10-001678PL Department Of Health, Board Of Medicine vs. John D. Campbell, M.D. Status: Closed Recommended Order on Wednesday, July 28, 2010.

Summary: Doctor was unable to practice medicine with reasonable skill and safety by reason of illness and mental and physical condition.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD OF )

MEDICINE, )

)

Petitioner, )

)

vs. ) Case No. 10-1678PL

)

JOHN D. CAMPBELL, M.D., )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a final hearing was held in this case

by video teleconference on April 22 and 29, 2010, in Lakeland

and Tallahassee, Florida, before Susan B. Harrell, a designated

Administrative Law Judge of the Division of Administrative

Hearings.

APPEARANCES

For Petitioner: Robert Anthonie Milne, Esquire

Ephraim Livingston, Esquire

Department of Health

Prosecution Services Unit

4052 Bald Cypress Way, Bin C-65

Tallahassee, Florida 32399

For Respondent: John D. Campbell, M.D., pro se

5805 Spirit Lake Road

Winter Haven, Florida 33880

STATEMENT OF THE ISSUES

The issues in this case are whether Respondent violated

Subsection 458.331(1)(s), Florida Statutes (2009), 1 and, if so,

what discipline should be imposed.

PRELIMINARY STATEMENT

On March 16, 2010, the Department of Health (Department),

filed an Administrative Complaint before the Board of Medicine

(Board), alleging that Respondent, John D. Campbell, M.D.

(Dr. Campbell), had violated Subsection 458.331(1)(s), Florida

Statutes, “by being unable to practice medicine with reasonable

skill and safety to patients by reason of illness or use of

alcohol, drugs, narcotics, chemicals, or any other type of

material or as a result of any mental or physical condition.”

At the time the Administrative Complaint was issued,

Dr. Campbell was under an Emergency Suspension Order.

Dr. Campbell requested an administrative hearing, and the case

was forwarded to the Division of Administrative Hearings for

assignment to an Administrative Law Judge.

The final hearing was commenced on April 22, 2010, by video

teleconference. During the hearing, the undersigned sua sponte

continued the final hearing to allow Dr. Campbell to complete

his discovery and to allow Petitioner to depose Dr. Campbell’s

previously undisclosed witnesses. The final hearing was

recommenced on April 29, 2010.

At the final hearing, the Department called James K.

Hampton as its witness. Petitioner’s Exhibits A through I; the

depositions of Dano A. Leli, M.D., Ann Tyson, M.D., and

Dr. Campbell; and exhibits to the depositions were admitted in

evidence. Dr. Campbell testified in his own behalf and called

Jerome Gropper, M.D., and James K. Hampton as his witnesses.

Respondent’s Exhibits 8, 8A, 10, 15, 15B, and 16 were admitted

in evidence. Respondent’s Exhibit 17 was not admitted in

evidence. Joint Exhibits 1 2 and 2 were admitted in evidence.

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

May 18, 2010. At the final hearing, the parties agreed to file

their proposed recommended orders within 20 days of the filing

of the Transcripts. On June 7, 2010, Petitioner filed a motion

to extend the time for filing proposed recommended orders for an

additional day. The motion was granted, and the time for filing

proposed recommended orders was extended to June 8, 2010. Both

parties filed proposed recommended orders, which have been

considered in the preparation of this Recommended Order.

FINDINGS OF FACT

1. The Department is the state agency charged with

regulating the practice of medicine in Florida pursuant to

Chapters 456 and 458 and Section 20.43, Florida Statutes.

2. At all times material to this Administrative Complaint,

Dr. Campbell was a licensed physician in the State of Florida,

having been issued license number ME 34315.

3. Dr. Campbell has suffered two motor vehicle accidents

which resulted in closed-head injuries and has sustained damage

to his brain resulting from hypoxia from cervical spine surgery.

He has some residual effects from his injuries such as some

word-finding problems, a tendency to cry easily, trouble with

his dexterity, and taking longer than normal to make a point.

He takes medications for his brain injuries, including Exelon

and Muvigil.

4. In or around January of 2005, Dr. Campbell self-

contacted Professional Resource Network (PRN), which is the

impaired practitioner’s program for the Board of Medicine

pursuant to Section 456.076, Florida Statutes. PRN is a program

that monitors the evaluation, care, and treatment of impaired

healthcare professionals. PRN oversees random drug screens and

provides for the exchange of information between treatment

providers and the Department for the protection of the public.

5. In or around November 2005, it was concluded that

Dr. Campbell’s then-current cognitive abilities were sufficient

to practice medicine safely based on completing the Special

Purpose Examination (SPEX). The SPEX is a computerized,

multiple-choice examination of current knowledge used by state

medical boards to re-examine a licensed or previously-licensed

physician’s ongoing level of basic medical knowledge.

6. In or around April of 2006, Dr. Campbell entered into a

licensure-long PRN contract, which included the involvement of a

psychiatrist.

7. In or around December of 2006, the Agency for Health

Care Administration (AHCA) performed a site visit regarding

Dr. Campbell’s participation in the LLC Medipass Program.

Medipass (Medicaid Provider Access System) is a primary care

case management program for Medicaid beneficiaries developed and

administered by Florida Medicaid. Florida NetPass LLC provides

clinical, pharmaceutical, diagnostic, and financial information

for patients to their physicians. It also provides service

network services, plan administration, utilization management,

credentialing of members, data analysis and reporting, and

preferred drug list education services.

8. By letter dated December 5, 2006, Dr. Campbell was

advised by Health Network One, Inc. (HN1), of the immediate

termination of his Primary Care Services Agreement with HS1

Medical Management, Inc. The basis for the termination of the

contract was the site review conducted in December 2006, which

led clinical staff to conclude that Dr. Campbell was not

mentally competent to practice medicine at that time and that

the continuation of the agreement would have a negative effect

on the patients’ care. The termination of the contract meant

that Dr. Campbell could not provide services to Florida NetPass,

MediPass beneficiaries.

9. On April 10, 2007, AHCA advised Dr. Campbell that it

was terminating his Medicaid Provider Agreement.

10. In July 2009, PRN sent Dr. Campbell a letter

requesting that he provide an update from his psychiatrist,

Ann Tyson, M.D. (Dr. Tyson). An update was provided in

October 2009 by Dr. Tyson, who concluded that Dr. Campbell’s

diagnosis and/or medication at that time did not affect his

ability to practice medicine.

11. In October 2009, PRN notified Dr. Campbell that it was

necessary for him to get new neuropsychological testing done.

Dr. Campbell did not have the funds to get the testing done at

that time.

12. In December 2009, Dr. Campbell saw Dano A. Leli, Ph.D.

(Dr. Leli), for a neuropsychological evaluation. Dr. Leli

credibly concluded as follows:

Based on all of the findings contained in

this neuropsychological evaluation coupled

with the information provided in the

available records, Dr. [Campbell] does not

appear to be safe to practice his profession

as a physician. This conclusion is based on

his above-described neuro-cognitive and

motor deficits; poor impulse control,

emotional lability, lack of respect for

interpersonal boundaries, poor stress

tolerance, impaired interpersonal reasoning,

judgment, planning, and problem-solving

skills; lack of insight to how his various

disorders are affecting his professional

behavior; and his seeming difficulty in

receiving any type of constructive feedback

designed to help him alter his behavior in a

more adaptive fashion.

In his deposition, Dr. Leli credibly testified that it was his

opinion that Dr. Campbell was not safe to practice medicine at

this time.

13. Dr. Campbell has difficulty with interpersonal space.

For example, he continued to unintentionally kick the test

examiner under the table during his evaluation testing. He also

rested his hands unusually close to the examiner’s hands to the

extent that it made the examiner uncomfortable. Dr. Campbell

did not recognize that he needed to keep boundaries between

them. A physician needs to be able to maintain personal

boundaries with his patients. Dr. Campbell’s inability to

maintain appropriate personal boundaries adversely affects his

ability to practice medicine.

14. Dr. Campbell demonstrated poor impulse control and

poor stress tolerance during his neuropsychological evaluation.

He swore frequently during the testing and had loud verbal

temper outbursts. A physician needs to be able to keep his

emotions in check when he is seeing patients; otherwise, a

physician cannot effectively respond to his patients.

15. During the evaluation, Dr. Campbell told Dr. Leli that

he was impulsive and that he cares for his patients too much.

Dr. Campbell told Dr. Leli that if he had a patient who was

experiencing a heart attack that he would take the patient to

the hospital in his personal car rather than call 911 for an

ambulance and paramedics. When Dr. Leli asked Dr. Campbell

whether Dr. Campbell understood the liability of doing that or

the danger to the patient, Dr. Campbell replied that he would

still take the patient to the hospital himself. Dr. Campbell’s

poor impulse control and poor judgment adversely affect his

ability to practice medicine.

16. Dr. Campbell has difficulty in judgment, planning, and

problem solving. During the evaluation process, Dr. Campbell

kept excusing himself to go to a nearby vending machine to get

soft drinks. He went so many times, that the evaluator finally

told him to go to a convenience store and purchase as many soft

drinks as he needed so that they could finish the testing

without the interruptions. Additionally, Dr. Campbell had

difficulty in using the vending machine. He tried to put a

dollar bill in the machine, but the machine would not take the

bill. Dr. Campbell went back to the evaluator, got change, and

went back to the vending machine. Dr. Campbell did not seem to

know what to do with the coins. Finally, the evaluator told him

to put the coins in the machine. A physician needs to be able

to plan and problem solve in dealing with patients.

Dr. Campbell’s difficulties in these areas adversely affect his

ability to practice medicine.

17. Dr. Campbell demonstrated difficulty with motor skills

during the evaluation. He was given a test in which he was to

tap a key similar to a telegraph key with his finger. He was

unable to tap the key with his finger; instead, he placed his

whole hand on the key. Dr. Campbell told Dr. Leli that he was

having difficulties with his fine motor skills, particularly

with his left upper extremity. Dr. Campbell also relayed that

he was having tremors in both upper extremities. A physician

needs to have fine motor skills in order to touch his patients

and make evaluations as well as to use mechanical devices.

Dr. Campbell’s difficulties with motor skills adversely affect

his ability to practice medicine.

18. Dr. Campbell does not understand how his behavior is

affecting other people. During the evaluation, Dr. Campbell

began to explain to the examiner a diagnosis of diabetes. After

he explained the process, which included the drawing of

diagrams, Dr. Campbell asked the examiner to reiterate to him

what he had just explained, as if he were trying to educate the

examiner. The explanation of diabetes was inappropriate in the

context of an evaluation setting, and Dr. Campbell did not

appear to know that it was inappropriate.

19. The test results of the evaluation demonstrated that

Dr. Campbell’s visual-motor intellectual abilities were

significantly declined when compared to functioning on at least

a high average level prior to his injuries. He showed a

significant decline on tests of visual concentration and

attention. He also had difficulties with auditory processing.

20. Dr. Campbell was given a verbal memory test of

stories. He would read a story and then would immediately

relate the contents of the story. Thirty minutes after reading

the story, he would be asked to relate the contents of the story

again. Dr. Campbell was average on immediate retrieval, but was

borderline impaired on delayed retrieval. This memory problem

would adversely affect his care of patients if he cannot recall

what the patient has told him within 30 minutes of the

conversation with the patient.

21. Dr. Campbell demonstrated difficulties in paying

attention to fine visual detail. This impairment adversely

relates to the practice of medicine because a physician has to

examine a patient’s body and pay attention to fine detail in

order to properly evaluate the patient.

22. Dr. Campbell demonstrated some persecutory thinking

during his evaluation, where he perceives that people, who are

not out to get him, are trying to hurt him. Such thinking can

adversely affect his ability to practice medicine because he

could easily misperceive an interaction between him and a

patient causing him to lose his clinical demeanor and clinical

efficacy.

23. In January 2010, Dr. Campbell advised Jerome Gropper,

M.D., who was Dr. Campbell’s case manager at PRN, that he had

had neuropsychological testing done in December 2009. This was

the first time that Dr. Gropper had heard that Dr. Campbell had

been tested. Dr. Gropper asked Dr. Campbell to send him a copy

of the test results.

24. During January 2010, Dr. Campbell also advised

Dr. Gropper that on the way to the testing in December 2009 that

he had fallen, had hurt his back, and had taken some Lyrica.

The effects of the Lyrica caused him not to be able to finish

the test, and he had to come back later to finish the test. On

the way home from the first testing he banged up his car.

Another time he had taken Lyrica and had made a left hand turn

on a red light and had stopped at a green light.

25. Dr. Campbell was required to keep PRN apprised of all

the medications that he was taking, and he had failed to do so

before taking the Lyrica. Dr. Gropper asked Dr. Campbell if he

had a prescription for Lyrica, Dr. Campbell said that he did.

When questioned about the prescription, Dr. Campbell became

upset and started yelling.

26. Dr. Campbell also told Dr. Gropper that the reason

that he had been upset during the site visit in December 2006

was because he had taken Neurontin for back pain, and he had an

adverse reaction to the drug.

27. Dr. Gropper asked Dr. Campbell to send a copy of the

prescription for Lyrica to PRN. When PRN received a copy of the

prescription, it was learned that the medication had been

prescribed in 2006. Dr. Gropper considered the taking of a

three-year-old prescription to be self-medicating.

28. By letter dated February 12, 2010, Judy S. Rivenbark,

M.D., the acting medical director of PRN, notified Dr. Campbell

that his monitoring contract with PRN was terminated and that

his case would be referred to the Department for further action.

By letter dated February 16, 2010, Dr. Rivenbark advised the

Department that Dr. Campbell had failed to progress in the PRN

program and that PRN was unable to say whether Dr. Campbell was

able to practice with reasonable skill and safety.

29. Dr. Tyson has been Dr. Campbell’s psychiatrist since

2007. When asked on deposition whether Dr. Campbell was

competent to practice medicine, she replied:

I don’t know that. I think there are

problems that have been magnified by this

process, and I think that, given

[Dr. Campbell’s] strengths, that [he] should

be given a chance to practice medicine. And

I think the only way that will happen is if

[he] practice [sic] under the supervision of

someone.

When asked if it was her opinion that Dr. Campbell could

practice safely without the supervision of another physician,

Dr. Tyson replied, “I don’t think that I should assume, at this

point, that he could practice safely without supervision, no.”

CONCLUSIONS OF LAW

30. The Division of Administrative Hearings has

jurisdiction over the parties to and the subject matter of this

proceeding. §§ 120.569 and 120.57, Fla. Stat.

31. Petitioner has the burden to establish the allegations

in the Administrative Complaint by clear and convincing

evidence. Department of Banking and Finance v. Osborne Stern

and Company , 670 So. 2d 932 (Fla. 1996).

32. Petitioner has alleged that Dr. Campbell violated

Subsection 459.331(1)(s), Florida Statutes, which provides that

discipline may be imposed if a physician is determined to be

“unable to practice medicine with reasonable skill and safety to

patients by reason of illness or use of alcohol, drugs,

narcotics, chemicals, or any other type of material or as a

result of any mental or physical condition.”

33. Petitioner has established by clear and convincing

evidence that Dr. Campbell is unable to practice medicine with

reasonable skill and safety to patients by reason of illness and

mental and physical conditions as set forth in paragraphs 12

through 22 above.

34. The disciplinary guidelines of the Board are found in

Florida Administrative Code Rule 64B8-8.001. The disciplinary

guidelines for a violation of Subsection 458.331(1)(s), Florida

Statutes, ranges from probation to denial or indefinite

suspension until the licensee is able to demonstrate the ability

to practice with reasonable skill and safety followed by

probation and an administrative fine from $1,000 to $5,000.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is RECOMMENDED that a final order be entering finding

that Dr. Campbell has violated Subsection 458.331(1)(s), Florida

Statutes, and suspending his license indefinitely until

Dr. Campbell is able to demonstrate the ability to practice with

reasonable skill and safety, followed by probation.

DONE AND ENTERED this 28th day of July, 2010, in

Tallahassee, Leon County, Florida.

S

SUSAN B. HARRELL

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

[phone]

Fax Filing [phone]

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 28th day of July, 2010.

ENDNOTES

1/ Unless otherwise indicated, all references to the Florida

Statutes are to the 2009 version.

2/ The parties stipulated to certain portions and revisions to

paragraphs 1 through 6 and 8 of the Administrative Complaint.

The parties did not agree to the remaining paragraphs of the

Administrative complaint.

COPIES FURNISHED :

Robert Anthonie Milne, Esquire

Ephraim Livingston, Esquire

Department of Health

Prosecution Services Unit

4052 Bald Cypress Way, Bin C-65

Tallahassee, Florida 32399

John D. Campbell, M.D.

5805 Spirit Lake Road

Winter Haven, Florida 33880

Josefina M. Tamayo, General Counsel

Department of Health

4052 Bald Cypress Way, Bin A-02

Tallahassee, Florida 32399-1701

Larry McPherson, Executive Director

Board of Medicine

Department of Health

4052 Bald Cypress Way

Tallahassee, Florida 32399-1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written 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.