangilipudi.

18. Other than the limited physical examination conducted

during S. M.'s initial visit on December 23, 1996, there is

nothing in her medical records to indicate that Dr. Mangilipudi

conducted any type of physical for S. M. during any of her

subsequent visits.

1 9. In December 1998, S. M. reported Dr. Mangilipudi's

conduct to the Lakeland Police Department. As a result of this

report, Detective Terri Smith initiated an investigation into

Dr. Mangilipudi's medical practices. During this investigation,

Detective Smith employed a female confidential informant, B. T.,

and a female undercover police officer, Detective Sherry Doty,

who was known to Dr. Mangilipudi as C. C. Detective Doty will be

herein referred to as C. C.

20. During the course of the investigatio n, both B. T. and

C. C. wore monitoring devices during each of their appointments

with Dr. Mangilipudi, except possibly B. T. during her

appointment on October 26, 1999, since there is no surveillance

tape or transcript of a surveillance tape in the record for

October 26, 1999. Detective Sherri Smith recorded the

conversations between B. T. and Dr. Mangilipudi and C.C. and

Dr. Mangilipudi.

21. The tapes of the recorded conversations were

transcribed. However, there was substantial portions of the

recorded conversations that were inaudible.

22. B. T. reviewed the tapes of her visits with

Dr. Mangilipudi and found the audible portions of the tapes to

accurately reflect the conversations between her and

Dr. Mangilipudi. However, B. T. did not testify at the hearing

concerning the inaudible portions of the tapes.

23. C. C. reviewed the tapes of her visits with

Dr. Mangilipudi and found the audible portions of the tapes to

accurately reflect the conversations between her and

Dr. Mangilipudi. C. C. testified at the hearing concerning the

inaudible portions the tapes of her conversations with

Dr. Mangilipudi. However, her memory appeared to be somewhat

selective.

24. On September 22, 1999, B. T. had an appointment with

Dr. Mangilipudi. Dr. Mangilipudi advised B. T. that her blood

pressure was high. B. T. did not complain of having any backache

or headaches. However, Dr. Mangilipudi's medical records

indicate that on September 22, 1999, that B. T. complained of

having headaches. B. T. told Dr. Mangilipudi that she took

Lorcet, but not for pain. When Dr. Mangilipudi inquired of B. T.

why she took Lorcet when she did not have pain, B. T. responded

that the Lorcet made her feel "hot inside," made her "more

sexual," and that Lorcet did for her what viagra did for men.

Even though Dr. Mangilipudi advised B. T. that she should not

take Lorcet for that reason, he gave B. T. a prescription for

Lorcet and a prescription for Xanax on September 2, 1999, which

were filled at the Medicine Shoppe in Plant City, Florida.

Although Xanax is rarely used as an antidepressant ,

Dr. Mangilipudi apparently prescribed the Xanax for B. T. because

she stated that she was having trouble handling her mother's

death.

25. Xanax is the brand name for Alprazolam, a Schedule IV

substance, listed in Section 893.03(4)(a), Florida Statutes.

26. Dr. Mangilipudi's medical records indicate that B. T.

had an appointment with Dr. Mangilipudi on October 26, 1999.

There is no surveillance tape or a transcript of a surveillance

tape in the record for October 26, 1999. However ,

Dr. Mangilipudi wrote B. T. a prescription for Xanax and a

prescription for Lorcet. Although it appears from a copy of each

of the prescriptions that they were filled, the record does not

indicate where or when the prescriptions were filled.

Dr. Mangilipudi's medical records for October 26, 1999, indicate

that B. T. was suffering from headaches.

27. On November 10, 1999, B. T. had an appointment with

Dr. Mangilipudi and was accompanied by C. C. The purpose of

C. C.'s visit was get Dr. Mangilipudi to take C. C. on as a new

patient. C. C. was not seen professionally that day by

Dr. Mangilipudi. However, Dr. Mangilipudi did see B. T.

professionally that day. The only medical problem that B. T.

complained of during her appointment was a burn on her hand.

During her appointment with Dr. Mangilipudi, B. T. told him of a

friend of hers that did not have any medical problems but was

experiencing muscle cramps during sex and needed something for

this problem. Dr. Mangilipudi wrote B. T. a prescription for

Xanax, which was filled in Plant City, Florida, that same day.

28. On December 2, 1999, B. T. and C. C. returned to

Dr. Mangilipudi's office for appointments. During B. T.'s

appointment, she told Dr. Mangilipudi that she was doing good,

but asked that the Xanax and Lorcet prescriptions be increased.

Dr. Mangilipudi increased the amount of Lorcet even though B. T.

had not complained of any pain.

29. During C. C.'s appointment on December 2, 1999, C. C.

did not relate any medical problems or complaints to

Dr. Mangilipudi. However, C. C. did tell Dr. Mangilipudi that

she needed a refill of hydrocodone that had been prescribed for

her by doctors "up north" and that she liked the hydrocodone

because it made her feel better in that it relaxed her.

Dr. Mangilipudi did not write C. C. a prescription for

hydrocodone that day but did write C. C. a prescription for Xanax

(Alprazolam). Dr. Mangilipudi noted in C. C.'s medical records

that she suffered from insomnia. However, C. C. did not complain

of, nor did she suffer from insomnia, on December 2, 1999. There

were no other discussions during this appointment concerning

C. C.'s medical conditions

30. On January 5, 2000, B. T. and C. C. returned to

Dr. Mangilipudi's office for their appointments. During B. T.'s

appointment, B. T. did not relate any indications of pain to

Dr. Mangilipudi. Dr. Mangilipudi briefly discussed her weight

gain over the holidays and B. T.'s blood pressure.

Dr. Mangilipudi then wrote B. T. a prescription for both Xanax

and Lorcet.

31. Dr. Mangilipudi's medical records on B. T. for

January 5, 2000, indicate that B. T. complained of a headache and

a backache. There are no comments reflected in either the

surveillance tape for January 5, 2000, or the transcript of that

tape that would indicate that B. T. made any complaint about a

headache or backache.

32. During C. C.'s appointment with Dr. Mangilipudi on

January 5, 2000, C. C. advised Dr. Mangilipudi that she was

having trouble relaxing during sex and asked him about getting a

prescription for Lorcet and about the possibility of using

Viagra. C. C. did not complain of any pain problems. However,

Dr. Mangilipudi recorded in C. C.'s medical record that she

complained of a headache and a backache. Dr. Mangilipudi gave

C. C. a prescription for Xanax and samples of Viagra on this

date. There is insufficient evidence to establish facts to show

that Dr. Mangilipudi improperly caressed C. C.'s face, improperly

rubbed her back underneath her shirt, and attempted to kiss C. C.

during the January 5, 2000, visit, notwithstanding C. C.'s

testimony to the contrary which I find lacks credibility, in that

even though C. C. was a seasoned undercover police officer she

made no attempt to establish this fact on the tape.

33. On February 10, 2000, B. T. had an appointment with

Dr. Mangilipudi wherein he took B. T.'s blood pressure and spoke

briefly about her blood pressure. There was no other medically

related conversation during this appointment. Dr. Mangilipudi

then gave B. T. another prescription for Lorcet and Xanax.

Although Dr. Mangilipudi wrote in B. T.'s medical record that she

complained of a headache and backache, there is nothing in the

surveillance tape or the transcript of that tape to reflect that

B. T. complained of either a headache or backache.

34. On February 17, 2000, C. C. had another appointment

with Dr. Mangilipudi. No physical examination of C. C. was

conducted by Dr. Mangilipudi on February 17, 2000. C. C.

requested that her prescription for Lorcet be refilled. However,

instead, Dr. Mangilipudi gave her a prescription for Vicodin

(hydrocodone) and Xanax. Although Dr. Mangilipudi noted in

C. C.'s medical record that she had complained of headaches,

backaches, and anxiety attacks, C. C. testified that she did not

complain of any pain or anxiety during this time.

35. When a medical doctor is presented with a new patient,

the standard of care requires that a complete medical history be

taken, which includes the cause of any injuries, the types of

medication the patient is taking, a listing of any illness the

patient may have or is presently suffering from, a listing of any

medicine allergies, and a complete physical examination. The

physical examination should include the patient's eyes, ears,

neck, skin, chest, heart, lungs, back, extremities, abdomen, and

neurological examination ; after the physical examination is

completed, any necessary tests or X-rays would be ordered.

36. Based on the facts in respect to S. M.'s treatment by

Dr. Mangilipudi, the failure of Dr. Mangilipudi to perform a

complete physical examination at anytime before prescribing

medication, especially a Schedule II drug, or continuing to

prescribe medication without the benefit of a complete physical

examination constitutes the failure to practice medicine with

that level of care, skill, and treatment which is recognized by a

reasonably prudent similar physician as being acceptable under

similar conditions and circumstances.

37. Dr. Mangilipudi failed to keep adequate medical records

with regard to S. M. in that Dr. Mangilipudi's medical records do

not justify why he continued to keep S. M. on those particular

medications, state how he formulated his diagnosis, contain

notations of any side effects of the medications being prescribed

for S. M., nor contain a notation of advising S. M. of any

possible side effects of the medication being prescribed.

38. Dr. Mangilipudi inappropriatel y prescribed medication

for S. M. in that he continued to prescribe the same medication,

even though S. M. was not responding to the medication, and

increased the medication without any justification.

39. In respect to the facts surrounding Dr. Mangilipudi's

treatment of B. T., the failure to conduct a complete physical

examination of B. T. and prescribing pain medication when there

were no complaints of pain by the patient constitute the failure

to practice medicine with that level of care, skill, and

treatment which is recognized by a reasonably prudent similar

physician as being acceptable under similar conditions and

circumstances.

40. Dr. Mangilipudi failed to keep adequate medical records

with respect to B. T. in that he falsified the medical records to

reflect that a complete physical examination had been conducted

when, in fact, a complete physical examination had not been

conducted.

41. Dr. Mangilipudi inappropriately prescribed a controlled

substance to B. T. outside the course of the physician's

professional practice for no legitimate purpose in that he

prescribed the controlled substance (pain medication) when B. T.

had not complained of any pain.

42. In respect to the facts surrounding Dr. Mangilipudi's

treatment of C. C., the failure to conduct a complete physical

examination of C. C. and the prescribing of Vicodin, Xanax, and

giving samples Viagra without any legitimate medical reason

constitutes the failure to practice medicine with that level of

care, skill, and treatment which is recognized by a reasonably

prudent similar physician as being acceptable under similar

conditions and circumstances.

43. Dr. Mangilipudi failed to keep adequate medical records

with respect to C. C.'s treatment in that: (a)

Dr. Mangilipudi falsified C. C.'s medical records to reflect that

a complete physical examination had been conducted when, in fact,

he had only examined her eyes, ears, and heartbeat; and (b )

Dr. Mangilipudi did not document any medical reasons for

prescribing Vicodin and Xanax.

44. Dr. Mangilipudi inappropriately prescribed controlled

substances to C. C. in that he prescribed Vicodin and Xanax

without conducting a physical examination and for apparently no

legitimate medical purpose.

45. In respect to the facts concerning Dr. Mang ilipudi's

conduct with S. M., Dr. Mangilipudi exercised his influence

within a patient-physician relationship for the purpose of

engaging in sexual activity with S. M.

CONCLUSIONS OF LAW

46. The Division has jurisdiction over the parties and

subject matter of this proceeding pursuant to

Section 120.57(1), Florida Statutes.

47. The burden of proof is on the party asserting the

affirmative of an issue before an administrative tribunal,

Florida Department of Transportation v. J.W.C. Company, Inc. , 396

So. 2d 778 (Fla. 1st DCA 1981). The Board has the burden of

proof in this proceeding. To meet its burden, the Board must

establish facts upon which its allegations are based by clear and

convincing evidence. Department of Banking and Finance, Division

Securities and Investor Protection v. Osborne Stern Company , 670

So. 2d 932 (Fla. 1996) and Sections 120.57(1)(j) and 458.331(3),

Florida Statutes.

48. Section 458.331(1)(j)(m)(q)(t)(x), (2), Florida

Statutes, provides as follows:

Grounds for disciplinary action; action by

the board and department.

(1 ) The following acts shall constitute

grounds for which the disciplinary actions

specified in subsection (2) may be taken:

* * *

(j ) Exercising influence within a patient-

physician relationship for purposes of

engaging a patient in sexual activity. A

patient shall be presumed to be incapable of

giving free, full, and informed consent to

sexual activity with his or her physician.

* * *

(m ) Failing to keep legible, as defined by

department rule in consultation with the

board, medical records that identify the

licensed physician or the physician extender

and supervising physician by name and

professional title who is or are responsible

for rendering, ordering, supervising, or

billing for each diagnostic or treatment

procedure and that justify the course of

treatment of the patient, including, but not

limited to, patient histories; examination

results; test results; records of drugs

prescribed, dispensed, or administered; and

reports of consultations and

hospitalizations.

* * *

(q ) Prescribing, dispensing,

administering, mixing, or otherwise preparing

a legend drug, including any controlled

substance, other than in the course of the

physician's professional practice. For the

purposes of this paragraph, it shall be

legally presumed that prescribing,

dispensing, administering, mixing, or

otherwise preparing legend drugs, including

all controlled substances, inappropriately or

in excessive or inappropriate quantities is

not in the best interest of the patient and

is not in the course of the physician's

professional practice, without regard to his

or her intent.

* * *

(t ) Gross or repeated malpractice or the

failure to practice medicine with that level

of care, skill, and treatment which is

recognized by a reasonably prudent similar

physician as being acceptable under similar

conditions and circumstances . . . As used in

this paragraph, . . . "the failure to

practice medicine with that level of care,

skill, and treatment which is recognized by a

reasonably prudent similar physician as being

acceptable under similar conditions and

circumstances," shall not be construed so as

to require more than one instance, event, or

act. . . .

* * *

(x ) Violating any provision of this

chapter, a rule of the board or department,

or a lawful order of the board or department

previously entered in a disciplinary hearing

or failing to comply with a lawfully issued

subpoena of the department.

* * *

(2 ) When the board finds any person guilty

of any of the grounds set forth in subsection

(1) . . . it may enter an order imposing one

or more of the following penalties:

* * *

(b ) Revocation or suspension of a license.

(c ) Restriction of practice.

(d ) Imposition of an administrative fine

not to exceed $10,000 for each count or

separate offense.

(e ) Issuance of a reprimand

(f ) Placement of the physician on

probation for a period of time and subject to

such conditions as the board may specify,

including, but not limited to, requiring the

physician to submit to treatment, to attend

continuing education courses, to submit to

reexamination, or to work under the

supervision of another physician. (Emphasis

furnished.)

48. Section 458.329, Florida Statutes, provides as follows:

Sexual misconduct in the practice of

medicine .-The physician-patient relationship

is founded on mutual trust. Sexual

misconduct in the practice of medicine means

violation of the physician-patient

relationship through which the physician uses

said relationship to induce or attempt to

induce the patient to engage, or to engage or

attempt to engage the patient, in sexual

activity outside the scope of the practice or

the scope of generally accepted examination

or treatment of the patient. Sexual

misconduct in the practice of medicine is

prohibited . (Emphasis furnished.)

49. Rule 64B8-9.008(1)(2)(a )1.2.3., Florida Administrative

Code, provides in pertinent part as follows:

(1 ) Sexual contact with a patient is

sexual misconduct and is a violation of

Sections 458.329 and 458.331(1)(j), Florida

Statutes.

(2 ) For purposes of this rule, sexual

misconduct between a physician and a patient

includes, but is not limited to;

(a ) Sexual behavior or involvement with a

patient including verbal or physical behavior

which

1. may reasonably interpreted as romantic

involvement with a patient regardless of

whether such involvement occurs in the

professional setting or outside of it;

2. may reasonably be interpreted as

intended for the sexual arousal or

gratification of the physician, the patient

or any third party; or

3. may reasonably be interpreted by the

patient as being sexual. (Emphasis

furnished.)

50. The Board has demonstrated by clear and convincing

evidence that Dr. Mangilipudi in his treatment of S. M., B. T.,

and C. C. violated Subsections 458.331(1)(j)(m)(q)(t)and(x), and

Section 458.329, Florida Statutes, and Rule 64B8-9.008, Florida

Administrative Code, and is thereby subject to discipline under

Section 458.331(2), Florida Statutes.

RECOMMENDATION

Based on the foregoing findings of fact and conclusions of

law and having reviewed the Recommended Range of Penalty under

Rule 64B8-8.001(2), Florida Administrative Code, and Aggravating

and Mitigating Circumstances under Rule 6B8-8.001(3), Florida

Administrative Code, it is recommended that the Board enter a

final order finding Dr. Mangilipudi guilty of the charges

outlined in the Administrative Complaint and imposing the

following penalty : revocation of his license to practice

medicine in the State of Florida.

DONE AND ENTERED this 14th day of August, 2001, in

Tallahassee, Leon County, Florida.

___________________________________

WILLIAM R. CAVE

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 [phone]

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 14th day of August, 2001.

COPIES FURNISHED :

Kim M. Kluck, Esquire

Agency for Health Care Administration

Post Office Box 14229

Tallahassee, Florida 32317-4229

Jack T. Edmund, Esquire

1125 East Main Street

Bartow, Florida 33830-5004

Tanya Williams, Executive Director

Board of Medicine

Department of Health

Northwood Centre

1940 North Monroe Street

Tallahassee, Florida 32399-0750

William W. Large, General Counsel

Department of Health

4052 Bald Cypress Way

Bin A00

Tallahassee, Florida 32399-1701

Theodore M. Henderson, Agency Clerk

Department of Health

4052 Bald Cypress Way

Bin A00

Tallahassee, Florida 32399-1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit exceptions within 15 days

from the date of this Recommended Order. Any exceptions to this

Recommended Order should be filed with the agency that will issue

the Final Order in this case.