01-003795PL Department Of Health, Board Of Medicine vs. Robert M. Knight, M.D. Status: Closed Recommended Order on Friday, April 19, 2002.

Summary: Inappropriate medical care provided to multiple patients; plans of treatment were unsupported by medical records.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD )

OF MEDICINE, )

)

Petitioner, )

)

vs. ) Case Nos. 01 - 2115PL

) 01 - 3795P L

ROBERT M. KNIGHT, M.D., ) 01 - 3796PL

) 01 - 3797PL

Respondent. )

)

RECOMMENDED ORDER

On January 22, 2002, a formal administrative hearing in

this case was held in Naples, Florida, before William F.

Quattlebaum, Administrative Law Judge, Division of

Administrative Hearings.

APPEARANCES

For Petitioner: Kathryn E. Price, Esquire

Agency for Health Care Administration

Office of the General Counsel

Post Office Box 14229

Tallahassee, Florida 32317 - 4229

Fo r Respondent: No Appearance

STATEMENT OF THE ISSUE

The issue in the case is whether the allegations in the

Administrative Complaints are correct and, if so, what penalty

should be imposed.

PRELIMINARY STATEMENT

On May 3, 2000, the Department of Health, Board of

Medicine, (Petitioner) filed an Administrative Complaint against

Robert M. Knight, M.D. (Respondent) alleging that he violated

applicable statutes and rules in providing medical care for a

patient. The Respondent filed a request for formal heari ng.

The request was forwarded to the Division of Administrative

Hearings, which scheduled a formal hearing. Prior to the

hearing, legal counsel for the Respondent withdrew from the

case, and the hearing was continued. Subsequently, the

Petitioner filed additional Administrative Complaints against

the Respondent. The Respondent requested formal hearings in the

additional cases, and the request was forwarded to the Division

of Administrative Hearings. The cases were consolidated and

scheduled for hearing .

At the commencement of the hearing, the Petitioner

voluntarily dismissed the Administrative Complaint filed in Case

Number 01 - 2115PL. Accordingly, jurisdiction is hereby

relinquished to the Petitioner for entry of an appropriate Final

Order in Case Nu mber 01 - 2115PL. This Recommended Order

addresses the allegations set forth in the remaining

Administrative Complaints.

During the hearing, the Petitioner presented the testimony

of four witnesses and had Exhibits numbered 1 - 9 admitted into

evidence. Th e Respondent did not attend the hearing and was not

represented by counsel.

A Transcript of the hearing was filed on March 4, 2002.

The Petitioner sought and was granted an extension of time for

filing a Proposed Recommended Order, which was timely filed and

was considered in the preparation of this Recommended Order.

FINDINGS OF FACT

1. At all times material to this case, the Respondent was

a licensed physician in the State of Florida, holding license

number ME0039986.

DOAH Case Number 01 - 3795PL

2. B etween May 22 and June 5, 1998, the Respondent ordered

a series of diagnostic lab tests for Patient C. H., a 63 - year -

old female.

3. As to the care provided to Patient C. H., the

Petitioner presented the testimony of Hamilton Fish, M.D., whose

testimony wa s persuasive and is credited.

4. According to Dr. Fish, many of the tests performed on

Patient C. H. were not medically indicated according to a review

of the information set forth in the patient's medical records,

and the medical treatment care provide d by the Respondent to the

patient was inappropriate and failed to meet the applicable

standard of care.

5. According to the hemoglobin test performed on

Patient C. H., the patient was diabetic and the diabetes was

uncontrolled. The Respondent did not provide proper treatment

to the patient for the diabetes.

6. According to one of the lab tests, Patient C. H. was

deficient in calcium. The Respondent did not provide

appropriate treatment for the calcium deficiency.

7. Although there was no medical indication that Patient

C. H. had a thyroid problem, the Respondent prescribed a thyroid

hormone medication. The thyroid medication was inappropriate

and could have exacerbated the diabetic condition.

DOAH Case Number 01 - 3796PL

8. The Petitioner introdu ced into evidence an

advertisement that appears to have been published in the June

25, 1999, edition of the "Sun - Sentinel Community News."

9. There is no evidence that the Respondent created, read,

placed, or paid for the advertisement in the newspaper.

10. The ad offered a complementary consultation with the

Respondent, who was identified in the ad as a diplomate of the

"American Board of Anti - Aging."

11. Florida law requires that a disclaimer appear in such

advertisements advising a patient of the right to essentially

decline non - free services that are recommended on the basis of

the free consultation. The cited advertisement did not include

the disclaimer.

12. The Petitioner's administrative rules prohibit

advertisement of affiliation with grou ps not "recognized" by the

Petitioner. The Petitioner has not approved of the "American

Board of Anti - Aging."

DOAH Case Number 01 - 3797PL

Patient D. E.

13. On or about July 21, 1998, the Respondent ordered a

series of diagnostic lab tests for Patient D. E ., a 53 - year - old

male.

14. According to the records, Patient D. E. had complained

of impotency and loss of sexual desire.

15. As to the care provided to Patient D. E., the

Petitioner presented the testimony of Timothy Shapiro, M.D.,

whose testimony was persuasive and is credited.

16. According to Dr. Shapiro, many of the tests performed

on Patient D. E. were not medically indicated according to a

review of the information set forth in the patient's medical

records.

17. At least one of the tests perf ormed on several of the

patients referenced herein (the "Barnes Basil Temperature Test")

is not recognized in the medical community as providing valid

information for the conventional diagnosis or treatment of any

disorder.

18. On or about August 18, 1998 , the Respondent diagnosed

Patient D. E. with hypothyroidism, panhypothyroidism, food

allergies, and impotence of organic origin. He prescribed

Cytomel, Armour Thyroid, and testosterone gel for the patient.

19. According to the testimony of Dr. Shapiro , the

prescribed medications were inappropriate because the medical

record fails to indicate any deficiencies being addressed by the

medication.

20. The course of treatment provided for the patient is

not documented by the medical records and is below the standard

of care.

Patient J. N.

21. On or about August 27, 1998, the Respondent ordered a

series of diagnostic lab tests for Patient J. N., a 50 - year - old

female.

22. According to the records, Patient J. N.'s symptoms

included fatigue, numbness, tin gling and burning in the

extremities, muscle and head aches, insomnia, swelling,

depression and easy bruising.

23. As to the care provided to Patient J. N., the

Petitioner presented the testimony of Hamilton Fish, M.D., whose

testimony was persuasive and is credited.

24. According to Dr. Fish, many of the tests performed on

Patient J. N. were not medically indicated according to a review

of the information set forth in the patient's medical records.

25. On or about September 10, 1998, the Respondent

diagnosed Patient J. N. with chronic fatigue, probable

hypothyroidism, and unspecified liver disorder. An existing

diagnosis of ischemic heart disease was confirmed; he prescribed

various medications for the patient.

26. According to the testimony of Dr. Fish, the prescribed

drugs (Cytomel, Hydrocortisone, Rezulin, and a female hormonal

transdermal gel) were inappropriate and below the standard of

care, and the medical records do not justify the course of

treatment provided by the Respondent.

Patie nt T. B.

27. On or about October 8, 1998, the Respondent ordered a

series of diagnostic lab tests for Patient T. B. (also

identified as T. P.) a 49 - year - old female.

28. According to the records, Patient T. B.'s symptoms

included muscle ache, migraines, i nsomnia, vaginal discharge,

and neck, back and stomach pain.

29. As to the care provided to Patient T. B., the

Petitioner presented the testimony of Hamilton Fish, M.D., whose

testimony was persuasive and is credited.

30. According to Dr. Fish, many of the tests performed on

Patient T. B. were not medically indicated according to a review

of the information set forth in the patient's medical records,

and the medical treatment care provided by the Respondent to the

patient was inappropriate and failed to meet the applicable

standard of care.

31. On or about October 21, 1998, the Respondent diagnosed

Patient T. B. with hyperthyroidism, migraine headaches, chronic

fatigue, yeast infection, and unspecified disorder of the

intestines, stomach, and duodenum . He prescribed various

medications for the patient.

32. According to the testimony of Dr. Fish, the prescribed

drugs (Cytomel and Armour Thyroid) were inappropriate and below

the standard of care, and the medical records do not justify the

course of t reatment provided by the Respondent.

33. The Respondent failed to perform a pelvic examination

or to refer the patient to a gynecologist despite the diagnosis

that she was suffering a yeast infection, and therefore failed

to meet the applicable standar d of care.

34. The diagnosis of unspecified disorder of the stomach,

duodenum, and intestines was apparently based on described pain.

There is nothing in the medical record indicating that

appropriate testing to determine causality was ordered or

perfo rmed.

Patient A. M.

35. On or about August 26, 1998, the Respondent ordered a

series of diagnostic lab tests for Patient A. M.

36. According to the records, Patient A. M.'s symptoms

included muscle and head ache, constipation, cramps and

menstrual irre gularity, decreased libido, sore throat and sinus

problems.

37. As to the care provided to Patient A. M., the

Petitioner presented the testimony of Hamilton Fish, M.D., whose

testimony was persuasive and is credited.

38. According to Dr. Fish, many of the tests performed on

Patient A. M. were not medically indicated according to a review

of the information set forth in the patient's medical records,

and the medical treatment care provided by the Respondent to the

patient was inappropriate and failed to meet the applicable

standard of care.

39. On or about September 9, 1998, the Respondent

diagnosed Patient T. B. with hypothyroidism, chronic fatigue,

hyperinsulinemia, and unspecified ovarian dysfunction. The lab

test results do not support the dia gnosis.

40. On December 2, 1998, the Respondent prescribed various

medications for the patient. According to the testimony of

Dr. Fish, the prescribed drugs (Cytomel, Rezulin, Glucophage,

glycine, and fish oil) were inappropriate for the patient and

below the standard of care, and the medical records do not

justify the course of treatment provided by the Respondent.

CONCLUSIONS OF LAW

41. The Division of Administrative Hearings has

jurisdiction over the parties to and subject matter of this

proce eding. Section 120.57(1), Florida Statutes.

42. The Petitioner has the burden of proving by clear and

convincing evidence the allegations against the Respondent.

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

43. The burden has not been met in Ca se Number 01 - 3796.

There is no evidence that the Respondent created, read, placed,

or paid for the advertisement in the newspaper.

44. As set forth in the preceding Findings of Fact, the

burden has been met in DOAH Cases Numbered 01 - 3795 and 01 - 3797.

The Respondent failed to keep records justifying the course of

treatment for the patients identified herein, offered diagnoses

without adequate or appropriate testing, and prescribed

inappropriate medications to the patients based on the

inadequate diagnos es.

45. Section 458.331, Florida Statutes, provides in

relevant part as follows:

458.331 Grounds for disciplinary action;

action by the board and department. --

* * *

(m) Failing to keep legible, as defined by

department rule in consultation with the

board, medical records that identify the

licensed physician or the physician extender

and supervising physician by name and

professional title who is or are responsible

for rendering, ordering, supervising, or

billing for each diagnostic or treatment

proc edure and that justify the course of

treatment of the patient, including, but not

limited to, patient histories; examination

results; test results; records of drugs

prescribed, dispensed, or administered; and

reports of consultations and

hospitalizations.

* * *

(q) Prescribing, dispensing,

administering, mixing, or otherwise preparing

a legend drug, including any controlled

substance, other than in the course of the

physician's professional practice. For the

purposes of this paragraph, it shall be

lega lly presumed that prescribing,

dispensing, administering, mixing, or

otherwise preparing legend drugs, including

all controlled substances, inappropriately or

in excessive or inappropriate quantities is

not in the best interest of the patient and

is not in the course of the physician's

professional practice, without regard to his

or her intent.

* * *

(t) Gross or repeated malpractice or the

failure to practice medicine with that level

of care, skill, and treatment which is

recognized by a reasonably pru dent similar

physician as being acceptable under similar

conditions and circumstances. The board

shall give great weight to the provisions of

s. 766.102 when enforcing this paragraph. As

used in this paragraph, "repeated

malpractice" includes, but is not limited to,

three or more claims for medical malpractice

within the previous 5 - year period resulting

in indemnities being paid in excess of

$25,000 each to the claimant in a judgment or

settlement and which incidents involved

negligent conduct by the phys ician. As used

in this paragraph, "gross malpractice" or

"the failure to practice medicine with that

level of care, skill, and treatment which is

recognized by a reasonably prudent similar

physician as being acceptable under similar

conditions and circums tances," shall not be

construed so as to require more than one

instance, event, or act. Nothing in this

paragraph shall be construed to require that

a physician be incompetent to practice

medicine in order to be disciplined pursuant

to this paragraph.

46 . In these cases, the evidence establishes that the

Respondent failed to keep records justifying the course of

treatment provided to the patients identified herein and

therefore has violated Section 458.331(1)(m), Florida Statutes.

47. The evidence estab lishes that the Respondent

inappropriately prescribed medications as set forth herein and

therefore has violated Section 458.331(1)(q), Florida Statutes.

48. The evidence establishes that the Respondent has

failed to practice medicine with that level of c are, skill, and

treatment which is recognized by a reasonably prudent similar

physician as being acceptable under similar conditions and

circumstances and has therefore violated Section 458.331(1)(t),

Florida Statutes.

49. Rule 64B8 - 8.001, Florida Admin istrative Code, sets

forth guidelines for imposition of disciplinary penalties based

upon violation of applicable statutes.

50. For a first time violation of Section 458.331(1)(m),

Florida Statutes, the rule provides a range of penalties from a

repriman d to denial or two years' suspension followed by

probation, and an administrative fine from $1,000 to $10,000.

51. For a first - time violation of Section 458.331(1)(q),

Florida Statutes, the rule provides a range of penalties from

one year probation to revocation or denial, and an

administrative fine from $1,000 to $10,000.

52. For a first time violation of Section 458.331(1)(t),

Florida Statutes, the rule provides a range of penalties from

two years' probation to revocation or denial, and an

adminis trative fine from $1,000 to $10,000.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is recommended that the Agency for Health Care

Administration, Board of Medicine, enter a final order suspending

the medical license o f Robert M. Knight, M.D., for a period of

one year followed by five - year period of probation, and imposing

an administrative fine of $5,000.

DONE AND ENTERED this 19th day of April, 2002, in

Tallahassee, Leon County, Florida.

____________________________ _______

WILLIAM F. QUATTLEBAUM

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675 SUNCOM 278 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 19th day of April, 2002.

COPIES FURNISHED :

Kathryn E. Price, Esquire

Agency for Health Care Administration

Post Office Box 14229

Tallahassee, Florida 32317 - 4229

Robert M. Knight, M.D.

56 50 Camino del Sol, Number 101

Boca Raton, Florida 33433

William W. Large, General Counsel

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1701

Mr. R. S. Power, Agency Clerk

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1701

Tanya Williams, Executive Director

Board of Medicine

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit wri tten 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.