08-004285PL Department Of Health, Board Of Medicine vs. Lucien Armand, M.D.
 Status: Closed
Recommended Order on Wednesday, June 17, 2009.


View Dockets  
Summary: Respondent violated the statutes and rules alleged when he performed Level II surgery in an office not registered for such surgery.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8DEPARTMENT OF HEALTH, BOARD OF )

14MEDICINE, )

16)

17Petitioner, )

19)

20vs. ) Case Nos. 08-4285PL

25) DOH Case No. 2006-38439

30LUCIEN ARMAND, M.D., )

34)

35Respondent. )

37_________________________________)

38RECOMMENDED ORDER

40Pursuant to notice, a formal hearing was held in this case

51before Larry J. Sartin, an Administrative Law Judge of the

61Division of Administrative Hearings, on April 6, 2009, by video

71teleconference between Lauderdale Lakes and Tallahassee,

77Florida.

78APPEARANCES

79For Petitioner: Diane K. Kiesling

84Assistant General Counsel

87Robert A. Milne

90Assistant General Counsel

93Department of Health

964052 Bald Cypress Way, Bin C-65

102Tallahassee, Florida 32399-3265

105For Respondent: Sean Ellsworth, Esquire

110Ellsworth Law Firm, P.A.

1141501 Collins Avenue, Suite 208

119Miami Beach, Florida 33139

123STATEMENT OF THE ISSUES

127The issues for determination are whether Respondent Lucien

135Armand, M.D., violated Section 458.331(1)(v), Florida Statutes

142(2006); Section 458.331(1)(nn), Florida Statutes (2006), by

149violating Florida Administrative Code Rule 64B8-9.009(2) and

156(4), and Section 458.351, Florida Statutes (2006); Section

164458.331(1)(m), Florida Statutes (2006); and Section

170458.331(1)(t), Florida Statutes (2006), as alleged in an Amended

179Administrative Complaint filed by the Department of Health

187before the Board of Medicine on June 20, 2008; and, if so, what

200disciplinary action should be taken against his license to

209practice medicine in the State of Florida.

216PRELIMINARY STATEMENT

218This case began with the filing by the Department of Health

229before the Board of Medicine of a four-count Amended

238Administrative Complaint, DOH Case Number 2006-38439, against

245Respondent Lucien Armand, M.D., an individual licensed to

253practice medicine in Florida. On or about July 20, 2008,

263Respondent, through counsel, filed a Petition for Formal

271Administrative Hearing and an Election of Rights form signed by

281Respondent, disputing the allegations of fact contained in the

290Amended Administrative Complaint and requesting a formal

297administrative hearing pursuant to Sections 120.569(2)(a) and

304120.57(1), Florida Statutes (2008).

308On August 29, 2008, the matter was filed with the Division

319of Administrative Hearings with a request that an administrative

328law judge be assigned to conduct proceedings pursuant to Section

338120.57(1), Florida Statutes (2008). The matter was designated

346DOAH Case Number 08-4285PL and was assigned to the undersigned.

356This case was consolidated with another case involving the

365parties, DOAH Case No. 08-4403PL, DOH Case No. 2005-63004, by

375Order of Consolidation entered September 12, 2008. The two

384cases were consolidated for purposes of hearing only. A

393separate Recommended Order is being entered in DOAH Case No. 08-

4044403PL.

405The final hearing was scheduled to be held on November 7,

4162008, by video teleconference between sites in Miami and

425Tallahassee, Florida, by Notice of Hearing by Video

433Teleconference entered September 12, 2008. The hearing was re-

442scheduled twice at the request of Respondent.

449On March 20, 2009, the parties filed a Joint Pre-Hearing

459Stipulation, in which they identified certain facts and issues

468of law they agreed on. To the extent relevant, those agreed

479upon facts and issues of law have been included in this

490Recommended Order.

492On March 31, 2009, an Order Granting Petitioner’s Motion

501for Official Recognition was entered.

506During the final hearing, Petitioner presented the

513testimony of Melinda Gray, Patient W.C., Christian Birkedal,

521M.D., and Angela Potter. Petitioner’s Exhibits 1 through 3, 6,

531and 8 through 14 were admitted. Respondent testified on his own

542behalf and had one exhibit admitted.

548The two-volume Transcript of the final hearing was filed on

558April 24, 2009. By Notice of Filing Transcript entered the same

569day, the parties were informed that the Transcript had been

579filed and that their proposed recommended orders were to be

589filed on or by May 25, 2009. May 25, 2009, was a holiday, so

603proposed orders were actually required to be filed on or before

614May 26, 2009.

617Petitioner’s Proposed Recommended Order and Dr. Armand’s

624Memorandum in Support of a Recommended Order Dismissing

632Administrative Complaints were filed on May 26, 2009. The post-

642hearing proposals of both parties have been fully considered in

652rendering this Recommended Order.

656All references to Florida Statutes in this Recommended

664Order are to the 2006 version unless otherwise noted.

673FINDINGS OF FACT

676A. The Parties .

6801. Petitioner, the Department of Health (hereinafter

687referred to as the "Department"), is the agency of the State of

700Florida charged with the responsibility for the investigation

708and prosecution of complaints involving physicians licensed to

716practice medicine in Florida. § 20.43 and Chs. 456 and 458,

727Fla. Stat.

7292. Respondent, Lucien Armand, M.D., is, and was at the

739times material to this matter, a physician licensed to practice

749medicine in Florida, having been issued license number ME 33997.

7593. Dr. Armand is board-certified in general surgery by the

769American Board of Surgery.

7734. Dr. Armand’s mailing address of record at all times

783relevant to this matter was 2071 Southwest 52nd Way, Plantation,

793Florida 33317. At the times relevant, Dr. Armand practiced

802medicine at 4100 South Hospital Drive, Suite 108, Plantation,

811Florida 33317. The office at which Dr. Armand practiced

820medicine was located very close to Plantation General Hospital

829(hereinafter referred to as “Plantation”).

8345. Dr. Armand has been the subject of three prior

844disciplinary matters arising out of five separate cases.

852Penalties were imposed in those three disciplinary matters. The

861Department summarized those disciplinary matters in paragraph 37

869of its Proposed Recommended Order:

874In DPR Case Numbers 0019222, 0019123 and

8810091224, Respondent was fined, received a

887reprimand, and was required to complete 30

894hours of Continuing Medical Education (CME)

900in general vascular surgery and risk

906management within the surgical practice. In

912Case Number 94-10100, Respondent was

917required to submit to and comply with an

925evaluation at the University of Florida, to

932pay a fine, was reprimanded, was required to

940complete twenty hours of CME in general

947surgery in performing Laparoscopic

951Cholecystectomy, and was placed on Probation

957for two (2) years. In Case Number 1999-

96558474, Respondent was restricted from

970performing Level II or above office surgery

977as defined in Rule 64B8-9.009(1)(d), Florida

983Administrative Code, until the Respondent

988demonstrated to the Board that he had

995successfully completed the University of

1000Florida Comprehensive Assessment and

1004Remedial Education Service (UF C.A.R.E.S.)

1009course and complied with all

1014recommendations, was reprimanded, was placed

1019on probation for two (2) years, was required

1027to attend the Florida Medical Association

1033“Quality Medical Record Keeping for Health

1039Care Practitioners” course, was required to

1045perform 100 hours of community service, and

1052was required to reimburse the Department for

1059costs.

10606. Dr. Armand, who is 70 years of age, has been practicing

1072medicine for 46 years. He has practiced medicine in Florida

1082since 1979. During the eight months prior to the final hearing

1093of this matter, Dr. Armand was working in South Sudan pursuant

1104to contract with the United States State Department.

1112B. October 6, 2006, Surgery on Patient W.C .

11217. On September 14, 2006, Patient W.C. presented to

1130Dr. Armand and was diagnosed as having a slow-growing left

1140inguinal hernia.

11428. Dr. Armand scheduled Patient W.C. for surgical repair

1151of the inguinal hernia. The surgery was scheduled for

1160October 6, 2006, at Dr. Armand’s office and, at the request of

1172Patient W.C., under local sedation.

11779. At approximately 9:30 a.m., October 6, 2006, Patient

1186W.C. arrived as scheduled at Dr. Armand’s office, accompanied by

1196his wife and child. Patient W.C., who was not asked to execute

1208any paperwork concerning the operation, was taken into a room

1218where he was directed to lie down. There were two nurses in the

1231room.

123210. Patient W.C. was given one shot of some form near the

1244site of the procedure. This shot is the only medication he

1255remembers receiving. He denied any recollection of having

1263received medication intravenously, intramuscularly, or rectally.

126911. According to Dr. Armand, Patient W.C. was given “local

1279anesthesia, Xylocaine 1% and ½% during the procedure and I gave

1290some oral sedation, 10mg. of Valium, by mouth.” Page 171, Lines

130119-21, Vol. II, Transcript of Final Hearing.

130812. At some point during the surgery, Patient W.C.’s

1317intestines eviscerated, pushed themselves out through the

1324hernia, making the hernia impossible to repair in the office.

133413. Due to the evisceration of Patient W.C.’s intestines,

1343Dr. Armand eventually closed the incision and decided to

1352transport Patient W.C. to Plantation to complete the procedure.

1361Dr. Armand’s testimony that he closed and took patient W.C. to

1372Plantation because Patient W.C. began “fidgeting” is not

1380credited.

138114. While Patient W.C. did not have any clear recollection

1391of the surgery while at Dr. Armand’s office, he did recall that

1403“I was shaking myself and one of the nurses put something on my

1416head and I went to sleep.” Page 40, Lines 20-22, Vol. I,

1428Transcript of Final Hearing. Patient W.C. later indicated that

1437“[o]ne of the ladies sprayed something on my face,” at which

1449point Patient W.C. “went to sleep.” Page 41, Lines 23-24, and

1460Page 42, Line 8, Vol. I, Transcript of Final Hearing. Patient

1471W.C. did not remember anything else from this point in the

1482surgery until he awoke at approximately 2:00 p.m., October 6,

14922006, in a room at Plantation.

149815. Patient W.C. was transported to Plantation after he

1507“fell asleep” by Dr. Armand.

151216. When Patient W.C. arrived at the Plantation emergency

1521representation to the emergency room physician, Cornell

1528Calinescu, M.D., was described as “somewhat sedated secondary to

1537Valium and Clonidine.” Patient W. C. was also described by Dr.

1548Calinescu and an emergency room nurse as able to speak.

155817. Upon admission to Plantation, Dr. Armand performed

1566emergency surgery on Patient W.C. under general anesthesia,

1574completing the procedure he had begun in his office. The

1584surgery was completed without further complication.

159018. As noted above, Patient W.C. has no recollection of

1600arriving at the Plantation emergency room, how he got to the

1611hospital, or anything else that took place after falling asleep

1621in Dr. Armand’s office, until he awoke in a hospital room later

1633in the afternoon.

1636C. Dr. Armand’s Medical Records for the October 6, 2006,

1646Surgery .

164819. Dr. Armand’s office notes for Patient W.C. lack any

1658documentation as to what took place in his office on October 6,

16702006. Dr. Armand did not record the date of the procedure; the

1682type of procedure performed; pre-operative care; any drugs that

1691were prescribed, dispensed, and/or administered; the type and

1699dosage of anesthetic sedation used; or post-operative care.

170720. Dr. Armand’s medical records for Patient W.C. also

1716failed to include any informed consent for the procedure

1725performed on October 6, 2006.

173021. As noted above, Dr. Armand did complete an operative

1740report after the emergency surgery performed on Patient W.C. at

1750Plantation.

1751D. Office Surgery; Level of Anesthesia .

175822. Florida Administrative Code Rule 64B8-9.009

1764(hereinafter referred to as the “Office Surgery Rule”)

1772prescribes standards for the performance of office surgery. In

1781providing those standards, the Office Surgery Rule defines three

1790levels of sedation and the conditions under which each level may

1801be achieved and must be performed. Level II and Level III

1812office surgery require registration of the physician’s office to

1821perform. Dr. Armand’s office was not registered to perform

1830Level II or Level III office surgery at the times relevant to

1842this proceeding. Only the first and second levels of office

1852surgery are relevant to this case.

185823. Florida Administrative Code Rule 64B8-9.009(3)

1864describes the types of procedures appropriate for “Level I”

1873office surgery, which Dr. Armand has argued he performed on

1883Patient W.C., as follows:

18871. Minor procedures such as excision of

1894skin lesions, moles, warts, cysts, lipomas

1900and repair of lacerations or surgery limited

1907to the skin and subcutaneous tissue

1913performed under topical or local anesthesia

1919not involving drug-inducted alteration of

1924consciousness other than minimal pre-

1929operative tranquilization of the patient.

19342. Liposuction involving the removal of

1940less than 4000cc supernatant fat is

1946permitted.

19473. Incision and drainage of superficial

1953abscesses, limited endoscopies such as

1958proctoscopes, skin biopsies, arthrocentesis,

1962thoracentesis, paracentesis, dilation of

1966urethra, cysto-scopic procedures, and closed

1971reduction of simple fractures or small joint

1978dislocations (i.e., finger and toe joints).

1984. . . .

19885. Chances of complication requiring

1993hospitalization are remote.

199624. Florida Administrative Code Rule 64B8-9.009(4)

2002describes the types of procedures appropriate for “Level II”

2011office surgery, which the Department argues Dr. Armand utilized

2020on Patient W.C., as follows:

20251. Level II Office Surgery is that in

2033which peri-operative medication and sedation

2038are used intravenously, intramuscularly, or

2043rectally, thus making intra and post-

2049operative monitoring necessary. Such

2053procedures shall include, but not be limited

2060to : hemorrhoidectomy, hernia repair ,

2065reduction of simple fractures, large joint

2071dislocations, breast biopsies, colonoscopy,

2075and liposuction involving the removal of up

2082to 4000cc supernatant fat.

20862. Level II Office surgery includes any

2093surgery in which the patient is placed in a

2102state which allows the patient to tolerate

2109unpleasant procedures while maintaining

2113adequate cardiorespiratory function and the

2118ability to respond purposefully to verbal

2124command and/or tactile stimulation.

2128Patients whose only response is reflex

2134withdrawal from a painful stimulus are

2140sedated to a greater degree than encompassed

2147by this definition. [Emphasis added].

215225. While the Department relies in part upon the language

2162of Florida Administrative Code Rule 64B8-9.009(4) that “[s]uch

2170procedures shall include, but not be limited to . . . hernia

2182repair . . .” to support its argument that the procedure

2193performed by Dr. Armand on Patient W.C. was in fact performed as

2205Level II surgery, this reliance is misplaced. Regardless of the

2215proper interpretation of this language of the Rule (whether it

2225clearly puts physicians on notice that all hernia repair surgery

2235must be conducted as Level II surgery or not), at best it

2247establishes a proscription. Such a proscription, cannot,

2254however, be relied upon to establish the “fact” that Level II

2265surgery was performed or not. The question of whether Dr.

2275Armand performed the procedure defined as “Level II” office

2284surgery is the disputed issue of fact in this case. Resolving

2295this factual dispute requires an ultimate factual determination,

2303which involves the application of a legal standard (the Rule) to

2314the historical facts (what Dr. Armand actually did) as found by

2325the trier-of-fact based upon the evidence. The Rule is not

2335evidence of what Dr. Armand did; rather it is the yardstick

2346against which Dr. Armand’s conduct must be measured and,

2355ultimately, judged.

235726. The evidence either way concerning the level of

2366surgery performed by Dr. Armand consisted of his testimony

2375denying that Level II surgery was performed, the testimony of

2385Patient W.C. concerning his condition, the description of

2393Patient W.C.’s condition by emergency room personnel, and the

2402opinion of the Department’s expert witness, Christian Brikedal,

2410M.D., as to the level of surgery.

241727. Dr. Armand’s denial that he performed Level II surgery

2427was not convincing because it was inconsistent with the

2436patient’s description of his condition on October 6, 2006, and

2446the description of his condition by emergency room staff when

2456arrived at Plantation. Patient W.C. had no recollection of

2465going to the hospital or anything that transpired there until he

2476awoke at about 2:00 p.m. the afternoon of October 6, 2006.

2487Emergency room staff noted that Patient W.C. was able to talk

2498when he arrived. These facts, convincingly proved, are more

2507consistent with what constitutes Level II surgery: “the patient

2516is placed in a state which allows the patient to tolerate

2527unpleasant procedures while maintaining . . . the ability to

2537respond purposefully to verbal command and/or tactile

2544stimulation.” This finding is further supported by Dr. Brikedal

2553opinion that Patient W.C.’s condition was consistent with having

2562undergone Level II sedatopm.

256628. Dr. Brikedal, whose testimony was convincing and

2574uncontroverted, was asked the following question and gave the

2583following answer at Page 22, Lines 7-14, Vol. I, Transcript of

2594Final Hearing:

2596Q Assuming W.C. is going to testify that

2604as soon as the complication occurred that he

2612was put to sleep and didn’t wake up until he

2622was in the hospital, are you able to reach

2631any conclusions about the level of sedation

2638that occurred?

2640A He would have to have been given a

2649sedative I.V. or I.M. to be that sleepy.

2657This opinion, as to Patient W.C.’s condition on October 6, 2006,

2668supports a finding that Patient W.C. was under Level II

2678anesthesia while surgery was being performed in Dr. Armand’s

2687office. Having found that Patient W.C. was under the level of

2698sedation described in the definition of “Level II” office

2707surgery, leads inescapably to the finding that Dr. Armand

2716administered Level II sedation to Patient W.C.

272329. The foregoing finding is further supported by the

2732portion of the Office Surgery Rule quoted, supra , in finding of

2743fact 24. Dr. Brikedal explained during the hearing why it is

2754“appropriate and necessary to do an inguinal hernia repair” as

2764Level II surgery: “Sedation to the point that the patient’s

2774comfortable so they’re able to or they’re not pushing against

2784you, inhibiting you from performing this very safely.” Page 24,

2794Lines 20-22, Vol. I, Transcript of Final Hearing. As a board-

2805certified general surgeon who has previously registered and had

2814his office accredited as an office at which Level II surgery

2825could be performed, Dr. Armand must have been aware of why it is

2838prudent to perform hernia repairs as Level II surgery. While

2848Dr. Armand may have begun the surgery as Level I, when Patient

2860W.C.’s intestines eviscerated, Dr. Armand must have realized

2868that taking Patient W.C. to Level II sedation would give him a

2880better opportunity to correct the problem. Unfortunately for

2888Dr. Armand, it was too late.

2894E. Office Surgery Rule Procedures .

290030. Florida Administrative Code Rule 64B8-9.009(2)

2906prescribes requirements for conducting “office surgery,” taking

2914into account of the level of sedation utilized during a

2924procedure.

292531. The hernia repair performed by Dr. Armand on Patient

2935W.C. constituted “surgery” as defined in Florida Administrative

2943Code Rule 64B8-9.009(1). Performance of the surgery in Dr.

2952defined in Florida Administrative Code Rule 64B8-9.009(1)(d).

295932. The “office surgery” performed by Dr. Armand on

2968Patient W.C. failed to comply, as required, with all the

2978requirements of Florida Administrative Code Rule 64B8-9.009(2),

2985applicable to conducting Level II office surgery and, in some

2995instances, Level I office surgery:

3000a. Dr. Armand failed to “maintain complete records” of the

3010surgical procedure as required by Florida Administrative Code

3018Rule 64B8-9.003, or a written informed consent from the patient

3028as required by Florida Administrative Code Rule 64B8-

30369.009(2)(a)(applicable in part to Level I and Level II surgery);

3046b. No log of Level II surgery was kept as required by

3058Florida Administrative Code Rule 64B8-9.009(2)(c);

3063c. No adverse incident report was filed as required by

3073Florida Administrative Code Rule 64B8-9.009(2)(k). This portion

3080of the rule requires that “[t]he surgeon shall report to the

3091Department of Health any adverse incidents that occur within the

3101office surgical setting . . . .” (Emphasis added). This

3111requirement is separate from any requirement that a hospital

3120report adverse incidents and the burden of reporting is put

3130directly on the surgeon; and

3135d. Dr. Armand did not have an established risk management

3145program as required by Florida Administrative Code Rule 64B8-

31549.009(2)(j).

3155F. The Standard of Care .

316133. Dr. Birkedal provided an opinion to the Department and

3171testified at the final hearing as to whether Dr. Armand’s

3181treatment of Patient W.C. met the “level of care, skill, and

3192treatment which, in light of all relevant surrounding

3200circumstances, is recognized as acceptable and appropriate by

3208reasonably prudent similar health care providers . . . .”

3218(Hereinafter referred to as the “Standard of Care”).

322634. In his original opinion dated December 22, 2007,

3235Dr. Birkedal indicated that he did not believe that Dr. Armand’s

3246care of Patient W.C. violated the Standard of Care. There were

3257caveats or assumptions, however, which Dr. Birkedal recognized

3265in his written opinion could change his opinion if not correct.

3276In particular, at the time of his original opinion,

3285Dr. Birkedalk had incorrectly assumed that the procedure

3293performed on Patient W.C. was a Level I procedure. Dr. Birkedal

3304recognized in his original opinion that, if his assumption were

3314incorrect, that his opinion would change: “[i]f he did give an

3325IV sedative, then he may have violated the standard of care if

3337his office is not licensed to give IV sedatives.”

334635. At hearing, Dr. Birkedal was of the opinion that

3356Dr. Armand had not simply performed Level I surgery and,

3366therefore, opined that he had violated the Standard of Care

3376because his office was not a properly licensed office surgery

3386suite.

338736. Dr. Birkedal also offered other opinions at hearing

3396concerning what he perceived were violations of the Standard of

3406Care, but those “violations” were not alleged by the Department

3416in the Amended Administrative Complaint.

3421CONCLUSIONS OF LAW

3424A. Jurisdiction .

342737. The Division of Administrative Hearings has

3434jurisdiction over the subject matter of this proceeding and of

3444the parties thereto pursuant to Sections 120.569 and 120.57(1),

3453Florida Statutes (2008).

3456B. The Burden and Standard of Proof .

346438. The Department seeks to impose penalties against

3472Dr. Armand’s license through the Amended Administrative

3479Complaint that include suspension or revocation of his license

3488and/or the imposition of an administrative fine. Therefore, the

3497Department has the burden of proving the specific allegations of

3507fact that support its charge that Dr. Armand committed the

3517statutory and rule violations alleged in the Amended

3525Administrative Complaint by clear and convincing evidence.

3532Department of Banking and Finance, Division of Securities and

3541Investor Protection v. Osborne Stern and Co. , 670 So. 2d 932

3552(Fla. 1996); Ferris v. Turlington , 510 So. 2d 292 (Fla. 1987);

3563Pou v. Department of Insurance and Treasurer , 707 So. 2d 941

3574(Fla. 3d DCA 1998); Nair v. Department of Business and

3584Professional Regulation , 654 So. 2d 205 (Fla. 1st DCA 1995); and

3595§ 120.57(1)(j), Fla. Stat. (2008)("Findings of fact shall be

3605based on a preponderance of the evidence, except in penal or

3616licensure disciplinary proceedings or except as otherwise

3623provided by statute.").

362739. What constitutes "clear and convincing" evidence was

3635described by the court in Evans Packing Co. v. Department of

3646Agriculture and Consumer Services , 550 So. 2d 112, 116, n. 5

3657(Fla. 1st DCA 1989), as follows:

3663. . . [C]lear and convincing evidence

3670requires that the evidence must be found to

3678be credible; the facts to which the

3685witnesses testify must be distinctly

3690remembered; the evidence must be precise and

3697explicit and the witnesses must be lacking

3704in confusion as to the facts in issue. The

3713evidence must be of such weight that it

3721produces in the mind of the trier of fact

3730the firm belief or conviction, without

3736hesitancy, as to the truth of the

3743allegations sought to be established.

3748Slomowitz v. Walker , 429 So. 2d 797, 800

3756(Fla. 4th DCA 1983).

3760See also In re Graziano , 696 So. 2d 744 (Fla. 1997); In re

3773Davey , 645 So. 2d 398 (Fla. 1994); and Walker v. Florida

3784Department of Business and Professional Regulation , 705 So. 2d

3793652 (Fla. 5th DCA 1998)(Sharp, J., dissenting).

3800C. The Charges of the Amended Administrative Complaint .

380940. Section 458.331(1), Florida Statutes, authorizes the

3816Board of Medicine (hereinafter referred to as the "Board"), to

3827impose penalties ranging from the issuance of a letter of

3837concern to revocation of a physician's license to practice

3846medicine in Florida if a physician commits one or more acts

3857specified therein.

385941. The four-count Amended Administrative Complaint

3865alleges that Dr. Armand violated the following provisions of

3874Section 458.331(1), Florida Statutes, in his treatment of

3882Patient W.C.:

3884a. Count One: Section 458.331(1)(v), Florida Statutes;

3891b. Count Two: Section 458.331(1)(nn), Florida Statutes

3898(2006), by violating Florida Administrative Code Rule 64B8-

39069.009(2) and (4), and Section 458.351, Florida Statutes;

3914c. Count Three: Section 458.331(1)(m), Florida Statutes;

3921and

3922d. Count Four: Section 458.331(1)(t), Florida Statutes,

3929the Standard of Care.

393342. In determining whether Dr. Armand committed the

3941alleged statutory violations, only those specific factual

3948grounds alleged by the Department in the Amended Administrative

3957Complaint can form the basis of a finding of violation. See

3968Trevisani v. Department of Health , 908 So. 2d 1108 (Fla. 1st DCA

39802005); Cottrill v. Department of Insurance , 685 So. 2d 1371

3990(Fla. 1st DCA 1996). As the Department acknowledged in its

4000Proposed Recommended Order, “[d]ue process prohibits the

4007Department from taking disciplinary action against a licensee

4015based on matters not specifically alleged in the charging

4024instrument, unless those matters have been tried by consent.

4033See Shore Village Property Owners’ Association, Inc . v.

4042Department of Environmental Protection , 824 So. 2d 208, 210

4051(Fla. 4th DCA 2002); and Delk v. Department of Professional

4061Regulation , 595 So. 2d 966, 967 (Fla. 5th DCA 1992).”

4071D. Count One: Section 458.331(1)(v), Florida Statutes .

407943. Section 458.331(1)(v), Florida Statutes, defines the

4086following disciplinable offense:

4089(v) Practicing or offering to practice

4095beyond the scope permitted by law or

4102accepting and performing professional

4106responsibilities which the licensee knows or

4112has reason to know that he or she is not

4122competent to perform. The board may

4128establish by rule standards of practice and

4135standards of care for particular practice

4141settings, including, but not limited to,

4147education and training, equipment and

4152supplies, medications including anesthetics,

4156assistance of and delegation to other

4162personnel, transfer agreements,

4165sterilization, records, performance of

4169complex or multiple procedures, informed

4174consent, and policy and procedure manuals.

418044. In particular, the Amended Administrative Complaint

4187alleges that Dr. Armand violated this prohibition because he

4196“performed Level II office surgery on Patient W.C. by attempting

4206to perform a hernia repair in his office” in violation of the

4218Office Surgery Rule.

422145. The evidence proved clearly and convincingly that Dr.

4230Armand performed Level II surgery on Patient W.C. on October 6,

42412006, when he knew or should have known that such surgery was

4253beyond the scope of what he was authorized to do under the

4265Officer Surgery Rule because he was not licensed at the time to

4277perform Level II surgery in his office.

4284E. Count Two: Section 458.331(1)(nn), Florida Statutes .

429246. Section 458.331(1)(nn), Florida Statutes, defines the

4299following disciplinable offense:

4302(nn) Violating any provision of this

4308chapter or chapter 456, or any rules adopted

4316pursuant thereto.

431847. In particular, Count Two of the Amended Administrative

4327Complaint goes on to allege that Dr. Armand violated Florida

4337Administrative Code Rule 64B8-9.009(2) and (4), “by performing

4345Level II office surgery on Patient W.C. in Respondent’s office

4355without complying with the requirements of Rule 64B8-9.009 as to

4365informed consent, staffing, equipment, crash cart, medications,

4372and assistance of other personnel.”

437748. While the Department admits that it failed to prove

4387whether Dr. Armand violated the standards of the Office Surgery

4397Rule concerning staffing, equipment, crash cart, medications,

4404and assistance of other personnel on October 6, 2006, it did

4415prove that Dr. Armand failed to obtain an informed consent from

4426Patient W.C.

442849. The Department’s suggestion that Dr. Armand’s failure

4436to file an adverse incident report as required by the Office

4447Surgery Rule in violation of Section 458.331(nn), Florida

4455Statutes, is rejected as a basis for discipline because the

4465Department did not specifically make this allegation in the

4474Amended Administrative Complaint. The only allegation in Count

4482Two of the Amended Administrative Complaint concerning Dr.

4490Armand’s failure to file an adverse incident report was based

4500upon Section 458.351, Florida Statutes.

450550. It is alleged that Dr. Armand violated Section

4514458.331(nn), Florida Statutes, by having violated Section

4521458.351, Florida Statutes, “by failing to file an adverse

4530incident report regarding the incident involving Patient W.C.”

4538Section 458.351, Florida Statutes, provides, in pertinent part,

4546the following:

4548(1) Any adverse incident that occurs on

4555or after January 1, 2000, in any office

4563maintained by a physician for the practice

4570of medicine which is not licensed under

4577chapter 395 must be reported to the

4584department in accordance with the provisions

4590of this section.

4593(2) Any physician or other licensee under

4600this chapter practicing in this state must

4607notify the department if the physician or

4614licensee was involved in an adverse incident

4621that occurred on or after January 1, 2000,

4629in any office maintained by a physician for

4637the practice of medicine which is not

4644licensed under chapter 395.

4648(3) The required notification to the

4654department must be submitted in writing by

4661certified mail and postmarked within 15 days

4668after the occurrence of the adverse

4674incident.

4675. . . .

467951. While not excusing his failure, the evidence did prove

4689that Dr. Armand’s failure to file an adverse incident report is

4700somewhat mitigated by the fact that the hospital filed one.

471052. The evidence proved clearly and convincingly that Dr.

4719Armand failed to file an adverse incident report as required by

4730Section 458.351, Florida Statutes.

4734F. Count Three; Violation of Section 458.331(1)(m),

4741Florida Statutes .

474453. Section 458.331(1)(m), Florida Statutes, defines the

4751following disciplinable offense:

4754Failing to keep legible, as defined by

4761department rule in consultation with the

4767board, medical records that identify the

4773licensed physician or the physician extender

4779and supervising physician by name and

4785professional title who is or are responsible

4792for rendering, ordering, supervising, or

4797billing for each diagnostic or treatment

4803procedure and that justify the course of

4810treatment of the patient, including, but not

4817limited to, patient histories; examination

4822results; test results; records of drugs

4828prescribed, dispensed, or administered; and

4833reports of consultations and

4837hospitalizations.

483854. In the Amended Administrative Complaint it is alleged

4847that Dr. Armand failed to keep adequate medical records in

4857violation of Section 458.331(m), Florida Statutes, in that he

4866failed to document one or more of the following:

4875a. A record of the procedure performed;

4882b. The date the procedure was performed;

4889c. A record of the drugs prescribed,

4896dispensed or administered;

4899d. The type and dosage of anesthetic

4906sedation used during the procedure;

4911e. The pre-operative and post-operative

4916care provided;

4918f. The informed consent;

4922g. The adverse incident report.

4927The Department proved clearly and convincingly that Dr. Armand

4936failed to keep medical records documenting these matters as

4945alleged in the Amended Administrative Complaint.

495155. The evidence proved clearly and convincingly that Dr.

4960Armand failed to keep medical records as alleged in the Amended

4971Administrative Complaint in violation of Section 458.331(1)(m),

4978Florida Statutes.

4980G. Count Four: Violation of Section 458.331(1)(t), Florida

4988Statutes .

499056. Section 458.331(1)(t), Florida Statutes, defines, in

4997part, the following disciplinable offense:

5002Committing medical malpractice as defined in

5008s. 456.50. The board shall give great

5015weight to the provisions of s. 766.102 when

5023enforcing this paragraph. Medical

5027malpractice shall not be construed to

5033require more than one instance, event, or

5040act.

504157. Section 456.50(1)(g), Florida Statutes, defines

5047medical malpractice as follows:

5051. . . the failure to practice medicine in

5060accordance with the level of care, skill,

5067and treatment recognized in general law

5073related to health care licensure. Only for

5080the purpose of finding repeated medical

5086malpractice pursuant to this section, any

5092similar wrongful act, neglect, or default

5098committed in another state or country which,

5105if committed in this state, would have been

5113considered medical malpractice as defined in

5119this paragraph, shall be considered medical

5125malpractice if the standard of care and

5132burden of proof applied in the other state

5140or country equaled or exceeded that used in

5148this state.

515058. Section 456.50(1)(e), Florida Statutes, defines “level

5157of care, skill, and treatment recognized in general law related

5167to Section 766.102, Florida Statutes, which defines the Standard

5176of Care as “[t]he prevailing professional standard of care for a

5187given health care provider shall be that level of care, skill,

5198and treatment which, in light of all relevant surrounding

5207circumstances, is recognized as acceptable and appropriate by

5215reasonably prudent similar health care providers.”

522159. In paragraph 39 of the Amended Administrative

5229Complaint, it is alleged that Dr. Armand violated the Standard

5239of Care in his treatment of Patient W.C. in one or more of the

5253following ways:

5255a. By performing inguinal hernia surgery

5261in his office in violation of Rule 64B8-

5269[9].009, FAC;

5271b. By violating Rule 64B8-9.009, FAC, by

5278performing invasive office surgery in an

5284office;

5285c. By administering sedation that

5290prevented the patient from signing the

5296necessary consent to the emergency surgery;

5302d. By failing to document his

5308preoperative, post operative, or operative

5313actions or anesthetic;

5316e. By failing to file an adverse incident

5324report as required by Section 458.351,

5330Florida Statutes (2006);

5333f. By failing to meet the Standards of

5341Practice and Care established by the Board

5348of Medicine in Rule 64B8-9.009, FAC.

535460. The alleged Standard of Care violations of paragraphs

536339a. and b. are essentially the same: Dr. Armand performed

5373surgery in his office in violation of the Office Surgery Rule.

5384The allegations of paragraphs 39c. and d. are more specific

5394failures on the part of Dr. Armand to follow the requirements of

5406the Office Surgery Rule. The allegation of paragraph 39f.

5415simply summarizes the allegations of paragraphs 39 a., b., c.

5425and d. The allegation of paragraph 39e. is the only allegation

5436that does not specifically turn on adherence to the Office

5446Surgery Rule.

544861. The Department has pointed out in its Proposed

5457Recommended Order that the Office Surgery Rule itself

5465establishes the Standard of Care. The Office Surgery Rule is

5475titled “Standard of Care for Office Surgery” and it prescribes

5485what the Board considers the prevailing professional standard of

5494care for any health care provider performing office surgery.

5503The Department’s interpretation of its own rule is persuasive

5512and is accepted.

551562. The Department next argues that Dr. Armand violated

5524the Standard of Care by failing to comply with the Office

5535Surgery Rule. Clearly and convincingly, Dr. Armand performed

5543Whether the surgery was performed at Level I or Level II, it was

5556performed in his office and he was required to comply with all

5568relevant portions of the Office Surgery Rule. His failure to do

5579so constituted a violation of the Office Surgery Rule and,

5589consequently, a violation of the Standard of Care.

559763. Again, regardless of the level of the surgery

5606performed, it was proved clearly and convincingly that he

5615performed “inguinal hernia surgery in his office in violation of

5625Rule 64B8-[9].009, FAC” and that he violated “Rule 64B8-9.009,

5634FAC, by performing invasive office surgery in an office” as

5644alleged in the Amended Administrative Complaint.

565064. The Department also proved, again without regard to

5659the level of the surgery performed, that Dr. Armand failed to

5670document his preoperative, post-operative, or operative actions

5677or anesthetic as required by the Office Surgery Rule.

568665. The Department failed to prove, however, that failure

5695to comply with Section 458.351, Florida Statutes, while a

5704violation of Section 456.331(nn), Florida Statutes, constitutes

5711a violation of the Standard of Care. The Office Surgery Rule,

5722while also requiring that adverse incident reports be filed,

5731does not refer to Section 358.351, Florida Statutes, and the

5741Department did not specifically allege in support of the charged

5751violation of the Standard of Care that Dr. Armand’s failure to

5762file the report violated any provision other than Section

5771458.351, Florida Statutes.

577466. In addition to alleging that Dr. Armand violated the

5784Standard of Care by failing to adhere to the requirements of the

5796Office Surgery Rule, the Department has argued in its Proposed

5806Recommended Order that Dr. Brikedal’s opinions at hearing

5814support a finding that the Standard of Care was violated

5824independent of the Office Surgery Rule. While Dr. Brikedal’s

5833testimony does support such a finding, the allegations of the

5843Amended Administrative Complaint concerning the Standard of Care

5851did not put Dr. Armand on notice that he was being charged with

5864any violation of the Standard of Care other than his failure to

5876comply with the Office Surgery Standard.

588267. The Department has proved clearly and convincingly

5890that Dr. Armand violated the Standard of Care as alleged in

5901Count Four of the Amended Administrative Complaint as more

5910specifically alleged in paragraph 39.a., b., c., d., and f. of

5921the Amended Administrative Complaint.

5925F. The Appropriate Penalty .

593068. In determining the appropriate punitive action to

5938recommend to the Board in this case, it is necessary to consult

5950the Board's "disciplinary guidelines," which impose restrictions

5957and limitations on the exercise of the Board's disciplinary

5966authority under Section 458.331, Florida Statutes. See Parrot

5974Heads, Inc. v. Department of Business and Professional

5982Regulation , 741 So. 2d 1231 (Fla. 5th DCA 1999).

599169. The Board's guidelines are set out in Florida

6000Administrative Code Rule 64B8-8.001(2), which provides for the

6008following range of penalties:

6012a. For a violation of Section 458.331(1)(v), Florida

6020Statutes: from two years' suspension to revocation and an

6029administrative fine from $1,000.00 to $10,000.00;

6037b. For a violation of Section 458.331(1)(nn), Florida

6045Statutes, second offense: from probation to revocation and an

6054administrative fine from $5,000.00 to $10,000.00;

6062c. For a violation of Section 458.331(1)(m), Florida

6070Statutes, second offense: from probation to suspension followed

6078by probation and an administrative fine of from $5,000.00 to

6089$10,000.00; and

6092d. For a violation of Section 458.331(1)(t), Florida

6100Statutes, second offense: from two years' probation to

6108revocation and an administrative fine from $5,000.00 to

6117$10,000.00

611970. Florida Administrative Code Rule 64B8-8.001(3)

6125provides that, in applying the penalty guidelines, the following

6134aggravating and mitigating circumstances are to be taken into

6143account:

6144(3) Aggravating and Mitigating

6148Circumstances. Based upon consideration of

6153aggravating and mitigating factors present

6158in an individual case, the Board may deviate

6166from the penalties recommended above. The

6172Board shall consider as aggravating or

6178mitigating factors the following:

6182(a) Exposure of patient or public to

6189injury or potential injury, physical or

6195otherwise: none, slight, severe, or death;

6201(b) Legal status at the time of the

6209offense: no restraints, or legal

6214constraints;

6215(c) The number of counts or separate

6222offenses established;

6224(d) The number of times the same offense

6232or offenses have previously been committed

6238by the licensee or applicant;

6243(e) The disciplinary history of the

6249applicant or licensee in any jurisdiction

6255and the length of practice;

6260(f) Pecuniary benefit or self-gain

6265inuring to the applicant or licensee;

6271(g) The involvement in any violation of

6278Section 458.331, Florida Statutes, of the

6284provision of controlled substances for

6289trade, barter or sale, by a licensee. In

6297such cases, the Board will deviate from the

6305penalties recommended above and impose

6310suspension or revocation of licensure;

6315(h) Any other relevant mitigating

6320factors.

632171. In its Proposed Recommended Order, the Department has

6330suggested that there are no mitigating circumstances and the

6339following aggravating circumstances in this case:

6345Based on the previous serious disciplinary

6351history of the Respondent, including

6356multiple violations of the standard of care,

6363the fact that W.C. was exposed to potential

6371harm, the fact that this is a four count

6380complaint, and because Respondent has been

6386disciplined in three previous cases for the

6393violation of Section 458.331(1)(m), Florida

6398Statutes, and on five previous occasions (in

6405seven cases) for violation of Section

6411458.331(1)(t), Florida Statutes, the level

6416of aggravating factors is high. . . .

6424This summary of aggravating circumstances is accurate.

643172. The Department overlooks, however, that, while there

6439was “potential” for harm to Patient W.C., in fact the surgery

6450ultimately was concluded without any actual physical harm to

6459Patient W.C. The Department also has failed to acknowledge the

6469fact that the violations concerning Dr. Armand’s failure to file

6479an adverse incident report are mitigated by the fact that the

6490hospital filed one. Finally, consideration should be given to

6499the fact that Dr. Armand has ceased performing Level II and

6510Level III surgery in an office setting and that he has

6521effectively closed his office practice.

652673. The Department has requested that it be recommended

6535that Dr. Armand’s medical license be revoked. As an

6544alternative, the Board may want to consider suspending Dr.

6553Armand’s right to practice medicine in Florida, while allowing

6562him keep his Florida medical license in order for him to

6573continue to practice medicine outside the United States through

6582his relationship with the United States Department of State.

6591Such an arrangement should be conditioned upon full disclosure

6600to the United States Department of State and should be

6610considered only if his continued licensure is a condition of his

6621employment by the United States Department of State.

6629RECOMMENDATION

6630Based on the foregoing Findings of Fact and Conclusions of

6640Law, it is

6643RECOMMENDED that the a final order be entered by the Board

6654of Medicine finding that Lucien Armand M.D., has violated

6663Section 458.331(1)(v), Florida Statutes (2006); Section

6669458.331(1)(nn), Florida Statutes (2006), by violating Florida

6676Administrative Code Rule 64B8-9.009 and Section 458.351, Florida

6684and Section 458.331(1)(t), Florida Statutes, to the extent found

6693in this Recommended Order; and indefinitely suspending his

6701license to practice medicine in Florida, but allowing him to

6711continue to practice medicine outside the United States through

6720his relationship with the United States Department of State

6729after full disclosure of the Board’s final order to the United

6740States Department of State. Should a medical license not be a

6751condition of employment by the United States Department of

6760State, his license should be revoked.

6766DONE AND ENTERED this 17th day of June, 2009, in

6776Tallahassee, Leon County, Florida.

6780___________________________________

6781LARRY J. SARTIN

6784Administrative Law Judge

6787Division of Administrative Hearings

6791The DeSoto Building

67941230 Apalachee Parkway

6797Tallahassee, Florida 32399-3060

6800(850) 488-9675 SUNCOM 278-9675

6804Fax Filing (850) 921-6847

6808www.doah.state.fl.us

6809Filed with the Clerk of the

6815Division of Administrative Hearings

6819this 17th day of June, 2009.

6825COPIES FURNISHED:

6827Diane Kiesling

6829Assistant General Counsel

6832Robert A. Milne

6835Assistant General Counsel

6838Department of Health

68414052 Bald Cypress Way, Bin C-65

6847Tallahassee, Florida 32399-3265

6850Sean Ellsworth, Esquire

6853Ellsworth Law Firm, P.A.

68571501 Collins Avenue, Suite 208

6862Miami Beach, Florida 33139

6866Larry McPherson, Executive Director

6870Board of Medicine

6873Department of Health

68764052 Bald Cypress Way

6880Tallahassee, Florida 32399-1701

6883Josefina M. Tamayo, General Counsel

6888Department of Health

68914052 Bald Cypress Way, Bin A02

6897Tallahassee, Florida 32399-1701

6900Dr. Ana M. Viamonte Ros, Secretary

6906Department of Health

69094052 Bald Cypress Way, Bin A00

6915Tallahassee, Florida 32399-1701

6918R. S. Power, Agency Clerk

6923Department of Health

69264052 Bald Cypress Way, Bin A-02

6932Tallahassee, Florida 32399-1701

6935NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

6941All parties have the right to submit written exceptions within

695115 days from the date of this recommended order. Any exceptions

6962to this recommended order should be filed with the agency that

6973will issue the final order in these cases.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 09/03/2009
Proceedings: Response to Dr. Armand's Exceptions to the Recommended Order filed.
PDF:
Date: 09/03/2009
Proceedings: Dr. Armand's Exceptions to the Administrative Law Judge's Recommended Orders filed.
PDF:
Date: 08/31/2009
Proceedings: Final Order filed.
PDF:
Date: 08/27/2009
Proceedings: Agency Final Order
PDF:
Date: 06/17/2009
Proceedings: Recommended Order
PDF:
Date: 06/17/2009
Proceedings: Recommended Order (hearing held April 6, 2009). CASE CLOSED.
PDF:
Date: 06/17/2009
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 05/26/2009
Proceedings: (Petitioner's) Proposed Recommended Order (filed in Case No. 08-004403PL).
PDF:
Date: 05/26/2009
Proceedings: (Petitioner's) Proposed Recommended Order filed.
PDF:
Date: 05/26/2009
Proceedings: Dr. Armand's Memorandum in Support of a Recommended Order Dismissing Administrative Complaints filed.
PDF:
Date: 04/24/2009
Proceedings: Notice of Filing Transcript.
Date: 04/24/2009
Proceedings: Transcript of Final Hearing (Volumes I&2) filed.
PDF:
Date: 04/13/2009
Proceedings: Notice of Filing (Respondent`s Exhibit 1, exhibit not available for viewing) filed.
Date: 04/06/2009
Proceedings: CASE STATUS: Hearing Held.
PDF:
Date: 03/31/2009
Proceedings: (Petitioner`s) Exhibit List (exhibits not available for viewing) filed.
PDF:
Date: 03/31/2009
Proceedings: (Petitioner`s) Witness List filed.
PDF:
Date: 03/31/2009
Proceedings: Notice of Filing Petitioner`s Exhibits filed.
PDF:
Date: 03/31/2009
Proceedings: Order Granting Petitioner`s Motion for Official Recognition.
PDF:
Date: 03/20/2009
Proceedings: Joint Prehearing Stipulation filed.
PDF:
Date: 03/17/2009
Proceedings: Notice of Taking Telephonic Deposition of Witness in Lieu of Live Testimony filed.
PDF:
Date: 03/16/2009
Proceedings: Petitioner`s Motion for Leave to Take Telephonic Deposition filed.
PDF:
Date: 03/13/2009
Proceedings: Petitioner`s Motion for Official Recognition filed.
PDF:
Date: 03/06/2009
Proceedings: Notice of Appearance of Co-counsel (of R. Milne) filed.
PDF:
Date: 01/09/2009
Proceedings: Order Granting Continuance and Re-scheduling Hearing by Video Teleconference (hearing set for April 6, 2009; 9:30 a.m.; Lauderdale Lakes and Tallahassee, FL).
PDF:
Date: 01/08/2009
Proceedings: Joint Response to Request for Dates for Rescheduled Hearing filed.
PDF:
Date: 01/05/2009
Proceedings: Respondent`s Reply to Department`s Opposition to Motion for Continuance filed.
PDF:
Date: 01/05/2009
Proceedings: Response in Opposition to Respondent`s Motion for Continuance filed.
PDF:
Date: 01/05/2009
Proceedings: Respondent`s Motion for Continuance filed.
PDF:
Date: 12/30/2008
Proceedings: Notice of Taking Depsoition (of D. Conn) filed.
PDF:
Date: 12/23/2008
Proceedings: Corrected Notice of Taking Deposition in Lieu of Live Testimony filed.
PDF:
Date: 12/23/2008
Proceedings: Notice of Taking Deposition in Lieu of Live Testimony filed.
PDF:
Date: 12/22/2008
Proceedings: Notice of Taking Deposition Duces Tecum (of C. Birkedal) filed.
PDF:
Date: 11/18/2008
Proceedings: Order Directing Filing of Exhibits
PDF:
Date: 10/30/2008
Proceedings: Notice of Serving Petitioner`s Response to Respondent`s First Set of Interrogatories filed.
PDF:
Date: 10/16/2008
Proceedings: Order Granting Continuance and Re-scheduling Hearing by Video Teleconference (hearing set for January 26, 2009; 9:30 a.m.; Lauderdale Lakes and Tallahassee, FL).
PDF:
Date: 10/14/2008
Proceedings: Respondent`s Unnopposed Motion for Continuance filed.
PDF:
Date: 10/08/2008
Proceedings: Notice of Change of Address filed.
PDF:
Date: 10/01/2008
Proceedings: Lucien Armand, M.D.`s Objection to Petitioner`s Request for Admissions & Interrogatories 6-20 filed.
PDF:
Date: 10/01/2008
Proceedings: Respondent, Lucien Armand, M.D.`s Notice of Serving First Set of Interrogatories filed.
PDF:
Date: 09/22/2008
Proceedings: Order Granting Motion to Consolidate Pleadings.
PDF:
Date: 09/15/2008
Proceedings: Amended Notice of Hearing by Video Teleconference (hearing set for November 7, 2008; 9:30 a.m.; Lauderdale Lakes and Tallahassee, FL; amended as to Amended as to issues).
PDF:
Date: 09/12/2008
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 09/12/2008
Proceedings: Notice of Hearing by Video Teleconference (hearing set for November 7, 2008; 9:30 a.m.; Lauderdale Lakes and Tallahassee, FL).
PDF:
Date: 09/12/2008
Proceedings: Order of Consolidation (DOAH Case Nos. 08-4285PL and 08-4403PL).
PDF:
Date: 09/12/2008
Proceedings: Motion to Consolidate filed.
PDF:
Date: 09/08/2008
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 09/04/2008
Proceedings: Notice of Appearance of Co-counsel filed.
PDF:
Date: 09/03/2008
Proceedings: Notice of Serving Petitioner`s First Request for Production, First Request for Interrogatories and First Request for Admissions to Respondent filed.
PDF:
Date: 09/02/2008
Proceedings: Initial Order.
PDF:
Date: 08/29/2008
Proceedings: Amended Administrative Complaint filed.
PDF:
Date: 08/29/2008
Proceedings: Election of Rights filed.
PDF:
Date: 08/29/2008
Proceedings: Petition for Formal Administrative Hearing filed.
PDF:
Date: 08/29/2008
Proceedings: Notice of Appearance (filed by D. Kiesling).
PDF:
Date: 08/29/2008
Proceedings: Agency referral filed.

Case Information

Judge:
LARRY J. SARTIN
Date Filed:
08/29/2008
Date Assignment:
09/02/2008
Last Docket Entry:
09/03/2009
Location:
Lauderdale Lakes, Florida
District:
Southern
Agency:
ADOPTED IN TOTO
Suffix:
PL
 

Counsels

Related DOAH Cases(s) (3):

Related Florida Statute(s) (7):

Related Florida Rule(s) (3):