01-001538N Sylvia Trice And Johnny Brown, On Behalf Of And As Parents And Natural Guardians Of Deanna Renea Brown, A Minor vs. Florida Birth-Related Neurological Injury Compensation Association Status: Closed DOAH Final Order on Thursday, January 24, 2002.

Summary: Proof failed to demonstrate that infant suffered permanent and substantial mental and physical impairment or that what impairment she suffered was related to oxygen deprivation or trauma suffered during birth.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

SYLVIA TRICE and JOHNNY BROWN, )

as parents and natural )

guardians of DEANNA RENEA )

BROWN, a minor, )

)

Petitioners, )

)

vs. ) Case No. 01 - 1538N

)

FLORIDA BIRTH - RELATED )

NEUROLOGICAL INJURY )

COMPENSATION ASSOCIATION, )

)

Responden t. )

)

FINAL ORDER

Pursuant to notice, the Division of Administrative Hearings,

by Administrative Law Judge William J. Kendrick, held a final

hearing in the above - st yled case on December 3, 2001, by video

teleconference, with sites in Tallahassee and West Palm Beach,

Florida.

APPEARANCES

For Petitioner: Johnny Brown, pro se

Sylvia Trice, pro se

3304 Avenue Q

Fort Pierce, Florida 34947

For Respondent: B. Forest Hamilton, Esquire

Post Office Box 38454

Tallahassee, Florida 32315 - 8454

STATEMENT OF THE ISSUE

At issue in this proceeding is whether Deanna Renea Brown, a

minor, suffered an injury for which compensation should be

awarded under the Florida Birth - Related Neurological Injury

Compensation Plan.

PRELIMINARY STATEMENT

On April 25, 2001, Sylvia Trice and Johnny Brown, as parents

and natural guardians of Deanna Renea Brown (Deanna), a minor,

filed a petition (claim) with the Division of Administrative

Hearings (DOAH) for compensation under the Florida Birth - Related

Neurological Injury Compensation Plan (Plan).

DOAH served the Florida Birth - Re lated Neurological Injury

Compensation Association (NICA) with a copy of the claim on

April 27, 2001. NICA reviewed the claim and on June 29, 2001,

gave notice that it had "determined that such claim is not a

'birth - related neurological injury' within the meaning of Section

766.302(2), Florida Statutes," and requested that "an order [be

entered] setting a hearing in this cause on the issue of

compensability." Such a hearing was held on December 3, 2001.

At hearing, the parties stipulated to the factual ma tters

set forth in paragraphs 1 and 2 of the Findings of Fact.

Petitioners Sylvia Trice and Johnny Brown testified on their own

behalf, and Petitioners' Exhibit 1 (the medical records filed

with DOAH on April 25, 2001), and Petitioners' Exhibit 2

(additio nal medical records from Children's Medical Services), as

well as Respondent's Exhibit 1 (the deposition of

Michael Duchowny, M.D., filed at hearing), and Respondent's

Exhibit 2 (the deposition of Donald C. Willis, M.D., filed

December 20, 2001), were rece ived into evidence. 1 No other

witnesses were called, and no further exhibits were offered.

The transcript of the hearing was filed December 10, 2001,

and the parties were initially accorded 10 days from that date to

file proposed final orders; however, at Petitioners' request the

time for filing was extended to January 4, 2002. Consequently,

the requirement that a final order be rendered within 30 days

after the transcript has been filed was waived. See Rule 28 -

106.216(2), Florida Administrative Code. R espondent elected to

file such a proposal, and it has been duly considered.

FINDINGS OF FACT

Fundamental findings

1. Petitioners, Sylvia Trice and Johnny Brown, are the

parents and natural guardians of Deanna Renea Brown, a minor.

Deanna was born a l ive infant on April 24, 1996, at Lawnwood

Regional Medical Center, a hospital located in Fort Pierce,

Florida, and her birth weight exceeded 2,500 grams.

2. The physician providing obstetrical services at Deanna's

birth was William Bryan King, M.D., who, at all times material

hereto, was a "participating physician" in the Florida Birth -

Related Neurological Injury Compensation Plan, as defined by

Section 766.302(7), Florida Statutes.

Deanna's birth

3. At or about 6:00 a.m., April 24, 1996, Msice (with

an estimated date of delivery of May 8, 1996, and the fetus

between 37 and 38 weeks gestation) awoke, while at home in bed,

with contractions/cramping and vaginal bleeding. Suspecting a

placental abruption, which she had experienced with a previous

pregn ancy, Msice immediately telephoned her physician's

office and was advised to proceed to the emergency room at

Lawnwood Regional Medical Center.

4. Msice presented at the Lawnwood Regional Medical

Center emergency room at approximately 6:25 a.m., A pril 24, 1996,

with the complaint of "bleeding, contractions." Admission

assessment noted the membranes intact, the presence of vaginal

bleeding, a closed cervix, and a fetal heart rate of 130 beats

per minute. The admission notes further reveal that Dr. King was

notified of Msice's evaluation at 7:00 a.m., and that

Ms. Trice apparently remained in the emergency room until

8:05 a.m., when, following Dr. King's arrival, she was admitted

to a labor room for further evaluation.

5. Regarding that evaluat ion, the record reveals that

extending from approximately 8:05 a.m. to 9:00 a.m., external

fetal monitoring was reassuring, with a fetal heart rate baseline

of 130 beats per minute, average long term variability,

accelerations, and no apparent deceleration s. Monitoring further

revealed uterine activity at every 3 minutes, with a duration of

50 to 60 seconds, of moderate intensity.

6. The record further reveals that, following admission to

the labor room, Dr. King performed a vaginal examination which

reve aled a moderate amount of bright red blood, with small clots.

The examination further revealed that "the cervix was closed,

soft, presenting part out of the pelvis." Diagnosis of suspected

abruption was made, which was confirmed by ultrasound, and it was

resolved to deliver by cesarean section.

7. Msice was moved to the operating room at or about

9:25 a.m., surgery started at 9:42 a.m., and Deanna was delivered

at 9:47 a.m., without apparent difficulty. During the cesarean

section, abruption with retroplacental clot was confirmed.

8. On delivery, Deanna evidenced a spontaneous cry, but

weak respiratory effort despite a heart rate above 120 beats per

minute. Deanna was suctioned and accorded oxygen by bag/mask and

blowby, with improved color and m uscle tone. Otherwise, no

intervention was required. Apgar scores were recorded as 7 at

one minute and 8 at five minutes.

9. The Apgar scores assigned to Deanna are a numerical

expression of the condition of a newborn infant, and reflect the

sum points gained on assessment of heart rate, respiratory

effort, muscle tone, reflex irritability, and color, with each

category being assigned a score ranging from the lowest score of

0 through a maximum score of 2. As noted, at one minute Deanna's

Apgar score to taled 7, with heart rate and reflex irritability

being graded at 2 each, and respiratory effort, muscle tone, and

color being graded at 1 each. At five minutes, Deanna's Apgar

score totaled 8, with heart rate, respiratory effort, and muscle

tone being gra ded at 2 each, and reflex irritability and color

being graded at 1 each. Such scores are not consistent with an

acute neurologic insult.

10. Following a brief stay in the intermediate nursery,

Deanna was transported to the newborn nursery, where she re mained

until she was discharged with her mother on April 27, 1996.

Notably, the newborn nursery admission assessment, at 10:30 a.m.,

was grossly normal, and there is no evidence of any significant

complication during her stay in the hospital.

Deanna's sub sequent development

11. Deanna's early development was apparently without any

significant complication until three to four months of age when

she was observed to be nonresponsive to loud sounds, and at or

about eleven months of age when evidence of hypot onia was

observed and she was seen by Dr. Luis Bello, a physician

associated with the Palm Beach Neurology Group. In his report of

April 7, 1997, Dr. Bello noted the results of his evaluation, as

follows:

Deanna was seen in follow - up visit today

after s he had an MRI. She is an 11 - month -

old - youngster that I saw at the DEI Clinic in

Stuart. The child has evidence of hypotonia.

The child is still not able to sit up or

walk. She has hypotonia that was assessed to

be a sign of underlying brain dysfunction .

There has not been history of regression.

She had a history of abruptio placentae.

On examination today, her head circumference

is 46 cm which is close to the 50th

percentile. The child did not have

dysmorphic features. She still remains with

the ax ial and distal hypotonia. Reflexes

remain normal with plantar responses

downgoing.

I had the chance to review the MRI of the

brain today at St. Mary's Hospital. The MRI

of the brain demonstrated the presence of

poor myelination pattern, especially in bo th

parietal regions. There is also evidence of

increased signal in the posterior occipital

regions which suggests the presence of a mild

degree of leukomalacia. No evidence of

ventricular asymmetry was noticed . . . .

IMPRESSION:

This young [child] rem ains with history of

hypotonia which appears to be secondary to

the presence of some degree of

leukoencephalopathy associated with poor

myelination pattern. Certainly it is

consistent with an insult that may be related

to the abruptio placentae that has n ow

resulted in delay in the gross and fine motor

skills. This is consistent with the presence

of static encephalopathy. At the present

time it is quite unpredictable, when the

child is going to be achieving milestones.

Intense PT, occupational therapy, and speech

therapy will be needed. The parents have

inquired about the possibility of mental

retardation and cerebral palsy. Certainly,

at the present time it is quite unpredictable

because many of the youngsters like this

could catch up with normal deve lopment with

intense therapy.

12. Since September 1997, Deanna has been followed through

Children's Medical Services. There, Deanna presented for her

initial pediatric screening visit with Dr. Robert Schloegel on

September 17, 1997. Dr. Schloegel repor ted the results of that

visit, as follows:

. . . This child has been referred by the

Community Health Center in Ft. Pierce for

evaluation of elevated calcium and phosphate

levels in her serum. She has also been

recently diagnosed with severe hearing loss.

She has been evaluated at the Hear Center in

Port St. Lucie as well as having a BAER

testing done at St. Mary's this last summer.

She is being fitted for hearing aids in the

near future. She has also had significant

developmental delays. She is a clie nt of the

Early Intervention Program and is currently

getting occupational and physician therapies.

According to the mother, this 16 - month - old

child is just able to sit up on her own. She

cannot crawl, she cannot walk. She does wave

and socially interac ts, although she does not

have any speech development, apparently

secondary to severe hearing problem.

She has been seen by the neurologist,

Dr. Bello, through a recommendation of the

Early Intervention Program. An MRI was done

that did show delayed matu ration of the white

matter. No other specific abnormalities.

She has had some blood testing including

chromosomes done that were apparently

normal . . . .

PHYSICAL EXAMINATION: . . . .

EXTREMITIES: Grossly normal. She had good

ROM. There was no s pasticity noted. Her

reflexes were brisk bilaterally, symmetrical.

NEUROLOGIC EXAMINATION: She was able to sit

on her own. When placed on her stomach, she

could not get up to a crawling position. She

did not support her own weight. Again, there

was n o speech.

ASSESSMENT:

1. Developmental delay, mainly gross motor

and speech.

2. Apparently severe hearing loss

bilaterally . . . .

13. Deanna continued to be followed at Children's Medical

Services through physicians associated with the Pediatric Cli nic,

Endocrine Clinic, Neurology Clinic, Genetic Clinic, Orthopedic

Clinic, and ENT C linic until at least March 2000, and was seen at

the Department of Otolaryngology, Shands Health Care, on

November 16, 2000, for a cochlear evaluation. Impression during

the course of treatment at Children's Medical Services was

cerebral palsy, with mild developmental delay, and significant

delay in speech development, secondary to severe bilateral

deafness.

14. On June 5, 2001, following the filing of the subject

claim, Deanna was examined by Dr. Michael Duchowny, a physician

board - certified in pediatrics, neurology with special competence

in child neurology, and clinical neuropsychology. Dr. Duchowny

reported the results of his neurology evaluation, as follows:

PHYSIC AL EXAMINATION reveals Deanna to be

alert and cooperative. She weighs 48 - pounds

and is 42 inches tall. The head

circumference measures 51.2 cm and the

fontanelles are closed. There are no cranial

or facial anomalies or asymmetries. The skin

is warm and moist without cutaneous stigmata.

She has antimongoloid slant to her eyes, but

no other dysmorphic features. The spine is

straight without dysraphism. Hearing aids

are noted in both ears. The neck is supple

without masses, thyromegaly or adenopathy an d

the cardiovascular, respiratory and abdominal

examinations are unremarkable.

NEUROLOGICAL EXAMINATION reveals Deanna to be

alert, pleasant and cooperative. There is an

absence of spoken language, but she can

communicate with her mother in simple sign

l anguage. This appears rudimentary however

and she clearly is not communicating at an

age appropriate level. She says some words

but they lack intonation as one might expect

in a hearing impaired child. She has an

appropriate attention span for age and i s

socially interactive and playful. There is

good central gaze fixation with conjugate

following movements and the pupils are 3 mm

and briskly reactive to direct and

conceptually presented light.

The funduscopic examination discloses well

demarcated disc margins without optic pallor.

The eye grounds are negative. There are no

facial asymmetries. The tongue and palate

move well. Motor examination reveals mild

generalized hypotonia without atrophy, focal

weakness or fasciculations. There are no

adventi tious movements. The outstretched

hands are held in a symmetric fashion with

minimal dystonic posturing. She cannot

perform rapid alternating movement sequences.

The deep tendon reflexes are 2 - 3 bilaterally

with both plantar responses in flexion. Her

gait is stable and appropriately based. She

turns well. The sensory examination reveals

no obvious sensitivity to touch of any of the

extremities. The neurovascular examination

reveals no cervical, cranial or ocular bruits

and no temperature or pulse as ymmetries.

In SUMMARY, Deanna presents as a 5 - year - old

ambidextrous girl with minimal dysmorphism,

hearing impairment and hearing based speech

impediment. She additionally displays

further delay in terms of her expressive

communication skills and has mil d generalized

hypotonia.

15. In his deposition testimony (Respondent's Exhibit 1),

Dr. Duchowny addressed the findings of his examination and the

significance of Deanna's impairments, as follows:

Q. Can you . . . give me a brief overview of

what your fi ndings were during that medical

examination?

A. Yes. Deanna . . . is a hearing impaired

five - year - old girl who has no spoken language

and communicated with her mother in simple

sign language.

The communication skills via sign appeared to

be rudimentary and she said some words but

there was a lack of phonic intonation.

I thought that her attention span was

appropriate for her age; that she was

socially interactive and playful, and she had

some minimal problems with coordination and

posturing, meaning ho lding her hands in a

mannered form.

Also that her muscle tone was slightly

decreased for her age level, and that she had

what is called an antimongoloid slant or a

downward slant to her eyes, which is a

dysmorphic feature, but essentially that was

the sum total of the abnormalities that were

noted on the neurological examination on that

day.

Q. And did you form an opinion as to the

degree of the . . . physical difficulties

that Deanna has?

A. From the physical standpoint I actually

thought that Deanna was functioning

essentially at age level.

She has . . . some mild hypotonia, but really

she was able to perform most movements

without difficulty, and certainly appears to

have a good functionality.

* * *

Q. And as to the . . . mental damage that

D eanna suffered?

A. Well, I think the only findings that can

be classified as mental would be her

communication skills and I think that the

type of speech impairment that she displayed

is more likely related to her peripheral

nerve deficit than it is to a ny brain injury.

* * *

Q. Did you form an opinion as to Deanna's

. . . future . . . develop[ment] . . . ?

A. Yes, I think that Deanna's prognosis is

actually quite good. I think she will have

normal or very close to normal motor function

and mig ht end up being slightly clumsy, but

nothing more serious than that.

I think she will continue to have speech

problems, but as with other hearing impaired

individuals, I would anticipate that Deanna

would be able to communicate, nonverbally,

primarily by signing.

The cause and timing of

Deanna's impairments

16. To address the issue of whether Deanna's impairments

were associated with an "injury to the brain or spinal cord . . .

caused by oxygen deprivation or mechanical injury occurring in

the course o f labor, delivery, or resuscitation in the immediate

post - delivery period in a hospital," as required for coverage

under the Plan, Petitioners offered selected medical records

relating to Msice's antepartum course, as well as those

associated with Dean na's birth and subsequent development.

Additionally, Petitioners testified on their own behalf, and

Respondent offered the deposition testimony of Dr. Duchowny,

whose qualifications are heretofore noted, and the deposition

testimony of Dr. Donald Willis, a physician board - certified in

obstetrics and gynecology, as well as maternal - fetal medicine.

17. As for the cause and timing of Deanna's impairments, it

was Dr. Duchowny's opinion that the detriments Deanna suffers

are, more likely than not, developmenta l in nature, and

attributable to an event of unknown etiology which occurred prior

to labor or delivery. As for Dr. Willis, he was of the opinion

that the medical records revealed no evidence of oxygen

deprivation or other trauma associated with Deanna's birth and,

moreover, that Msice was not in labor at the time she

presented to the hospital or thereafter. Dr. Willis expressed

his views, as follows:

Q. Before we get to the actual condition of

the child at birth and her hospital course,

did you fo rm a conclusion as to whether or

not Sylvia Trice was in labor, given the

medical records that you reviewed?

A. I do not feel that she was in labor. The

cervix was closed and the presenting part was

out of the pelvis, which would suggest that

she was no t in labor at the time of her

presentation or at the time of delivery.

Q. Okay. Please continue with your

description of the child's hospital course.

A. Well, let me go back and get some things

in order a little bit. We do not have the

actual fetal m onitor strip available from

this case, but the nurse's notes are

available, which describe about 45 minutes of

fetal monitoring that was done after

admission to the hospital and prior to her

C esarean section delivery, and the nurse's

notes describe a norma l fetal rate pattern

with normal variability and no fetal

distress.

At birth the baby's weight was 3,145 grams,

consistent with 38 weeks. Apgar scores were

7/8. And at the time of Cesarean section, I

should mention that the placental abruption

was confi rmed.

The baby did require some blow - by oxygen and

five to six breaths with assisted ventilation

with the bag and mask. And otherwise, really

no resuscitative efforts were required. The

baby went to the intermediate nursery for a

brief period of observa tion and then was

transferred to the normal newborn nursery and

was discharged home with the mother on day

three of life.

Q. In your review of the medical records,

did you find any indication that the child

had suffered a hypoxic or ischemic event

during labor or delivery?

A. No, I did not find evidence of either of

those.

Q. In your opinion, did the child evidence

any traumatic event during labor or delivery?

A. No.

Q. Would you describe Deanna Brown's

delivery to be that of a normal healthy

chil d?

A. That's correct. I would describe it as

normal. The Apgar scores were not low. In

fact, the baby did so well after birth,

actually no blood gases were done or are

available in the chart, and the baby went to

the normal newborn nursery shortly aft er

delivery, so essentially a normal newborn.

Coverage under the Plan

18. Pertinent to this case, coverage is affordable by the

Plan for infants who suffer a "birth - related neurological

injury," defined as an injury to the brain or spinal cord . . .

cau sed by oxygen deprivation or mechanical injury occurring in

the course of labor, delivery, or resuscitation in the immediate

post - delivery period in a hospital which renders the infant

permanently and substantially mentally and physically impaired."

Secti on 766.302(2), Florida Statutes.

19. Here, the medical records and the testimony of the

physicians and other witnesses offered by the parties have been

carefully considered. So considered, it must be concluded that

the proof failed to demonstrate that De anna suffered a "birth -

related neurological injury" since the proof failed to

demonstrate that, more likely than not, her impairments were

associated with a brain or spinal cord injury caused by oxygen

deprivation or mechanical injury occurring in the cour se of

labor, delivery, or resuscitation in the immediate post - delivery

period, or that any injury Deanna may have suffered rendered her

permanently and substantially mentally and physically impaired.

CONCLUSIONS OF LAW

20. The Division of Administrative Hearings has

jurisdiction over the parties to, and the subject matter of,

these proceedings. Section 766.301, et seq. , Florida Statutes.

21. The Florida Birth - Related Neurological Injury

Compensation Plan was established by the Legislature "for the

purp ose of providing compensation, irrespective of fault, for

birth - related neurological injury claims" relating to births

occurring on or after January 1, 1989. Section 766.303(1),

Florida Statutes.

22. The injured "infant, his personal representative,

pare nts, dependents, and next of kin," may seek compensation

under the Plan by filing a claim for compensation with the

Division of Administrative Hearings. Sections 766.302(3),

766.303(2), 766.305(1), and 766.313, Florida Statutes. The

Florida Birth - Related Neurological Injury Compensation

Association, which administers the Plan, has "45 days from the

date of service of a complete claim . . . in which to file a

response to the petition and to submit relevant written

information relating to the issue of wheth er the injury is a

birth - related neurological injury." Section 766.305(3), Florida

Statutes.

23. If NICA determines that the injury alleged in a claim

is a compensable birth - related neurological injury, it may award

compensation to the claimant, provided that the award is approved

by the administrative law judge to whom the claim has been

assigned. Section 766.305(6), Florida Statutes. If, on the

other hand, NICA disputes the claim, as it has in the instant

case, the dispute must be resolved by the assi gned administrative

law judge in accordance with the provisions of C hapter 120,

F lorida Statutes. Sections 766.304, 766.307, 766.309, and

766.31, F lorida Statutes.

24. In discharging this responsibility, the administrative

law judge must make the followi ng determination based upon the

available evidence:

(a) Whether the injury claimed is a birth -

related neurological injury. If the claimant

has demonstrated, to the satisfaction of the

administrative law judge, that the infant has

sustained a brain or s pinal cord injury

caused by oxygen deprivation or mechanical

injury and that the infant was thereby

rendered permanently and substantially

mentally and physically impaired, a

rebuttable presumption shall arise that the

injury is a birth - related neurologica l injury

as defined in s. 766.303(2).

(b) Whether obstetrical services were

delivered by a participating physician in the

course of labor, delivery, or resuscitation

in the immediate post - delivery period in a

hospital; or by a certified nurse midwife i n

a teaching hospital supervised by a

participating physician in the course of

labor, delivery, or resuscitation in the

immediate post - delivery period in a hospital.

Section 766.309(1), Florida Statutes. An award may be sustained

only if the administra tive law judge concludes that the "infant

has sustained a birth - related neurological injury and that

obstetrical services were delivered by a participating physician

at birth." Section 766.31(1), Florida Statutes.

25. Pertinent to this case, "birth - relat ed neurological

injury" is defined by Section 766.302(2), Florida Statutes, to

mean:

. . . injury to the brain or spinal cord of a

live infant weighing at least 2,500 grams at

birth caused by oxygen deprivation or

mechanical injury occurring in the course of

labor, delivery, or resuscitation in the

immediate post - delivery period in a hospital,

which renders the infant permanently and

substantially mentally and physically

impaired. This definition shall apply to

live births only and shall not include

disabi lity or death caused by genetic or

congenital abnormality.

26. As the claimants, the burden rested on Petitioners to

demonstrate entitlement to compensation. Section 766.309(1)(a),

Florida Statutes. See also Balino v. Department of Health and

Rehabili tative Services , 348 So. 2d 349, 350 (Fla. 1st DCA 1977),

("[T]he burden of proof, apart from statute, is on the party

asserting the affirmative issue before an administrative

tribunal").

27. Here, the proof failed to support the conclusion that,

more lik ely than not, Deanna suffered an injury to the brain or

spinal cord caused by oxygen deprivation or mechanical injury

occurring in the course of labor, delivery, or resuscitation that

rendered her permanently and substantially mentally and

physically impai red. Consequently, the record developed in this

case failed to demonstrate that Deanna suffered a "birth - related

neurological injury," within the meaning of Section 766.302(2),

Florida Statutes, and the subject claim is not compensable under

the Plan. Se ctions 766.302(2), 766.309(1), and 766.31(1),

Florida Statutes. See also Florida Birth - Related Neurological

Injury Compensation Association v. Florida Division of

Administrative Hearings , 686 So. 2d 1349 (Fla. 1997).

28. Where, as here, the administrativ e law judge determines

that ". . . the injury alleged is not a birth - related

neurological injury . . . he [is required to] enter an order [to

such effect] and . . . cause a copy of such order to be sent

immediately to the parties by registered or certified mail."

Section 766.309(2), Florida Statutes. Such an order constitutes

final agency action subject to appellate court review. Section

766.311(1), Florida Statutes.

CONCLUSION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

ORDER ED that the petition for compensation filed by Sylvia

Trice and Johnny Brown, as parents and natural guardians of

Deanna Renea Brown, a minor, be and the same is hereby denied

with prejudice.

DONE AND ORDERED this 24th day of January, 2002, in

Tallahassee, Leon County, Florida.

___________________________________

WILLIAM J. KENDRICK

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675 SUNCOM 278 - 9675

Fax Fil ing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 24th day of January, 2002.

ENDNOTE

1/ Respondent was accorded 7 days from the date the transcript

was filed to note any objection it migh t have to Petitioners'

Exhibit 2. Respondent noted no objection and Petitioners'

Exhibit 2 has been received into evidence.

COPIES FURNISHED:

(By certified mail)

Sylvia Trice

Johnny Brown

3304 Avenue Q

Fort Pierce, Florida 34947

Lynn Larson, Executiv e Director

Florida Birth - Related Neurological

Injury Compensation Association

1435 Piedmont Drive, East, Suite 101

Post Office Box 14567

Tallahassee, Florida 32312

B. Forest Hamilton, Esquire

Post Office Box 38454

Tallahassee, Florida 32315 - 8454

Will iam Bryan King, M.D.

1301 Lawnwood Circle

Fort Pierce, Florida 34950 - 4825

Lawnwood Regional Medical Center

1700 South 23rd Street

Fort Pierce, Florida 34954

Ms. Charlene Willoughby

Agency for Health Care Administration

Consumer Services Unit

Post Offic e Box 14000

Tallahassee, Florida 32308

Mark Casteel, General Counsel

Department of Insurance

The Capitol, Lower Level 26

Tallahassee, Florida 32399 - 0300

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this F inal O rder is entit led

to judicial review pursuant to Sections 120.68 and 766.311,

Florida Statutes. Review proceedings are governed by the Florida

Rules of Appellate Procedure. Such proceedings are commenced by

filing one copy of a Notice of Appeal with the Agency Clerk o f the

Division of Administrative Hearings and a second copy, accompanied

by filing fees prescribed by law, with the appropriate District

Court of Appeal. See Section 120.68(2), Florida Statutes, and

Florida Birth - Related Neurological Injury Compensation A ssociation

v. Carreras , 598 So. 2d 299 (Fla. 1st DCA 1992). The Notice of

Appeal must be filed within 30 days of rendition of the order to

be reviewed.